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Publications

Journal Article Ahead of print

PubMed: 42933582 DOI: 10.1016/j.bbi.2026.107089

Self-reported sleep disturbances during chemotherapy mediate circulating IL-1β effects on subjective cognitive decline in breast cancer patients.

Brain Behav Immun

Authors: Zoe M Tapp, Jeremy T Beales, Seth Adarkwah Yiadom, Sagar D Sardesai, Nicole O Williams, Margaret E Gatti-Mays, Daniel G Stover, Preeti K Sudheendra, Erica Dawson, Robert Wesolowski, Rebecca R Andridge, Leah M Pyter

Affiliations

  • Institute of Brain, Behavior and Immunology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
  • Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
  • Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
  • Department of Neurology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
  • Institute of Brain, Behavior and Immunology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
  • Institute of Brain, Behavior and Immunology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
  • Institute of Brain, Behavior and Immunology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Abstract

Chemotherapy can cause cognitive decline that may persist for years after treatment and reduce quality of life in cancer patients. Identifying factors during chemotherapy that contribute to post-treatment side effects could inform strategies to prevent or mitigate long-term consequences. Sleep disturbances, particularly difficulty falling or staying asleep, are highly prevalent during chemotherapy and can exacerbate cognitive symptoms. Although cross-sectional associations among cognitive decline, sleep disturbances, and inflammatory markers have been examined in cancer patients, the longitudinal dynamics of sleep and inflammation during treatment related to post-treatment cognition remain unclear. We hypothesized that increased sleep disturbances during chemotherapy predict worse cognitive decline after treatment, mediated by increased pro-inflammatory markers. To test this, 75 breast cancer patients provided blood samples to measure circulating inflammatory markers (IL-6, TNFα, IL-1β, CRP), completed questionnaires assessing sleep disturbance and perceived cognition, and underwent objective cognitive testing. Assessments occurred before, during, and approximately three months after chemotherapy. Longitudinal relationships among sleep disturbances, inflammation, and cognition were evaluated. Sleep disturbances increased during chemotherapy associated with concurrent increases in IL-6, TNFα, and IL-1β. Increased sleep disturbances during chemotherapy predicted decreased subjective, but not objective, cognition after treatment. Among inflammatory markers, increased IL-1β during chemotherapy predicted worse subjective cognition after treatment. Contrary to our hypothesis, sleep disturbances mediated the relationship between elevated IL-1β during chemotherapy and post-treatment subjective cognitive decline. These findings highlight sleep disturbance as a key, modifiable factor during chemotherapy that predicts persistent cognitive symptoms and suggest that improving sleep may mitigate cognitive deficits without directly modulating inflammation.

MeSH

Neurobehavioral Manifestations, Breast Neoplasms, Sleep, Neoplasms, Cognitive Dysfunction, Drug Therapy, Aftercare, Signs And Symptoms, Breast, Therapeutics, Cognition, Chemotherapy