Depressive Symptoms, Sleep Profiles and Serum Melatonin Levels in a Sample of Breast Cancer Patients
Received 26 February 2019
Accepted for publication 2 December 2019
Published 13 February 2020 Volume 2020:12 Pages 135—149
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 4
Editor who approved publication: Professor Steven A Shea
Nevin FW Zaki,1,2 Yomna M Sabri,2 Omar Farouk,3 Amany Abdelfatah,4 David Warren Spence,5 Ahmed S Bahammam,6,7 Seithikurippu R Pandi-Perumal8
1Sleep Research Unit, Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 2Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 3Mansoura University Oncology Center, Mansoura, Egypt; 4Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 5Independent Researcher, Toronto, ON, Canada; 6University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 7The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia; 8Somnogen Canada Inc, Toronto, ON, Canada
Correspondence: Nevin FW Zaki
Department of Psychiatry, Faculty of Medicine, Mansoura University, PO Box 36551, Mansoura, Egypt
Background: Chronobiological changes have been detected in various physiological functions of patients with breast cancer, suggesting dysregulation in the pineal gland and melatonin secretion. This study aimed to assess and measure serum melatonin levels pre- and postoperatively in patients who had been diagnosed for the first time with breast cancer.
Methods: A sample of first-time breast cancer patients, consisting of 45 women aged 25– 65 years, was evaluated and psychometric assessment was completed using the Beck Depression Inventory (BDI), Insomnia Severity Index (White, Weinberg et al) and the Epworth Sleepiness Scale (Cardoso, Spence et al). The Morningness-Eveningness questionnaire (MEQ) was used to assess the chronotype. Serum melatonin levels were measured by radioimmunoassay.
Results: Morning and moderately morning chronotypes were prevalent among the sample (25%, 45.8%, respectively). The finding of a mean BDI score of 13.5± 11.2 indicated that depressive symptoms were prevalent among the sample. Despite the finding that a mean of the participants apparently had no symptoms of daytime sleepiness (the mean and standard deviations of the ESS were 7.5± 4.4), scores on the ISI (a mean of 16.7±SD 7.3) indicated that insomnia symptoms were prevalent in the sample. Melatonin levels showed an inverse relationship with insomnia severity as measured by the ISI and depression severity, as assessed by the BDI. The postoperative melatonin levels were higher than the preoperative levels. Additionally, the psychometric profile differed among various pathological types of breast cancer according to their hormone receptor profile.
Conclusion: Serum melatonin levels correlated significantly with self-reported sleep quality and psychometric profiles of depression in the present sample of breast cancer patients. The melatonin assay, which is relatively easy to carry out, provided a convenient, objective measure of an important biological correlate of sleep quality and depression. This assay thus represented a confirmatory alternative to the self-report instruments, which may sometimes be unreliable. Future studies should further evaluate the utility of melatonin measures in psychiatric and sleep complaints of breast cancer patients.
Keywords: beck depression, breast cancer, chronotype, circadian, melatonin
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