Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Obstetrics and Gynecology, Monash University, Australia.
Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China.
Sleep Med. 2019 Mar;55:14-21. doi: 10.1016/j.sleep.2018.11.022. Epub 2018 Dec 14.
This prospective cohort study captured the patterns of sleep, sleep-wake activity rhythm, and first-morning urinary melatonin in breast cancer patients undergoing adjuvant chemotherapy.
Breast cancer patients undergoing adjuvant chemotherapy wore wrist actigraph for 168 h and collected first-morning void urine samples before treatment, during the first, and at the last cycle of chemotherapy. We converted actigraphy data into sleep duration, sleep efficiency, nighttime total wake time, percent rhythm, F-statistic, amplitude, mesor, and acrophase. We then assessed urinary 6-sulfatoxymelatonin (aMT6s) levels.
This cohort contained 180 participants. Compared with the baseline, sleep efficiency during the first and last cycle decreased by 10.16% [95% confidence interval (95% CI): 5.85%, 14.47%] and 5.01% (95% CI: 0.50%, 9.53%), respectively. Similarly, percent rhythm decreased by 27.20% (95% CI: 19.95%, 34.45%) during the first cycle and 21.20% (95% CI: 13.52, 28.89) during the last cycle. Taking the baseline as the reference, aMT6s levels during the first and last cycle decreased by 11.27% (95% CI: 0.37%, 22.16%) and 14.74% (95% CI: 2.34, 27.11), respectively.
The first administration of adjuvant chemotherapy is associated with sleep disturbance and sleep-wake activity rhythm disruption among breast cancer patients, while the disturbance and disruption during the last cycle are less severe; nevertheless, repeated administration of chemotherapy results in progressive impairment of nocturnal melatonin production.
本前瞻性队列研究旨在观察接受辅助化疗的乳腺癌患者的睡眠模式、睡眠-觉醒活动节律和晨尿褪黑素水平。
接受辅助化疗的乳腺癌患者佩戴腕部活动记录仪 168 小时，并在治疗前、第一个周期和最后一个周期采集晨尿。我们将活动记录仪数据转换为睡眠时间、睡眠效率、夜间总清醒时间、节律百分比、F 统计量、振幅、中值和峰相位。然后评估尿液中 6-硫酸褪黑素（aMT6s）水平。
该队列包含 180 名参与者。与基线相比，第一个周期和最后一个周期的睡眠效率分别下降了 10.16%（95%可信区间[95%CI]：5.85%，14.47%）和 5.01%（95%CI：0.50%，9.53%）。同样，第一个周期的节律百分比下降了 27.20%（95%CI：19.95%，34.45%），最后一个周期下降了 21.20%（95%CI：13.52%，28.89%）。与基线相比，第一个周期和最后一个周期的 aMT6s 水平分别下降了 11.27%（95%CI：0.37%，22.16%）和 14.74%（95%CI：2.34%，27.11%）。
辅助化疗的首次给药与乳腺癌患者的睡眠障碍和睡眠-觉醒活动节律紊乱有关，而最后一个周期的干扰和紊乱程度较轻；然而，反复化疗会导致夜间褪黑素生成逐渐受损。
