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评估基于时间型的个体化光疗对乳腺癌幸存者的影响:疲劳和睡眠中断的初步发现。

Evaluating chronotypically tailored light therapy for breast cancer survivors: Preliminary findings on fatigue and disrupted sleep.

机构信息

College of Nursing, Michigan State University, East Lansing, Michigan, USA.

Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.

出版信息

Chronobiol Int. 2022 Feb;39(2):221-232. doi: 10.1080/07420528.2021.1992419. Epub 2021 Nov 3.

Abstract

More than one-third of cancer survivors experience significant residual symptoms after treatment completion. Fatigue and sleep disruption often co-occur and exacerbate each other. The purpose of this preliminary analysis was to examine the effect of a chronotypically tailored light therapy on fatigue and sleep disruption in female survivors 1-3 years post-completion of chemotherapy and/or radiation for stage I to III breast cancer. The data for this analysis were collected as part of an ongoing two-group randomized controlled trial (NCT03304587). Participants were randomized to receive either bright blue-green light (experimental) or dim red light (control). Light therapy was self-administered using a light visor cap at home. Both groups received 30-min daily light therapy for 14 consecutive days either between 19:00 and 20:00 h (for morning chronotypes) or within 30 min of waking in the morning (for evening chronotypes). Fatigue and sleep quality were self-reported using the Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue, PROMIS-Sleep Disturbance, Pittsburgh Sleep Quality Index, and a daily log before (pre-test) and following the light intervention (post-test). Linear mixed model analysis or generalized estimating equations examined group difference overtime adjusting for pre-test scores. No between-group differences were found. However, after adjusting for the baseline fatigue, the experimental group reported significant decreases in fatigue ( < .001) and sleep disturbance ( = .024) overtime. The experimental group also reported significantly better subjective sleep quality after 14 d of light therapy ( = .017). Positive trends in sleep latency, sleep duration, night-time awakenings, and early morning awakenings were also observed. Unexpectedly, sleep disturbance significantly decreased in the control group ( = .030). Those who received dim light control reported significantly shorter sleep latency ( = .002), longer total sleep time ( = .042), and greater habitual sleep efficiency ( = .042). These findings suggest that bright light therapy significantly improved post-treatment fatigue and subjective sleep quality in breast cancer survivors. Although it remains to be confirmed, the findings additionally show unexpected benefits of dim light on sleep. Properly timed light exposure may optimize the therapeutic effect and can be the key for successful light therapy. How the administration timing coupled with wavelengths (short vs. long) and intensity of light affecting fatigue and disrupted sleep requires further investigation.

摘要

超过三分之一的癌症幸存者在治疗完成后仍存在明显的残留症状。疲劳和睡眠中断通常同时发生,并相互加重。本初步分析的目的是研究根据时间类型量身定制的光疗法对完成 I 期至 III 期乳腺癌化疗和/或放疗后 1 至 3 年的女性幸存者的疲劳和睡眠中断的影响。本分析的数据是作为正在进行的两项群组随机对照试验(NCT03304587)的一部分收集的。参与者被随机分配接受明亮的蓝绿光(实验组)或暗淡的红光(对照组)。光疗法在家中使用光面罩帽自行进行。两组均接受每天 30 分钟的光疗法,连续 14 天,时间分别为 19:00 至 20:00(用于晨型人)或在早上醒来后 30 分钟内(用于晚型人)。使用患者报告的结果测量信息系统(PROMIS)-疲劳、PROMIS-睡眠障碍、匹兹堡睡眠质量指数和每日日志,在光干预之前(前测)和之后(后测)自我报告疲劳和睡眠质量。线性混合模型分析或广义估计方程检查了随时间调整前测分数的组间差异。未发现组间差异。然而,在调整基线疲劳后,实验组报告疲劳(<0.001)和睡眠障碍(=0.024)随时间显著下降。实验组还报告说,在 14 天的光疗后,主观睡眠质量显著提高(=0.017)。睡眠时间、夜间醒来和清晨醒来的睡眠潜伏期也观察到了积极的趋势。出乎意料的是,对照组的睡眠障碍显著下降(=0.030)。接受暗淡光控制的人报告说,睡眠潜伏期明显缩短(=0.002),总睡眠时间延长(=0.042),习惯性睡眠效率提高(=0.042)。这些发现表明,强光疗法显著改善了乳腺癌幸存者的治疗后疲劳和主观睡眠质量。尽管仍有待证实,但这些发现还表明暗淡光对睡眠有意外的益处。适当的定时光照可能会优化治疗效果,是光疗成功的关键。光照的时间安排与波长(短与长)和光强度如何影响疲劳和睡眠中断,需要进一步研究。

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