Vagal regulation, cortisol, and sleep disruption in women with metastatic breast cancer.
OBJECTIVE
To determine the relationship between hypothalamic pituitary axis (HPA) dysregulation, vagal functioning, and sleep problems in women with metastatic breast cancer.


METHODS
Sleep was assessed by means of questionnaires and wrist actigraphy for 3 consecutive nights. The ambulatory, diurnal variation in salivary cortisol levels was measured at 5 time points over 2 days. Vagal regulation was assessed via respiratory sinus arrhythmia (RSA(TF)) during the Trier Social Stress Task.


METHODS
Ninety-nine women (54.6 +/- 9.62 years) with metastatic breast cancer.


RESULTS
Longer nocturnal wake episodes (r = 0.21, p = 0.04, N=91) were associated with a flatter diurnal cortisol slope. Sleep disruption was also associated with diminished RSA(TF). Higher RSA baseline scores were significantly correlated with higher sleep efficiency (r = 0.39, p = 0.001, N=68) and correspondingly lower levels of interrupted sleep (waking after sleep onset, WASO; r = -0.38, p = 0.002, N=68), lower average length of nocturnal wake episodes (r = -0.43, p < 0.001, N=68), and a lower self-reported number of hours of sleep during a typical night (r = -0.27, p = 0.02, N=72). Higher RSA AUC was significantly related to higher sleep efficiency (r = 0.45, p < 0.001, N=64), and a correspondingly lower number of wake episodes (r = -0.27, p = 0.04, N=64), lower WASO (r = -0.40, p = 0.001, N=64), and with lower average length of nocturnal wake episodes (r = -0.41, p = 0.001, N=64). While demographics, disease severity, and psychological variables all explained some portion of the development of sleep disruption, 4 of the 6 sleep parameters examined (sleep efficiency, WASO, mean number of waking episodes, average length of waking episode) were best explained by RSA.


CONCLUSIONS
These data provide preliminary evidence for an association between disrupted nocturnal sleep and reduced RSA the subsequent day, confirming an association between disrupted nocturnal sleep and flattened diurnal cortisol rhythm in women with metastatic breast cancer. They suggest that the stress-buffering effects of sleep may be associated with improved parasympathetic tone and normalized cortisol patterns during the day.
University of Rochester Wilmot Cancer Center, Rochester, NY, USA. Oxana_Palesh@urmc.rochester.edu
Oxana
O
Palesh
Jamie M
JM
Zeitzer
Ansgar
A
Conrad
Janine
J
Giese-Davis
Karen M
KM
Mustian
Varinia
V
Popek
Karen
K
Nga
David
D
Spiegel
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000503:physiopathology*; D013315:Stress, Psychological / Q000150:complications; D014630:Vagus Nerve / Q000503:physiopathology*
D006854:Hydrocortisone