The effects of mindfulness-based stress reduction on objective and subjective sleep parameters in women with breast cancer: a randomized controlled trial

Abstract Objective: The purpose of this study was to investigate the effects of mindfulness-based stress reduction for breast cancer survivors (MBSR(BC)) on multiple measures of objective and subjective sleep parameters among breast cancer survivors (BCS). Methods: Data were collected using a two-armed randomized controlled design among BCS enrolled in either a 6-week MBSR(BC) program or a usual care (UC) group with a 12-week follow-up. The present analysis is a subset of the larger parent trial (ClinicalTrials.gov Identifier: NCT01177124). Seventy-nine BCS participants (mean age 57 years), stages 0-III, were randomly assigned to either the formal (in-class) 6-week MBSR(BC) program or UC. Subjective sleep parameters (SSP) (i.e., sleep diaries and the Pittsburgh Sleep Quality Index (PSQI)) and objective sleep parameters (OSP) (i.e., actigraphy) were measured at baseline, 6 weeks, and 12 weeks after completing the MBSR(BC) or UC program. Results: Results showed indications of a positive effect of MBSR(BC) on OSP at 12 weeks on sleep efficiency (78.2% MBSR(BC) group versus 74.6% UC group, p = 0.04), percent of sleep time (81.0% MBSR(BC) group versus 77.4% UC group, p = 0.02), and less number waking bouts (93.5 in MBSR (BC) group versus 118.6 in the UC group, p < 0.01). Small nonsignificant improvements were found in SSP in the MBSR(BC) group from baseline to 6 weeks (PSQI total score, p = 0.09). No significant relationship was observed between minutes of MBSR(BC) practice and SSP or OSP. Conclusions: These data suggest that MBSR(BC) may be an efficacious treatment to improve objective and subjective sleep parameters in BCS

Race/Ethnicity, Subjective and Objective Sleep Quality, Physical and Psychological Symptoms in Breast Cancer Survivors

Breast cancer is a major health problem and comprises the largest population of cancer survivors in the United States, estimated at 2.9 million women, accounting for 22% of all cancer survivors (National Cancer Institute, 2013). The advances in breast cancer screening, diagnosis and treatment has increased the importance of survivorship needs. A major concern among breast cancer survivors (BCS) is sleep disturbances. This study used an innovative approach to examine ethnic and racial disparities in sleep disturbances present in BCS. In addition, this study also explored sleep disturbances across different races/ethnicities. This study was a secondary data analysis of baseline data from the supplement study of the MBSR Symptom Cluster Trial for Breast Cancer Survivors/ 1R01CA131080, conducted by Dr. Lengacher. Sleep was measured using the Pittsburgh Sleep Quality Index, sleep diary (subjective), and sleep actigraphy (objective). The sample consists of 79 women who had been diagnosed with breast cancer (Stage 0, I, II, III), completed lumpectomy and/or mastectomy, and were within 2 weeks to 2 years post radiation and/or chemotherapy treatment. The aims for this study were to: 1) explore racial/ethnic differences in objectively measured sleep patterns among BCS; 2) estimate and compare the correlation between objective and subjective sleep quality by racial/ethnic groups among BCS; 3) examine which sleep actigraphy measure appears to have the strongest relationship with physical and psychological symptoms; and 4) explore whether these relationships (i.e. between objective sleep and self-reported symptoms) appear to be modified by race/ethnicity. The first aim was conducted using analysis of variance (ANOVA) and analysis of covariance (ANCOVA). Results indicated that white, non Hispanic BCS had improved objective sleep quality compared to minority BCS. The second aim was conducted using Pearson\u27s correlation with significant correlations found between subjective and objective sleep onset latency (r= .310, p= .016), and total sleep time (TST) (r= .328, p= .011) for the white, non-Hispanic group. The third aim was conducted using Pearson\u27s correlation with significant correlations between sleep onset latency and depression (r= .247, p= .029); sleep efficiency and depression (r= -.233, p= .040); sleep efficiency and fatigue (r= -.207, p= .045); and WASO and pain (r= .277, p= .014). There were no significant correlations between the anxiety score and actigraphy parameters. Using the significant correlations from the results of the third aim, multiple regression analysis was conducted with age as a covariate to test the fourth aim. The main effect of depression on sleep efficiency was significant (p= .044) with less depression associated with higher sleep efficiency. The interaction term, depression by race/ethnicity, had a non-significant effect on sleep efficiency (p= .299). The main effect of pain on WASO was significant (p= .008), and increased pain was associated with longer WASO. The interaction term, race/ethnicity by pain, had a non-significant effect on WASO (p= .148). The main effect of depression predicting sleep onset latency was significant (p= .027), and the interaction term, depression by race/ethnicity, had a trend towards a significant effect (p= .092) on predicting sleep onset latency. The interaction between depression and race/ethnicity predicting sleep onset latency was further decomposed using multiple regression. The average sleep onset latency was longer in the minority group with high depression levels (42 minutes) compared to the white, non-Hispanics with high depression levels (29 minutes). Race modified the effect of depression on sleep onset latency in this sample of BCS. These finding suggest that the experience of objective sleep disturbances is different among races/ethnicities. Additional research is needed to further explore racial/ethnic differences in subjective and objective sleep disturbances and its impact on physical and psychological symptoms among BCS. As the number of BCS continue to rise, it is becoming increasingly important to recognize sleep disturbances and their potential physical and psychological effects early in BCS, specifically in different races and ethnicities. It is anticipated that these findings may contribute to improved symptom management for women of different races and ethnicities

