Sleep duration and breast cancer risk: A meta‐analysis of observational studies

Studies on the association of short or long sleep duration with breast cancer risk have reported inconsistent results. We quantitatively assessed this association by conducting a meta‐analysis based on the evidence from observational studies. In April 2013, we performed electronic searches in PubMed, EmBase and the Cochrane Library to identify studies examining the effect of sleep duration on breast cancer incidence. The odds ratio (OR) was used to measure any such association in a random‐effects model. The analysis was further stratified by confounding factors that could bias the results. A total of six studies (two case–control and four cohort studies) involving 159,837 individuals were included in our meta‐analysis. Our study did not show an association between either short or long sleep duration and breast cancer risk (short sleep duration data: pooled OR = 1.01, 95% confidence interval (CI) = 0.90–1.14, p = 0.853; long sleep duration data: pooled OR = 0.95, 95% CI = 0.86–1.04, p = 0.251). Moreover, we did not identify any statistically significant association between sleep duration and breast cancer risk in all the subgroup analyses. In conclusion, our findings indicate that sleep duration has no effect on breast cancer risk.     

夜间睡眠时间与女性乳腺癌发病风险的前瞻性队列研究

目的 我国女性乳腺癌发病率逐年上升,夜间睡眠时间长短可能与一系列健康效应相关,为探究夜间睡眠时间与乳腺癌发病关联性,本研究以唐山开滦集团前瞻性动态队列中的女性人群为基础进行了相关分析.方法 采用2006-2011年开滦集团体检人群中女性人群资料,收集社会人口学资料、睡眠习惯、身高、体质量等基线信息及乳腺癌发病结局信息.采用Cox比例风险回归模型分析夜间睡眠时间与女性乳腺癌发病风险的关联性.结果 共纳入24 692名女性体检者,总随访108 029.22人年,平均随访时间为4.38年,新发乳腺癌病例107例.以夜间睡眠7h为参比组,单因素分析提示夜间睡眠偏短(≤6h,HR=0.99,95％CI=0.52～1.87)或偏长(≥8h,HR=0.84,95％CI=0.49～1.45)与乳腺癌发病风险无统计学关联.调整年龄、受教育程度、饮酒等混杂因素后,分析仍显示夜间睡眠时间偏短(HR=0.82,95％CI=0.43～1.56)或偏长(HR=0.94,95％CI=0.54～1.64)与女性乳腺癌的发病无统计学关联.按年龄、打鼾情况和BMI分层分析及敏感性分析后,结果仍未发现存在显著性关联.结论 本研究结果尚不支持夜间睡眠时间偏短或偏长与女性乳腺癌的发病风险存在关联性.     

Short duration of sleep increases risk of colorectal adenoma

BACKGROUND:

Short duration and poor quality of sleep have been associated with increased risks of obesity, cardiovascular disease, diabetes mellitus, and total mortality. However, few studies have investigated their associations with risk of colorectal neoplasia.

METHODS:

In a screening colonoscopy‐based case‐control study, the Pittsburg Sleep Quality Index (PSQI) was administered to 1240 study participants before colonoscopy.

RESULTS:

Three hundred thirty‐eight (27.3%) of the participants were diagnosed with incident colorectal adenomas. Although there was no appreciable difference in the overall PSQI score between cases and adenoma‐free controls (5.32 vs 5.11; P = .37), the authors found a statistically significant association of colorectal adenoma with the PSQI component 3, which corresponds to sleep duration (P = .02). Cases were more likely to average less than 6 hours of sleep per night (28.9% vs 22.1% in controls, P = .01). In multivariate regression analysis adjusted for age, gender, race, smoking, family history of colorectal cancer, and waist‐to‐hip ratio, individuals averaging less than 6 hours per night had an almost 50% increase in risk of colorectal adenomas (OR = 1.47; CI = 1.05‐2.06, P for trend = .02) as compared with individuals sleeping at least 7 hours per night. Cases were also more likely to report being diagnosed with sleep apnea (9.8% vs 6.5%, P = .05) and more likely to have worked alternate shifts (54.0% vs 46.1%, P = .01), although these differences were not significant in multivariate models.

CONCLUSIONS:

Shorter duration of sleep significantly increases risk of colorectal adenomas. The authors' results suggest sleep duration as a novel risk factor for colorectal neoplasia. Cancer 2011. © 2010 American Cancer Society.     

