PURPOSE: The interplay between sleep quality, anxiety, and depression among breast cancer patients remains poorly understood. This study aimed to investigate and compare the symptoms relationships among these three factors in Chinese breast cancer patients, utilizing two sleep assessments. METHODS: Our study encompassed 288 participants diagnosed with breast cancer, from whom we collected demographic information through questionnaires. Sleep quality symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI) and wrist actigraphy, while anxiety and depression symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). Network analyses were conducted using R to calculate the centrality (strength) and further identify central symptoms and bridge symptoms in two networks that differed by sleep assessments. Central symptoms are closely related to other symptoms, whereas bridge symptoms indicate that symptoms may increase spread risk between different conditions. RESULTS: In the network using PSQI data, "I have lost interest in my appearance" had the highest strength centrality (r = 2.417), followed by "sleep duration" (r = 1.068) and "sleep efficiency" (r = 0.955). In the network using wrist actigraphy data, "wake after sleep onset" had the highest strength value (r = 2.437), followed by "sleep efficiency" (r = 2.397) and "sleep latency" (r = 1.506). Two bridge symptoms were identified: "I feel cheerful" and "I look forward with enjoyment to things" in both networks. CONCLUSIONS: Depressive symptoms played a leading role in the sleep-anxiety-depression network, underscoring the need for targeted intervention tailored to survivors' specific needs. IMPLICATIONS FOR CANCER SURVIVORS: Health workers can give priority to symptom-specific screening and therapies, incorporating psychological support into standard cancer care.