School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, UK.
Adult Psychology Unit, Falkirk Community Hospital, Falkirk, Scotland, UK.
Sleep. 2019 Mar 1;42(3). doi: 10.1093/sleep/zsy245.
Insomnia in cancer patients is prevalent, persistent, and confers risk for physical and psychological disorder. We must better understand how insomnia develops in cancer patients and explore the main contributors to its chronicity so that insomnia management protocols can be integrated more effectively within cancer care. This study monitors the etiology of insomnia in breast cancer patients and identifies risk factors for its persistence.
One hundred seventy-three females with newly diagnosed, non-metastatic breast cancer were tracked from diagnosis for 12 months. Participants completed monthly sleep assessments using the Insomnia Severity Index (ISI) and 3 monthly health-related quality-of-life assessments using the European Organisation for Research and Treatment of Cancer - Breast (EORTC QLQ-C30-BR23) scale. Clinical data on disease status and treatment regimens were also assessed.
Prior to diagnosis, 25% of participants reported sleep disturbance, including 8% with insomnia syndrome (IS). Prevalence increased at cancer diagnosis to 46% (18% IS) and remained stable thereafter at around 50% (21% IS). We also explored sleep status transitions. The most common pattern was to remain a good sleeper (34%-49%) or to persist with insomnia (23%-46%). Seventy-seven percent of good sleepers developed insomnia during the 12-month period and 54% went into insomnia remission. Chemotherapy (odds ratio = 0.08, 95% confidence interval [CI] 0.02-0.29, p < .001) and pre-diagnosis ISI scores (odds ratio = 1.13/unit increase in pre-diagnosis sleep score, 95% CI 1.05-1.21, p = .001) were identified as the main risk factors for persistent insomnia.
These data advance our understanding of insomnia etiology in cancer patients and help identify those who should be prioritized for insomnia management protocols.
癌症患者中失眠症普遍存在、持续存在且会增加身体和心理障碍的风险。我们必须更好地了解癌症患者失眠症的发展情况，并探索其慢性化的主要因素，以便更有效地将失眠症管理方案纳入癌症护理中。本研究监测了乳腺癌患者失眠症的病因，并确定了其持续性的风险因素。
173 名新诊断为非转移性乳腺癌的女性患者从诊断起被跟踪了 12 个月。参与者使用失眠严重程度指数（ISI）每月进行睡眠评估，并使用欧洲癌症研究与治疗组织-乳腺癌（EORTC QLQ-C30-BR23）量表每 3 个月进行一次健康相关生活质量评估。还评估了疾病状况和治疗方案的临床数据。
在诊断之前，25%的参与者报告存在睡眠障碍，其中 8%患有失眠症（IS）。在诊断时，患病率增加到 46%（18%IS），此后一直稳定在 50%左右（21%IS）。我们还探讨了睡眠状态的转变。最常见的模式是保持良好的睡眠者（34%-49%）或持续失眠（23%-46%）。在 12 个月期间，77%的良好睡眠者发展为失眠症，54%进入失眠症缓解期。化疗（优势比=0.08，95%置信区间[CI]0.02-0.29，p<0.001）和诊断前 ISI 评分（优势比=1.13/诊断前睡眠评分每增加一个单位，95%CI 1.05-1.21，p=0.001）被确定为持续性失眠症的主要风险因素。
这些数据增进了我们对癌症患者失眠症病因的理解，并有助于确定应优先考虑失眠症管理方案的人群。
