JMIR Publications

ABSTRACT

Background:

Insomnia burdens breast cancer patients, exceeding prevalence in other malignancies. While excessive screen time is known to disrupts sleep in children and adolescents, its impact on breast cancer patients remains underexplored, particularly regarding how perceived stigma may modify screen-related sleep disruption.

Objective:

To investigate the associations between objectively measured total daily and self-reported pre-sleep screen time with incident insomnia in breast cancer patients, while assessing the effect measure modification by perceived stigma.

Methods:

This cross-sectional study recruited 778 breast cancer patients from the Department of Breast Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, between August 1, 2023, and February 20, 2024. Total daily and pre-sleep screen times were assessed as exposures, while incident insomnia, diagnosed according to the DSM-5, served as the main outcome. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between screen time and insomnia, employing hierarchical adjustment across three models.

Results:

Among the 240 participants with complete data on total daily screen time (median age, 51.8 years [SD, 10.6]), 77.5% were diagnosed with insomnia. In the 644 participants with data on pre-sleep screen time (median age, 53.5 years [SD, 10.8]), 65.1% met the criteria for insomnia. The median total daily screen time was 334.0 minutes (IQR, 232.5–440.3), while the median pre-sleep screen time was 30.0 minutes (IQR, 10.0–120.0). Each 30-minute increase in total daily and pre-sleep screen time raised insomnia odds by 14% (aOR 1.14; 1.05–1.23) and 41% (aOR 1.41; 1.26–1.57), respectively. High exposure conferred 2.46-fold (> median [334 min/day]) and 3.22-fold (> median [30 min]) elevated odds. Stratified by perceived stigma, participants with both high daily screen time and high stigma had the greatest incidence of insomnia (aOR 4.53 [1.42–14.49]). A similar pattern was seen for high pre-sleep screen time and high stigma (aOR 2.59[1.54-4.37]). However, effect measure modification was not significant on either the multiplicative or additive scale.

Conclusions:

This cross-sectional study revealed associations between screen time exposure and insomnia in breast cancer patients. These findings substantiate integrating screen time reduction into supportive oncology care as a modifiable insomnia mitigation target.