title: Pre-diagnostic Sleep Duration and Sleep Quality in Relation to Subsequent Cancer Survival.
abstract: OBJECTIVE
  Poor sleep quality and short sleep duration have been associated with elevated risk for several cancer types; however, the relationship between sleep and cancer outcomes has not been well characterized. We assessed the association between pre-diagnostic sleep attributes and subsequent cancer survival within the Women's Health Initiative (WHI).
  
  
  METHODS
  We identified WHI participants in whom a first primary invasive cancer had been diagnosed during follow-up (n = 21,230). Participants provided information on sleep characteristics at enrollment. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between these pre-diagnostic sleep characteristics and cancer-specific survival for all cancers combined and separately for common cancers. Analyses were adjusted for age, study arm, cancer site, marital status, income, smoking, physical activity, and time to diagnosis.
  
  
  RESULTS
  No individual pre-diagnostic sleep characteristics were found to be significantly associated with cancer survival in analyses of all cancer sites combined; however, women who reported short sleep duration (≤ 6 h sleep/night) combined with frequent snoring (≥ 5 nights/w experienced significantly poorer cancer-specific survival than those who reported 7-8 h of sleep/night and no snoring (HR = 1.32, 95% CI: 1.14-1.54). Short sleep duration (HR = 1.46, 95% CI: 1.07-1.99) and frequent snoring (HR = 1.34, 95% CI: 0.98-1.85) were each associated with poorer breast cancer survival; those reporting short sleep combined with frequent snoring combined had substantially poorer breast cancer survival than those reporting neither (HR = 2.14, 95% CI: 1.47-3.13).
  
  
  CONCLUSIONS
  Short sleep duration combined with frequent snoring reported prior to cancer diagnosis may influence subsequent cancer survival, particularly breast cancer survival.
authors.affiliation: Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.|Epidemiology Department, School of Public Health, University of Washington, Seattle, WA.
authors.forename: Amanda I
authors.initials: AI
authors.lastname: Phipps
authors.affiliation: Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.|Epidemiology Department, School of Public Health, University of Washington, Seattle, WA.
authors.forename: Parveen
authors.initials: P
authors.lastname: Bhatti
authors.affiliation: Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Marian L
authors.initials: ML
authors.lastname: Neuhouser
authors.affiliation: Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Chu
authors.initials: C
authors.lastname: Chen
authors.affiliation: Health Promotion Sciences Division, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ.
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Crane
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Candyce H
authors.initials: CH
authors.lastname: Kroenke
authors.affiliation: Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY.
authors.forename: Heather
authors.initials: H
authors.lastname: Ochs-Balcom
authors.affiliation: Mid-Atlantic MIRECC, Durham VAMC, Durham, NC.
authors.forename: Michelle
authors.initials: M
authors.lastname: Rissling
authors.affiliation: Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Beverly M
authors.initials: BM
authors.lastname: Snively
authors.affiliation: Stanford Prevention Research Center, Stanford University, School of Medicine, Palo Alto, CA.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.affiliation: Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: Miriam M
authors.initials: MM
authors.lastname: Treggiari
authors.affiliation: Department of Neurology, University of Washington, Seattle, WA.
authors.forename: Nathaniel F
authors.initials: NF
authors.lastname: Watson
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012890:Sleep; D012893:Sleep Wake Disorders / Q000150:complications*; D012913:Snoring / Q000150:complications; D017741:Survivors; D013997:Time Factors
keywords: cancer; sleep duration; snoring; survival