Anxiety and Opioid Use Markers for Sleep Disturbance Following Surgery for Breast Cancer

Patients who were younger, had baseline anxiety, and reported opioid use were more likely to experience sleep disturbance a year after undergoing surgery for breast cancer, as reported in a study published in The Clinical Journal of Pain.

According to authors of a longitudinal, prospective study, “a growing body of research suggests a bidirectional relationship between sleep and pain, in which a vicious cycle may form, with impaired sleep worsening pain and increased pain subsequently impairing sleep.” They therefore recruited patients (N=259) scheduled to undergo breast cancer surgery at Brigham and Women’s Hospital between 2014 and 2017 to participate in their study evaluating the relationship between breast cancer surgery and sleep disturbance.

Patients responded to a battery of pain and psychological evaluations including the Patient-Reported Outcomes Information System (PROMIS), the Pain Severity Index (PSI), and the Positive And Negative Affect Scale (PANAS) instruments prior to surgery and then again at 2 weeks, 6 months, and 1 year following surgery. Predictors for sleep disturbance at 1 year were evaluated.

The mean age of study participants was 55.5±12.4 years. Most (86.4) were White. Breast-conserving surgery (lumpectomy) was performed in 52.5%, and 63.7% underwent sentinel lymph node biopsy. At baseline, 5.1% used opioids. Baseline PSI score was 4.1±9.3 points.

During the study, there was little change in PROMIS sleep disturbance scores (51.2 points at baseline, 52.2 points at 2 weeks and returning to baseline levels at 6 and 12 months). Sleep disturbance was reported by 18% of study participants at 2 weeks and by 12% of study participants at 6 months.

Longitudinal sleep disturbance correlated significantly with longitudinal scores of depression (r, 0.289; P <.001), anxiety (r, 0.265; P <.001), PANAS negative score (r, 0.260; P <.001), physical impact of pain (r, 0.255; P <.001), somatization (r, 0.247; P <.001), PSI (r, 0.152; P <.001), pain catastrophizing (r, 0.148; P <.001) worst pain severity (r, 0.143; P <.001), and PANAS positive score (r, -0.300; P <.001).

In the multivariate analysis, longitudinal sleep disturbance was associated with mastectomy (β, -2.74; P =.008), PANAS positive score (β, -0.14; P =.010), age (β, -0.09; P =.008), PSI score (β, 0.19; P <.001), PROMIS anxiety score (β, 0.45; P <.001), and opioid use (β, 3.14; P =.017) at baseline.

This study was limited by its observational, cohort design, in which causal relationships could not be evaluated.

These data indicate that among women undergoing surgery for breast cancer, those who were younger, reported baseline opioid use, and experienced anxiety and pain were more likely to experience sleep disturbance 1 year after surgery. The study authors suggest that patients with these characteristics may benefit from presurgical sleep or anxiety interventions.