School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Sleep Med. 2019 Feb;54:153-158. doi: 10.1016/j.sleep.2018.10.025. Epub 2018 Nov 12.
Sleep has been closely linked to breast cancer risk. However, the association between sleep and breast cancer prognosis remains unclear. The aim of this study was to evaluate the separate and joint effects of multiple sleep characteristics on breast cancer prognosis among Chinese women.
A total of 1580 breast cancer patients were recruited between October 2008 and December 2014 and followed up until December 31, 2017 in Guangzhou. Multivariate Cox models were conducted to estimate the hazard ratios (HR) and 95% confidence intervals (95%CI) for breast cancer prognosis in association with sleep characteristics.
Long sleep duration at night (>9 h) (HR = 2.33, 95%CI: 1.01-5.42), poor sleep quality (HR = 3.08, 95%CI: 1.74-5.47), and impaired daytime function (HR = 2.49, 95%CI: 1.65-3.79) after diagnosis were associated with an increased risk of breast cancer progression. Both short sleep duration (<6 h) (HR = 2.00, 95%CI: 1.06-3.77, P = 0.011) and long sleep duration (>9 h) (HR = 4.69, 95%CI: 1.31-16.78, P = 0.187) increased the progression risk only among patients with impaired but not normal daytime function. In addition, daytime napping significantly modified the effect of short sleep duration on the progression (HR = 3.55, 0.59, 95%CI: 1.55-7.97, 0.23-1.53 for patients without and with daytime napping, respectively, P = 0.005). Stratification results suggested that the associations were more evident among pre-menopausal patients, although no significant interaction was observed.
Our findings suggested that inadequate sleep duration to feel one's best and poor sleep quality after diagnosis were associated with an increased risk of breast cancer progression, particularly for pre-menopausal women.
睡眠与乳腺癌风险密切相关。然而，睡眠与乳腺癌预后之间的关系尚不清楚。本研究旨在评估多种睡眠特征对中国女性乳腺癌预后的单独和联合影响。
本研究共纳入了 1580 名 2008 年 10 月至 2014 年 12 月期间确诊的乳腺癌患者，并于 2017 年 12 月 31 日进行随访。采用多变量 Cox 模型评估与睡眠特征相关的乳腺癌预后的风险比（HR）和 95%置信区间（95%CI）。
诊断后夜间睡眠时长过长（>9 小时）（HR=2.33，95%CI：1.01-5.42）、睡眠质量差（HR=3.08，95%CI：1.74-5.47）和白天功能受损（HR=2.49，95%CI：1.65-3.79）与乳腺癌进展风险增加相关。短睡眠时间（<6 小时）（HR=2.00，95%CI：1.06-3.77，P=0.011）和长睡眠时间（>9 小时）（HR=4.69，95%CI：1.31-16.78，P=0.187）仅增加了白天功能受损患者的进展风险，而对白天功能正常的患者无影响。此外，白天小睡显著改变了短睡眠时间对进展的影响（HR=3.55，0.59，95%CI：1.55-7.97，0.23-1.53，分别为白天无小睡和有小睡的患者，P=0.005）。分层结果表明，这些关联在绝经前患者中更为明显，但未观察到显著的交互作用。
本研究结果表明，诊断后睡眠不足和睡眠质量差与乳腺癌进展风险增加相关，尤其是在绝经前女性中。
