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

Charlotte Kreutz, Jana Müller, Martina E Schmidt, Karen Steindorf, Charlotte Kreutz, Jana Müller, Martina E Schmidt, Karen Steindorf

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.

Keywords: Actigraphy; Breast cancer; Insomnia; PSQI; Sleep.

Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Scatter plots of PSQI and ActiGraph of total sleep time (TST) (PSQI, bedtime to get up time; actigraphy, total sleep time), effective sleep time (EST) (PSQI, effective sleep time; actigraphy, total sleep time minus WASO), sleep latency (SL), sleep efficiency (SE)
Fig. 2
Fig. 2
Bland-Altman plots of PSQI and actigraphy of total sleep time (TST) (PSQI, bedtime to get up time; actigraphy, total sleep time), effective sleep time (EST) (PSQI, effective sleep time; actigraphy, total sleep time–WASO), sleep latency (SL), sleep efficiency (SE)

References

    1. Lampio L, Polo-Kantola P, Polo O, Kauko T, Aittokallio J, Saaresranta T. Sleep in midlife women: effects of menopause, vasomotor symptoms, and depressive symptoms. Menopause. 2014;21(11):1217–1224. doi: 10.1097/GME.0000000000000239.
    1. Malone M, Harris A, Luscombe D. Assessment of the impact of cancer on work, recreation, home management and sleep using a general health status measure. J R Soc Med. 1994;87(7):386–389.
    1. Schmidt ME, Wiskemann J, Steindorf K. Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis. Qual Life Res. 2018;27:2077–2086. doi: 10.1007/s11136-018-1866-8.
    1. Savard J, Simard S, Blanchet J, Ivers H, Morin CM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep. 2001;24:583–590. doi: 10.1093/sleep/24.5.583.
    1. Zhai L, Zhang H, Zhang D. Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety. 2015;32:664–670. doi: 10.1002/da.22386.
    1. Rissling BM, Gray KE, Ulmer CS. Sleep disturbance, diabetes, and cardiovascular disease in postmenopausal veteran women. Gerontologist. 2016;56:54–66. doi: 10.1093/geront/gnv668.
    1. Suzuki E, Yorifuji T, Ueshima K. Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: a population-based cohort study. Prev Med. 2009;49:135–141. doi: 10.1016/j.ypmed.2009.06.016.
    1. Yaffe K, Laffan AM, Harrison SL. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011;306:613–619.
    1. Lee-Chiong TL. Sleep and sleep disorders: an overview. Med Clin N Am. 2004;88:xi–xiv. doi: 10.1016/j.mcna.2004.02.005.
    1. Van de Water AT, Holmes A, Hurley DA. Objective measurements of sleep for non-laboratory settings as alternatives to polysomnography—a systematic review. J Sleep Res. 2011;20:183–200. doi: 10.1111/j.1365-2869.2009.00814.x.
    1. Brown AC, Smolensky MH, D’Alonzo GE, Redman DP. Actigraphy: a means of assessing circadian patterns in human activity. Chronobiol Int. 1990;7:125–133. doi: 10.3109/07420529009056964.
    1. Tyron WW. Issues of validity in actigraphic sleep assessment. Sleep. 2004;27(1):158–165. doi: 10.1093/sleep/27.1.158.
    1. Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. 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. 2016;25:52–73. doi: 10.1016/j.smrv.2015.01.009.
    1. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res. 2002;53:737–740. doi: 10.1016/S0022-3999(02)00330-6.
    1. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychatry Res. 1989;28:193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Curcio G, Tempesta D, Scarlata S, Marzano C, Moroni F, Rossini PA, Ferrara M, De Gennaro L. Validity of the Italian version of the Pittsburgh Sleep Quality Index (PSQI) Neurol Sci. 2013;34:511–519. doi: 10.1007/s10072-012-1085-y.
    1. Buysse DJ, Reynolds CF, Monk TH, Hoch CC, Yeager AL, Kupfer DJ. Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI) Sleep. 1991;14:331–338.
    1. Mondal P, Gjevre JA, Taylor-Gjevre RM, Lim HJ. Relationship between the Pittsburgh Sleep Quality Index and the Epworth sleepiness scale in a sleep laboratory referral population. Nat Sci Sleep. 2013;5:15–21.
    1. Reinsel RA, Starr TD, O'Sullivan B, Passik SD, Kavey NB. Polysomnographic study of sleep in survivors of breast cancer. J Clin Sleep Med. 2015;11(12):1361–1370. doi: 10.5664/jcsm.5264.
    1. Sadeh A, Sharkey KM, Carskadon MA. Activity-based sleep-wake identification: an empirical test of methodological issues. Sleep. 1994;17:201–207. doi: 10.1093/sleep/17.3.201.
    1. Jean-Louis G. Sleep estimation from wrist movement quantified by different actigraphic modalities. J Neurosci Methods. 2001;105(2):185–191. doi: 10.1016/S0165-0270(00)00364-2.
    1. Jean-Louis G, Kripke GF, Mason WJ, Elliott JA, Youngstedt SD. Determination of sleep and wakefulness with the actigraph data analysis software (ADAS) Sleep. 1996;19(9):739–743.
    1. Blood ML, Sack RL, Percy DC, Pen JC. A comparison of sleep detection by wrist actigraphy, behavioral response, and polysomnography. Sleep. 1997;20(6):388–395.
    1. 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. 10.3390/s19194160
