Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer.
Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer.
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DOI：
10.1097/psy.0000000000000097
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发表时间：
2014-09
影响因子：
3.3
通讯作者：
Janusek LW
中科院分区：
文献类型：
--
作者：
Tell D;Mathews HL;Janusek LW
研究睡眠行为的日常变化、持续的睡眠障碍和疲劳是否可以预测新近诊断为早期乳腺癌的妇女的皮质醇昼夜节律。女性(N=130，年龄=55。6±9.4岁)采集唾液5次/天/2天测定皮质醇。日记被用来评估前一天的午睡时间、夜间觉醒、睡眠潜伏期和早晨的休息时间。使用多维疲劳症状问卷和匹兹堡睡眠质量问卷测量持续疲劳和睡眠障碍。数据采用多水平生长曲线模型进行分析。更严重的持续疲劳(b=0.035，p=.032)或睡眠障碍(b=0.026，p=.006)预示皮质醇下降较慢。更大的持续性疲劳也预示着更高的唤醒皮质醇(b=0.154，p=.030)和更低的皮质醇唤醒反应(CAR)(b=−0.146，p=.005)。前一天午睡时间越长，CAR越高(b=0.042，p=0.050)，皮质醇下降越剧烈(b=−0.035，p=0.003)。更长的睡眠潜伏期预示着皮质醇线性下降更大(b=−0.013，p<；.001)，以及更大的二次斜率曲率(b=0.0007，p<；.001)。早晨休息较少预示着较低的觉醒皮质醇(b=−0.187，p=.004)，较高的CAR(b=0.124，p=.016)和较慢的皮质醇下降(b=0.023，p=.042)。睡眠行为的每日变化和持续的睡眠干扰和疲劳都与皮质醇节律被打乱有关。相比之下，前一天的午睡与更强健的皮质醇节律有关。这些发现尤其与患有乳腺癌的女性有关，她们经常经历睡眠障碍和疲劳。需要进一步的研究来确定乳腺癌患者睡眠障碍和下丘脑-垂体-肾上腺轴失调之间的因果关系。
To examine whether day-to-day variations in sleep behaviors, ongoing sleep disturbance and fatigue predict the cortisol diurnal rhythm in women recently diagnosed with early stage breast cancer. Women (N=130, age=55. 6±9.4 years) collected saliva 5×/day/2 days for cortisol. Diaries were used to assess prior-day nap duration, nocturnal awakenings, sleep latency, and morning restfulness. Ongoing fatigue and sleep disturbance were measured using the Multidimensional Fatigue Symptom Inventory and the Pittsburg Sleep Quality Inventory. Data were analyzed using multilevel growth curve modeling. Greater ongoing fatigue (b=0.035, p = .032), or sleep disturbance (b=0.026, p = .006) predicted a slower cortisol decline. Greater ongoing fatigue also predicted higher awakening cortisol (b=0.154, p = .030) and lower cortisol awakening response (CAR) (b=−0.146, p = .005). Longer prior-day naps predicted higher CAR (b=0.042, p=.050), and a steeper cortisol decline (b=−0.035, p = .003). Longer sleep latency predicted both a greater cortisol linear decline (b=−0.013, p < .001), and a greater quadratic slope curvature (b=0.0007, p < .001). Feeling less rested in the morning predicted lower awakening cortisol (b=−0.187, p= .004), higher CAR (b=0.124, p=.016) and a slower cortisol decline (b=0.023, p=.042). Both daily variations in sleep behaviors and ongoing sleep disturbance and fatigue associated with a disrupted cortisol rhythm. In contrast, prior-day napping associated with a more robust cortisol rhythm. These findings are particularly relevant to women with breast cancer who often experience sleep disturbance and fatigue. Additional research is needed to determine causal pathways between sleep disturbance and dysregulation of the hypothalamic-pituitary-adrenal axis in patients with breast cancer.