The Effect of Systematic Light Exposure on Sleep in a Mixed Group of Fatigued Cancer Survivors

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1 SCIENTIFIC INVESTIGATIONS The Effect of Systematic Light Exposure on Sleep in a Mixed Group of Fatigued Cancer Survivors 3 5,6 5 ; 2 1 Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; 2 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; 3 Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; 4 Department of Psychology, Reykjavik University, Reykjavik, Iceland; 5 Department of Psychiatry, University of California, San Diego, California; 6 Department of Medicine, University of California, San Diego, California; 7 Department of Clinical and Social Psychology, University of Rochester, Rochester, New York Study Objectives: Sleep disturbances are commonly reported by cancer survivors. Systematic light exposure using bright light has been used to improve sleep in other populations. In this secondary data analysis, the effect of morning administration of bright light on sleep and sleep quality was examined in a mixed group of fatigued cancer survivors. Methods: Forty-four cancer survivors screened for cancer-related fatigue were randomized to either a bright white light or a comparison dim red light condition. Participants were instructed to use a light box every morning for 30 minutes for 4 weeks. Wrist actigraphy and the Pittsburgh Sleep Quality Index were administered at 4 time points: prior to light treatment (baseline), 2 weeks into the intervention, during the last week of the intervention, and 3 weeks postintervention. Thirty-seven participants completed the end-of-intervention assessment. Results: more in the bright light condition over time compared with the dim light condition (F 3,42 = 5.55; P 2 = 0.28). By the end also seen in sleep quality, total sleep time, and wake after sleep onset for participants favoring the bright light condition. Conclusions: Clinical Trial Registration: Keywords: Citation: light exposure on sleep in a mixed group of fatigued cancer survivors. J Clin Sleep Med.. BRIEF SUMMARY Current Knowledge/Study Rationale: Systematic light exposure (sle) using morning bright light therapy has commonly been used to treat seasonal we sought to investigate the effect of sle on sleep in a mixed group of fatigued cancer survivors following primary cancer treatment. Study Impact: the potential to provide cancer survivors with an easy-to-use and inexpensive tool that could improve quality of life. Larger-scale studies to test the INTRODUCTION Sleep disturbances are reported by cancer patients at a sig- 1 Among posttreatment cancer survivors, 23% to 44% experience in- 2 lence of insomnia symptoms reported by cancer survivors For example, in a study of fatigue in breast cancer survivors, Risk factors for sleep problems among cancer patients include - factors (eg, cancer worry), and comorbid medical disorders Journal of Clinical Sleep Medicine, Vol. 14, No. 1 31

2 5 6 applies to cancer survivors after primary treatment as well, - cations but many cancer patients are reluctant to add more from rods and cones, 11 populations and 14 and, in our current sample, 15 bance in a mixed group of fatigued cancer survivors following METHODS Study Design - 15 Recruitment and Procedures naires, participants completed a self-report measure of sleep Apparatus Light 16 - Actigraphy Measures Fatigue ,19 Sleep Quality disturbance, sleep latency, day dysfunction due to sleepi- Journal of Clinical Sleep Medicine, Vol. 14, No. 1 32

3 21 Actigraphy Sleep Outcomes - Sociodemographic and Medical Data Data Analysis 22, t main effects and a time by group variable to test interaction 2 SS effect 2 SS effect + SS error of P RESULTS Participant Characteristics Figure 1 Table groups (t P = groups (t 38 P = Subjective Sleep Outcome Sleep Quality on the PSQI P - F 2,54 P = treatment (F 1,34 P tion (F 2,54 P = As can be seen in Figure 2 t 54 P = Objective Sleep Outcomes Total Sleep Time P - for time (F 3,42 P F 1,42 P F 3,42 P 2 24 As can be seen in Figure 3, total sleep time tended Journal of Clinical Sleep Medicine, Vol. 14, No. 1 33

4 Figure 1 Consort diagram. P = F 3,42 P = F 1,42 P = - F 3,42 P = 2 Figure 4 - post hoc repeated- effect for time (F 3,42 P = (F 1,42 P = - F 3,42 P = Wake After Sleep Onset P = F 3,42 P F 1,42 P - F 3,42 P = 2 (see Figure 5 Journal of Clinical Sleep Medicine, Vol. 14, No. 1 34

5 Table 1 Participant characteristics. Variable Dim Red Light (n = 25) Bright White Light (n = 19) All Participants (n = 44) P* Sex Female 20 (80.0) 5 (20.0) Race White Other 5 (20.0) 22 (50.0) (50.0) Educational level Less than a college degree College degree or higher 23 (52.3) 2 (4.5) Employment status Full-time 5 (26.3) Part-time 0 (0.0) 5 (26.3) 22 (50.0) $80,000 or above 2 (8.0) Time since primary treatment, years 24 (54.5) Breast cancer 2 (8.0) 3 (6.8) Baseline fatigue and sleep scores Sleep quality, PSQI score.50 Total sleep time, hours.30 Wake after sleep onset, hours P Chronic Illness Therapy Fatigue, PSQI = Pittsburgh Sleep Quality Index. DISCUSSION morning may improve cancer-related fatigue in a mixed group related symptoms 4 - Journal of Clinical Sleep Medicine, Vol. 14, No. 1 35

6 Figure 2 P (P P Figure 3 Least squares mean and standard error bars for total sleep time over time. The repeated-measures linear mixed model showed that neither the main effect for time (P P P =.06). - 25, Journal of Clinical Sleep Medicine, Vol. 14, No. 1 36

7 Figure 4 included for reference. P P P =.003). tib = time in bed in hours. Figure 5 The repeated-measures linear mixed model showed that the main effects for time (P =.66) and for treatment condition (P P 28, Journal of Clinical Sleep Medicine, Vol. 14, No. 1 37

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9 SUBMISSION & CORRESPONDENCE INFORMATION Submitted for publication July 21, 2017 Accepted for publication September 26, 2017 DISCLOSURE STATEMENT Journal of Clinical Sleep Medicine, Vol. 14, No. 1 39