***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study examined the relationship between objective ly measured nocturnal hot flashes and objective ly measured sleep in breast cancer survivors with insomnia . Twenty-four women who had completed treatment for non-metastatic breast cancer participated . All were enrolled in a study of cognitive-behavioral treatment for chronic insomnia .  Nocturnal hot flashes and sleep  were measured by skin conductance and polysomnography  , respectively . The 10-minute periods around hot flashes were found to have significantly more wake time , and more stage changes to lighter sleep , than other 10-minute periods during the night . Nights with hot flashes had a significantly higher percentage of wake time , a lower percentage of Stage 2 sleep , and a longer REM latency compared to nights without hot flashes . Overall , hot flashes were found to be associated with less efficient , more disrupted sleep . Nocturnal hot flashes , or their underlying mechanisms , should be considered as potential contributors to sleep disruption in women with breast cancer who report poor sleep ABSTRACT Epidemiological and animal studies have suggested an association between habitual sleep patterns and cardiovascular ( CV ) disease , but the results are still controversial . Therefore , the aims of this study are to investigate the relationships between habitual sleep patterns and CV disease based on Prospect i ve Urban Rural Epidemiology ( PURE ) China study . PURE China study recruited 46 285 participants , aged 35–70 , from 12 provinces and 115 communities in China . Habitual sleep patterns and CV disease were self-reported . Multilevel logistic regression was used in our analysis . In this study , 39 515 participants were eligible in our analysis , including 23 345 ( 59.1 % ) women and 16 170 ( 40.9 % ) men . Sleeping ≥9 h per day was associated with increased odds of CV disease ( OR = 1.16 , 95 % CI : 1.01–1.32 , p = 0.033 ) compared with sleeping 7–8 h per day . Taking daytime naps was also associated with an increased odds of CV disease , and the CV odds increased with increasing napping duration ( p for trend < 0.001 ) . For the sleeping < 6 h per day , we only found an association with coronary artery disease ( CAD ) ( OR = 1.58 , 95 % CI : 1.01–2.48 , p = 0.046 ) . Participants with only 7–8 h sleep per night had lowest prevalence of CV disease ( OR = 0.77 , 95 % CI : 0.65–0.90 , p = 0.001 ) compared with other sleep patterns . Napping , long and short duration of habitual sleep may increase the odds of CV disease . Only participants sleeping 7–8 hours at night are recommended in this study , and large longitudinal studies are needed to confirm these results Hypotheses . Sleep disorders are associated with an increased risk of cancer , including breast cancer ( BC ) .  Physical activity ( PA ) can produce beneficial effects on sleep . Study design . We design ed a r and omized controlled trial to test the effect of 3 months of physical activity on sleep and circadian rhythm activity level evaluated by actigraphy . Methods . 40 BC women , aged 35 - 70 years , were r and omized into an intervention ( IG ) and a control group ( CG ) . IG performed a 3 month of aerobic exercise . At baseline and after 3 months , the following parameters were evaluated both for IG and CG : anthropometric and body composition measurements , energy expenditure and motion level ; sleep parameters ( Actual Sleep Time-AST , Actual Wake Time-AWT , Sleep Efficiency-SE , Sleep Latency-SL , Mean Activity Score-MAS , Movement and Fragmentation Index-MFI and Immobility Time-IT ) and activity level circadian rhythm using the Actigraph Actiwatch . Results . The CG showed a deterioration of sleep , whereas the IG showed a stable pattern . In the CG the SE , AST and IT decreased and the AWT , SL , MAS and MFI increased . In the IG , the SE , IT , AWT , SL , and MAS showed no changes and AST and MFI showed a less pronounced change in the IG than in the CG . The rhythmometric analysis revealed a significant circadian rhythm in two groups . After 3 months of PA , IG showed reduced fat mass % , while CG had improved weight and BMI . Conclusion . Physical activity may be beneficial against sleep disruption . Indeed , PA prevented sleep worsening in IG . PA can represent an integrative intervention therapy able to modify sleep behaviour Background Many breast cancer survivors experience fatigue , mood , and sleep disturbances .  