Analysis of postoperative sleep quality and influencing factors in patients with non-small cell lung cancer

doi:10.19983/j.issn.2096-8493.20230027

Abstract

Abstract:

Objective: To analyze the sleep quality status and influencing factors of non-small-cell lung cancer (NSCLC) patients within one month postoperative. Methods: The convenience sampling method was used for survey questionnaire (including general information questionnaire and Pittsburgh Sleep Quality Index (PSQI)) in 163 NSCLC patients who underwent thoracoscopic surgery from the Department of Thoracic Surgery of Shanghai Pulmonary Hospital, from January to February 2022. Univariate and multivariate logistic regressions were used to analyze the influencing factors of sleep quality in postoperative patients with NSCLC. Results: Excluding 8 questionnaires that did not meet the inclusion criteria, 155 patients were finally included as the study subjects in the analysis. The results revealed that the score (M(Q₁,Q₃)) of sleep quality was 8.00 (5.00, 12.00). The prevalence of sleep disturbances was 56.8% (88/155), mainly included frequent nighttime cough (>3 episodes per week)(44.5% (69/155)) and frequent nighttime awakeners (>3 episodes per week)(40.0% (62/155)). Multivariate logistic regression analysis revealed that female, postoperative pain, >7d retention of chest tube were more susceptible to cause sleep disturbance during the postoperative period (OR (95%CI)=2.786 (1.201-6.460), 4.731 (1.881-11.898), and 4.855 (1.010-23.348); P=0.017, 0.001 and 0.049, respectively). Lung segmentectomy appeared to be a protective factor associated with better sleep quality (OR (95%CI)=0.305 (0.101-0.922), P=0.035). Conclusion: Poor sleep quality was prevalent among participants with NSCLC patients within 1 month after surgery. Patients of middle-aged and older female received lobectomy, with >7d retention of chest tube, and suffered postoperative pain had poorer sleep quality, and they should be paid more attention. Individualized nursing measures and health education programs based on patients’ demography characteristics and symptom groups could reduce the incidence of postoperative sleep disorders and improve the prognosis of NSCLC patients.

Key words: Carcinoma, non-small-cell lung, Postoperative care, Pulmonary surgical procedures, Sleep disorders, Sickness impact profile

CLC Number:

R473.73

Chen Xinxin, Li Yumei, Yang Yingzi, Hu Yachen, Fan Jiaxin. Analysis of postoperative sleep quality and influencing factors in patients with non-small cell lung cancer[J]. Journal of Tuberculosis and Lung Disease , 2023, 4(3): 203-209. doi: 10.19983/j.issn.2096-8493.20230027

Figures/Tables 4

自变量	β值	s $x ˉ$ 值	Wald χ²值	OR (95%CI)值	P值
年龄(岁)
0~44				1.000
45~64	0.933	0.534	3.049	2.541(0.892~7.237)	0.081
≥65	-0.083	0.706	0.014	0.920(0.231~3.670)	0.906
女性	1.024	0.429	5.698	2.786(1.201~6.460)	0.017
文化程度
小学及以上				1.000
初中	-0.119	0.732	0.026	0.888(0.211~3.729)	0.871
高中/中专	-1.067	0.729	2.139	0.344(0.082~1.437)	0.144
大专及以上	-1.053	0.752	1.964	0.349(0.080~1.522)	0.161
油烟接触史
无				1.000
二手烟	0.882	0.544	2.628	2.415(0.832~7.010)	0.105
环境油烟	0.919	0.594	2.389	2.506(0.782~8.034)	0.122
手术方式
肺叶切除术				1.000
肺段切除术	-1.187	0.564	4.427	0.305(0.101~0.922)	0.035
其他	-0.243	0.496	0.240	0.784(0.297~2.072)	0.624
留置胸管时间>7d	1.580	0.801	3.888	4.855(1.010~23.348)	0.049
疼痛	1.554	0.471	10.906	4.731(1.881~11.898)	0.001
咳嗽	0.264	0.516	0.263	1.303(0.474~3.579)	0.608

