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Supportive Care in Cancer

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Open Access 01-02-2021 | Insomnia | Original Article

Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy

Authors: Charlotte Kreutz, Jana Müller, Martina E. Schmidt, Karen Steindorf

Published in: Supportive Care in Cancer | Issue 2/2021

Abstract

Purpose

To characterize sleep problems and to compare subjective and objective assessments in breast cancer patients starting neoadjuvant chemotherapy.

Methods

Sleep characteristics of 54 breast cancer patients starting neoadjuvant chemotherapy were analyzed. Subjective sleep characteristics were assessed with the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measurements with an accelerometer (ActiGraph wGT3X-BT) worn on the wrist for 7 consecutive days.

Results

According to the common PSQI cut-off of 8, 10 (18.87%) of the patients were poor sleepers. ActiGraph measures did not mirror this classification as values for poor, and good sleepers did not differ significantly. Overall, Bland-Altman plots illustrated higher ActiGraph values for sleep efficiency and effective sleep time and lower values for sleep latency, compared with PSQI. For total sleep time, less disagreement between both measures was observed. Actigraphy was limited in precise identification of sleep begin and sleep latency but provided supplementary information about number and minutes of awakenings during the night.

Conclusion

Subjective and objective measurement methods differed substantially in various parameters, with limitations in both methods. A combination of both methods might be most promising.

Trial Registration

Clinicaltrials.gov: NCT02999074

Available only for authorised users

Lampio L, Polo-Kantola P, Polo O, Kauko T, Aittokallio J, Saaresranta T (2014) Sleep in midlife women: effects of menopause, vasomotor symptoms, and depressive symptoms. Menopause 21(11):1217–1224. https://doi.org/10.1097/GME.0000000000000239CrossRefPubMed

Malone M, Harris A, Luscombe D (1994) Assessment of the impact of cancer on work, recreation, home management and sleep using a general health status measure. J R Soc Med 87(7):386–389PubMedPubMedCentral

Schmidt ME, Wiskemann J, Steindorf K (2018) Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis. Qual Life Res 27:2077–2086. https://doi.org/10.1007/s11136-018-1866-8CrossRefPubMed

Savard J, Simard S, Blanchet J, Ivers H, Morin CM (2001) Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24:583–590CrossRef

Zhai L, Zhang H, Zhang D (2015) Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety 32:664–670CrossRef

Rissling BM, Gray KE, Ulmer CS (2016) Sleep disturbance, diabetes, and cardiovascular disease in postmenopausal veteran women. Gerontologist 56:54–66CrossRef

Suzuki E, Yorifuji T, Ueshima K (2009) Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: a population-based cohort study. Prev Med 49:135–141CrossRef

Yaffe K, Laffan AM, Harrison SL (2011) Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA 306:613–619PubMedPubMedCentral

Lee-Chiong TL (2004) Sleep and sleep disorders: an overview. Med Clin N Am 88:xi–xiv. https://doi.org/10.1016/j.mcna.2004.02.005CrossRefPubMed

10.

Van de Water AT, Holmes A, Hurley DA (2011) Objective measurements of sleep for non-laboratory settings as alternatives to polysomnography—a systematic review. J Sleep Res 20:183–200CrossRef

11.

Brown AC, Smolensky MH, D’Alonzo GE, Redman DP (1990) Actigraphy: a means of assessing circadian patterns in human activity. Chronobiol Int 7:125–133CrossRef

12.

Tyron WW (2004) Issues of validity in actigraphic sleep assessment. Sleep 27(1):158–165CrossRef

13.

Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A (2016) The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev 25:52–73CrossRef

14.

Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F (2002) Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 53:737–740CrossRef

15.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychatry Res 28:193–213CrossRef

16.

Curcio G, Tempesta D, Scarlata S, Marzano C, Moroni F, Rossini PA, Ferrara M, De Gennaro L (2013) Validity of the Italian version of the Pittsburgh Sleep Quality Index (PSQI). Neurol Sci 34:511–519. https://doi.org/10.1007/s10072-012-1085-yCrossRefPubMed

17.

Buysse DJ, Reynolds CF, Monk TH, Hoch CC, Yeager AL, Kupfer DJ (1991) Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep 14:331–338PubMed

18.