Purpose This study aims to compare a meditative movement practice , Qigong/Tai Chi Easy ( QG/TCE ) with sham Qigong ( SQG ) , testing effects of meditation/breath aspects of QG/TCE on breast cancer survivors ’ persistent fatigue and other symptoms . Methods This double-blind , r and omized controlled trial tested 12 weeks of QG/TCE versus SQG on fatigue , depression , and sleep among 87 postmenopausal , fatigued breast cancer survivors , stages 0–III , age 40–75 .  Results Fatigue decreased significantly in the QG/TCE group compared to control at post-intervention ( p = 0.005 ) and 3 months follow-up ( p = 0.024 ) , but not depression and sleep quality . Improvement occurred over time for both interventions in depression and sleep quality ( all p < 0.05 ) . Conclusions QG/TCE showed significant improvement over time compared to SQG  for fatigue , but not depression or sleep . Both QG/TCE and SQG showed improvement for two prevalent symptoms among breast cancer survivors , depression and sleep dysfunction OBJECTIVE To investigate the associations between sleep duration and mortality in the elderly by controlling for sleep quality . METHOD Data were collected from participants in a cohort study in Shizuoka , Japan . A total of 14,001 elderly residents ( aged 65 - 85 years ) , r and omly chosen from all 74 municipalities in the prefecture , completed question naires that evaluated sleep duration , sleep complaints , and the use of hypnotics . Participants were followed from 1999 to 2006 . We analyzed 11,395 subjects to estimate the hazard ratios ( HR ) for mortality from all causes and cardiovascular disease ( CVD ) . RESULTS With 60,252 person-years , 1004 deaths were identified . While short sleep duration and mortality were not associated , longer sleep duration was associated with higher risk of mortality in both sexes . Compared with those who slept 7 h , the multivariate HR and 95 % confidence interval of CVD mortality for those who slept > or = 10 h was 1.95 ( 1.18 - 3.21 ) and , for those who slept < or = 5 h , it was 1.10 ( 0.62 - 1.93 ) . Although no clear association was found between sleep quality and mortality , long sleep duration was associated with higher risk of CVD mortality among those with poor sleep quality . CONCLUSION Long sleep duration is associated with higher risk of CVD mortality among the elderly with poor sleep quality OBJECTIVE To improve mechanistic underst and ing , this pilot r and omized controlled trial examined mediators of an exercise intervention effects on sleep in breast cancer survivors ( BCS ) . METHODS Forty-six postmenopausal BCS ( ≤Stage II , off primary treatment ) were r and omized to a 3-month exercise intervention or control group . Intervention included 160 min/week of moderate intensity aerobic walking , twice weekly resistance training ( resistance b and s ) , and six discussion groups ( to improve adherence ) . Blinded assessment s at baseline and post-intervention included sleep disturbance ( PSQI and PROMIS ® ) , objective sleep quality ( accelerometer ) , serum cytokines , accelerometer physical activity , cardiorespiratory fitness , body composition , fatigue , and psychosocial factors . Mediation was tested using Freedman-Schatzkin difference-in-coefficients tests . RESULTS When compared with control , the intervention group demonstrated a significant increase in PSQI sleep duration ( i.e. , fewer hours of sleep/night ) ( d = 0.73 , p = .03 ) . Medium to large but non-significant st and ardized effect sizes were noted for PSQI daytime somnolence ( d = -0.63 , p = .05 ) and accelerometer latency ( d = -0.49 , p = .14 ) . No statistically significant mediators were detected for PSQI sleep duration score or accelerometer latency . Daytime somnolence was mediated by tumor necrosis factor-alpha ( mediated 23 % of intervention effect , p < .05 ) , interleukin (IL)-6:IL-10 ( 16 % , p < .01 ) , IL-8:IL-10 ( 26 % , p < .01 ) , and fatigue ( 38 % , p < .05 ) . Mediating or enhancing relationships for several of the sleep outcomes were noted for accelerometer physical activity , PROMIS ® fatigue , exercise social support , and /or physical activity enjoyment . CONCLUSIONS Inflammation and psychosocial factors may mediate or enhance sleep response to our exercise intervention . Further study is warranted to confirm our results and translate our findings into more effective interventions aim ed at improving sleep quality in BCS Background Cancer-related fatigue ( CRF ) and insomnia are major complaints in breast cancer survivors ( BC ) .  