Sleep reactivity predicts insomnia in patients diagnosed with breast cancer

Abstract

Study objectives: To examine the role of sleep reactivity as a predictor of insomnia in patients diagnosed with breast cancer.Methods: One hundred and seventy three women with breast cancer participated and were followed up over a period of 9 months. At baseline participants were assigned to a high (n=114) or low (n=59) sleep reactivity group, based on their responses to the Ford Insomnia Response to Stress Test (FIRST). We assessed whether these FIRST groupings (high / low sleep reactivity) predicted changes in insomnia over time using the Insomnia Severity Index (ISI). We also tested if these FIRST groupings predicted insomnia disorder (using ISI index cut-offs) at three different time points (T3, T6 and T9).Results: Individuals with high sleep reactivity were more likely to experience a worsening of insomnia.Using logistic regression we also found that FIRST grouping predicted insomnia disorder. Results remained significant after controlling for estimated pre-morbid sleep, age and whether someone had chemotherapy.Conclusions: Our study shows that sleep reactivity may be a robust predictor of insomnia within breast cancer populations. Sleep reactivity should be considered in routine clinical assessments as a reliable way to identify patients at risk of developing insomnia. This would facilitate early sleep intervention for those patients who are considered high risk.

The sleep response to stress: how sleep reactivity can help us prevent insomnia and promote resilience to trauma

“…Ultimately, this study reveals that even normal sleepers with high sleep reactivity experience a considerable worsening of their sleep during cancer care and, more importantly, that the FIRST can identify patients at‐risk of insomnia disorder prior to this foreseeable precipitant (Rehman et al, 2022). This suggests the FIRST may be useful for detecting individuals most in need of preventive insomnia treatment before they encounter predictable stressors (e.g., new emergency responders prior to first‐time emergency work) (Reffi & Cheng, 2023).…”

“…A team in Scotland built on this enterprise of early risk detection among women diagnosed with non‐metastatic breast cancer ( N = 173, mean age 58 years) (Rehman et al, 2022), a population beset by high rates of unremitting insomnia (Fleming et al, 2019; Savard et al, 2011). All women had a prognosis of >6 months and enrolled shortly following their diagnosis but prior to beginning cancer treatment.…”

“…Moreover, because this sample did not report clinically significant sleep disturbances prior to their cancer diagnosis, we can infer that individuals with a sleep system highly reactive to stress will not necessarily present with insomnia symptoms and thus might not be detected as being at high risk of insomnia if screening relied solely on presenting sleep complaints (Rehman et al, 2022). Such early identification is critical for triaging high-risk patients most in need of early Taken together, these studies illustrate how the predictive utility of the FIRST generalises to the unpredictable and novel stress of the COVID-19 pandemic.…”

Adaptation and Validation of the Turkish Version of the Ford Insomnia Response to Stress Test in University Students

“…A total score above 14 indicates clinical insomnia. [22][23][24][25][26][27][28] Boysan et al found a sufficient internal consistency coefficient (Cronbach's α = 0.79) of the Turkish version of the ISI. 35 We found robust internal consistency (Cronbach's α = 0.80) in our study.…”

“…27 Sleep reactivity using the FIRST has also been validated as a predictor of insomnia following a cancer diagnosis. 28 In light of the above findings, the FIRST may help as a tool to predict development of insomnia after various types of stress exposures.…”