2008年，世界睡眠醫(yī)學(xué)會將每年春分前的星期五定為世界睡眠日。2019年3月15日世界睡眠日主題：健康睡眠，健康增壽。此外，中國睡眠研究會于2003年將每年3月21日定為中國的世界睡眠日。2019年中國的世界睡眠日主題：健康睡眠，益智護(hù)腦。

　　2019年3月，世界睡眠醫(yī)學(xué)會《睡眠醫(yī)學(xué)》在線發(fā)表中國香港中文大學(xué)、瑪嘉烈醫(yī)院、威爾斯親王醫(yī)院的研究報告，分析了輔助化療對乳腺癌患者睡眠和褪黑素分泌的影響。

　　該前瞻隊列研究于2015年5月～2016年12月入組早期乳腺癌術(shù)后輔助化療患者180例，佩戴運(yùn)動記錄手環(huán)168小時，并在治療前、化療第一個周期和最后一個周期收集早晨首次尿樣。將手環(huán)記錄數(shù)據(jù)轉(zhuǎn)換為睡眠持續(xù)時間、睡眠效率、夜間覺醒時間長短、節(jié)律比例、F值、幅度、中值、峰值，隨后測定6-羥基黑色素硫酸鹽的尿濃度。

　　結(jié)果，化療第一個周期、最后一個周期與治療前相比：

• 睡眠效率分別下降10.16%、5.01%（95%置信區(qū)間：5.85%～14.47%、0.50%～9.53%）

• 節(jié)律比例分別下降27.20%、21.20%（95%置信區(qū)間：19.95%～34.45%、13.52%～28.89%）

• 尿褪黑素分別下降11.27%、14.74%（95%置信區(qū)間：0.37%～22.16%、2.34%～27.11%）

　　因此，該研究結(jié)果表明，化療可以迅速干擾乳腺癌患者的睡眠質(zhì)量和睡眠規(guī)律，而化療結(jié)束時對睡眠質(zhì)量和睡眠規(guī)律的影響較輕；不過，反復(fù)化療引起夜間褪黑素分泌逐漸減少。

Sleep Med. 2019 Mar;55:14-21.

Disruption of sleep, sleep-wake activity rhythm, and nocturnal melatonin production in breast cancer patients undergoing adjuvant chemotherapy: prospective cohort study.

Li W, Kwok CC, Chan DC, Ho AW, Ho CS, Zhang J, Wing YK, Wang F, Tse LA.

The Chinese University of Hong Kong, Hong Kong SAR, China; Monash University, Australia; Princess Margaret Hospital, Hong Kong SAR, China; Prince of Wales Hospital, Hong Kong SAR, China.

HIGHLIGHTS

• Chemotherapy rapidly disrupts sleep and sleep-wake activity rhythm.

• Disruption at the end of chemotherapy is less severe.

• Nocturnal melatonin secretion is progressively impaired in chemotherapy.

OBJECTIVE: This prospective cohort study captured the patterns of sleep, sleep-wake activity rhythm, and first-morning urinary melatonin in breast cancer patients undergoing adjuvant chemotherapy.

METHODS: Breast cancer patients undergoing adjuvant chemotherapy wore wrist actigraph for 168 h and collected first-morning void urine samples before treatment, during the first, and at the last cycle of chemotherapy. We converted actigraphy data into sleep duration, sleep efficiency, nighttime total wake time, percent rhythm, F-statistic, amplitude, mesor, and acrophase. We then assessed urinary 6-sulfatoxymelatonin (aMT6s) levels.

RESULTS: This cohort contained 180 participants. Compared with the baseline, sleep efficiency during the first and last cycle decreased by 10.16% [95% confidence interval (95% CI): 5.85%, 14.47%] and 5.01% (95% CI: 0.50%, 9.53%), respectively. Similarly, percent rhythm decreased by 27.20% (95% CI: 19.95%, 34.45%) during the first cycle and 21.20% (95% CI: 13.52, 28.89) during the last cycle. Taking the baseline as the reference, aMT6s levels during the first and last cycle decreased by 11.27% (95% CI: 0.37%, 22.16%) and 14.74% (95% CI: 2.34, 27.11), respectively.

CONCLUSION: The first administration of adjuvant chemotherapy is associated with sleep disturbance and sleep-wake activity rhythm disruption among breast cancer patients, while the disturbance and disruption during the last cycle are less severe; nevertheless, repeated administration of chemotherapy results in progressive impairment of nocturnal melatonin production.

KEYWORDS: Anti-cancer treatment; Breast cancer; Circadian rhythm; Melatonin; Sleep; Sleep-wake activity rhythm

PMID: 30743205

DOI: 10.1016/j.sleep.2018.11.022