ASPO Abstracts
Sleep after breast cancer: Predictors of distinct insomnia trajectories in premenopausal women
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2023
Abstract Body:
Purpose: Sleep disruptions are common in cancer survivors and can negatively impact quality of life. Young breast cancer survivors face unique challenges and may have distinct sleep patterns. We examined trajectories of sleep quality/insomnia over 3 years among young survivors. Methods: 836 women, ≤45 years old with stage I-III breast cancer, were recruited to the Menstrual Cycle Maintenance and Quality of Life After Breast Cancer Study within 8 months of diagnosis. Sleep was assessed at 6-month intervals from baseline through 3 years post-recruitment, using the Women's Health Initiative Insomnia Rating Scale (WHIIRS), a measure of sleep quality and insomnia symptoms. Group-based trajectory modeling was used to identify distinct trajectories of insomnia symptoms. The final model was chosen by comparing the average posterior probability of assignment (PPA) and examining the distinctiveness and interpretability of the trajectories. Key demographic, quality of life and clinical factors were assessed in multinomial logistic regression models as predictors of group membership. Results: The mean age of participants was 38 years (range: 20-45 years) at enrollment. Three distinct sleep trajectories were identified: low probability of insomnia (n=277, 33.1%), moderate probability (n=354, 42.4%), and high probability (n=205, 24.5%). Average PPA was between 75%-82% for each group. WHIIRS scores were relatively stable over time. Insomnia symptoms were worse at baseline, but improved for the low probability and moderate probability groups. Older age (p=0.03), lower education (p=0.03), lower income (p=0.04), having received chemotherapy (p=0.003) and/or hormone therapy (p=0.02), hot flashes (p=0.007), night sweats (p=0.001), and lower SF-12 physical (p<0.0001) and SF-12 mental health component scores (p<0.0001) were associated with participants in the moderate and high probability insomnia groups. Conclusion: Insomnia symptoms are problematic for some young breast cancer survivors. We identified three distinct sleep trajectories and factors associated with sleep problems. Analyses such as this enable us to identify high-risk patients that could benefit from sleep interventions to address this important survivorship issue.
Keywords: sleep, insomnia, breast cancer, trajectories