Relationship between sleep-related impairment and cognitive functioning among breast cancer survivors

Abstract Purpose Sleep-related impairment and cancer-related cognitive decline (CRCD) are common, disruptive symptoms affecting breast cancer survivors. This study examined the association between sleep-related impairment and both self-reported and objective cognitive functioning in breast cancer survivors following treatment. Methods Participants ( N = 253) from the I Can! Improving Cognition After Cancer study completed the NIH Toolbox Digit Symbol test to measure Processing Speed and a battery of neurocognitive tests of Memory, Executive Functioning, and Attention domains. Self-reported cognition was assessed with the PROMIS Cognitive Function and Abilities scales. Sleep-related impairment was measured by the PROMIS Sleep-Related Impairment scale. Multiple linear regression models were used to examine the associations between sleep-related impairment and the six cognitive outcomes, adjusting for demographic and cancer treatment factors. Results Participants were on average 59 (SD = 8.9) years old, majority identified as White (77%) and were college graduates (42%). Fifty-seven percent of participants underwent chemotherapy, 80% received hormone therapy, and 81% were treated with radiation. Greater sleep-related impairment was significantly associated with worse executive function ( β = −0.01, 95% CI: −0.022, −0.000, p = 0.04), worse cognitive abilities ( β = −0.28, 95% CI: −0.375, −0.184, p < 0.001), and worse cognitive function ( β = −0.25, 95% CI: −0.323, −0.167, p < 0.001). No significant associations were observed for memory, attention, or processing Speed. Conclusion Greater sleep-related impairment was associated with poorer self-reported cognitive functioning and modest differences in executive functioning among breast cancer survivors, underscoring the importance of addressing sleep-related impairment in this population. Implications for Cancer Survivors Assessing sleep-related impairment during survivorship care may help identify survivors experiencing cognitive difficulties and related daytime functional concerns.