Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer
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OBJECTIVES: To examine whether day-to-day variations in sleep behaviors, ongoing sleep disturbance, and fatigue predict the cortisol diurnal rhythm in women recently diagnosed as having early-stage breast cancer. METHODS: Women (N = 130, mean [standard deviation] age = 55.6 [9.4] years) collected saliva 5×/day/2 days for cortisol. Diaries were used to assess prior-day nap duration, nocturnal awakenings, sleep latency, and morning restfulness. Ongoing fatigue and sleep disturbance were measured using the Multidimensional Fatigue Symptom Inventory and the Pittsburg Sleep Quality Inventory. Data were analyzed using a multilevel growth curve modeling. RESULTS: Greater ongoing fatigue (b = 0.035, p = .032), or sleep disturbance (b = 0.026, p = .006) predicted a slower cortisol decline. Greater ongoing fatigue also predicted higher awakening cortisol (b = 0.154, p = .030) and lower cortisol awakening response (CAR; b = -0.146, p = .005). Longer prior-day naps predicted higher CAR (b = 0.042, p = .050) and a steeper cortisol decline (b = -0.035, p = .003). Longer sleep latency predicted both a greater cortisol linear decline (b = -0.013, p < .001) and a greater quadratic slope curvature (b = 0.0007, p < .001). Feeling less rested in the morning predicted lower awakening cortisol (b = -0.187, p = .004), higher CAR (b = 0.124, p = .016), and a slower cortisol decline (b = 0.023, p = .042). CONCLUSIONS: Both daily variations in sleep behaviors and ongoing sleep disturbance and fatigue are associated with a disrupted cortisol rhythm. In contrast, prior-day napping is associated with a more robust cortisol rhythm. These findings are particularly relevant to women with breast cancer who often experience sleep disturbance and fatigue. Additional research is needed to determine causal pathways between sleep disturbance and dysregulation of the hypothalamic-pituitary-adrenal axis in patients with breast cancer.
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Sleep disturbance and fatigue are found to go hand in hand with disruption of cortisol rhythms in breast cancer patients.
“sleep disturbance and fatigue are found to go hand in hand with disruption of cortisol rhythms in these patients (Tell et al., 2014).”
From The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis. (2022) · cites this paper as Tell et al., 2014
Other studies in cancer research pointed out that sleep disturbance and fatigue were associated with disrupted cortisol rhythms.
“other studies in cancer research pointed out that sleep disturbance and fatigue were associated with disrupted cortisol rhythms (Schmidt et al., 2016;Tell et al., 2014).”
From The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis. (2022) · cites this paper as Tell et al., 2014
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- Authors
- Tell, D., Mathews, H. L., & Janusek, L. W.
- Affiliations
- Loyola University Chicago (US)
- Corresponding author
- Tell, Dina
- Venue
- Psychosomatic Medicine
- Published
- 2014-09
- Volume
- 76
- Issue
- 7
- Pages
- 519-528
- ISSN
- 0033-3174 (ISSN-L)
- PMC
- PMC4163097
- OpenAlex
- W2324978815
- Cited by
- 48
- References
- 56
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 8 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 4 · 2017: 5 · 2016: 7 · 2015: 1
- FWCI
- 6.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01CA125455)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- breast cancer, diurnal cortisol rhythm, sleep disorders, fatigue, napping, cortisol awakening response, sleep latency, nocturnal awakenings, hypothalamic-pituitary-adrenal axis, women, day-to-day variability
- MeSH terms
- Breast Neoplasms, Circadian Rhythm, Fatigue, Female, Humans, Hydrocortisone, Middle Aged, Saliva, Sleep, Sleep Wake Disorders
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