Mondal P, Gjevre JA, Taylor-Gjevre RM, Lim HJ (2013) Relationship between the Pittsburgh Sleep Quality Index and the Epworth sleepiness scale in a sleep laboratory referral population. Nat Sci Sleep 5:15–21PubMedPubMedCentral

19.

Reinsel RA, Starr TD, O'Sullivan B, Passik SD, Kavey NB (2015) Polysomnographic study of sleep in survivors of breast cancer. J Clin Sleep Med 11(12):1361–1370. https://doi.org/10.5664/jcsm.5264CrossRefPubMedPubMedCentral

20.

Sadeh A, Sharkey KM, Carskadon MA (1994) Activity-based sleep-wake identification: an empirical test of methodological issues. Sleep 17:201–207CrossRef

21.

Jean-Louis G (2001) Sleep estimation from wrist movement quantified by different actigraphic modalities. J Neurosci Methods 105(2):185–191CrossRef

22.

Jean-Louis G, Kripke GF, Mason WJ, Elliott JA, Youngstedt SD (1996) Determination of sleep and wakefulness with the actigraph data analysis software (ADAS). Sleep 19(9):739–743PubMed

23.

Blood ML, Sack RL, Percy DC, Pen JC (1997) A comparison of sleep detection by wrist actigraphy, behavioral response, and polysomnography. Sleep 20(6):388–395PubMed

24.

Ameen MS, Cheung LM, Hauser T, Hahn MA, Schabus M (2019) About the accuracy and problems of consumer devices in the assessment of sleep. Sensors 19. https://doi.org/10.3390/s19194160

25.

Conley S, Knies A, Batten J, Ash G, Miner B, Hwang Y, Jeon S, Redeker NS (2019) Agreement between actigraphic and polysomnographic measures of sleep in adults with and without chronic conditions: a systematic review and meta-analysis. Sleep Med Rev 46:151–160CrossRef

26.

Gruwez A, Bruyneel AV, Bruyneel M (2019) The validity of two commercially-available sleep trackers and actigraphy for assessment of sleep parameters in obstructive sleep apnea patients. PLoS One 14:e0210569. https://doi.org/10.1371/journal.pone.0210569CrossRefPubMedPubMedCentral

27.

Lemola S, Ledermann T, Friedman EM (2013) Variability of sleep duration is related to subjective sleep quality and subjective well-being: an actigraphy study. PLoS One 8(8):e71292. https://doi.org/10.1371/journal.pone.0071292CrossRefPubMedPubMedCentral

28.

Berger AM, Farr LA, Kuhn BR, Fischer P, Agrawal S (2007) Values of sleep/wake, activity/rest, circadian rhythms, and fatigue prior to adjuvant breast cancer chemotherapy. J Pain Symptom Manag 33(4):398–409CrossRef

29.

Ancoli-Israel S, Liu L, Marler MR, Parker BA, Jones V, Sadler GR, Dimsdale J, Cohen-Zion M, Fiorentino L (2006) Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer 14(3):201–207CrossRef

30.

Beck SL, Berger AM, Barsevick AM, Wong B, Stewart KA, Dudley WN (2010) Sleep quality after initial chemotherapy for breast cancer. Support Care Cancer 18(6):679–689. https://doi.org/10.1007/s00520-009-0662-yCrossRefPubMed

31.

Fontes F, Gonçalves M, Maia S, Pereira S, Severo M, Lunet N (2017) Reliability and validity of the Pittsburgh Sleep Quality Index in breast cancer patients. Support Care Cancer 25:3059–3066. https://doi.org/10.1007/s00520-017-3713-9CrossRefPubMed

32.

Grutsch JF, Wood PA, Du-Quiton J, Reynolds JL, Lis CG, Levin RD, Daehler MA, Gupta D, Quiton DFT, Hrushesky WJM (2011) Validation of actigraphy to assess circadian organization and sleep quality in patients with advanced lung cancer. J Circadian Rhythms 9(4). https://doi.org/10.1186/1740-3391-9-4

33.

