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Sleep Disturbance In The First Year After Mastectomy Among Patients With Or Without Reconstruction
Sigurast S. Olafsson, Bachelor of Science1, Jason Clain, Doctor of Medicine2, K Mikayla Flowers, Master of Science3, Erin Taylor, Doctor of Medicine2, Jessica Erdmann-Sager, Doctor of Medicine2, Justin Broyles, Doctor of Medicine2, Kristin L. Shreiber, Doctor of Medicine, Doctor of Philosophy3.
1Harvard Medical School, Boston, MA, USA, 2Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA, 3Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.

Introduction: Reconstruction following mastectomy has become increasingly popular. Sleep disturbances following surgery have the potential to adversely impact quality of life. It is important for breast and reconstructive surgeons to understand how surgical extent, including reconstruction, may impact sleep habits of their patients. In this prospective longitudinal study, we aimed to examine sleep disturbance in patients who underwent mastectomy with and without reconstruction throughout the first year following surgery.
Methods: Patients completed the PROMIS Sleep Disturbance short form preoperatively and then at 2 weeks, 6 months, and 12 months post-operatively. Independent sample t-test or Mann-Whitney U tests were used to compare groups who did or did not receive reconstruction. Association of factors with sleep disturbance over time was investigated using GEE linear regression.
Results: This subset (n=123) of a larger cohort of postoperative patients included women who had a mastectomy with and without reconstruction; 34 (28%) had no reconstruction and 89 (72%) had reconstruction. Patients in the group receiving reconstruction were younger (49 vs 58 years, p=0.001) and had longer surgical duration (257 vs 132 minutes, p<0.001), but were not more likely to receive chemotherapy, radiation, or nodal surgery. Baseline anxiety, depression, or Pain Catastrophizing Score (PCS) was not different between groups. Sleep disturbance was higher in the reconstruction group at some later timepoints (6 and 12 months postoperatively (PROMIS sleep disturbance at 6 months:17.5 vs 22, p=0.003; PROMIS sleep disturbance at 6 months:18.7 vs 22.5, p=0.046). However, an overall model assessing sleep disturbance over the first year after surgery which concurrently took both age and surgical type into account, revealed that (younger) age (beta=-0.142, p=0.027), but not surgical type (beta=-2.704, p=0.113) was associated with greater sleep disturbance.
Conclusion: Overall, this study suggests that younger age, rather than surgical types, is associated with greater sleep disturbance in the first year after surgery.
Patients <50.5 years old
PROMIS Sleep Score By Reconstruction Group
Avg PROMIS Sleep Scorep-value
Pre-opNo recon23.220.733
With recon22.35
14d post-opNo recon27.100.820
With recon26.46
6m post-opNo recon20.250.293
With recon23.07
12m post-opNo recon18.440.178
With recon22.80
Patients >50.5 years old
PROMIS Sleep Score By Reconstruction Group
Avg PROMIS Sleep Scorep-value
Pre-opNo recon19.350.590
With recon20.49
14d post-opNo recon20.190.551
With recon21.86
6m post-opNo recon16.320.032
With recon20.65
12m post-opNo recon18.940.239
With recon21.97


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