Sleep duration and the risk of breast cancer: the Ohsaki Cohort Study

In a prospective study of 23 995 Japanese women, short sleep duration was associated with higher risk of breast cancer (143 cases), compared with women who slept 7 h per day, the multivariate hazard ratio of those who slept 相似文献   

Sleep duration and the risk of prostate cancer: the Ohsaki Cohort Study

In a prospective study of prostate cancer incidence (127 cases), among 22 320 Japanese men, sleep duration was associated with lower risk; the multivariate hazard ratio of men who slept >or=9 h per day compared with those who slept less was 0.48 (95% confidence interval: 0.29-0.79, P for trend=0.02).     

Sleep duration,spot urinary 6‐sulfatoxymelatonin levels and risk of breast cancer among Chinese women in Singapore

We previously reported an inverse association between sleep duration and breast cancer risk in the prospective, population‐based Singapore Chinese Health Study (SCHS) cohort (Wu et al., Carcinogenesis 2008;29:1244–8). Sleep duration was significantly positively associated with 6‐sulfatoxymelatonin (aMT6s) levels determined in a spot urine, but aMT6s levels in breast cancer cases were lacking (Wu et al., Carcinogenesis 2008;29:1244–8). We updated the sleep duration–breast cancer association with 14 years of follow‐up of 34,028 women in the SCHS. In a nested case–control study conducted within the SCHS, randomly timed, prediagnostic urinary aMT6s concentrations were compared between 248 incident breast cancer and 743 individually matched cohort controls. Three female controls were individually matched to each case on age at baseline interview (within 3 years), dialect group, menopausal status, date of baseline interview (within 2 years), date of urine sample collection (within 6 months) and timing of urine collection during the day (within 1 hr). Cox proportional hazards and conditional regression models with appropriate adjustment for confounders were used to examine the sleep– and aMT6s–breast cancer relationships. Breast cancer risk was not significantly associated with sleep duration; adjusted odds ratio (OR) for 9+ vs. ≤6 hr is 0.89 [95% confidence interval (95% CI) = 0.64–1.22]. Prediagnostic aMT6s levels did not differ between breast cancer cases and matched controls; adjusted OR for highest versus lowest quartiles is 1.00 (95% CI = 0.64–1.54). We conclude that sleep duration is not significantly associated with breast cancer risk reduction. Melatonin levels derived from randomly timed spot urine are unrelated to breast cancer. Randomly timed, spot urine‐derived melatonin levels are noninformative as surrogates of nocturnal melatonin production.     

Breast cancer and circadian disruption from electric lighting in the modern world

Breast cancer is the leading cause of cancer death among women worldwide, and there is only a limited explanation of why. Risk is highest in the most industrialized countries but also is rising rapidly in the developing world. Known risk factors account for only a portion of the incidence in the high‐risk populations, and there has been considerable speculation and many false leads on other possibly major determinants of risk, such as dietary fat. A hallmark of industrialization is the increasing use of electricity to light the night, both within the home and without. It has only recently become clear that this evolutionarily new and, thereby, unnatural exposure can disrupt human circadian rhythmicity, of which three salient features are melatonin production, sleep, and the circadian clock. A convergence of research in cells, rodents, and humans suggests that the health consequences of circadian disruption may be substantial. An innovative experimental model has shown that light at night markedly increases the growth of human breast cancer xenografts in rats. In humans, the theory that light exposure at night increases breast cancer risk leads to specific predictions that are being tested epidemiologically: evidence has accumulated on risk in shift workers, risk in blind women, and the impact of sleep duration on risk. If electric light at night does explain a portion of the breast cancer burden, then there are practical interventions that can be implemented, including more selective use of light and the adoption of recent advances in lighting technology and application. CA Cancer J Clin 2014;64:207–218. ^© 2013 American Cancer Society.     

Importance of radiation time and dose factors on outcome for childhood medulloblastoma*

