Uncovering the symptom relationship among sleep quality, anxiety, and depression in Chinese patients with breast cancer: multidimensional data validation using PSQI versus actigraphy

Yining Tao; Qixi Liu; Xinxin Ye; Jie Feng; Huanju Liu; Jinqing Wu; Jing Zhang; Qian Lin; Jingzhan Lu; Renyang Liu

doi:10.1007/s11764-024-01649-5

Uncovering the symptom relationship among sleep quality, anxiety, and depression in Chinese patients with breast cancer: multidimensional data validation using PSQI versus actigraphy

J Cancer Surviv. 2024 Aug 14. doi: 10.1007/s11764-024-01649-5. Online ahead of print.

Authors

Yining Tao¹, Qixi Liu², Xinxin Ye³, Jie Feng^{4

5}, Huanju Liu⁶, Jinqing Wu⁷, Jing Zhang⁸, Qian Lin⁸, Jingzhan Lu⁹, Renyang Liu¹⁰

Affiliations

¹ Clinical Research Center, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China.
² Department of Nursing, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China.
³ Department of Sports Science, Zhejiang University, Hangzhou, Zhejiang, China.
⁴ Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
⁵ Department of Hospital Infection-Control, Tongde Hospital of Zhejiang Province, Hangzhou, China.
⁶ Women's Hospital and Institute of Genetics, Zhejiang University School of Medicine, Hangzhou, China.
⁷ Department of Joint Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China.
⁸ Department of Breast Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China.
⁹ Institute of Health Informatics, University College London, London, UK.
¹⁰ Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China. [email protected].

PMID: 39141310
DOI: 10.1007/s11764-024-01649-5

Abstract

Purpose: The interplay between sleep quality, anxiety, and depression among breast cancer patients remains poorly understood. This study aimed to investigate and compare the symptoms relationships among these three factors in Chinese breast cancer patients, utilizing two sleep assessments.

Methods: Our study encompassed 288 participants diagnosed with breast cancer, from whom we collected demographic information through questionnaires. Sleep quality symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI) and wrist actigraphy, while anxiety and depression symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). Network analyses were conducted using R to calculate the centrality (strength) and further identify central symptoms and bridge symptoms in two networks that differed by sleep assessments. Central symptoms are closely related to other symptoms, whereas bridge symptoms indicate that symptoms may increase spread risk between different conditions.

Results: In the network using PSQI data, "I have lost interest in my appearance" had the highest strength centrality (r_s = 2.417), followed by "sleep duration" (r_s = 1.068) and "sleep efficiency" (r_s = 0.955). In the network using wrist actigraphy data, "wake after sleep onset" had the highest strength value (r_s = 2.437), followed by "sleep efficiency" (r_s = 2.397) and "sleep latency" (r_s = 1.506). Two bridge symptoms were identified: "I feel cheerful" and "I look forward with enjoyment to things" in both networks.

Conclusions: Depressive symptoms played a leading role in the sleep-anxiety-depression network, underscoring the need for targeted intervention tailored to survivors' specific needs.

Implications for cancer survivors: Health workers can give priority to symptom-specific screening and therapies, incorporating psychological support into standard cancer care.

Keywords: Anxiety; Breast cancer; Depression; Network analysis; Sleep quality; Symptom assessment.