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Elevated perceived stress scale (PSS) scores are associated with increased risk of poor sleep assessed by global PSQI scores: cancer and hypnotics-stratified analysis in an adult population-based study

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Abstract

Patients with cancer tend to have an increased risk of sleep disorders. The exact association between cancer and sleep disorders remains uncertain. We aimed to investigate whether elevated perceived stress is linked to a higher risk of sleep disorders in patients with and without cancer history respectively. A total of 941 adult individuals from the Midlife in the United States (MIDUS) study were included in this study. Multivariate analyses were used for assessing the association between Perceived Stress Scale (PSS) and Global Pittsburgh Sleep Quality Index (PSQI) Score. Adjusted for age, gender, BMI, blood pressure (BP), smoking and drinking status, exercise, disease history, and blood biomarkers, elevated PSS score was significantly associated with a higher PSQI score in the linear regression model (0.189 [0.154–0.224], p < 0.001; Model 2). The higher PSS score was still significantly associated with Poor sleep status (score > 5) in the logistic regression model (1.062 [1.036–1.090], p < 0.001; Model 2). Stratified analysis showed that the association between PSS and poor sleep status was affected by hypnotics use, but not by ever cancer history. Elevated PSS is linked with a higher risk of poor sleep status in the adult population from the United States. Elevated PSS might mediate the association of cancer and poor sleep quality. Future studies need to evaluate whether reducing PSS can improve sleep status in patients with cancer history.

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References

  1. Yong L, Wheaton AG, Chapman DP, et al. Sleep duration and chronic diseases among U.S. adults age 45 years and older: evidence from the 2010 Behavioral Risk Factor Surveillance System. Sleep. 2010;2013(10):1421–7.

    Google Scholar 

  2. Otte JL, Carpenter JS, Manchanda S, et al. Systematic review of sleep disorders in cancer patients: can the prevalence of sleep disorders be ascertained. Cancer Med. 2015;2:183–200.

    Article  Google Scholar 

  3. Huang Y, Zhu M. Increased global PSQI score Is associated with depressive symptoms in an adult population from the United States. Nat Sci Sleep. 2020;12:487–95.

    Article  Google Scholar 

  4. Kasai T, Floras JS, Bradley TD. Sleep apnea and cardiovascular disease: a bidirectional relationship. Circulation. 2012;126:1495–510.

    Article  Google Scholar 

  5. Huang Y, Jiang Y, Zhu M. The relationship between global sleep score and inflammatory markers in obese adults from the United States. Nat Sci Sleep. 2019;11:317–24.

    Article  Google Scholar 

  6. Marshall N. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton health study. Sleep. 2008;31:1079–85.

    Article  Google Scholar 

  7. Lianqi L, Michelle R, Loki N, et al. The longitudinal relationship between fatigue and sleep in breast cancer patients undergoing chemotherapy. Sleep. 2012;2:237–45.

    Google Scholar 

  8. Costa AR, Fontes F, Pereira S, et al. Impact of breast cancer treatments on sleep disturbances—a systematic review. Breast. 2014;23:697–709.

    Article  Google Scholar 

  9. Law E, Palermo T, Lord H, et al. Co-morbid pain and sleep disturbance: sleep outcomes in a randomized controlled trial of internet-based cognitive-behavioral therapy for insomnia. J Pain. 2012;13:S97–S97.

    Article  Google Scholar 

  10. Kim Y, Kim YE, Park EO, et al. REM sleep behavior disorder portends poor prognosis in Parkinson’s disease: A systematic review. J Clin Neuroence Off J Neurosurg Soc Australasia. 2018;47:6–13.

    Google Scholar 

  11. Liu C, Xie B, Chou CP, et al. Perceived stress, depression and food consumption frequency in the college students of China seven cities. Physiol Behav. 2007;92:748–54.

    Article  CAS  Google Scholar 

  12. Cantekin I, Tan M. The influence of music therapy on perceived stressors and anxiety levels of hemodialysis patients. Ren Fail. 2012;35:105–9.

    Article  Google Scholar 

  13. Katsarou AL, Triposkiadis F, Panagiotakos D. Perceived stress and vascular disease: where are we now. Angiology. 2013;64:529–34.

    Article  Google Scholar 

  14. Pruessner JC, Hellhammer DH, Kirschbaum C. Burnout, Perceived stress, and cortisol responses to awakening. Psychosom Med. 1999;61:197–204.

    Article  CAS  Google Scholar 

  15. Rod N, Nielsen Tage S, et al. Perceived stress and cause-specific mortality among men and women: results from a prospective cohort study. Am J Epidemiol. 2008;168:481–91.