The purpose of this study was to investigate the relationship of posterior fossa radiation therapy duration (PFRTD) and relapse‐free survival (RFS) following adjuvant craniospinal RT for childhood medulloblastoma. A retrospective audit was performed assessing all children aged <18 years managed with adjuvant craniospinal RT for medulloblastoma in Australia and New Zealand in 1980–1993. Children receiving prolonged (>180 days) pre‐RT chemotherapy were excluded. Data were obtained for potential prognostic factors in domains of patient, tumour and treatment factors. Radiation therapy time factors assessed were PFRTD and time interval from surgery to commencement of RT (SRTD). The end‐point assessed was RFS and analysis was performed using Cox regression and Kaplan–Meier survival. One hundred and eighty‐nine children were identified from 10 oncology units, with data available from 182 children for analysis. Median follow up was 5.3 years. Seventy‐three per cent of children presented with disease confined to the cerebellum; 13% had initial neuraxis disease. Macroscopic resection was described in 54%; 42% received adjuvant chemotherapy. Median RT dose and RT duration to PF was 55 Gy and 45 days, respectively. Seventy‐eight relapses occurred with a 10‐year actuarial RFS of 58.2% (standard error ± 4%). On univariate analysis, increasing PF dose (P = 0.002), age >5 years (P = 0.006), and more thorough extent of surgical resection (P = 0.043) were associated with improved RFS; PFRTD (P = 0.20) and SRTD (P = 0.51) were not associated with RFS. On multivariate analysis, although both PF dose (P = 0.004) and extent of surgery (P = 0.045) remained strongly significant, RT duration was now associated with RFS (P = 0.049). Other factors assessed that did not reach significance were patient age, local tumour extent, presence of internal shunt and use of chemotherapy. The importance of local treatment factors was confirmed in this audit with established prognostic factors such as primary tumour macroscopic resection and adequate PF RT dose being associated with RFS. A treatment time effect is weakly suggested, although less significant than RT dose delivered.     

Lung cancer risks in relation to vegetable and fruit consumption and smoking

In a case-control study on lung cancer, risk was analysed in relation to smoking habits and frequency of vegetable and fruit consumption. Lung cancer cases in West Sweden and population controls were interviewed using a questionnaire where the frequency of consumption of dietary items and smoking habits were assessed. The material presented comprises 177 female and 359 male confirmed cases of lung cancer and 916 population controls. There was a dose-response relationship in regard to the number of cigarettes smoked and the number of years smoked, the latter factor being more important. After adjustment for number of cigarettes smoked/day and number of years smoked, the risk for those who seldom consumed vegetables was about twice of that among those who consumed vegetables frequently, both among nonsmokers, smokers and former smokers. This risk increase in relation to vegetable consumption also was present for different smoking categories. A similar tendency, although less pronounced, was found for fruit consumption. The results demonstrate that dietary factors are related to the risk for lung cancer, although smoking is the dominant risk factor.     

Cervical cancer and duration of using hormonal contraceptives

Aim:   To address the association between the duration of using oral contraceptives and cervical cancer, excluding HPV-DNA positive women.
Methods:   The sample consisted of 300 women over 30 years of age with newly diagnosed invasive cervical cancer who were admitted to the seven general hospitals in Tehran between 1 January 2005 and 31 December 2006. The control group consisted of 319 women in the same age group admitted to the same hospitals with conditions judged to be unrelated to any of the known or suspected risk factors for cervical cancer. The main outcome measures were the duration of using oral contraceptives and risk of cervical cancer.
Results:   Forty-five patients versus 48 controls had ever used oral contraceptives, and the corresponding unadjusted odds ratio (OR) was 0.9 (0.6–1.2). The OR of cervical cancer increased with the duration of using oral contraceptives, being 3.4 (1.2–11) for more than 20 years of use and 2.3 (1.2–5) for a use of 15–20 years, compared with less than a use of oral contraceptives for 10 years. The adjusted OR for parity and less than 8 years since they had last used oral contraceptives were 1.2 (1.08–1.4) and 1.4 (1.01–2.1) respectively.
Conclusion:   Our findings suggest that parity and a duration of less than 8 years since the women last used oral contraceptives increase their risk of cervical cancer.     

Impressive and durable response in a case of multiple relapsed mantle cell lymphoma treated with bortezomib and rituximab

Relapsed mantle cell lymphoma (MCL) usually represents a hard challenge, especially after the failure of high-dose therapy or in elderly patients, and although new agents have been investigated, responses are often short and a significant proportion of patients finally die from progressive disease. Here, we report a case of a relapsed MCL patient that achieved durable response with bortezomib and rituximab. Treatment regimen consisted of bortezomib 1.6 mg/m² and rituximab 375 mg/m² intravenously on days 1–8–15–22 for the 1st course, followed by 2 courses of bortezomib with the same schedule. After the third course, patients in CR, PR or SD received other 3 courses. The patient achieved a CR, but because of the high risk of relapse we started a 4-week maintenance therapy with rituximab and bortezomib for 4 courses administered at six month interval. After a follow-up of 62 months, the patient maintained CR. We suggest rituximab plus bortezomib could play an important role in the treatment of patients with relapsed/refractory MCL. Maintenance therapy could be an interesting option, especially for patients with a high relapse risk rate.     