    1. Conley S, Knies A, Batten J, Ash G, Miner B, Hwang Y, Jeon S, Redeker NS. Agreement between actigraphic and polysomnographic measures of sleep in adults with and without chronic conditions: a systematic review and meta-analysis. Sleep Med Rev. 2019;46:151–160. doi: 10.1016/j.smrv.2019.05.001.
    1. Gruwez A, Bruyneel AV, Bruyneel M. The validity of two commercially-available sleep trackers and actigraphy for assessment of sleep parameters in obstructive sleep apnea patients. PLoS One. 2019;14:e0210569. doi: 10.1371/journal.pone.0210569.
    1. Lemola S, Ledermann T, Friedman EM. Variability of sleep duration is related to subjective sleep quality and subjective well-being: an actigraphy study. PLoS One. 2013;8(8):e71292. doi: 10.1371/journal.pone.0071292.
    1. Berger AM, Farr LA, Kuhn BR, Fischer P, Agrawal S. Values of sleep/wake, activity/rest, circadian rhythms, and fatigue prior to adjuvant breast cancer chemotherapy. J Pain Symptom Manag. 2007;33(4):398–409. doi: 10.1016/j.jpainsymman.2006.09.022.
    1. Ancoli-Israel S, Liu L, Marler MR, Parker BA, Jones V, Sadler GR, Dimsdale J, Cohen-Zion M, Fiorentino L. Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer. 2006;14(3):201–207. doi: 10.1007/s00520-005-0861-0.
    1. Beck SL, Berger AM, Barsevick AM, Wong B, Stewart KA, Dudley WN. Sleep quality after initial chemotherapy for breast cancer. Support Care Cancer. 2010;18(6):679–689. doi: 10.1007/s00520-009-0662-y.
    1. Fontes F, Gonçalves M, Maia S, Pereira S, Severo M, Lunet N. Reliability and validity of the Pittsburgh Sleep Quality Index in breast cancer patients. Support Care Cancer. 2017;25:3059–3066. doi: 10.1007/s00520-017-3713-9.
    1. 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). 10.1186/1740-3391-9-4
    1. Jakobsen G, Engstrøm M, Thronæs M, Løhre ET, Kaasa S, Fayers P, Hjermstad MJ, Klepstad P. Sleep quality in hospitalized patients with advanced cancer: an observational study using self-reports of sleep and actigraphy. Support Care Cancer. 2019;28:2015–2023. doi: 10.1007/s00520-019-04998-5.
    1. Hinz A, Glaesmer H, Brähler E, Löffler M, Engel C, Enzenbach C, Hegerl U, Sander C. 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. 2017;30:57–63. doi: 10.1016/j.sleep.2016.03.008.
    1. Carpenter JS, Andrykowski MA. Psychometric evaluation of the Pittsburgh sleep quality index. J Psychosom Res. 1998;45:5–13. doi: 10.1016/S0022-3999(97)00298-5.
    1. ActiGraph (2018) Where can I find documentation for the Sadeh and Cole Kripke algorithms?
    1. ActiGraph (2018) What does the “detect sleep periods” button do and how does it work?
    1. Giavarina D. Understanding bland Altman analysis. Biochem Med. 2015;25(2):141–151. doi: 10.11613/BM.2015.015.
    1. Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR, Spielman AJ, Kyle SD. The evidence base of sleep restriction therapy for treating insomnia disorder. Sleep Med Rev. 2014;18(5):415–425. doi: 10.1016/j.smrv.2014.01.006.
    1. 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. Differences in sleep disturbance and fatigue between patients with breast and prostate cancer at the initiation of radiation therapy. J Pain Symptom Manag. 2011;42(2):239–250. doi: 10.1016/j.jpainsymman.2010.11.010.
    1. Moore CM, Schmiege SJ, Matthews EE. Actigraphy and sleep diary measurements in breast cancer survivors: discrepancy in selected sleep parameters. Behav Sleep Med. 2015;13(6):472–490. doi: 10.1080/15402002.2014.940108.
    1. Palesh O, Aldridge-Gerry A, Zeitzer JM, Koopman C, Neri E, Giese-Davis J, Jo B, Kraemer H, Nouriani B, Spiegel D. Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep. 2014;37(5):837–842. doi: 10.5665/sleep.3642.
    1. Otte JL, Payne JK, Carpenter JS. Nighttime variability in wrist actigraphy. J Nurs Meas. 2011;19(2):105–114. doi: 10.1891/1061-3749.19.2.105.
    1. Miaskowski C, Lee K, Dunn L, Dodd M, Aouizerat BE, West C, Paul SM, Cooper B, Wara W, Swift P. Sleep-wake circadian activity rhythm parameters and fatigue in oncology patients before the initiation of radiation therapy. Cancer Nurs. 2011;34(4):255–268. doi: 10.1097/NCC.0b013e3181f65d9b.
    1. Aili K, Åström-Paulsson S, Stoetzer U, Svartengren M, Hillert L. Reliability of actigraphy and subjective sleep measurements in adults: the design of sleep assessments. J Clin Sleep Med. 2017;13(1):39–47. doi: 10.5664/jcsm.6384.
    1. Sadeh A. The role and validity of actigraphy in sleep medicine: an update. Sleep Med Rev. 2011;15(4):259–267. doi: 10.1016/j.smrv.2010.10.001.
    1. Harvey AG, Tang N. (Mis) perception of sleep in insomnia: a puzzle and a resolution. Psychol Bull. 2012;138(1):77–101. doi: 10.1037/a0025730.
    1. Knab B, Engel RR. Perception of waking and sleeping: possible implications for the evaluation of insomnia. Sleep. 1988;11(3):265–272. doi: 10.1093/sleep/11.3.265.
    1. Saletu B, Anderer P, Saletu-Zyhlarz GM. Recent advances in sleep research. Psychiatr Danub. 2013;25(4):426–434.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe