Sleep Quality in Women with Breast Cancer: A Longitudinal Analysis of Predictors for One-Year Post-Diagnosis

Abstract

Breast cancer (BC) remains a significant public health concern worldwide, posing considerable challenges to individuals' health and well-being. Among the myriad of issues faced by breast cancer survivors (BCS), sleep disturbances emerge as a prevalent and often debilitating problem. Understanding the complex interplay of factors influencing sleep quality in BCS is crucial for developing targeted interventions to mitigate these disturbances and improve overall quality of life. The purpose of this dissertation is to generate comprehensive knowledge regarding sleep quality in women with BC, while also characterizing associated factors contributing to these disturbances. By delving into the multifaceted nature of sleep disturbances in BCS, this research aims to expand upon the existing body of knowledge surrounding the causes of sleep disruptions in this population. This dissertation follows the three-manuscript style dissertation that provides knowledge regarding sleep disturbances, while also characterizing associated factors in women with breast cancer from pre-diagnosis to 1- year post diagnosis. The first manuscript used existing data from the prospective Women’s Health after Breast Cancer Study (N=606) to examine sleep quality, quantity, and self-reported causes of sleep disturbance among female breast cancer patients at the time of diagnosis and one year after treatment. The second manuscript is an integrative review of current literature to describe the risk factors of poor sleep quality among BCS based on Spielman's three-factor model of insomnia (3 P's model). This theoretical basis for the review examines cancer-related factors that predispose, precipitate, and perpetuate insomnia. The third manuscript utilizes a secondary data analysis approach to assess the association between different types of breast cancer treatments, breast cancer symptoms, cancer characteristics and sleep quality using longitudinal data from the Women’s Health after Breast Cancer Study (N=715). Findings add to the existing body of knowledge on the causes of sleep disturbances in BCSs by exploring the influence of factors that affect sleep quality. Results provide a better understanding of the myriad of contributing factors that increase the potential for short- or long-term sleep disruptions among BCSs and the resulting outcomes on individuals' health and health-related QoL. Further, the results contribute to the existing literature on salient factors and conditions that aggravate sleeping problems in BCSs at diagnosis prior to treatment and at one-year post-diagnosis. Specifically, results from this study have significantly advanced our understanding of the predisposing and precipitating factors associated with sleep disturbances among BCS.