与乳腺癌相关睡眠障碍相关的临床和遗传因素：“CAGE-Sleep”研究——一项横断面研究。

Clinical and Genetic Factors Associated With the Breast Cancer-Related Sleep Disorders: The "CAGE-Sleep" Study-A Cross-Sectional Study.

机构信息

Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon.

出版信息

J Pain Symptom Manage. 2021 Sep;62(3):e46-e55. doi: 10.1016/j.jpainsymman.2021.02.022. Epub 2021 Feb 22.

DOI:10.1016/j.jpainsymman.2021.02.022

PMID:33631331

Abstract

CONTEXT

Despite being among the most reported concerns in breast cancer patients, sleep disturbances are still poorly assessed and managed in routine clinical practice. Correctly evaluating these symptoms and understanding the underlying clinical and genetic factors would help medical teams develop an adequate treatment strategy for each patient.

OBJECTIVES

To explore the severity of insomnia as well as sleep quality in a sample of Lebanese women with breast cancer undergoing chemotherapy; 2) To examine the correlation between sociodemographic, clinical, psychiatric (anxiety and depression), genetic factors, and alterations in sleep patterns.

METHODS

A cross-sectional study was carried out using the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) (December 2017-June 2019; Ethical reference number: CEHDF1016). All patients gave their written consent and were genotyped for several polymorphisms in CLOCK, CRY2, PER2, COMT, DRD2, OPRM1, and ABCB1 genes using Lightcycler® (Roche).

RESULTS

Our sample included a total of 112 women. Almost half of the patients reported insomnia problems (with 20.5% moderate insomnia and 7.1% severe insomnia). Multivariable analyses taking the PSQI score as the dependent variable, showed that higher depression score and dyslipidemia (yes versus no) were significantly associated with higher PSQI scores (worse sleep quality), whereas having the DRD2 CT genotype versus CC and a higher chemotherapy cycle number were significantly associated with lower PSQI scores (better sleep quality). Depression was also significantly associated with higher ISI scores. When forcing all the genes in each model, the results remained the same except for depression that has been replaced by anxiety in the multivariable analysis.

CONCLUSION

Our study confirms the relationship between anxiety/depression, cycle number, dyslipidemia and DRD2 polymorphism with insomnia and highlights the importance of treating all associated factors to improve the overall QOL of patients.

摘要

背景

尽管睡眠障碍是乳腺癌患者最常报告的问题之一，但在常规临床实践中，这些问题仍未得到充分评估和管理。正确评估这些症状并了解潜在的临床和遗传因素将有助于医疗团队为每位患者制定适当的治疗策略。

目的

1）探讨正在接受化疗的黎巴嫩乳腺癌女性样本中失眠的严重程度和睡眠质量；2）研究社会人口统计学、临床、精神科（焦虑和抑郁）、遗传因素与睡眠模式改变之间的相关性。

方法

使用匹兹堡睡眠质量指数（PSQI）和失眠严重程度指数（ISI）进行横断面研究（2017 年 12 月至 2019 年 6 月；伦理参考编号：CEHDF1016）。所有患者均签署书面同意书，并使用 Lightcycler®（罗氏）对 CLOCK、CRY2、PER2、COMT、DRD2、OPRM1 和 ABCB1 基因的多个多态性进行基因分型。

结果

我们的样本共包括 112 名女性。近一半的患者报告存在失眠问题（20.5%为中度失眠，7.1%为重度失眠）。多变量分析以 PSQI 评分为因变量，结果表明，较高的抑郁评分和血脂异常（是而非否）与 PSQI 评分较高（睡眠质量较差）显著相关，而 DRD2 CT 基因型与 CC 基因型和较高的化疗周期数与 PSQI 评分较低（睡眠质量较好）显著相关。抑郁与 ISI 评分显著相关。在将每个模型中的所有基因纳入强制模型后，结果保持不变，除了多变量分析中用焦虑取代了抑郁。