Lengacher, C.A., Reich, R.R., Paterson, C.L., Jim, H.S., Ramesar, S., Alinat, C.B., . . . Kip, K.E. (2015). The effects of mindfulness‐based stress reduction on objective and subjective sleep parameters in women with breast cancer: A randomized controlled trial. Psycho‐Oncology, 24, 424–432.

To investigate the effects of mindfulness-based stress reduction (MBSR) on sleep parameters in women with breast cancer

Patients were randomized to the MBSR group or a usual care wait-list control group. MBSR was delivered in two-hour weekly sessions six times, including educational materials related to relaxation, meditation, healthy lifestyle, practice of meditation, yoga, body scan and walking meditation, and supportive group interaction and discussion. Patients were asked to practice meditative techniques 15–45 minutes daily. Study measures were obtained at baseline, six weeks, and 12 weeks.

• N = 79–77 (completed 12 weeks)
• MEAN AGE = 57 years (SD = 9.7 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All patients were diagnosed with breast cancer and had completed initial treatment within two weeks to two years previously. All had surgery. About half had stage 3 or 4 disease.
• OTHER KEY SAMPLE CHARACTERISTICS: 73% Caucasian; 59,5% married; 80% had at least some college or vocational education; 40% had an income of $40,000 or more; 30% were employed more than 32 hours per week

• SITE: Multi-site
• SETTING TYPE: Outpatient  
• LOCATION: Florida, United States

• PHASE OF CARE: Transition phase after active treatment

Randomized, controlled trial

• ActiGraph
• Pittsburgh Sleep Quality Index (PSQI)
• Sleep diary for 72 hours after each study assessment

From baseline to six weeks, there were no differences between the groups. From 6–12 weeks, there were improvements in the MBSR group in sleep efficiency and the number of times patients awoke as measured by actigraphy (between groups Cohen’s d = 0.33 – 0.38; p = 0.04; p < 0.01). There were no differences between groups in PSQI or sleep diary findings. Sleep efficiency, the percent of time per night in sleep, was 78.2% in the MBSR group compared to 74.6% in the control group. All sleep parameters improved in both groups. There was no correlation between how much individuals practiced and sleep outcomes.

The use of MBSR resulted in improvements in some sleep parameters.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Unintended interventions or applicable interventions not described that would influence results
• Other limitations/explanation: No information was provided as to whether any patients were receiving other sleep-related interventions or medications. Compliance with actigraphy, home practice, and diary use was not clear. A 4% difference in sleep time was statistically significant and had a moderate effect size, but one might question if this is clinically relevant as well. It is not clear whether the six weekly sessions were given in the first six weeks or conducted every other week over the entire course of the study. Baseline sleep efficiency scores were 80%, suggesting there may be a ceiling effect in measure as well as a testing effect with repeated use of the PSQI.

The findings of this study suggest that MBSR as provided in this intervention might improve some sleep parameters compared to usual care control patients; however, sleep parameters did improve over time in all participants. This is a low-risk type of intervention, but it involves multiple sessions delivered in person. It is not known whether different delivery methods can be successful, what the appropriate and necessary timing should be, or what the frequency and duration of the delivered interventions should be.