A qualitative study of sleep in young breast cancer survivors: "No longer able to sleep through the night".

Sleep disturbance is common among women with breast cancer and is associated with greater symptom distress and poorer outcomes. Yet, for the unique subgroup of young women with breast cancer (YWBC), there is limited information on sleep. To address the gap in our understanding of sleep health in YWBC, we explored their perspective on sleep quality, sleep changes over time, contributing factors, and any strategies used to promote sleep. As part of an explanatory sequential mixed method study, we recruited a sub-sample of 35 YWBC (≤ 50 years of age at the time of diagnosis) from the larger quantitative study phase. These participants were within the first 5 years since diagnosis and completed primary and systemic adjuvant therapy. We conducted virtual semi-structured interviews, transcribed them verbatim, and analyzed data with an interpretive description approach. YWBC experience difficulty falling asleep, waking up at night, and not feeling refreshed in the morning. They attributed interrupted sleep to vasomotor symptoms, anxiety/worry, ruminating thoughts, everyday life stressors, and discomfort. The sleep disturbance was most severe during and immediately after treatment but persisted across the 5 years of survivorship. The participants reported trying pharmacologic and non-pharmacologic strategies to improve the quantity and quality of their sleep. Future research would benefit from longitudinal designs to capture temporal changes in sleep and develop interventions to improve sleep health. Clinically, assessment of sleep health is indicated for YWBC related to the prevalence of disturbed sleep. IMPLICATIONS FOR CANCER SURVIVORS: Early access to sleep assessment and management, ideally before cancer treatment, would be beneficial for young breast cancer survivors. In addition, cancer treatment plans should include physical and psychological symptoms, especially those reported by women in this study: vasomotor symptoms, anxiety and worry, discomfort, and pain.

Struggling, Adapting, and Holding Each Other Up: A Qualitative Study of Oncology Nurses During the First Year of the COVID-19 Pandemic.

PURPOSE: To explore the experience of oncology nurses during the first year of the COVID-19 pandemic. PARTICIPANTS & SETTING: 21 RNs, advanced practice RNs, and physician associates from inpatient and ambulatory care settings at a comprehensive cancer center in the northeastern United States. METHODOLOGIC APPROACH: A qualitative study using interpretive description was conducted through semistructured interviews. Data were recorded and transcribed verbatim, reviewed for accuracy, and coded into themes following an iterative process of analysis. FINDINGS: The theme of "Doing It Together: Struggling, Adapting, and Holding Each Other Up" describes the experience of oncology nurses during the first year of the COVID-19 pandemic. The following three themes provide further insight: "Struggling With Constant Change and Uncertainty," "Managing Workload Intensity," and "Experiencing Emotional Distress." As the year progressed, "Identifying Benefits and Finding Hope" began to emerge. IMPLICATIONS FOR NURSING: The findings suggest a need for programs to help nurses cope with the continuing effects of the COVID-19 pandemic, mental health and well-being resources, and nursing guidelines for telehealth and relocation to other units.

Factors associated with sleep health in young women after breast cancer treatment.

Young women with breast cancer (YWBC) report physical and psychological symptom distress after therapy but little is known about their sleep health. The purpose of this study was to identify sociodemographic, clinical, and psychosocial factors associated with sleep health and assess the potential role of appraisal of illness and coping on sleep health. An adapted cognitive appraisal and coping conceptual framework guided the study. We used a cross-sectional design with 159 women who were diagnosed with stage I-III breast cancer ≤50 years old. Sleep health was measured by the Pittsburgh Sleep Quality Index (PSQI). The mean age was 43.6 years (SD = 6.8), the majority of whom were non-Hispanic White (84%) and completed chemotherapy or radiotherapy (>70%). More than half of participants (55%) reported poor sleep health (PSQI > 8), and those with worse family functioning and from a racial/ethnic minority group were significantly more likely to have poor sleep health. Cognitive appraisal had a minimal mediation effect for anxiety on sleep health, and coping did not mediate the effect of any psychosocial variables on sleep health. Poor sleep health is a significant clinical problem in YWBC. Further research is needed to explore sleep health disparities among diverse cancer survivors and to examine sleep health in the context of family. Sleep assessment, management, and appropriate referrals to sleep providers should be part of routine survivorship care.

Trajectory of self-care in people with stable heart failure and insomnia after two self-care interventions.

