Sleep quality, anxiety and depression in women with breast cancer: A cross-sectional study in the São Paulo metropolitan area
TL;DR
Sleep disorders are strongly associated with anxiety in women with breast cancer, highlighting the need for systematic screening and integrated psychological management in outpatient oncological care.
Abstract
INTRODUCTION The bidirectional relationship between mental health and sleep represents a central clinical challenge in oncological care. In women with breast cancer, hypothalamic-pituitary-adrenal axis hyperactivation and increased pro-inflammatory cytokines from treatment impair sleep architecture and amplify anxiety and depressive symptoms. In Brazil, poor sleep quality prevalence ranges from 16.1% to 35.1% in the general population, while international oncology studies report rates of 67–90%. Despite this, national data on the joint prevalence of sleep disorders and mental health symptoms in outpatients remain scarce.
Method
Analytical cross-sectional study with 211 women in outpatient breast cancer treatment at state hospitals in the São Paulo metropolitan region. Three validated instruments were applied: PSQI-BR (sleep quality), Epworth Sleepiness Scale (daytime sleepiness) and HADS (anxiety and depression), alongside a clinical-sociodemographic form. Sample size by Wald method (n=208; 95% CI). Analyses in Stata 17.0: Pearson correlation, chi-square, multiple linear and logistic regression. CEP-FMABC: CAAE 90818825.2.0000.0082. RESULT Poor sleep quality (PSQI≥5): 78.7% (95% CI: 72.5–84.1). Excessive daytime sleepiness (ESS≥10): 23.2%. Anxiety symptoms in 38.9%; depressive in 25.6%. Anxiety was associated with poor sleep quality (χ²=10.70; p=0.001); depression with sleepiness (χ²=4.16; p=0.041). Logistic regression: anxiety was the only independent predictor of poor sleep quality (OR=1.157; 95% CI: 1.042–1.285; p=0.006; AUC=0.734).
Discussion
Prevalence far exceeded that of the Brazilian general population, consistent with international oncology literature. Anxiety emerged as the main determinant, supporting the cognitive-emotional hyperarousal model.
Conclusion
Sleep disorders are strongly associated with anxiety in women with breast cancer, highlighting the need for systematic screening and integrated psychological management in outpatient oncological care.