Psychological Factors Associated with Poor Sleep Prior to Breast Surgery: An Exploratory Study

Abstract

This study explored the relationship between psychological factors (including intrusive thoughts, anxiety, well-being, depressed mood) and poor sleep the night before surgery. Patients (N = 39) scheduled for breast surgery (mean age = 47 years) wore an actiwatch at home the night before surgery to provide an objective indication of sleep duration and sleep efficiency. Participants also completed 3 measures of their psychological experience during the week prior to surgery. In separate regression analyses, intrusive thoughts, anxiety, and emotional well-being were each related to sleep duration the night before surgery, when controlling for age, body mass index, ethnicity, and marital status. No relationships were found between depressed mood, physical or social well-being, and sleep duration. In a multiple regression model that included all significant variables, intrusive thoughts were most strongly associated with sleep duration. Intrusive thoughts were also significantly related to sleep efficiency. Results suggest that patients’ intrusions about impending surgery are associated with lower sleep duration and sleep efficiency the night before surgery. Additional research is warranted to explore the implications of these associations for patients, as well as possible interventions to improve sleep in this clinical setting.

Keywords:

• anxiety
• intrusive thoughts
• sleep duration
• sleep efficiency
• surgery

ACKNOWLEDGEMENTS

This research was supported by grants from the National Cancer Institute (CA105222; CA81137, K07CA131473), the American Cancer Society (CRTG 00-312-01; PF-05-098-01-CPPB), and the Department of Defense (DAMD17-99-1-9303). The information contained in this report is solely the responsibility of the authors and does not necessarily reflect the position or policy of the Department of Defense, the National Cancer Institute, or the National Institutes of Health. Portions of this work were presented at the 66th Annual American Psychosomatic Society meeting in 2008. The authors would like to acknowledge the contributions of Alexis Kowalski, MPH, as study coordinator and Suzy Blumenthal, MPH, for her assistance with the actigraphy data. We would also like to thank the study participants for their contribution of time and effort.

Notes

Note. ^aMinutes of sleep between sleep onset and sleep end time, measured by actigraphy the night before surgery.

^bThe ratio of total sleep time to the total time in bed multiplied by 100, measured by actigraphy the night before surgery.

^cFirst 10-min period in which no activity occurred after getting into bed, measured by actigraphy the night before surgery.

^dLast 10-min period, before rising in which no activity occurred, measured by actigraphy on the morning of surgery.

Note. ^aMinutes of sleep between sleep onset and sleep end time, measured by actigraphy the night before surgery.

^bThe ratio of total sleep time to the total time in bed multiplied by 100, measured by actigraphy the night before surgery.