OBJECTIVE: To describe (1) self-care trajectories among adults with heart failure (HF) and insomnia over 1-year; (2) the extent to which trajectories varied between cognitive behavioral therapy for insomnia (CBT-I) or HF self-care intervention; and (3) the associations between self-care trajectories and clinical and demographic characteristics, sleep, symptoms and stress, and functional performance. METHODS: We conducted secondary analysis of data from a randomized controlled trial of the effects of CBT-I compared with HF self-care education among adults with stable HF and insomnia. We used the Self-Care of Heart Failure Index v6.2. The analytic approaches included t-tests, group-based trajectory modeling, ANOVA, and chi-square. RESULTS: We included 175 participants (M age=63.0 (12.9) years, White, N = 100]. We found four self-care trajectories: Low self-care (N = 47, 26.8%); Moderate self-care (N = 68, 38.9%): Adequate self-care (N = 42, 24.0%); and Optimal self-care (N = 18, 10.3%). There was no difference in self-care trajectories between interventions. The low self-care group had the most severe baseline fatigue, anxiety, and perceived stress, and lowest cognitive abilities. CONCLUSION: Both interventions prevented declining self-care. Future research is needed to determine the most efficacious intervention to improve self-care trajectories. PRACTICE IMPLICATIONS: Healthcare providers should provide ongoing self-care support for those with persistently low and moderate self-care.

Sleep Deficiency: A Symptoms Perspective: Exemplars from Chronic Heart Failure, Inflammatory Bowel Disease, and Breast Cancer.

Sleep deficiency is associated with disabling daytime symptoms, including excessive daytime sleepiness (EDS) and fatigue. The purpose of this article is to discuss the contributions of sleep deficiency and sleep disorders to fatigue and EDS among people with chronic conditions. We use exemplars from the literature on chronic heart failure, inflammatory bowel disease, and breast cancer to (1) describe the prevalence of fatigue and EDS and their consequences; (2) examine the evidence for the contributions of sleep deficiency and sleep disorders to these symptoms; and (3) recommend implications for future research and practice.

Sleep health in young women with breast cancer: a narrative review.

PURPOSE: The purpose of this narrative review was to synthesize the evidence on sleep health in young women with breast cancer and provide recommendations for clinical practice and research. METHODS: Multiple databases were searched (OVID Medline, OVID PsycINFO, OVID Embase, and Scopus) using the search terms "breast neoplasm", "young women", "sleep", "sleep disturbance", "sleep problems", "sleep deficiency", and "insomnia". There were 467 titles and abstracts screened, and 82 full-text papers were reviewed, yielding 11 research publications for inclusion. RESULTS: Sleep problems are prevalent among young women with breast cancer and are associated with vasomotor symptoms of menopause and psychological symptom distress. The evidence, however, is weak due to methodological and design aspects of the studies. CONCLUSIONS: Poor sleep health in women with breast cancer is a clinically relevant problem that persists after treatment. As sleep is multidimensional and multifactorial, future research should evaluate sleep with objective sleep measures as well as self-reports; consider longitudinal designs; include factors that potentially contribute to poor sleep quality, such as physical and psychological symptom distress, family stressors, and competing life demands for this age group; and explore the perspective of this younger population of survivors on sleep. For clinical practice, survivorship visits should incorporate sleep assessment for all breast cancer survivors, especially younger women.

Sleep Characteristics, Mood, Somatic Symptoms, and Self-Care Among People With Heart Failure and Insomnia.

BACKGROUND: Almost 50% of people with heart failure (HF) experience chronic insomnia and must perform self-care to manage their day-to-day healthcare needs. Understanding multifactorial influences on self-care, including demographic, clinical, and sleep characteristics, and mood and somatic symptoms will help identify people at highest risk for poor self-care. However, past research focused only on the associations of single symptoms and self-care. Multivariate approaches are needed to account for the synergistic associations of self-care with sleep, mood, and somatic symptoms among people with HF. OBJECTIVES: The aims of the study were to (a) evaluate the levels of self-care maintenance and self-care confidence among people with stable HF and chronic insomnia; (b) identify the clinical and demographic correlates of self-care maintenance and confidence among people with stable HF and chronic insomnia; and (c) identify the associations between sleep characteristics, mood and somatic symptoms, and self-care maintenance and confidence among people with stable HF and chronic insomnia. METHODS: We utilized a cross-sectional design with 195 adult participants who had chronic HF and insomnia. We assessed for symptoms of anxiety; depression; dyspnea; fatigue; stress; insomnia severity; and sleep disturbance, impairment, and quality. Self-care was measured using the Self-Care for Heart Failure Index v6.2. We used generalized linear models to test the associations between the demographic and clinical factors and self-care maintenance and confidence; exploratory and confirmatory factor analysis to identify the factor structure underlying the symptoms; and structural equation modeling to test the combined associations of the demographic and clinical factors and latent factors with self-care maintenance and confidence. RESULTS: Self-care maintenance, confidence, and management were inadequate in most participants. We identified three latent factors among the nine symptoms: "sleep characteristics," "mood," and "somatic symptoms." In the structural equation model, "sleep characteristics," White race, and having a left ventricular ejection fraction of <45 were associated with self-care maintenance. Age was negatively associated with self-care confidence. DISCUSSION: Poor sleep characteristics negatively influence the ability of people with HF and insomnia to perform self-care behaviors. Knowledge of the associations among age, left ventricular ejection fraction, and race with self-care will help clinicians and future researchers identify those at risk for poor self-care.

