- Email: [email protected]
W-D-013 LONGITUDINAL ASSOCIATIONS BETWEEN CORTISOL LEVELS AND INSOMNIA IN PATIENTS TREATED FOR PROSTATE CANCER
S98
Abstracts of 4th International Congress of WASM & 5th Conference of CSS / Sleep Medicine 12, Suppl. 1 (2011) S1–S130
nitive therapy constitutes an interesting approach for the treatment of insomnia, because it decreases the impact of cognitive factors that tend to maintain this condition.
W-D-012
IS INSOMNIA ASSOCIATED WITH THE OCCURRENCE OF INFECTIONS IN CANCER PATIENTS? RESULTS FROM A LONGITUDINAL STUDY
Sophie Ruel, Caroline Desautels, Josée Savard, Hans Ivers. Laval University Cancer Research Center, Canada Introduction and Objectives: The psychoneuroimmunological model proposes that psychological factors, such as stress and depression, can have an impact on health through immune downregulation. Sleep impairments have also been found to be related to a greater vulnerability to developing respiratory infections, but this question has yet to be investigated in cancer patients, in whom insomnia is a significant problem, affecting up to 60% of them. The aim of this study was to evaluate the role of insomnia in predicting the occurrence of infection episodes and symptoms in cancer patients throughout their treatment trajectory. Materials and Methods: Patients scheduled to undergo surgery for cancer (N = 962) completed a structured interview to assess symptoms of infectious illness as well as the Insomnia Interview Schedule at three time points: at baseline (T1), as well as 2 (T2) and 6 (T3) months later. At each time point, patients were categorized into the following three groups: insomnia syndrome, insomnia symptoms, good sleepers. Results: Mixed-model analyses revealed a significant between-groups difference on the occurrence of infection episodes, F(2,1578) = 3.43, p=0.03, and symptoms, F(2,1578) = 3.23, p=0.04, at T3, but not at T1 and T2. Specifically, the presence of an insomnia syndrome was associated with a significantly greater number of infection episodes and symptoms in patients, as compared to the other two groups. Conclusion: These findings suggest that there is a relationship between the presence of an insomnia syndrome and the risk of infections in cancer patients, but only during cancer treatments. Although more research is needed on this issue, it would appear that insomnia potentiates the risk of developing infections during cancer treatments. Acknowledgements: This study was supported by a training award held by both the first and the second authors from the PORT program and by a grant held by the fourth author from the Canadian Institutes of Health Research (MOP – 69073).
W-D-013
LONGITUDINAL ASSOCIATIONS BETWEEN CORTISOL LEVELS AND INSOMNIA IN PATIENTS TREATED FOR PROSTATE CANCER
Josée Savard 1 , Séverine Hervouet 1 , Hans Ivers 2 . 1 Université Laval, Canada; 2 Université Laval, United States Introduction and Objectives: In the general population, studies have found a relationship between insomnia and hyperactivity of the hypothalamopituitary-adrenocortical (HPA) system, but it is not clear whether hypercortisolemia is a risk factor or a consequence of insomnia. As part of a larger longitudinal study, this investigation aimed to assess whether increased cortisol levels are a better predictor of insomnia at a subsequent time point than the reverse path (insomnia predicting higher cortisol) in patients with prostate cancer. Materials and Methods: Sixty men scheduled to receive radiation therapy for prostate cancer, with or without androgen deprivation therapy (ADT), were assessed prior to receiving any treatment (baseline) and at seven additional times over a period of 16 months (1, 2, 4, 6, 8, 12, and 16 months) using the Insomnia Severity Index and plasma levels of cortisol. Data were analyzed using mixed modeling regressions controlling for temporal dependency and treatments received (with vs. without ADT). Results: Greater insomnia symptoms at one time point were significantly predicted (beta=0.94) by insomnia symptoms, t(308)=46.91, p<0.001, and cortisol levels (beta=0.07), t(308)=3.36, p=0.001, at the previous assessment. Conversely, higher cortisol levels at one assessment were significantly predicted by cortisol levels at the previous time point (beta = 0.25), t(293)=4.79, p=0.001, marginally predicted by insomnia symptoms assessed at the same time (beta=0.11), t(293)=1.90, p=0.06, but not significantly predicted by insomnia symptoms at the preceding time point, t(293)=0.38, p=0.70.