Duration and outcome of persistent candidaemia in newborn infants

The aims of the study were to define the duration of candidaemia in newborn infants and to determine the incidence of persistent hospital-acquired candidaemia and its associated morbidity and mortality compared with non-persistent candidaemia. This retrospective study, included 56 neonates admitted to the neonatal intensive care unit from 1996 to 2000 who had one or more positive blood cultures for Candida spp. The most prevalent pathogen was Candida albicans (64.3%). Mean disease duration was 6.9 +/- 5.5 days (median 6 days). Twenty-nine patients (52%) had a positive blood culture for >5 days (persistent candidaemia). There were no statistically significant differences between the infants with persistent and non-persistent candidaemia in background or predisposing clinical factors. Fungal endocarditis was present in four patients (13.7%) with persistent disease and one patient (3.7%) with non-persistent disease (odds ratio 4.19), and uveitis developed in one patient. Ten patients (17.8%) died--five with persistent and five with non-persistent disease (P = 1.0). These findings indicate that persistent neonatal candidaemia may be associated with an increased risk of Candida endocarditis, but not with other complications or increased mortality.     

Computed tomographic cephalometric analysis of Chinese patients with obstructive sleep apnoea

Variations of craniofacial and upper airway structures are recognized to contribute to the phenomenon of obstructive sleep apnoea (OSA). Most previous cephalometric studies were performed using erect lateral radiographs in Caucasian patients. The present project aims to determine cephalometric measurements, utilizing CT, in normal Chinese subjects and in Chinese patients with OSA. Computed tomography of 25 patients with OSA (proven using overnight polysomnography), and of 25 age‐, sex‐, height‐, bodyweight‐ and body mass index (BMI)‐matched control subjects were prospectively performed. Thirteen standard bony and soft‐tissue measurements were obtained from the CT lateral scout view of the head and neck, taken with each subject in the neutral supine position. The cross‐sectional area was calculated at two axial levels (velopharynx and hypopharynx). The measurements in the two groups, OSA and control subjects, were compared. The measurements for hyoid position (P = 0.00), nasal cavity length (P = 0.01), mandibular prognathism (P = 0.05), tongue size (P = 0.02), oropharyngeal airway space (P = 0.02), posterior tongue airway space (P = 0.04) and cross‐sectional areas at the level of the velopharynx (P = 0.00) and hypopharynx (P = 0.01) differed significantly between the two groups. In conclusion, CT cephalometric measurements show that certain anatomical variations in the head and neck are likely to contribute to the pathogenesis of OSA in Chinese patients.     

夜间睡眠时间与女性结直肠癌发病关系的前瞻性队列研究

目的 研究夜间睡眠时间与女性结直肠癌发病风险关系.方法 自2006年5月开始,以开滦集团全体在职及离退休女性职工为调查对象,建立开滦集团女性动态队列并对其随访.收集研究对象夜间睡眠时间、吸烟等基线信息及结局事件信息.采用多因素Cox比例风险回归模型分析调查对象夜间睡眠时间与结直肠癌发病风险关系.结果 共有24 688名研究对象进入队列,共计随访108 020.76人年,平均4.38年,共收集结直肠癌新发病例32例.调整年龄等混杂因素后,与夜间睡眠时间7h组相比,睡眠时间≤6 h组、≥8 h组结直肠癌发病风险的HR(95％CI)值分别为0.41(0.14 ～1.22),0.56(0.23 ～1.40),差异无统计学意义(P＜0.05).分别按鼾症、基线BMI水平情况分层后,也未发现夜间睡眠时间长短与结直肠癌发病风险的显著相关性.结论 目前研究结果尚不能肯定夜间睡眠时间长度与中国女性结直肠癌发病风险的显著关联.     

Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia

BACKGROUND: Dexamethasone improves the cure rate of childhood acute lymphoblastic leukemia (ALL) but causes physical and behavioral adverse events. The objective of the current study was to determine the effect of dexamethasone exposure on sleep and fatigue in pediatric patients with ALL. METHODS: One hundred pediatric patients with low-risk or standard-risk ALL were enrolled on 1 of 3 protocols (St. Jude Total XV, Children's Oncology Group [COG] 9904, or COG 9905) at 3 institutions. The mean age of the cohort was 9.24 +/- 3.23 years (range, 5.03-18.14 years). The majority of patients were white (79%) males (62%) with standard-risk ALL (63%). The cohort was divided into 4 subgroups: St. Jude low-risk, St. Jude standard-risk, COG low-risk, and COG standard-risk. Patients wore a wrist actigraph to monitor sleep activity during 2 consecutive 5-day periods: During the first period, they did not receive dexamethasone; and, during the second period, they did. Patients and their parents completed fatigue instruments on Days 2 and 5 of each period, and parents completed sleep diaries. RESULTS: Actual sleep minutes, sleep duration, total daily nap minutes, and fatigue increased significantly during the dexamethasone treatment for 3 to 4 of the subgroups. Total daily nap minutes increased significantly for both standard-risk groups during the dexamethasone treatment. Parents reported significant increases in their child's nighttime awakenings, restless sleep, and nap time during dexamethasone treatment. CONCLUSIONS: Dexamethasone treatment during continuation therapy for childhood ALL significantly and adversely altered sleep and fatigue, confirming that sleep and fatigue are behavioral responses to dexamethasone.     

