Sleep disturbance mediates the effect of vasomotor symptoms on mood in younger breast cancer survivors

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 498-531-Female Repro Endocrinology & Case Reports
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-507
Amanda Vincent*1, Sanjeeva Ranasinha2, Padaphet Sayakhot1, Darren Mansfield3 and Helena Jane Teede4
1Monash University, Clayton, Victoria, Australia, 2Monash University, Clayton VIC, Australia, 3Southern Health, Clayton, Victoria, Australia, 4Monash University, Clayton VIC, Australia
Aim: Treatment- induced early menopause occurs in over 80% of premenopausal women diagnosed with breast cancer (BC). The “domino theory” (1) postulates a causal inter-relationship between vasomotor symptoms (VMS), sleep disturbance and mood. This study investigated the relationship between VMS, sleep and mood in women aged 40-51 years with non-metastatic BC.

Method: Cross sectional observational study using validated questionnaires (Greene Climacteric Scale and Hospital Anxiety and Depression Scale (HADS)). Women (n=114) were recruited from the community and hospital outpatient clinics. Frequency determination and Structural Equation Modeling (SEM) were used to examine the relationship between (1) the latent variable, VMS with two indicators (hot flushes, night sweats) (2) anxiety, a latent variable with five indicators (heart beating quickly/ strongly, feeling tense/ nervous, difficulty in sleeping, panic attacks, excitable) (3) depression, a latent variable with five indicators (feeling tired/ lacking in energy, loss of interest in most things, feeling unhappy/depressed,  crying spells, irritability) and (4) the indicator variable, difficulty sleeping.

Results: The mean age of participants was 47 years and 94% became menopausal after BC diagnosis. Difficulty sleeping was reported by 82% of women with 45% reporting “quite a bit/ extremely”. Most women reported night sweats (77% of women with 47% reporting “quite a bit/extremely”) and hot flushes (84% of women with 50% reporting quite a bit/ extremely). HADS scores indicated clinically relevant depression and anxiety in 98% and 99% of BC women respectively.   SEM revealed that VMS contributed to difficulty sleeping (Standardized coefficient=0.54, p<0.001) and difficulty sleeping mediated the relationship between VMS and anxiety (Standardized coefficient =0.34, p=0.03). However difficulty sleeping did not have a significant direct impact on depression (Standardized coefficient =-0.03, p=0.8) although, anxiety was a strong predictor of depression (0.83, p=0.015). There was evidence to support the hypothesized model, χ2 (51, N=114) =86.06, p=0.002, Comparative Fit Index (CFI)= 0.94).

Conclusions: VMS, sleep and mood disturbance are commonly experienced by younger women with BC. In our model, VMS directly influence sleep disturbance but have an indirect effect on mood which is mediated by sleep disturbance. Sleep disturbance is a contributor to anxiety but other factors need to be identified

1.         Regestein QR. Menopause. 2010;17(1):16-8.

Nothing to Disclose: AV, SR, PS, DM, HJT

*Please take note of The Endocrine Society's News Embargo Policy at

Sources of Research Support: Victorian Cancer Agency Early Career Bench and Bedside Collaboration  awarded to PS.