Sleep duration and breast cancer prognosis: perspectives from the Women’s Healthy Eating and Living Study
To examine whether baseline sleep duration or changes in sleep duration are associated with breast cancer prognosis among early-stage breast cancer survivors in the multi-center Women’s Healthy Eating and Living Study.
Data were collected from 1995 to 2010. Analysis included 3047 women. Sleep duration was self-reported at baseline and follow-up intervals. Cox proportional hazard models were used to investigate whether baseline sleep duration was associated with breast cancer recurrence, breast cancer-specific mortality, and all-cause mortality. Time-varying models investigated whether changes in sleep duration were associated with breast cancer prognosis.
Compared to women who slept 7–8 h/night at baseline, sleeping ≥9 h/night was associated with a 48% increased risk of breast cancer recurrence (Hazard ratio [HR] 1.48, 95% Confidence interval [CI] 1.01, 2.00), a 52% increased risk of breast cancer-specific mortality (HR 1.52, 95% CI 1.09, 2.13), and a 43% greater risk of all-cause mortality (HR 1.43, 95% CI 1.07, 1.92). Time-varying models showed analogous increased risk in those who inconsistently slept ≥9 h/night (all P < 0.05), but not in those who consistently slept ≥9 h/night.
Consistent long or short sleep, which may reflect inter-individual variability in the need for sleep, does not appear to influence prognosis among early-stage breast cancer survivors.
KeywordsSleep Longitudinal modeling Survival Survivorship
Dr. Marinac was supported by the National Cancer Institute of the National Institutes of Health under award number F31 CA183125. Research support was also provided by funding from the National Cancer Institute under award numbers U54 CA155435, and R01 CA166293. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with ethical standards
Conflict of interest
The authors have no financial or conflicts of interest to disclose.
All procedures performed involving human participants were in accordance with the ethical standards of the University of California, San Diego and 6 other clinical sites, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Howlander N, Noone A, Krapacho M, Miller D, Boship K, Alterkruse SF, C.L. K, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, E.J. F, Cronin KA SEER Cancer Statistics Revier, 1975–2013, National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/csr/1975_2013/. Based on November 2015 SEER data submission, posted to the SEER web site, April 2016
- 3.Alfano CM, Lichstein KL, Vander Wal GS, Smith AW, Reeve BB, McTiernan A, Bernstein L, Baumgartner KB, Ballard-Barbash R (2011) Sleep duration change across breast cancer survivorship: associations with symptoms and health-related quality of life. Breast Cancer Res Treat 130(1):243–254. doi: 10.1007/s10549-011-1530-2 PubMedPubMedCentralCrossRefGoogle Scholar
- 15.Phipps AI, Bhatti P, Neuhouser ML, Chen C, Crane TE, Kroenke CH, Ochs-Balcom H, Rissling M, Snively BM, Stefanick ML, Treggiari MM, Watson NF (2016) Pre-diagnostic sleep duration and sleep quality in relation to subsequent cancer survival. J Clin Sleep Med 12(4):495–503. doi: 10.5664/jcsm.5674 PubMedPubMedCentralCrossRefGoogle Scholar
- 18.Palesh O, Aldridge-Gerry A, Zeitzer JM, Koopman C, Neri E, Giese-Davis J, Jo B, Kraemer H, Nouriani B, Spiegel D (2014) Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep 37(5):837–842. doi: 10.5665/sleep.3642 PubMedPubMedCentralGoogle Scholar
- 20.Pierce JP, Faerber S, Wright FA, Rock CL, Newman V, Flatt SW, Kealey S, Jones VE, Caan BJ, Gold EB, Haan M, Hollenbach KA, Jones L, Marshall JR, Ritenbaugh C, Stefanick ML, Thomson C, Wasserman L, Natarajan L, Thomas RG, Gilpin EA, Women’s Healthy E, Living study g (2002) A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) Study. Control Clin Trials 23(6):728–756PubMedCrossRefGoogle Scholar
- 21.Pierce JP, Natarajan L, Caan BJ, Parker BA, Greenberg ER, Flatt SW, Rock CL, Kealey S, Al-Delaimy WK, Bardwell WA, Carlson RW, Emond JA, Faerber S, Gold EB, Hajek RA, Hollenbach K, Jones LA, Karanja N, Madlensky L, Marshall J, Newman VA, Ritenbaugh C, Thomson CA, Wasserman L, Stefanick ML (2007) Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA 298(3):289–298. doi: 10.1001/jama.298.3.289 PubMedPubMedCentralCrossRefGoogle Scholar
- 25.Patterson RE, Flatt SW, Saquib N, Rock CL, Caan BJ, Parker BA, Laughlin GA, Erickson K, Thomson CA, Bardwell WA, Hajek RA, Pierce JP (2010) Medical comorbidities predict mortality in women with a history of early stage breast cancer. Breast Cancer Res Treat 122(3):859–865. doi: 10.1007/s10549-010-0732-3 PubMedPubMedCentralCrossRefGoogle Scholar
- 29.Kosinski M, Keller SD, Hatoum HT, Kong SX, Ware JE, Jr (1999) The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: tests of data quality, scaling assumptions and score reliability. Medical care 37(5 Suppl):MS10–MS22PubMedGoogle Scholar
- 31.Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Hillard PJA, Katz ES, Kheirandish-Gozal L, Neubauer DN, O’Donnell AE, Ohayon M, Peever J, Rawding R, Sachdeva RC, Setters B, Vitiello MV, Ware JC (2015) National sleep foundation’s updated sleep duration recommendations: final report. Sleep Health 1(14):233–243. doi: 10.1016/j.sleh.2015.10.004 CrossRefGoogle Scholar
- 39.Reynold AM, Bowles ER, Saxena A, Fayad R, Youngstedt SD (2014) Negative Effects of Time in Bed Extension: a Pilot Study. J Sleep Med Disord 1(1):1Google Scholar
- 40.Bardwell WA, Natarajan L, Dimsdale JE, Rock CL, Mortimer JE, Hollenbach K, Pierce JP (2006) Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer. J Clin Oncol 24(16):2420–2427. doi: 10.1200/JCO.2005.02.0081 PubMedCrossRefGoogle Scholar
- 43.Musselman DL, Miller AH, Porter MR, Manatunga A, Gao F, Penna S, Pearce BD, Landry J, Glover S, McDaniel JS, Nemeroff CB (2001) Higher than normal plasma interleukin-6 concentrations in cancer patients with depression: preliminary findings. Am J Psychiatry 158(8):1252–1257. doi: 10.1176/appi.ajp.158.8.1252 PubMedCrossRefGoogle Scholar