A call to action for expanded sleep research in pediatric oncology: A position paper on behalf of the International Psycho‐Oncology Society Pediatrics Special Interest Group

Sleep and circadian rhythms are closely related to physical and psychosocial well‐being. However, sleep and circadian rhythm disruptions are often overlooked in children with cancer, as they are frequently considered temporary side effects of therapy that resolve when treatment ends. Yet, evidence from adult oncology suggests a bidirectional relationship wherein cancer and its treatment disrupt sleep and circadian rhythms, which are associated with negative health outcomes such as poor immune functioning and lower survival rates. A growing body of research demonstrates that sleep problems are prevalent among children with cancer and can persist into survivorship. However, medical and psychosocial outcomes of poor sleep and circadian rhythmicity have not been explored in this context. It is essential to increase our understanding because sleep and circadian rhythms are vital components of health and quality of life. In children without cancer, sleep and circadian disturbances respond well to intervention, suggesting that they may also be modifiable in children with cancer. We present this paper as a call to (a) incorporate sleep or circadian rhythm assessment into pediatric cancer clinical trials, (b) address gaps in understanding the bidirectional relationship between sleep or circadian rhythms and health throughout the cancer trajectory, and (c) integrate sleep and circadian science into oncologic treatment.     

诱导睡眠后化疗预防含顺铂方案所致呕吐的疗效观察

目的了解睡眠后化疗对呕吐的预防作用。方法化疗前预防性使用恩丹西酮或胃复安的同时,分别选用安定或氯丙嗪或复方氯丙嗪注射液肌注。结果实验组总有效率为９３．５％,对照组为５２．７％（Ｐ＜０．００１）。实验组中恩丹西酮和胃复安的有效率分别为９６．７％和９０．６％（Ｐ＞０．０５）;对照组分别为８０．７％和４１．５％（Ｐ＜０．０１）。两组中胃复安的有效率比较差异显著（Ｐ＜０．０１）。逐日疗效比较中,两组第１～３天疗效差异显著（Ｐ＜０．０１）。结论诱导睡眠后化疗对含顺铂方案所致呕吐有预防作用。     

Quality of sleep and quality of life in caregivers of breast cancer patient

BACKGROUND: Sleep is an important issue for cancer patients and caregivers and poor sleep quality may have deleterious effects on health. This study will examine the correlation between sleep quality and quality of life of breast cancer caregivers. METHOD: A cross-sectional and correlational design was used to explore the relationship between sleep quality and the quality of life of caregivers. Sixty-one participants were identified by invasive early breast cancer patients, who were diagnosed within the period of 18-month period, as their primary caregivers. The World Health Organization Questionnaire on Quality of Life: BREF-Taiwan version (WHOQOL-BREF-TAIWAN) and the Chinese Pittsburgh Sleep Quality Index (CPSQI) were used to measure the quality of life and sleep quality of caregivers, respectively. RESULT: Eighty-nine percent of caregivers from this study reported possible sleep difficulties. The scores of CPSQI scores were negatively correlated with the score of every domain of the WHOQOL-BREF-TAIWAN. DISCUSSION: The results suggest that sleep quality may have an impact on several aspects of the quality of life of caregivers. Understanding the correlation between sleep quality and the quality of life of caregivers may assist health professionals in enhancing the sleep quality of caregivers and their ability to care for patients and themselves.     

Localized Cutaneous Verrucous Sporotrichosis of 26 Years Duration

Summary:  A case of localized cutaneous verrucous sporotrichosis of 26 years duration was studied in São Paulo (Brazil). Clinical aspects and therapeutic measures are discussed.
Zusammenfassung:  Es wird über einen Fall von lokalisierter, verruköser Sporotrichose der Haut von 26 Jahren Dauer in São Paulo (Brasilien) berichtet. Klinische Aspekte und Therapiemaßnahmen werden diskutiert.