Conclusion: Longitudinally, cortisol levels better predicted insomnia severity than insomnia severity predicted cortisol levels in patients treated for prostate cancer. Although replication of these findings is warranted, it would appear that interventions aiming at reducing the stress levels which are associated with HPA hyperactivity could contribute to preventing the development of insomnia in prostate cancer patients. Acknowledgements: NARSAD and the Canadian Institutes of Health Research.
W-D-014
MEMORY COMPLAINTS AND OBJECTIVE PERFORMANCE DEFICITS IN INDIVIDUALS WITH INSOMNIA
Émilie Fortier-Brochu, Charles M. Morin. Université Laval, Canada Introduction and Objectives: While a significant proportion of individuals with insomnia report memory problems, studies examining the relationship between these complaints and objective memory performance are scarce. The aim of this study was to examine differences in objective memory performance in individuals with insomnia with or without memory complaints. Materials and Methods: Participants were 25 adults (mean age = 44.4; 56.0% women) with primary insomnia who completed a battery of questionnaires and neuropsychological tests including the Multifactorial Memory Questionnaire (MMQ) and the California Verbal Learning Test – II (CVLT-II). The MMQ includes 3 scales assessing 1) contentment with memory, 2) subjective memory ability, and 3) use of memory strategies. Using the median score of the whole sample for each MMQ subscale as a cut-off score, participants were classified as being either satisfied (x>44; n=13) or dissatisfied (n=12) with their memory, having good (x>53; n=13) or poor (n=12) memory ability, and using (x>30; n=12) or not using (n=13) memory strategies. T-tests were computed to compare individuals with and without each type of memory complaint on CVLT-II scores normalized for age, gender and education. Results: Participants reporting poor memory ability performed significantly (p<0.05) worse than those reporting good memory ability on measures of delayed recall, long-delay retention and recognition. Participants reporting the use of more memory strategies performed significantly better on long-delay retention than those reporting fewer strategies. There was no significant difference between individuals who were satisfied and those who were dissatisfied with their memory. Conclusion: Distinct types of memory complaints were differentially associated with objective memory performance in individuals with insomnia. Complaints pertaining to memory ability were associated with lower performance in measures assessing the long-term storage process of newly learned verbal information, whereas self-reported use of memory strategies appeared related to improved performance on these measures. Acknowledgements: Supported by the Canadian Institutes of Health Research
W-D-015
NOCTURNAL INSOMNIA SYMPTOMS AND DAYTIME FUNCTIONING IMPAIRMENTS
Lynda Bélanger 1 , Min Xu 2 , Hans Ivers 1 , Melanie LeBlanc 1 , Junjian Zhang 2 , Charles M. Morin 1 . 1 Université Laval, Canada; 2 Zhongnan Hospital of Wuhan University, China Introduction and Objectives: The relationship between nocturnal insomnia symptoms and reported daytime consequences remains poorly understood. This study examined whether the type and severity of diurnal symptoms varied according to the type of nocturnal insomnia complaint. Materials and Methods: Participants were 514 adults (mean age = 46.9; 70% women) selected from a larger population-based sample taking part in a longitudinal study of insomnia. Responses to the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) were used to classify participants into one of five groups based on the nature of insomnia symptoms: (1) difficulty initiating sleep (early; N=75), (2) difficulty maintaining sleep (middle; N=55), (3) early morning awakenings (late; N=75), (4) mixed (N=206), or (5) non-restorative sleep (NRS; N=103). Participants completed measures of daytime fatigue and sleepiness, depression and anxiety symptoms, and quality-of-life. Group differences were tested using ANOVAS with multiple range tests for post-hoc comparisons. Results: Individuals with middle and late insomnias did not differ significantly from each other on any of the daytime indicators. Few significant
Abstracts of 4th International Congress of WASM & 5th Conference of CSS / Sleep Medicine 12, Suppl. 1 (2011) S1–S130
nitive therapy constitutes an interesting approach for the treatment of insomnia, because it decreases the impact of cognitive factors that tend to maintain this condition.