Cognitive behavioral therapy for insomnia has sustained effects on insomnia, fatigue, and function among people with chronic heart failure and insomnia: the HeartSleep Study.

STUDY OBJECTIVES: Insomnia is common among adults with chronic heart failure (HF) and associated with daytime symptoms and decrements in function. The purpose of this randomized controlled trial (RCT) was to evaluate the sustained effects over one year of CBT-I (Healthy Sleep: HS) compared with HF self-management education (Healthy Hearts; attention control: HH) on insomnia severity, sleep characteristics, symptoms, and function among people with stable HF. The primary outcomes were insomnia severity, actigraph-recorded sleep efficiency, and fatigue. METHODS: We randomized adults with stable HF with preserved or reduced ejection fraction who had at least mild insomnia (Insomnia severity index >7) in groups to HS or HH (4 sessions/8 weeks). We obtained wrist actigraphy and measured insomnia severity, self-reported sleep characteristics, symptoms (fatigue, excessive daytime sleepiness, anxiety, depression), and six-minute walk distance at baseline, within one month of treatment, and at 6 and 12 months. We used general linear mixed models (GLMM) and generalized estimating equations (GEE) to evaluate the effects. RESULTS: The sample included 175 participants (M age = 63 ± 12.9 years; 43% women; 18% Black; 68% New York Heart Association Class II or II; 33%; LVEF < 45%) randomized to HS (n = 91) or HH (n = 84). HS had sustained effects on insomnia severity, sleep quality, self-reported sleep latency and efficiency, fatigue, excessive daytime sleepiness, and six-minute walk distance at 12 months. CONCLUSIONS: CBT-I produced sustained improvements in insomnia, fatigue, daytime sleepiness, and objectively measured physical function among adults with chronic HF, compared with a robust HF self-management program that included sleep hygiene education. CLINICAL TRIAL INFORMATION: Insomnia Self-Management in Heart Failure; https://clinicaltrials.gov/ct2/show/NCT02660385; NCT02660385.

Agreement between actigraphic and polysomnographic measures of sleep in adults with and without chronic conditions: A systematic review and meta-analysis.

Wrist actigraphy (ACT) may overestimate sleep and underestimate wake, and the agreement may be lower in people with chronic conditions who often have poor sleep and low activity levels. The purpose of this systematic review is to compare the agreement between ACT and polysomnographic (PSG) measures of sleep in adults without chronic conditions and sleep complaints (healthy) and with chronic conditions. We conducted a systematic review and meta-analysis using PRISMA guidelines. We searched PubMed, OVIDEMBASE, OVIDMEDLINE, OVIDPsycINFO, CENTRAL, CINAHL, ClinicalTrials.gov, International Clinical Trials Registry, and Open Grey. We included 96 studies with a total of 4134 participants, of whom 762 (18.4) were healthy adults and 724 (17.5%) were adults with chronic conditions. Among adults with chronic conditions, ACT overestimated TST, compared to PSG [M = 22.42 min (CI 95%: 11.92, 32.91 min)] and SE [M = 5.21% (CI 95%: 1.41%-9.00%)]. ACT underestimated SOL [M = -7.70 min (CI 95%: -15.22, -0.18 min)], and WASO [M = -10.90 min (CI 95%: -26.01, 4.22 min)]. These differences were consistently larger between ACT and PSG sleep measures compared to healthy adults. Research is needed to better understand factors that influence the agreement between ACT and PSG among people with chronic conditions.