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Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer.
Psychosom Med. 2014 Sep; 76(7):519-28.PM

Abstract

OBJECTIVES

To examine whether day-to-day variations in sleep behaviors, ongoing sleep disturbance, and fatigue predict the cortisol diurnal rhythm in women recently diagnosed as having early-stage breast cancer.

METHODS

Women (N = 130, mean [standard deviation] age = 55.6 [9.4] years) collected saliva 5×/day/2 days for cortisol. Diaries were used to assess prior-day nap duration, nocturnal awakenings, sleep latency, and morning restfulness. Ongoing fatigue and sleep disturbance were measured using the Multidimensional Fatigue Symptom Inventory and the Pittsburg Sleep Quality Inventory. Data were analyzed using a multilevel growth curve modeling.

RESULTS

Greater ongoing fatigue (b = 0.035, p = .032), or sleep disturbance (b = 0.026, p = .006) predicted a slower cortisol decline. Greater ongoing fatigue also predicted higher awakening cortisol (b = 0.154, p = .030) and lower cortisol awakening response (CAR; b = -0.146, p = .005). Longer prior-day naps predicted higher CAR (b = 0.042, p = .050) and a steeper cortisol decline (b = -0.035, p = .003). Longer sleep latency predicted both a greater cortisol linear decline (b = -0.013, p < .001) and a greater quadratic slope curvature (b = 0.0007, p < .001). Feeling less rested in the morning predicted lower awakening cortisol (b = -0.187, p = .004), higher CAR (b = 0.124, p = .016), and a slower cortisol decline (b = 0.023, p = .042).

CONCLUSIONS

Both daily variations in sleep behaviors and ongoing sleep disturbance and fatigue are associated with a disrupted cortisol rhythm. In contrast, prior-day napping is associated with a more robust cortisol rhythm. These findings are particularly relevant to women with breast cancer who often experience sleep disturbance and fatigue. Additional research is needed to determine causal pathways between sleep disturbance and dysregulation of the hypothalamic-pituitary-adrenal axis in patients with breast cancer.

Links

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Authors+Show Affiliations

Tell D
From the Department of Health Promotion (D.T., L.W.J.), Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois; and Department of Microbiology Immunology (H.L.M.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
Mathews HL
No affiliation info available
Janusek LW
No affiliation info available

MeSH

Breast NeoplasmsCircadian RhythmFatigueFemaleHumansHydrocortisoneMiddle AgedSalivaSleepSleep Wake Disorders

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25186656

Citation

Tell, Dina, et al. "Day-to-day Dynamics of Associations Between Sleep, Napping, Fatigue, and the Cortisol Diurnal Rhythm in Women Diagnosed as Having Breast Cancer." Psychosomatic Medicine, vol. 76, no. 7, 2014, pp. 519-28.
Tell D, Mathews HL, Janusek LW. Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer. Psychosom Med. 2014;76(7):519-28.
Tell, D., Mathews, H. L., & Janusek, L. W. (2014). Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer. Psychosomatic Medicine, 76(7), 519-28. https://doi.org/10.1097/PSY.0000000000000097
Tell D, Mathews HL, Janusek LW. Day-to-day Dynamics of Associations Between Sleep, Napping, Fatigue, and the Cortisol Diurnal Rhythm in Women Diagnosed as Having Breast Cancer. Psychosom Med. 2014;76(7):519-28. PubMed PMID: 25186656.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer. AU - Tell,Dina, AU - Mathews,Herbert L, AU - Janusek,Linda Witek, PY - 2014/9/5/entrez PY - 2014/9/5/pubmed PY - 2015/6/24/medline SP - 519 EP - 28 JF - Psychosomatic medicine JO - Psychosom Med VL - 76 IS - 7 N2 - OBJECTIVES: To examine whether day-to-day variations in sleep behaviors, ongoing sleep disturbance, and fatigue predict the cortisol diurnal rhythm in women recently diagnosed as having early-stage breast cancer. METHODS: Women (N = 130, mean [standard deviation] age = 55.6 [9.4] years) collected saliva 5×/day/2 days for cortisol. Diaries were used to assess prior-day nap duration, nocturnal awakenings, sleep latency, and morning restfulness. Ongoing fatigue and sleep disturbance were measured using the Multidimensional Fatigue Symptom Inventory and the Pittsburg Sleep Quality Inventory. Data were analyzed using a multilevel growth curve modeling. RESULTS: Greater ongoing fatigue (b = 0.035, p = .032), or sleep disturbance (b = 0.026, p = .006) predicted a slower cortisol decline. Greater ongoing fatigue also predicted higher awakening cortisol (b = 0.154, p = .030) and lower cortisol awakening response (CAR; b = -0.146, p = .005). Longer prior-day naps predicted higher CAR (b = 0.042, p = .050) and a steeper cortisol decline (b = -0.035, p = .003). Longer sleep latency predicted both a greater cortisol linear decline (b = -0.013, p < .001) and a greater quadratic slope curvature (b = 0.0007, p < .001). Feeling less rested in the morning predicted lower awakening cortisol (b = -0.187, p = .004), higher CAR (b = 0.124, p = .016), and a slower cortisol decline (b = 0.023, p = .042). CONCLUSIONS: Both daily variations in sleep behaviors and ongoing sleep disturbance and fatigue are associated with a disrupted cortisol rhythm. In contrast, prior-day napping is associated with a more robust cortisol rhythm. These findings are particularly relevant to women with breast cancer who often experience sleep disturbance and fatigue. Additional research is needed to determine causal pathways between sleep disturbance and dysregulation of the hypothalamic-pituitary-adrenal axis in patients with breast cancer. SN - 1534-7796 UR - https://www.unboundmedicine.com/medline/citation/25186656/Day_to_day_dynamics_of_associations_between_sleep_napping_fatigue_and_the_cortisol_diurnal_rhythm_in_women_diagnosed_as_having_breast_cancer_ DB - PRIME DP - Unbound Medicine ER -