Sleep, diurnal cortisol, and survival among women with metastatic breast cancer

Sleep, diurnal cortisol, and survival among women with metastatic breast cancer

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Rationale : In previous research, we found that flattened diurnal cortisol predicted early mortality with breast cancer, independent of other known risk factors, and this has since been confirmed among patients with lung cancer.In that study, loss of diurnal variation in cortisol was associated with self-reported awakenings during the night, implying an interaction with sleep disruption.This suggested that objective measures of sleep would clarify the relationship between disruption of circadian cortisol rhythms and sleep disturbance.Methods : Here we recruited 101 women with metastatic breast cancer and 16 age- and socioeconomic status-matched controls.

We measured sleep using full electroencephalographic (EEG), electro-oculographic, and electromyographic recordings in the clinical research center, where we were also able to draw blood samples throughout the night using a long IV line through a hole in the wall.Sleep measures were confirmed with two cartoon martian with big head nights of home EEG recordings and 2 weeks of actigraphy.Results : Among 63 for whom complete cortisol and sleep data are now available, we observed a phase shift in the relationship between the peak of cortisol and wake time such that patients woke earlier than their cortisol peak.Controls woke on average 1 h 20 min before the cortisol peak, whereas patients woke 1 h 54 min before.

This control–patient difference was not statistically significant.However, among all subjects, there was a significant.38 correlation between folk rivet sweat diurnal cortisol slope and time from waking to the cortisol peak, such that those who woke earlier in relation to the cortisol peak had flatter cortisol slopes.Among the patients alone, the correlation was.

43.This suggests that flattening of diurnal cortisol is associated with early morning waking.In the sample of 101, we found a relationship between misalignment of preferred and actual bedtimes and disease-free interval (DFI), the time from initial breast cancer diagnosis to date of metastasis.Shorter DFI is a strong predictor of reduced survival time.

Going to bed earlier or later than preferred bedtime was associated with shorter DFIs, compared with aligned bedtime (HR = 3.25, 95%CI = 1.17–8.98, p=.

023, and HR = 3.55, 95%CI = 1.33–9.45, p=.

011, respectively).Mean DFI was 92.1 months (preferred), 39.8 months (earlier than preferred), and 54.

1 months (later than preferred; Log Rank p=.002).Conclusions : Thus waking ahead of the normal morning cortisol peak was related to flatter diurnal cortisol, and misalignment of preferred and actual sleep times was also associated with poor prognosis.