title: Quality of sleep and related factors during chemotherapy in patients with stage I/II breast cancer.
abstract: BACKGROUND
  Insomnia causes severe distress in patients with breast cancer who receive chemotherapy. Few studies have focused on using objective methods to assess sleep. This study explored the quality of sleep and related factors in patients with breast cancer during chemotherapy.
  
  
  METHODS
  The participants were 16 women with stage I or II breast cancer receiving their third cycle of chemotherapy with cyclophosphamide, epirubicin and fluorouracil, or cyclophosphamide, methotrexate and fluorouracil. The effects of chemotherapy on sleep were assessed on the 8th and 9th days of the third cycle, i.e. the active phase in terms of side effects, and the last 2 days before the start of the fourth cycle for comparison. Instruments used to assess sleep quality and related factors included actigraphy, the Hospital Anxiety and Depression Scale (HADS), the Symptom Distress Scale (SDS), the Fatigue Visual Analogue Scale (FVAS), the Epworth Sleepiness Scale (ESS), and sleep logs.
  
  
  RESULTS
  During the active phase, patients showed an anxiety tendency with an average HADS score of 7.8 +/- 3.8. The average FVAS score was 4 +/- 2, indicative of mild fatigue, and SDS score (1.8 +/- 0.3) also indicated mild symptom distress. The number of awakenings each night was 2.2 +/- 1.6 by sleep logs, and the total time spent awake during these episodes was 47.8 +/- 26.1 minutes by Actiwatch. Sleep efficiency measured by Actiwatch in the active phase was 82.1 +/- 9.4% below the normal limit. Daytime sleepiness assessed by ESS showed mild sleepiness (6.0 +/- 3.5) in the active phase.
  
  
  CONCLUSIONS
  The study showed poor sleep quality and daytime sleepiness in patients with breast cancer during the active phase of chemotherapy. Chemotherapy may bring symptom distress to patients and adversely influence sleep quality.
authors.affiliation: Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Hsiao-Hsuan
authors.initials: HH
authors.lastname: Kuo
authors.forename: Ming-Jang
authors.initials: MJ
authors.lastname: Chiu
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Liao
authors.forename: Shiow-Li
authors.initials: SL
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000209:etiology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology*; D013315:Stress, Psychological / Q000209:etiology