Factors associated with poor sleep quality in women with cancer

Mansano-Schlosser, Thalyta Cristina; Ceolim, Maria Filomena

doi:10.1590/1518-8345.1478.2858

Objectives: to analyze the factors associated with poor sleep quality, its characteristics and components in women with breast cancer prior to surgery for removing the tumor and throughout the follow-up.

Method: longitudinal study in a teaching hospital, with a sample of 102 women. The following were used: a questionnaire for sociodemographic and clinical characterization, the Pittsburgh Sleep Quality Index; the Beck Depression Inventory; and the Herth Hope Scale. Data collection covered from prior to the surgery for removal of the tumor (T0) to T1, on average 3.2 months; T2, on average 6.1 months; and T3, on average 12.4 months. Descriptive statistics and the Generalized Estimating Equations model were used.

Results: depression and pain contributed to the increase in the score of the Pittsburgh Sleep Quality Index, and hope, to the reduction of the score - independently - throughout follow-up. Sleep disturbances were the component with the highest score throughout follow-up.

Conclusion: the presence of depression and pain, prior to the surgery, contributed to the increase in the global score of the Pittsburgh Sleep Quality Index, which indicates worse quality of sleep throughout follow-up; greater hope, in its turn, influenced the reduction of the score of the Pittsburgh Sleep Quality Index.

Descriptors:
Sleep; Breast Neoplasms; Depression; Nursing; Hope; Longitudinal Studies

[TFN1] *Minimum salaries in Brazilian reais R$ 724.00 Brazil, 2014; †TNM: Tumor (T), Node (N) and Metastasis (M).

Sociodemographic and clinical characteristics		N	%
Marital status
	Has partner	56	54.9
Work situation
	Retired	47	46.1
	Employed	23	22.6
	Unemployed	32	31.4
With whom patient lives
	Family members	90	88.2
	Alone	7	06.9
	Others	5	04.9
Family income
	Up to 5 minimum salaries*	93	91.2
	6 to 10 minimum salaries	9	08.8
Report of any other chronic illness
	Yes	37	36.3
Symptoms related to the menopause
	Yes	36	35.3
Report of pain
	Yes	40	39.2
Staging (according to the TNM)^†
	I/II	83	81.4
	III	19	18.6
Neoadjuvant chemotherapy
	Yes	26	25.2
Surgery undertaken
	Mastectomy	57	55.9
	Quadrantectomy	44	43.1
	No information	01	01.0

	T0			T1			T2			T3
	M*	SD^†	Med^‡	M*	SD^†	Med^‡	M*	SD^†	Med^‡	M*	SD^†	Med^‡
Sleep characteristics					SD^†	Med^‡	M*	SD^†	Med^‡	M*	SD^†	Med^‡
Duration (hours)	6.5	01.9	7.0	6.4	2.0	7.0	6.5	1.9	7.0	7.0	1.5	7.5
Efficiency (%)	95.8	27.6	94.0	86.3	23.5	86.0	87.5	24.7	89.0	88.4	19.9	89.0
Components of the PSQI§-BR					23.5	86.0	87.5	24.7	89.0	88.4	19.9	89.0
Sleep quality	1.2	1.3	1.0	1.2	1.3	1.0	1.2	1.2	1.0	1.5	1.2	1.0
Latency	1.4	0.9	2.0	1.3	1.5	1.0	1.3	1.0	1.0	1.2	0.9	1.0
Duration	1.0	1.2	1.0	1.2	1.2	1.0	1.1	1.1	1.0	0.7	0.9	0.5
Efficiency	0.8	1.1	0.0	1.1	1.2	0.0	1.0	1.2	0.0	0.8	1.1	0.0
Disturbances	1.4	0.6	1.0	1.5	0.6	1.0	1.5	0.6	1.5	1.6	0.6	2.0
Use of sleeping medication	0.8	1.3	0.0	0.5	1.0	0.0	0.7	1.2	0.0	0.9	1.2	0.0
Daytime dysfunction	0.5	0.8	0.0	0.4	0.7	0.0	0.7	0.7	1.0	0.9	0.9	1.0
Total score of the PSQI-BR	7.1	4.4	7.0	7.3	4.7	6.5	7.4	4.8	6.5	7.3	4.3	7.0

Factors	Coefficient	Confidence Interval 95%		p-value
Age (years)	0.03	-0.04	-0.09	0.4108
Marital status (ref*: married)	0.54	-0.68	1.76	0.3892
Years of study (years)	0.09	-0.09	0.26	0.3235
Symptoms of the menopause (ref: no)	0.28	-0.99	1.55	0.6697
Staging of the tumor (ref: I or II)	1.25	-0.16	2.66	0.0822
Neoadjuvant chemotherapy (ref: no)	0.02	-1.47	1.51	0.9775
Dimension of the tumor (centimeters)	-0.13	-0.44	0.18	0.4009
Depression (ref: absent or minimal)	2.23	1.42	3.04	0.0001
Pain (ref: no)	1.31	0.01	2.62	0.0481
Score of the HHS^† (score)	-0.08	-0.14	-0.02	0.0105

Factors associated with poor sleep quality in women with cancer1

Factors associated with poor sleep quality in women with cancer¹