    Article  Google Scholar 

  16. Fliege H, Rose M, Arck P, et al. The perceived stress questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples. Psychosom Med. 2005;67:78–88.

    Article  Google Scholar 

  17. Kimura T, Yokoyama A, Kohno N, et al. Perceived stress, severity of asthma, and quality of life in young adults with asthma. Allergol Int. 2009;58:71–9.

    Article  Google Scholar 

  18. Lale G, Nenir E, et al. Does psychodrama affect perceived stress, anxiety-depression scores and saliva cortisol in patients with depression. Psychiatry Investig. 2018;15:970–5.

    Article  Google Scholar 

  19. Véronique, Goussé, Virginie, et al. Impact of perceived stress, anxiety-depression and social support on coping strategies of parents having a child with Gilles de la Tourette syndrome. Archives of Psychiatric Nursing. 2016; 30:109–113.

  20. Drake CL, Cheng P, Almeida DM, et al. Familial risk for insomnia is associated with abnormal cortisol response to stress. Sleep. 2017;40:zsx143.

    PubMed Central  Google Scholar 

  21. Shaver JLF, Johnston SK, Lentz MJ, et al. Stress exposure, psychological distress, and physiological stress activation in midlife women with insomnia. Psychosom Med. 2002;64:793–802.

    PubMed  Google Scholar 

  22. Dienberg Love G, Seeman TE, Weinstein M, et al. Bioindicators in the MIDUS national study: protocol, measures, sample, and comparative context. J Aging Health. 2010;22:1059–80.

    Article  Google Scholar 

  23. Gruenewald TL, Karlamangla AS, Hu P, et al. History of socioeconomic disadvantage and allostatic load in later life. Soc Sci Med. 2012;74:75–83.

    Article  Google Scholar 

  24. Buysse DJ, Iii CF, Monk TH, et al. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.

    Article  CAS  Google Scholar 

  25. Shahid A, Wilkinson K, Marcu S, et al. Pittsburgh sleep quality index (PSQI), STOP, THAT and one hundred other sleep scales. Springer, New York. 2011;28:193–213.

    Google Scholar 

  26. Cohen S. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.

    Article  CAS  Google Scholar 

  27. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  28. Karim J, Weisz R, Bibi Z, et al. Validation of the eight-item Center for epidemiologic studies depression scale (CES-D) among older adults. Curr Psychol. 2015;34:681–92.

    Article  Google Scholar 

  29. Brummett BH, Krystal AD, Ashley-Koch A, et al. Sleep quality varies as a function of 5-HTTLPR genotype and stress. Psychosom Med. 2007;69:621–4.

    Article  CAS  Google Scholar 

  30. Kerstedt T, Orsini N, Petersen H, et al. Predicting sleep quality from stress and prior sleep—a study of day-to-day covariation across six weeks. Sleep Med. 2012;13:674–9.

    Article  Google Scholar 

  31. Norlander T, Johansson A, Bood SA. The Affective Personality: Its Relation To Quality Of Sleep, Well-Being And Stress. Soc Behav Personal Int J. 2005;33:709–22.

    Article  Google Scholar 

  32. Vrinten C, David B, et al. Does psychosocial stress exacerbate avoidant responses to cancer information in those who are afraid of cancer? A population-based survey among older adults in England. Psychology & Health. 2017;33:117–29.

    Article  Google Scholar 

  33. Green MR, Barnes B, Mccormick CM. Social instability stress in adolescence increases anxiety and reduces social interactions in adulthood in male long–evans rats. Dev Psychobiol. 2013;55:849–59.

    Article  Google Scholar 

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Acknowledgments

We thank all individuals who were responsible for the planning and administering of MIDUS study and making the datasets of MIDUS study available on their website. We also acknowledge the reviewers and editors for reviewing our work.

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Authors and Affiliations

  1. Oncology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China

    Yilin Xu & Anwen Liu

  2. Jiangxi Key Laboratory of Clinical Translational Cancer Research, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China

    Yilin Xu & Anwen Liu

Authors
  1. Yilin Xu
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  2. Anwen Liu
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Correspondence to Anwen Liu.

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Xu, Y., Liu, A. Elevated perceived stress scale (PSS) scores are associated with increased risk of poor sleep assessed by global PSQI scores: cancer and hypnotics-stratified analysis in an adult population-based study. Sleep Biol. Rhythms 19, 361–368 (2021). https://doi.org/10.1007/s41105-021-00325-w

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  • DOI: https://doi.org/10.1007/s41105-021-00325-w

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