title: Trajectories of sleep disturbance and daytime sleepiness in women before and after surgery for breast cancer.
abstract: BACKGROUND
  Sleep disturbance is a problem for oncology patients.
  
  
  OBJECTIVE
  To evaluate how sleep disturbance and daytime sleepiness (DS) changed from before to six months following surgery and whether certain characteristics predicted initial levels and/or the trajectories of these parameters.
  
  
  METHODS
  Patients (n=396) were enrolled prior to surgery and completed monthly assessments for six months following surgery. The General Sleep Disturbance Scale was used to assess sleep disturbance and DS. Using hierarchical linear modeling, demographic, clinical, symptom, and psychosocial adjustment characteristics were evaluated as predictors of initial levels and trajectories of sleep disturbance and DS.
  
  
  RESULTS
  All seven General Sleep Disturbance Scale scores were above the cutoff for clinically meaningful levels of sleep disturbance. Lower performance status; higher comorbidity, attentional fatigue, and physical fatigue; and more severe hot flashes predicted higher preoperative levels of sleep disturbance. Higher levels of education predicted higher sleep disturbance scores over time. Higher levels of depressive symptoms predicted higher preoperative levels of sleep disturbance, which declined over time. Lower performance status; higher body mass index; higher fear of future diagnostic tests; not having had sentinel lymph node biopsy; having had an axillary lymph node dissection; and higher depression, physical fatigue, and attentional fatigue predicted higher DS prior to surgery. Higher levels of education, not working for pay, and not having undergone neo-adjuvant chemotherapy predicted higher DS scores over time.
  
  
  CONCLUSIONS
  Sleep disturbance is a persistent problem for patients with breast cancer. The effects of interventions that can address modifiable risk factors need to be evaluated.
authors.affiliation: School of Nursing, University of California, San Francisco, California 94143-0610, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Van Onselen
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lee
authors.forename: Laura
authors.initials: L
authors.lastname: Dunn
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Aouizerat
authors.forename: Claudia
authors.initials: C
authors.lastname: West
authors.forename: Marylin
authors.initials: M
authors.lastname: Dodd
authors.forename: Bruce
authors.initials: B
authors.lastname: Cooper
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D018450:Disease Progression; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D016896:Treatment Outcome; D016387:Women's Health / Q000706:statistics & numerical data; D055815:Young Adult