Better sleep yields greater weight loss for breast cancer survivors

Breast cancer survivors who have adequate sleep achieve greater benefits from behavioural weight loss (BWL) intervention than those with poor sleep, according to the results from the POWER-Remote trial.

“Among breast cancer survivors receiving a 12-month behavioural intervention, those who reported poor sleep at baseline had only half the weight loss of those with better sleep,” the researchers said.

In POWER-remote, women with prior stage 0 to III breast cancer with BMI ≥25 kg/m² were randomly allocated to BWL (n=47) or self-directed approach (n=46). The research team collected weight and self-reported sleep (NIH PROMIS Adult Sleep Disturbance Short Form) at baseline and at 6 and 12 months.

Multiple regression analyses were also conducted to examine the relationships of the study arms, age, baseline sleep, and BMI with weight loss in both the full sample and cohorts stratified by baseline sleep.

A significant interaction was observed between baseline sleep and treatment (BWL vs self-directed) for weight loss at 6 (p=0.024) and 12 months (p=0.019). [Obesity 2026;34:334-343]

Sleep quality

Weight loss among better sleepers was ‒6.16 percent and ‒7.53 percent at 6 (p<0.001) and 12 months (p=0.001) in BWL vs self-directed arms, respectively, while that among poor sleepers was ‒3.15 percent and ‒2.44 percent at 6 (p=0.056) and 12 months (p=0.321), respectively. The effect of BWL was greater among better sleepers and minimal among poor sleepers.

Specifically, 51 percent of women in the BWL arm lost at least 5 percent of their baseline body weight at 6 months relative to just 12 percent of those in the self-directed arm (odds ratio [OR], 7.9, 95 percent confidence interval [CI], 2.6‒23.9; p=0.0003). These findings persisted at 12 months (51 percent vs 17 percent; OR, 5.2, 95 percent CI, 1.8‒14.2; p=0.003).

“While these findings are promising and consistent with both the general obesity literature and cancer weight loss studies, greater understanding of other modifiable factors that may augment BWL approaches is needed,” the researchers said. [Curr Breast Cancer Rep 2013;5:222-246]

“Our findings demonstrate a strong association between sleep disturbance and weight loss with the POWER-remote intervention, but they do not show a strong association with the self-directed approach,” they added.

Obesity

One potential reason for the greater weight loss in the sleep subgroups in the BWL but not the self-directed arm is the bidirectional association between exercise, a major component of the BWL intervention, and sleep, according to the researchers.

“Overall, there is a pressing need for future randomized studies to determine if detection and subsequent treatment of sleep disturbances are a critical and neglected component of weight loss treatment,” they said.

Breast cancer survivors with obesity are at greater risk of recurrence (12 percent to 19 percent) and mortality (21 percent to 22 percent). [Breast Cancer 2022;29:575-588]

“Obesity at and following breast cancer diagnosis is associated with reduced quality of life and increased risk of adverse treatment effects (eg, neuropathy),” the researchers said. [J Natl Cancer Inst 2017;109:djw206]

“While challenging, addressing overweight and obesity by adapting treatment to individual characteristics, such as sleep disturbance, may ultimately improve weight loss, and potentially survival outcomes, in women with early-stage breast cancer,” they added.