Imsomnia and Aromatase Inhibitors
Posted 12/20/2012
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Once again, we now have data and a study to support what many of us already knew. Greater than 50% of women who take one of the aromatase inhibitors report difficulty with sleep. Of course, normal aging is often associated with less good sleep patterns (note that the cliche is "sleeping like a baby", not "sleeping like a fifty year old"), but the stress, worries, joint and muscle aches and pains, and hot flashes that may result from the AI can exascerbate the problem.
This article from Support Care in Cancer reflects a study done with more than 400 women. Not surprisingly, it reports the findings, but does not offer up good solutions. Or any solutions, actually. We know the standard suggestions of routine, using the bed and bedroom only for sleep and intimacy, no caffeine or alcohol for some hours before going to bed, etc. Sometimes these help and sometimes they don't. Here is the abstract and then a link to read more:
Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors
Krupali Desai & Jun J. Mao & Irene Su & Angela DeMichele & Qing Li & Sharon X. Xie &
Philip R. Gehrman
Abstract
Purpose Insomnia is increasingly recognized as a major
symptom outcome in breast cancer; however, little is known
about its prevalence and risk factors among women receiving
aromatase inhibitors (AIs), a standard treatment to increase
disease-free survival among breast cancer patients.
Methods A cross-sectional survey study was conducted
among postmenopausal women with stage 0–III breast cancer
receiving adjuvant AI therapy at an outpatient breast
oncology clinic of a large university hospital. The insomnia
severity index (ISI) was used as the primary outcome.
Multivariate logistic regression analyses were performed to
evaluate risk factors.
Results Among 413 participants, 130 (31.5 %) had subthreshold
insomnia on the ISI, and 77 (18.64 %) exceeded
the threshold for clinically significant insomnia. In a multivariate
logistic regression model, clinically significant insomnia
was independently associated with severe joint pain
(adjusted odds ratio (AOR) 4.84, 95 % confidence interval
(CI) 1.71–13.69, P00.003), mild/moderate hot flashes
(AOR 2.28, 95 % CI 1.13–4.60, P00.02), severe hot flashes
(AOR 2.29, 95 % CI 1.23–6.81, P00.015), anxiety (AOR
1.99, 95 % CI 1.08–3.65, P00.027), and depression (AOR
3.57, 95 % CI 1.48–8.52, P00.004). Age (>65 vs. <55 years;
AOR 2.31; 95 % CI 1.11–4.81; P00.026) and time since
breast cancer diagnosis (<2 vs. 2–5 years; AOR 1.94; 95 %
CI 1.02–3.69; P00.045) were also found to be significant
risk factors. Clinical insomnia was more common among
those who used medication for treating insomnia and pain.
Conclusions Insomnia complaints exceed 50 % among AI
users. Clinically significant insomnia is highly associated
with joint pain, hot flashes, anxiety and depression, age, and
time since diagnosis.
Keywords Breast cancer . Insomnia . Aromatase inhibitors
http://www.ncbi.nlm.nih.gov/pubmed/22584732
Methods A cross-sectional survey study was conducted
among postmenopausal women with stage 0–III breast cancer
receiving adjuvant AI therapy at an outpatient breast
oncology clinic of a large university hospital. The insomnia
severity index (ISI) was used as the primary outcome.
Multivariate logistic regression analyses were performed to
evaluate risk factors.
Results Among 413 participants, 130 (31.5 %) had subthreshold
insomnia on the ISI, and 77 (18.64 %) exceeded
the threshold for clinically significant insomnia. In a multivariate
logistic regression model, clinically significant insomnia
was independently associated with severe joint pain
(adjusted odds ratio (AOR) 4.84, 95 % confidence interval
(CI) 1.71–13.69, P00.003), mild/moderate hot flashes
(AOR 2.28, 95 % CI 1.13–4.60, P00.02), severe hot flashes
(AOR 2.29, 95 % CI 1.23–6.81, P00.015), anxiety (AOR
1.99, 95 % CI 1.08–3.65, P00.027), and depression (AOR
3.57, 95 % CI 1.48–8.52, P00.004). Age (>65 vs. <55 years;
AOR 2.31; 95 % CI 1.11–4.81; P00.026) and time since
breast cancer diagnosis (<2 vs. 2–5 years; AOR 1.94; 95 %
CI 1.02–3.69; P00.045) were also found to be significant
risk factors. Clinical insomnia was more common among
those who used medication for treating insomnia and pain.
Conclusions Insomnia complaints exceed 50 % among AI
users. Clinically significant insomnia is highly associated
with joint pain, hot flashes, anxiety and depression, age, and
time since diagnosis.
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