Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York.
College of Pharmacy, The Ohio State University, Columbus, Ohio.
J Clin Sleep Med. 2018 Jan 15;14(1):81-86. doi: 10.5664/jcsm.6886.
Night shift work is associated with increased breast cancer risk, possibly from altered sleep. Epidemiologic evidence is sparse regarding sleep disturbances and breast cancer tumor markers. We examined sleep disturbance in association with breast tumor aggressiveness and mortality following diagnosis.
We analyzed associations of measures of sleep disturbance in a sample of 1,122 incident breast cancer cases from the Western New York Exposures and Breast Cancer (WEB) Study. Sleep disturbance was assessed using self-administered questionnaires; responses about difficulty falling asleep, waking up frequently, having trouble staying asleep, and waking up feeling tired and worn out were used to create a summary sleep disturbance score. We used general linear models to examine associations of sleep disturbance with markers of tumor aggressiveness among cases: estrogen receptor (ER) status, progesterone receptor (PR) status, and human epidermal growth factor receptor-2 (HER2) status; tumor size, stage, grade, lymph node involvement, and presence of metastasis. In addition, we examined the association between sleep disturbance and survival using Cox regression.
Among breast cancer cases, sleep disturbance was higher for women with ER- / PR- tumors compared to women with ER+ / PR+ tumors, even after adjusting for potential covariates ( for trend = .02). Results suggest that the association of sleep quality differs by menopausal status, where mild sleep disturbance is associated with higher breast cancer mortality in premenopausal women; however, we had a relatively small sample size.
Sleep disturbance may be associated with aggressive subtypes of breast cancer; however, further studies are needed.
夜班工作与乳腺癌风险增加有关，可能是由于睡眠改变所致。关于睡眠障碍与乳腺癌肿瘤标志物的流行病学证据很少。我们研究了诊断后睡眠障碍与乳腺癌肿瘤侵袭性和死亡率之间的关系。
我们分析了来自西纽约暴露与乳腺癌（WEB）研究的 1122 例新发乳腺癌病例样本中睡眠障碍的测量值的相关性。使用自我管理问卷评估睡眠障碍；入睡困难、频繁醒来、难以入睡、醒来时感到疲倦和疲惫的反应用于创建一个总结睡眠障碍评分。我们使用一般线性模型来检查睡眠障碍与病例中肿瘤侵袭性标志物之间的关联：雌激素受体（ER）状态、孕激素受体（PR）状态和人表皮生长因子受体-2（HER2）状态；肿瘤大小、分期、分级、淋巴结受累和转移的存在。此外，我们使用 Cox 回归检验睡眠障碍与生存之间的关联。
在乳腺癌病例中，与 ER+/PR+肿瘤的女性相比，ER-/PR-肿瘤的女性睡眠障碍更高，即使在调整了潜在的混杂因素后（趋势=0.02）。结果表明，睡眠质量的相关性因绝经状态而异，在绝经前女性中，轻度睡眠障碍与更高的乳腺癌死亡率相关；然而，我们的样本量相对较小。
睡眠障碍可能与侵袭性乳腺癌亚型有关，但需要进一步研究。
