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Prevalence and risk factors of sleep disturbances in breast cancersurvivors: systematic review and meta-analyses

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Abstract

Background

Breast cancer remains the most frequently diagnosed malignancy among women worldwide, with rising incidence numbers. In Belgium, one out of eight women will be diagnosed with breast cancer. Fortunately, 80% of those breast cancer patients will still be alive 10 years after diagnosis due to improvements in screening and treatment strategies. However, an important portion of the breast cancer survivors (BCS) will face side effects, such as sleep disturbances, long after treatment ends. It has been demonstrated that untreated insomnia in BCS negatively impacts mood, physical symptoms, pain sensitivity, fatigue, and quality of life. Furthermore, insomnia is increasingly considered an independent risk factor for future depression in BCS. The importance of understanding sleep disturbances in cancer populations has been highlighted and recognized as warranting further research. Therefore, the purpose of this systematic review was to determine the prevalence and the risk factors for the development of sleep disturbances in BCS.

Methods

PubMed, Web of Science, and PEDro were systematically screened for studies encompassing data regarding the prevalence or risk factors of sleep disturbances in BCS. If possible, meta-analyses were performed. Subgroup analyses were undertaken based on the methodological quality, study design, type of sleep disturbance, and the use of a measurement tool with strong psychometric properties to investigate significant heterogeneity (I2 > 50%) across studies.

Results

A total of 27 studies were found eligible. The pooled estimate for sleep disturbances prevalence is 0.40 (95% confidence interval (CI) = [0.29–0.52], I2 = 100%, p < 0.00001) and ranged from 0.14 (95% CI = [0.04–0.24]) to 0.93 (95% CI = [0.91–0.95]). Subgroup analyses did not reduce the heterogeneity among studies. Meta-analyses were performed for seven risk factors. Significant differences for the odds of developing sleep disturbances were found for hot flashes (pooled OR (ORp) 2.25, 95% CI = [1.64–3.08], I2 = 0%, p = 0.90), race (ORp 2.31, 95% CI = [1.56–3.42], I2 = 0%, p = 0.47), and menopause (ORp 1.84, 95% CI = [1.11–3.06], I2 = 0%, p = 0.70). After withdrawing the studies that did not rely on the use of a measurement tool with strong psychometric properties, pain (ORp 2.31, 95% CI = [1.36–3.92], I2 = 27%, p = 0.25), depressive symptoms (ORp 3.20, 95% CI [2.32–4.42], I2 = 0%, p = 0.63), and fatigue (ORp 2.82, 95% CI = [1.98–4.02], I2 = 0%, p = 0.60) became significant as well, with a substantial decrease of heterogeneity.

Conclusion

Prevalence for sleep disturbances ranged from 0.14 to 0.93 with the vast majority of the studies investigating insomnia and sleep-wake disturbances. High heterogeneity makes it difficult to draw firm conclusions. Pain, depressive symptoms, hot flashes, fatigue, non-Caucasian race, and menopausal status were significantly associated with increased odds for developing sleep disturbances.

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Authors and Affiliations

  1. Pain in Motion International Research Group http://www.paininmotion.be

    Laurence Leysen, Jo Nijs, Thomas Bilterys, Eveline Van Looveren & Roselien Pas

  2. Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, 1090, Brussels, Belgium

    Laurence Leysen, Astrid Lahousse, Jo Nijs, Nele Adriaenssens, Sergei Ivakhnov, Thomas Bilterys, Roselien Pas & David Beckwée

  3. Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium

    Jo Nijs

  4. Department of Oncology, University Hospital Brussels, Brussels, Belgium

    Nele Adriaenssens

  5. Experimental and Applied Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium

    Olivier Mairesse

  6. Sleep Laboratory and Unit for Chronobiology, Brugmann University Hospital, Brussels, Belgium

    Olivier Mairesse

  7. Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Building B3, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Thomas Bilterys & Eveline Van Looveren

  8. Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium

    David Beckwée

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Appendices

Appendix 1

Table 4 Search terms
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Appendix 2

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Prevalence of sleep disturbances in breast cancer survivors

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Appendix 3: Methodological quality

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NOS < 7

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NOS ≥ 7

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Appendix 4: Study design

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Longitudinal studies

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Cross-sectional studies

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Appendix 5: Type of sleep disturbance

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Sleep-wake disturbance + sleep difficulty

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Insomnia

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Short sleepers

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Appendix 6

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Validated measurement tool

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Appendix 7: Pain

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Pain before subgroup analysis

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Pain after subgroup analysis

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Appendix 8: Depressive symptoms

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Depressive symptoms before subgroup analysis

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Depressive symptoms after subgroup analysis

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Appendix 9

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Hot flashes

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Appendix 10: Fatigue

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Fatigue before subgroup analysis

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Fatigue after subgroup analysis

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Appendix 11

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Anxiety

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Appendix 12

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Race

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Appendix 13

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Menopause

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Leysen, L., Lahousse, A., Nijs, J. et al. Prevalence and risk factors of sleep disturbances in breast cancersurvivors: systematic review and meta-analyses. Support Care Cancer 27, 4401–4433 (2019). https://doi.org/10.1007/s00520-019-04936-5

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