W-D-012
IS INSOMNIA ASSOCIATED WITH THE OCCURRENCE OF INFECTIONS IN CANCER PATIENTS? RESULTS FROM A LONGITUDINAL STUDY
Sophie Ruel, Caroline Desautels, Josée Savard, Hans Ivers. Laval University Cancer Research Center, Canada Introduction and Objectives: The psychoneuroimmunological model proposes that psychological factors, such as stress and depression, can have an impact on health through immune downregulation. Sleep impairments have also been found to be related to a greater vulnerability to developing respiratory infections, but this question has yet to be investigated in cancer patients, in whom insomnia is a significant problem, affecting up to 60% of them. The aim of this study was to evaluate the role of insomnia in predicting the occurrence of infection episodes and symptoms in cancer patients throughout their treatment trajectory. Materials and Methods: Patients scheduled to undergo surgery for cancer (N = 962) completed a structured interview to assess symptoms of infectious illness as well as the Insomnia Interview Schedule at three time points: at baseline (T1), as well as 2 (T2) and 6 (T3) months later. At each time point, patients were categorized into the following three groups: insomnia syndrome, insomnia symptoms, good sleepers. Results: Mixed-model analyses revealed a significant between-groups difference on the occurrence of infection episodes, F(2,1578) = 3.43, p=0.03, and symptoms, F(2,1578) = 3.23, p=0.04, at T3, but not at T1 and T2. Specifically, the presence of an insomnia syndrome was associated with a significantly greater number of infection episodes and symptoms in patients, as compared to the other two groups. Conclusion: These findings suggest that there is a relationship between the presence of an insomnia syndrome and the risk of infections in cancer patients, but only during cancer treatments. Although more research is needed on this issue, it would appear that insomnia potentiates the risk of developing infections during cancer treatments. Acknowledgements: This study was supported by a training award held by both the first and the second authors from the PORT program and by a grant held by the fourth author from the Canadian Institutes of Health Research (MOP – 69073).
W-D-013
LONGITUDINAL ASSOCIATIONS BETWEEN CORTISOL LEVELS AND INSOMNIA IN PATIENTS TREATED FOR PROSTATE CANCER
Josée Savard 1 , Séverine Hervouet 1 , Hans Ivers 2 . 1 Université Laval, Canada; 2 Université Laval, United States Introduction and Objectives: In the general population, studies have found a relationship between insomnia and hyperactivity of the hypothalamopituitary-adrenocortical (HPA) system, but it is not clear whether hypercortisolemia is a risk factor or a consequence of insomnia. As part of a larger longitudinal study, this investigation aimed to assess whether increased cortisol levels are a better predictor of insomnia at a subsequent time point than the reverse path (insomnia predicting higher cortisol) in patients with prostate cancer. Materials and Methods: Sixty men scheduled to receive radiation therapy for prostate cancer, with or without androgen deprivation therapy (ADT), were assessed prior to receiving any treatment (baseline) and at seven additional times over a period of 16 months (1, 2, 4, 6, 8, 12, and 16 months) using the Insomnia Severity Index and plasma levels of cortisol. Data were analyzed using mixed modeling regressions controlling for temporal dependency and treatments received (with vs. without ADT). Results: Greater insomnia symptoms at one time point were significantly predicted (beta=0.94) by insomnia symptoms, t(308)=46.91, p<0.001, and cortisol levels (beta=0.07), t(308)=3.36, p=0.001, at the previous assessment. Conversely, higher cortisol levels at one assessment were significantly predicted by cortisol levels at the previous time point (beta = 0.25), t(293)=4.79, p=0.001, marginally predicted by insomnia symptoms assessed at the same time (beta=0.11), t(293)=1.90, p=0.06, but not significantly predicted by insomnia symptoms at the preceding time point, t(293)=0.38, p=0.70.
