title: Sleep quality following hematopoietic stem cell transplantation: longitudinal trajectories and biobehavioral correlates.
abstract: The present study examined changes in sleep quality following hematopoietic stem cell transplantation (HSCT) and investigated associations with biobehavioral factors. Individuals undergoing HSCT for hematologic malignancies (N=228) completed measures of sleep quality and psychological symptoms pre-transplant and 1, 3, 6 and 12 months post transplant. Circulating inflammatory cytokines (IL-6, TNF-α) were also assessed. Sleep quality was poorest at 1 month post transplant, improving and remaining relatively stable after 3 months post transplant. However, approximately half of participants continued to experience significant sleep disturbance at 6 and 12 months post transplant. Mixed-effects linear regression models indicated that depression and anxiety were associated with poorer sleep quality, while psychological well-being was associated with better sleep. Higher circulating levels of IL-6 were also linked with poorer sleep. Subject-level fixed effects models demonstrated that among individual participants, changes in depression, anxiety and psychological well-being were associated with corresponding changes in sleep after covarying for the effects of time since transplant. Sleep disturbance was most severe when depression and anxiety were greatest and psychological well-being was lowest. Findings indicate that sleep disturbance is a persistent problem during the year following HSCT. Patients experiencing depression or anxiety and those with elevated inflammation may be at particular risk for poor sleep.
authors.affiliation: Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Nelson
authors.affiliation: Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Coe
authors.affiliation: 1] Hematology/Oncology Division, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA [2] Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Juckett
authors.affiliation: 1] Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA [2] Center for Sleep Medicine and Research, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Rumble
authors.affiliation: Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Rathouz
authors.affiliation: 1] Hematology/Oncology Division, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA [2] Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: P
authors.initials: P
authors.lastname: Hematti
authors.affiliation: 1] Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA [2] Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Costanzo
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012890:Sleep; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology