Division of Urology, Durham Veterans Affairs Health Care System, Durham, North Carolina.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
Prostate. 2020 Nov;80(15):1304-1313. doi: 10.1002/pros.24052. Epub 2020 Aug 24.
Disrupted sleep has been associated with increased risk of certain cancers. Little data exist in prostate cancer. We tested the association between sleep quality and prostate cancer diagnosis overall and by tumor grade in the Reduction by Dutasteride of Prostate Cancer Events chemoprevention trial. We hypothesized that worse sleep quality would be associated with increased tumor aggressiveness.
At baseline, 5614 men completed a validated six-item questionnaire on sleep quality. We generated a composite score categorized into tertiles to measure overall sleep quality and assessed each sleep quality question individually. Logistic regression was used to test associations between baseline sleep quality and overall, low-grade and high-grade prostate cancer diagnosis at 2-year study-mandated biopsy. Models were stratified by nocturia.
Overall sleep quality was unrelated to overall or low-grade prostate cancer. Worse overall sleep quality was associated with elevated odds of high-grade prostate cancer (odds ratio [OR] 1.15; 95% confidence interval [CI]: 0.83-1.60 and OR 1.39; 95% CI: 1.01-1.92). Men reporting trouble falling asleep at night sometimes vs never had elevated odds of high-grade prostate cancer (OR: 1.51; 95% CI: 1.08-2.09) while trouble staying awake during the day was associated with decreased odds of low-grade prostate cancer (OR: 0.65; 95% CI: 0.49-0.86). Results were similar within strata of nocturia severity.
Overall, associations between sleep quality and prostate cancer were inconsistent. However, there was some evidence for a positive association between insomnia and high-grade prostate cancer, and an inverse relationship between daytime sleepiness and low-grade prostate cancer; findings that should be validated by future studies.
睡眠中断与某些癌症的风险增加有关。在前列腺癌中，相关数据较少。我们检测了睡眠质量与前列腺癌整体诊断以及多瘤分级在 dutasteride 降低前列腺癌事件化学预防试验中的相关性。我们假设，睡眠质量越差，肿瘤侵袭性越高。
在基线时，5614 名男性完成了一项关于睡眠质量的经过验证的六项目问卷。我们生成了一个复合评分，分为三分位数，以衡量整体睡眠质量，并单独评估每个睡眠质量问题。使用逻辑回归测试基线睡眠质量与 2 年研究规定活检时的总体、低级别和高级别前列腺癌诊断之间的关联。模型按夜间多尿分层。
整体睡眠质量与总体或低级别前列腺癌无关。整体睡眠质量较差与高级别前列腺癌的几率升高相关（比值比[OR]1.15；95%置信区间[CI]：0.83-1.60 和 OR 1.39；95% CI：1.01-1.92）。报告夜间入睡困难的男性与高级别前列腺癌的几率升高相关（OR：1.51；95% CI：1.08-2.09），而白天睡眠困难与低级别前列腺癌的几率降低相关（OR：0.65；95% CI：0.49-0.86）。夜间多尿严重程度分层内的结果相似。
总体而言，睡眠质量与前列腺癌之间的关联不一致。然而，有一些证据表明失眠与高级别前列腺癌之间存在正相关，而白天嗜睡与低级别前列腺癌之间存在负相关；这些发现需要通过未来的研究加以验证。
