Supportive Care in Cancer

, Volume 21, Issue 1, pp 43–51 | Cite as

Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors

  • Krupali DesaiEmail author
  • Jun J. Mao
  • Irene Su
  • Angela DeMichele
  • Qing Li
  • Sharon X. Xie
  • Philip R. Gehrman
Original Article



Insomnia is increasingly recognized as a major symptom outcome in breast cancer; however, little is known about its prevalence and risk factors among women receiving aromatase inhibitors (AIs), a standard treatment to increase disease-free survival among breast cancer patients.


A cross-sectional survey study was conducted among postmenopausal women with stage 0–III breast cancer receiving adjuvant AI therapy at an outpatient breast oncology clinic of a large university hospital. The insomnia severity index (ISI) was used as the primary outcome. Multivariate logistic regression analyses were performed to evaluate risk factors.


Among 413 participants, 130 (31.5 %) had subthreshold insomnia on the ISI, and 77 (18.64 %) exceeded the threshold for clinically significant insomnia. In a multivariate logistic regression model, clinically significant insomnia was independently associated with severe joint pain (adjusted odds ratio (AOR) 4.84, 95 % confidence interval (CI) 1.71–13.69, P = 0.003), mild/moderate hot flashes (AOR 2.28, 95 % CI 1.13–4.60, P = 0.02), severe hot flashes (AOR 2.29, 95 % CI 1.23–6.81, P = 0.015), anxiety (AOR 1.99, 95 % CI 1.08–3.65, P = 0.027), and depression (AOR 3.57, 95 % CI 1.48–8.52, P = 0.004). Age (>65 vs. <55 years; AOR 2.31; 95 % CI 1.11–4.81; P = 0.026) and time since breast cancer diagnosis (<2 vs. 2–5 years; AOR 1.94; 95 % CI 1.02–3.69; P = 0.045) were also found to be significant risk factors. Clinical insomnia was more common among those who used medication for treating insomnia and pain.


Insomnia complaints exceed 50 % among AI users. Clinically significant insomnia is highly associated with joint pain, hot flashes, anxiety and depression, age, and time since diagnosis.


Breast cancer Insomnia Aromatase inhibitors 



We would like to thank all the breast cancer survivors, physicians, nurse practitioners, and staff for their support. We would like to thank all the work study students for their dedication to the data collection and management process. Funding support was received from the Penn Clinical Pharmacogenomic Epidemiology Pilot Grant National Institutes of Health (NIH) 5P20RR020741, Penn Institute of Aging Pilot Grant, and NIH AT004695. Dr. Mao is supported by the American Cancer Society CCCDA-08-107-01 and NIH K23 AT004112.

Conflict of interest



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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Krupali Desai
    • 1
    Email author
  • Jun J. Mao
    • 1
    • 2
    • 3
  • Irene Su
    • 5
  • Angela DeMichele
    • 2
    • 3
  • Qing Li
    • 1
  • Sharon X. Xie
    • 2
  • Philip R. Gehrman
    • 4
  1. 1.Department of Family Medicine and Community HealthUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Abramson Cancer CenterUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Psychiatry and Penn Sleep CenterUniversity of Pennsylvania Health SystemPhiladelphiaUSA
  5. 5.Division of Reproductive Endocrinology, Department of Reproductive MedicineUniversity of California at San Diego School of MedicineLa JollaUSA

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