Minority Breast Cancer Survivors: The Association between Race/Ethnicity, Objective Sleep Disturbances, and Physical and Psychological Symptoms

Background. Limited research has been conducted on the moderating effect of race/ethnicity on objective sleep disturbances in breast cancer survivors (BCSs). Objective. To explore racial/ethnic differences in objective sleep disturbances among BCSs and their relationship with self-reported symptoms. Intervention/Methods. Sleep disturbance and symptoms were measured using actigraphy for 72 hours and self-reported questionnaires, respectively, among 79 BCSs. Analysis of covariance, Pearson’s correlation, and multivariate regression were used to analyze data. Results. Sixty (75.9%) participants listed their ethnicity as white, non-Hispanic and 19 (24.1%) as minority. Total sleep time was 395.9 minutes for white BCSs compared to 330.4 minutes for minority BCSs. Significant correlations were seen between sleep onset latency (SOL) and depression, SOL and fatigue, and sleep efficiency (SE) and fatigue among minority BCSs. Among white BCSs, significant correlations were seen between SE and pain and wake after sleep onset (WASO) and pain. The association between depression and SOL and fatigue and SOL appeared to be stronger in minority BCSs than white BCSs. Conclusions. Results indicate that white BCSs slept longer than minority BCSs, and race/ethnicity modified the effect of depression and fatigue on SOL, respectively. Implications for Practice. As part of survivorship care, race/ethnicity should be included as an essential component of comprehensive symptom assessments

Minority Breast Cancer Survivors: The Association between Race/Ethnicity, Objective Sleep Disturbances, and Physical and Psychological Symptoms

Background. Limited research has been conducted on the moderating effect of race/ethnicity on objective sleep disturbances in breast cancer survivors (BCSs). Objective. To explore racial/ethnic differences in objective sleep disturbances among BCSs and their relationship with self-reported symptoms. Intervention/Methods. Sleep disturbance and symptoms were measured using actigraphy for 72 hours and self-reported questionnaires, respectively, among 79 BCSs. Analysis of covariance, Pearson’s correlation, and multivariate regression were used to analyze data. Results. Sixty (75.9%) participants listed their ethnicity as white, non-Hispanic and 19 (24.1%) as minority. Total sleep time was 395.9 minutes for white BCSs compared to 330.4 minutes for minority BCSs. Significant correlations were seen between sleep onset latency (SOL) and depression, SOL and fatigue, and sleep efficiency (SE) and fatigue among minority BCSs. Among white BCSs, significant correlations were seen between SE and pain and wake after sleep onset (WASO) and pain. The association between depression and SOL and fatigue and SOL appeared to be stronger in minority BCSs than white BCSs. Conclusions. Results indicate that white BCSs slept longer than minority BCSs, and race/ethnicity modified the effect of depression and fatigue on SOL, respectively. Implications for Practice. As part of survivorship care, race/ethnicity should be included as an essential component of comprehensive symptom assessments

The Effects of Mindfulness-based Stress Reduction on Objective and Subjective Sleep Parameters in Women with Breast Cancer: A Randomized Controlled Trial

Objective: The purpose of this study was to investigate the effects of mindfulness-based stress reduction for breast cancer survivors (MBSR(BC)) on multiple measures of objective and subjective sleep parameters among breast cancer survivors (BCS). Methods: Data were collected using a two-armed randomized controlled design among BCS enrolled in either a 6-week MBSR(BC) program or a usual care (UC) group with a 12-week follow-up. The present analysis is a subset of the larger parent trial (ClinicalTrials.gov Identifier: NCT01177124). Seventy-nine BCS participants (mean age 57 years), stages 0–III, were randomly assigned to either the formal (in-class) 6-week MBSR(BC) program or UC. Subjective sleep parameters (SSP) (i.e., sleep diaries and the Pittsburgh Sleep Quality Index (PSQI)) and objective sleep parameters (OSP) (i.e., actigraphy) were measured at baseline, 6 weeks, and 12 weeks after completing the MBSR(BC) or UC program. Results: Results showed indications of a positive effect of MBSR(BC) on OSP at 12 weeks on sleep efficiency (78.2% MBSR(BC) group versus 74.6% UC group, p = 0.04), percent of sleep time (81.0% MBSR(BC) group versus 77.4% UC group, p = 0.02), and less number waking bouts (93.5 in MBSR(BC) group versus 118.6 in the UC group, p \u3c 0.01). Small nonsignificant improvements were found in SSP in the MBSR(BC) group from baseline to 6 weeks (PSQI total score, p = 0.09). No significant relationship was observed between minutes of MBSR(BC) practice and SSP or OSP. Conclusions: These data suggest that MBSR(BC) may be an efficacious treatment to improve objective and subjective sleep parameters in BCS