Aerobic training ( AT ) , the st and ard therapy for CRF in BC , shows only minor to moderate treatment effects . Other evidence -based treatments include cognitive behavioral therapy , e.g. , sleep education/restriction ( SE ) and mindfulness-based therapies . We investigated the effectiveness of a 10-week multimodal program ( MT ) consisting of SE , psycho-education , eurythmy- and painting-therapy , administered separately or in combination with AT ( CT ) and compared both arms to AT alone . Methods In a pragmatic comprehensive cohort study BC with chronic CRF were allocated r and omly or by patient preference to ( a ) MT , ( b ) CT ( MT + AT ) or ( c ) AT alone . Primary endpoint was a composite score of the Pittsburgh Sleep Quality Index and the Cancer Fatigue Scale after 10 weeks of intervention ( T1 ) ; a second endpoint was a follow-up assessment 6 months later ( T2 ) . The primary hypothesis stated superiority of CT and non-inferiority of MT vs. AT at T1 . A closed testing procedure preserved the global α-level . The intention-to-treat analysis included propensity scores for the mode of allocation and for the preferred treatment , respectively . Results Altogether 126 BC were recruited : 65 were r and omized and 61 allocated by preference ; 105 started the intervention . Socio-demographic parameters were generally balanced at baseline . Non-inferiority of MT to AT at T1 was confirmed ( p < 0.05 ) , yet the confirmative analysis stopped as it was not possible to confirm superiority of CT vs. AT ( p = 0.119 ) . In consecutive exploratory analyses MT and CT were superior to AT at T1 and T2 ( MT ) or T2 alone ( CT ) , respectively . Conclusions The multimodal CRF-therapy was found to be confirmatively non-inferior to st and ard therapy and even yielded exploratively sustained superiority . A r and omized controlled trial including a larger sample size and a longer follow-up to evaluate multimodal CRF-therapy is highly warranted . Trial registerDRKS-ID : DRKS00003736 . Recruitment period June 2011 to March 2013 . Date of registering 19 June 2012 PURPOSE S/ OBJECTIVES To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidence d by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate . DESIGN Experimental , two-group pretest , post-test . SETTING Two university teaching hospital outpatient radiation therapy departments . SAMPLE 46 women beginning a six-week program of radiation therapy for early stage breast cancer . METHODS Following r and om assignment , subjects in the exercise group maintained an individualized , self-paced , home-based walking exercise program throughout treatment . The control group received usual care . Dependent variables were measured prior to and at the end of radiation therapy . In addition , symptoms were assessed at the end of three weeks of treatment . MAIN RESEARCH VARIABLES Participation in the walking exercise program , physical functioning fatigue , emotional distress , and difficulty sleeping . FINDINGS Hypothesis testing by multivariate analysis of covariance , with pretest scores as covariates , indicated significant differences between groups on outcome measures ( p < 0.001 ) . The exercise group scored significantly higher than the usual care group on physical functioning ( p = 0.003 ) and symptom intensity , particularly fatigue , anxiety , and difficulty sleeping . Fatigue was the most frequent and intense subjective symptom reported . CONCLUSIONS A self-paced , home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy . IMPLICATION S FOR NURSING PRACTICE Nurse-prescribed and -monitored exercise is an effective , convenient , and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment PURPOSE Interventions to increase physical activity among breast cancer survivors are needed to improve health and quality of life and possibly to reduce the risk of disease recurrence and early mortality . Therefore , we report the feasibility and preliminary outcomes of a pilot r and omized trial design ed to increase physical activity in sedentary breast cancer survivors receiving horm 
    Output:
    
Subgroup analyses revealed no clear differences between interventions conducted during versus after breast cancer treatment .
Regarding the objective measurements , no significant effects were found .
Conclusions Physical as well as mind – body exercise can improve subjective sleep problems  in breast cancer patients .
In contrast , there was no effect of exercise on objective sleep measures .