Objective: Fatigue and insomnia are the two most frequent and distressing symptoms experienced by women treated with adjuvant breast cancer chemotherapy. This study examined the outcomes of a sleep intervention designed to improve sleep and modify fatigue during and following chemotherapy. This presentation will compare the findings obtained by a daily diary with the data collected by the wrist actigraph and describe the advantages and disadvantages of use of each method to measure sleep. Design: A prospective, repeated measures quasi-experimental design was used for this feasibility study. Population, Sample, Setting, Years: Women recently diagnosed with Stage I or II Breast Cancer who were free of unstable co-morbidities and starting Adriamycin-based chemotherapy were eligible. The sample consisted of 25 Caucasian women ages 43-66 (X=55.3), most had some post-secondary education, were married and employed. All had surgery followed by chemotherapy. Eight also received 4 rounds of Taxol, 10 had radiation, and 18 were taking Tamoxifen. The setting was Midwestern urban oncology clinics and patient homes. The study was conducted between 1999-2001. Intervention and Outcome Variables: The intervention consisted of sleep hygiene counseling, relaxation therapy, sleep curtailment and stimulus control methods. Outcomes included several sleep variables (latency, wake after sleep onset, sleep efficiency, total rest, night awakenings and daytime naps) and fatigue (peak and daily fatigue intensity). Methods: Reliable and valid instruments were used: Daily Diary, wrist actigraphs and Piper Fatigue Scale (PFS). An Individual Sleep Promotion Plan (ISPP) was negotiated by the researcher and each woman at 30, 60 and 90 days after the last chemotherapy treatment and reinforced one week later. Follow-up occurred 1 year after the first treatment. Data Management included Epi-Info, Action 3 and SPSS programs. Findings: Advantages and disadvantages of each measure of sleep were identified, including: incomplete diary entries and forgetting to push the marker to separate day from night on the actigraph. Data from both the diary and actigraph on latency, sleep efficiency, total rest, and daytime naps demonstrated wide ranges, with means within normal limits. Both methods also determined that the number of night awakenings and time awake after sleep onset (WASO) were higher than normal and reflected sleep disturbances. T-tests were used to compare the findings obtained by actigraphs with the diary entries at each measurement time. Results of comparisons of all sleep variables were significantly different (p=.020 -.000). Mean fatigue (PFS) scores (0-10) ranged from 3.2 -3.4 early, and were down to 2.87 at 1 year. Conclusions: In this study, sleep diaries and wrist actigraphy generated significantly different data.The actigraph recorded more frequent and longer night sleep disturbances and longer daytime naps than the diary entries. Researchers need to be familiar with the advantages and disadvantages of each method of measurement. Implications: Future sleep intervention studies using a larger sample need to focus on reducing the frequency and duration of nighttime awakenings and recognize the advantages and disadvantages of each method used to measure sleep.
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