Conclusion: Longitudinally, cortisol levels better predicted insomnia severity than insomnia severity predicted cortisol levels in patients treated for prostate cancer. Although replication of these findings is warranted, it would appear that interventions aiming at reducing the stress levels which are associated with HPA hyperactivity could contribute to preventing the development of insomnia in prostate cancer patients. Acknowledgements: NARSAD and the Canadian Institutes of Health Research.
W-D-014
MEMORY COMPLAINTS AND OBJECTIVE PERFORMANCE DEFICITS IN INDIVIDUALS WITH INSOMNIA
Émilie Fortier-Brochu, Charles M. Morin. Université Laval, Canada Introduction and Objectives: While a significant proportion of individuals with insomnia report memory problems, studies examining the relationship between these complaints and objective memory performance are scarce. The aim of this study was to examine differences in objective memory performance in individuals with insomnia with or without memory complaints. Materials and Methods: Participants were 25 adults (mean age = 44.4; 56.0% women) with primary insomnia who completed a battery of questionnaires and neuropsychological tests including the Multifactorial Memory Questionnaire (MMQ) and the California Verbal Learning Test – II (CVLT-II). The MMQ includes 3 scales assessing 1) contentment with memory, 2) subjective memory ability, and 3) use of memory strategies. Using the median score of the whole sample for each MMQ subscale as a cut-off score, participants were classified as being either satisfied (x>44; n=13) or dissatisfied (n=12) with their memory, having good (x>53; n=13) or poor (n=12) memory ability, and using (x>30; n=12) or not using (n=13) memory strategies. T-tests were computed to compare individuals with and without each type of memory complaint on CVLT-II scores normalized for age, gender and education. Results: Participants reporting poor memory ability performed significantly (p<0.05) worse than those reporting good memory ability on measures of delayed recall, long-delay retention and recognition. Participants reporting the use of more memory strategies performed significantly better on long-delay retention than those reporting fewer strategies. There was no significant difference between individuals who were satisfied and those who were dissatisfied with their memory. Conclusion: Distinct types of memory complaints were differentially associated with objective memory performance in individuals with insomnia. Complaints pertaining to memory ability were associated with lower performance in measures assessing the long-term storage process of newly learned verbal information, whereas self-reported use of memory strategies appeared related to improved performance on these measures. Acknowledgements: Supported by the Canadian Institutes of Health Research
W-D-015
NOCTURNAL INSOMNIA SYMPTOMS AND DAYTIME FUNCTIONING IMPAIRMENTS
Lynda Bélanger 1 , Min Xu 2 , Hans Ivers 1 , Melanie LeBlanc 1 , Junjian Zhang 2 , Charles M. Morin 1 . 1 Université Laval, Canada; 2 Zhongnan Hospital of Wuhan University, China Introduction and Objectives: The relationship between nocturnal insomnia symptoms and reported daytime consequences remains poorly understood. This study examined whether the type and severity of diurnal symptoms varied according to the type of nocturnal insomnia complaint. Materials and Methods: Participants were 514 adults (mean age = 46.9; 70% women) selected from a larger population-based sample taking part in a longitudinal study of insomnia. Responses to the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) were used to classify participants into one of five groups based on the nature of insomnia symptoms: (1) difficulty initiating sleep (early; N=75), (2) difficulty maintaining sleep (middle; N=55), (3) early morning awakenings (late; N=75), (4) mixed (N=206), or (5) non-restorative sleep (NRS; N=103). Participants completed measures of daytime fatigue and sleepiness, depression and anxiety symptoms, and quality-of-life. Group differences were tested using ANOVAS with multiple range tests for post-hoc comparisons. Results: Individuals with middle and late insomnias did not differ significantly from each other on any of the daytime indicators. Few significant