Jakobsen G, Engstrøm M, Thronæs M, Løhre ET, Kaasa S, Fayers P, Hjermstad MJ, Klepstad P (2019) Sleep quality in hospitalized patients with advanced cancer: an observational study using self-reports of sleep and actigraphy. Support Care Cancer 28:2015–2023. https://doi.org/10.1007/s00520-019-04998-5CrossRefPubMed

34.

Hinz A, Glaesmer H, Brähler E, Löffler M, Engel C, Enzenbach C, Hegerl U, Sander C (2017) Sleep quality in the general population: psychometric properties of the Pittsburgh Sleep Quality Index, derived from a German community sample of 9284 people. Sleep Med 30:57–63CrossRef

35.

Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh sleep quality index. J Psychosom Res 45:5–13CrossRef

36.

ActiGraph (2018) Where can I find documentation for the Sadeh and Cole Kripke algorithms?

37.

ActiGraph (2018) What does the “detect sleep periods” button do and how does it work?

38.

Giavarina D (2015) Understanding bland Altman analysis. Biochem Med 25(2):141–151CrossRef

39.

Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR, Spielman AJ, Kyle SD (2014) The evidence base of sleep restriction therapy for treating insomnia disorder. Sleep Med Rev 18(5):415–425. https://doi.org/10.1016/j.smrv.2014.01.006CrossRefPubMed

40.

Garrett K, Dhruva A, Koetters T, West C, Paul SM, Dunn LB, Aouizerat BE, Cooper BA, Dodd M, Lee K, Wara W, Swift P, Miaskowski C (2011) Differences in sleep disturbance and fatigue between patients with breast and prostate cancer at the initiation of radiation therapy. J Pain Symptom Manag 42(2):239–250. https://doi.org/10.1016/j.jpainsymman.2010.11.010CrossRef

41.

Moore CM, Schmiege SJ, Matthews EE (2015) Actigraphy and sleep diary measurements in breast cancer survivors: discrepancy in selected sleep parameters. Behav Sleep Med 13(6):472–490. https://doi.org/10.1080/15402002.2014.940108CrossRefPubMed

42.

Palesh O, Aldridge-Gerry A, Zeitzer JM, Koopman C, Neri E, Giese-Davis J, Jo B, Kraemer H, Nouriani B, Spiegel D (2014) Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep 37(5):837–842. https://doi.org/10.5665/sleep.3642CrossRefPubMedPubMedCentral

43.

Otte JL, Payne JK, Carpenter JS (2011) Nighttime variability in wrist actigraphy. J Nurs Meas 19(2):105–114CrossRef

44.

Miaskowski C, Lee K, Dunn L, Dodd M, Aouizerat BE, West C, Paul SM, Cooper B, Wara W, Swift P (2011) Sleep-wake circadian activity rhythm parameters and fatigue in oncology patients before the initiation of radiation therapy. Cancer Nurs 34(4):255–268CrossRef

45.

Aili K, Åström-Paulsson S, Stoetzer U, Svartengren M, Hillert L (2017) Reliability of actigraphy and subjective sleep measurements in adults: the design of sleep assessments. J Clin Sleep Med 13(1):39–47. https://doi.org/10.5664/jcsm.6384CrossRefPubMedPubMedCentral

46.

Sadeh A (2011) The role and validity of actigraphy in sleep medicine: an update. Sleep Med Rev 15(4):259–267. https://doi.org/10.1016/j.smrv.2010.10.001CrossRefPubMed

47.

Harvey AG, Tang N (2012) (Mis) perception of sleep in insomnia: a puzzle and a resolution. Psychol Bull 138(1):77–101. https://doi.org/10.1037/a0025730CrossRefPubMed

48.

Knab B, Engel RR (1988) Perception of waking and sleeping: possible implications for the evaluation of insomnia. Sleep 11(3):265–272CrossRef

49.

Saletu B, Anderer P, Saletu-Zyhlarz GM (2013) Recent advances in sleep research. Psychiatr Danub 25(4):426–434PubMed

Title: Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy
Authors: Charlotte Kreutz
Jana Müller
Martina E. Schmidt
Karen Steindorf
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Insomnia
Breast Cancer
Breast Cancer
Polysomnography
Cytostatic Therapy
Published in: Supportive Care in Cancer / Issue 2/2021
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-020-05580-0

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Abstract

Purpose

Methods

Results

Conclusion

Trial Registration

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