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Sleep disturbance among breast cancer survivors and controls from midlife to early older adulthood: Pink SWAN

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Abstract

Purpose

To compare sleep disturbance from 5 years pre- to 5 years post-diagnosis between breast cancer survivors (BCS) and women without cancer over the same period and to identify BCS subgroups exhibiting different sleep trajectories.

Methods

Analyses included data from 152 BCS and 2163 controls from 20 years of follow-up in the longitudinal Study of Women’s Health Across the Nation (SWAN), a multi-racial/ethnic cohort study. SWAN participants were assessed approximately annually from 1995 to 2015 using a standardized protocol. Pink SWAN focused on women who reported no cancer at SWAN enrollment and developed incident breast cancer after enrollment or did not develop breast cancer. Nonparametric locally weighted scatterplot smoothing plots and linear mixed models were used to compare the prevalence of the most frequently reported sleep problem, frequently waking several times a night (a sleep maintenance problem) during the previous 2 weeks, between BCS and controls in the 5 years pre- to 5 years post-diagnosis. We characterized heterogeneity among BCS on this sleep problem using group-based trajectories and examined pre-diagnosis variables as predictors of group membership.

Results

No differences were found between BCS and controls in prevalence of frequent nighttime awakenings either before or after diagnosis. Among BCS, three trajectory groups were identified. Thirty-seven percent of BCS had consistently low prevalence of waking several times per night, 30% had high prevalence, and 33% had increasing prevalence which started 2 years pre-diagnosis. Prevalence of pre-diagnosis vasomotor symptoms, anxiety, depressive symptoms, and smoking differed among these groups.

Conclusion

Among mid-aged women diagnosed with breast cancer, this diagnosis did not trigger/amplify a sleep maintenance problem. The majority of BCS had similar levels of this sleep problem from pre- to post-diagnosis.

Implications for Cancer Survivors

Although sleep maintenance problems were not amplified by a cancer diagnosis, a subset of BCS may have sleep issues that should be monitored and treated, as indicated.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The Study of Women’s Health Across the Nation (SWAN) is supported by the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the Office of Research on Women’s Health (ORWH) (Grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, and U19AG063720). Pink SWAN was supported by the National Cancer Institute R01CA199137. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NCI, NIA, NINR, ORWH, or the NIH. Dr. Goyal was supported by the National Cancer Institute R25 CA122061.

Author information

Authors and Affiliations

  1. Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA

    Neha Goyal

  2. Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA

    Beverly J. Levine & Nancy E. Avis

  3. Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MB, USA

    Sybil L. Crawford

Authors
  1. Neha Goyal
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  2. Beverly J. Levine
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  3. Sybil L. Crawford
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  4. Nancy E. Avis
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Contributions

Nancy E. Avis: conceptualization, formal analysis, funding acquisition, writing—original draft. Beverly Levine: formal analysis, writing—original draft. Sybil L. Crawford: funding acquisition, formal analysis, writing—review and editing. Neha Goyal: formal analysis, writing—original draft, review, and editing.

Corresponding author

Correspondence to Nancy E. Avis.

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This study was approved by the Institutional Board at each site. All participants provided written informed consent.

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The authors declare no competing interests.

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Goyal, N., Levine, B.J., Crawford, S.L. et al. Sleep disturbance among breast cancer survivors and controls from midlife to early older adulthood: Pink SWAN. J Cancer Surviv 18, 489–498 (2024). https://doi.org/10.1007/s11764-022-01247-3

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  • DOI: https://doi.org/10.1007/s11764-022-01247-3

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