SLEEP - Breast Cancer Patients have Progressively Impaired Sleep-Wake Activity Rhythms during Chemotherapy

VOLUME 32, ISSUE 09

SLEEP-WAKE RHYTHMS IN BREAST CANCER PATIENTS
Breast Cancer Patients have Progressively Impaired Sleep-Wake Activity Rhythms during Chemotherapy

Josée Savard, PhD¹; Lianqi Liu, MD²; Loki Natarajan, PhD^3,4; Michelle B. Rissling,MA^2,5; Ariel B. Neikrug, MS^2,5; Feng He^3,4; Joel E. Dimsdale, MD^2,4,5; Paul J. Mills, PhD^2,4,5; Barbara A. Parker, MD^4,6; Georgia Robins Sadler, PhD^4,5,7; Sonia Ancoli-Israel, PhD^2,4,5

¹School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, Canada; ²Department of Psychiatry and ³Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA; ⁴Rebecca and John Moores University of California San Diego Cancer Center, San Diego, CA; ⁵SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA: ⁶Department of Medicine and ⁷Department of Surgery, University of California San Diego, San Diego, CA

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Purpose:Prior cross-sectional studies have shown that cancer patients have sleep-wake activity cycles that show little distinction between daytime and nighttime, a pattern indicative of circadian disruption. This pattern is seen both before and during cancer treatment. Long-term data are needed, however, to assess to what extent circadian rhythm impairments evolve over the course of chemotherapy. The goal of this study was to assess the longitudinal course of sleep-wake activity rhythms before and during chemotherapy for breast cancer.

Patients and Methods:Ninety-five women scheduled to receive neoadjuvant or adjuvant anthracycline based chemotherapy for a stage I-III breast cancer participated. The participants wore a wrist actigraph for 72 consecutive hours at baseline (pre-chemotherapy), as well as during the weeks 1, 2 and 3 (W1, W2, W3) of cycle 1 and cycle 4 of chemotherapy. Sleep-wake circadian activity variables were computed based on actigraphic data.

Results: Compared to baseline, with the exception of acrophase, all circadian rhythm variables examined, including amplitude, mesor, up-mesor, down-mesor, and rhythmicity were significantly impaired during the first week of both chemotherapy cycles. Although the circadian variables approached baseline values during W2 and W3 of cycle 1, most remained significantly more impaired during W2 and W3 of cycle 4.

Conclusion: These data suggest that the first administration of chemotherapy is associated with transient disruption of sleep-wake rhythm, while repeated administration of chemotherapy results in progressively worse and more enduring impairments in sleep-wake activity rhythms.

Keywords: Cancer, circadian rhythms, sleep-wake activity, chemotherapy

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