References 39

[1]	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2021, 71(3):209-249. doi:10.3322/caac.21660. doi: 10.3322/caac.21660 URL
[2]	Ton TT, Kovi RC, Peddada TN, et al. Cobalt-induced oxidative stress contributes to alveolar/bronchiolar carcinogenesis in B6C3F1/N mice. Arch Toxicol, 2021, 95(10):3171-3190. doi:10.1007/s00204-021-03146-5. doi: 10.1007/s00204-021-03146-5
[3]	Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1):17-48. doi:10.3322/caac.21763. doi: 10.3322/caac.21763 URL
[4]	Granger CL, McDonald CF, Irving L, et al. Low physical activity levels and functional decline in individuals with lung cancer. Lung Cancer, 2014, 83(2):292-299. doi:10.1016/j.lungcan.2013.11.014. doi: 10.1016/j.lungcan.2013.11.014 pmid: 24360323
[5]	Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol, 2010, 28(2):292-298. doi:10.1200/JCO.2009.22.5011. doi: 10.1200/JCO.2009.22.5011 pmid: 19933917
[6]	黎银焕, 周燕斌, 黄琬玲, 等. 肺癌患者睡眠与生活质量影响因素的回归分析. 中华肿瘤防治杂志, 2011, 18(23):1874-1877. doi:10.16073/j.cnki.cjcpt.2011.23.018. doi: 10.16073/j.cnki.cjcpt.2011.23.018
[7]	He Y, Sun LY, Peng KW, et al. Sleep quality, anxiety and depression in advanced lung cancer: patients and caregivers. BMJ Support Palliat Care, 2022, 12(e2):e194-e200. doi:10.1136/bmjspcare-2018-001684. doi: 10.1136/bmjspcare-2018-001684
[8]	Rampes S, Ma K, Divecha YA, et al. Postoperative sleep disorders and their potential impacts on surgical outcomes. J Biomed Res, 2019, 34(4):271-280. doi:10.7555/JBR.33.20190054. doi: 10.7555/JBR.33.20190054 pmid: 32519977
[9]	Martin RE, Loomis DM, Dean GE. Sleep and quality of life in lung cancer patients and survivors. J Am Assoc Nurse Pract, 2021, 34(2):284-291. doi:10.1097/JXX.0000000000000625. doi: 10.1097/JXX.0000000000000625 pmid: 34225324
[10]	方积乾. 卫生统计学. 7版. 北京: 人民卫生出版社, 2012.
[11]	刘丹. 临床科研项目样本量的要求. 中国医学伦理学, 2019, 32(6):716-718. doi:10.12026/j.issn.1001-8565.2019.06.06. doi: 10.12026/j.issn.1001-8565.2019.06.06
[12]	臧瑜, 于虹, 李妍, 等. 肺癌患者症状群的调查研究. 中华护理杂志, 2016, 51(3):316-320. doi:10.3761/j.issn.0254-1769.2016.03.012. doi: 10.3761/j.issn.0254-1769.2016.03.012
[13]	Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res, 1989, 28(2):193-213. doi:10.1016/0165-1781(89)90047-4. doi: 10.1016/0165-1781(89)90047-4 URL
[14]	张作记. 行为医学量表手册. 北京: 中华医学电子音像出版社, 2013.
[15]	路桃影, 李艳, 夏萍, 等. 匹兹堡睡眠质量指数的信度及效度分析. 重庆医学, 2014, 43(3):260-263. doi:10.3969/j.issn.1671-8348.2014.03.002. doi: 10.3969/j.issn.1671-8348.2014.03.002
[16]	Bhaisare S, Gupta R, Saini J, et al. Sleep-Disordered Brea-thing in Newly Diagnosed Patients of Lung Cancer. Cureus, 2022, 14(5):e25230. doi:10.7759/cureus.25230. doi: 10.7759/cureus.25230
[17]	Chen HM, Tsai CM, Wu YC, et al. Effect of walking on circadian rhythms and sleep quality of patients with lung cancer: a randomised controlled trial. Br J Cancer, 2016, 115(11):1304-1312. doi:10.1038/bjc.2016.356. doi: 10.1038/bjc.2016.356
[18]	谷庆隆. 上气道咳嗽综合征的诊断与鉴别. 中国医刊, 2020, 55(10):1049-1051. doi:10.3969/j.issn.1008-1070.2020.10.002. doi: 10.3969/j.issn.1008-1070.2020.10.002
[19]	中国睡眠研究会. 中国失眠症诊断和治疗指南. 中华医学杂志, 2017, 97(24): 1844-1856. doi:10.3760/cma.j.issn.0376-2491.2017.24.002. doi: 10.3760/cma.j.issn.0376-2491.2017.24.002
[20]	Ida M, Onodera H, Yamauchi M, et al. Preoperative sleep disruption and postoperative functional disability in lung surgery patients: a prospective observational study. J Anesth, 2019, 33(4):501-508. doi:10.1007/s00540-019-02656-y. doi: 10.1007/s00540-019-02656-y pmid: 31190287
[21]	Haack M, Simpson N, Sethna N, et al. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology, 2020, 45(1):205-216. doi:10.1038/s41386-019-0439-z. doi: 10.1038/s41386-019-0439-z pmid: 31207606
[22]	Chen Y, Lu X, Hu L. Transcutaneous Auricular Vagus Nerve Stimulation Facilitates Cortical Arousal and Alertness. Int J Environ Res Public Health, 2023, 20(2):1402. doi:10.3390/ijerph20021402. doi: 10.3390/ijerph20021402 URL
[23]	Choi E, Wan E, Kwok J, et al. The mediating role of sleep quality in the association between nocturia and health-related quality of life. Health Qual Life Outcomes, 2019, 17(1):181. doi:10.1186/s12955-019-1251-5. doi: 10.1186/s12955-019-1251-5
[24]	Balbo M, Leproult R, Van Cauter E. Impact of sleep and its disturbances on hypothalamo-pituitary-adrenal axis activity. Int J Endocrinol, 2010, 2010:759234. doi:10.1155/2010/759234. doi: 10.1155/2010/759234
[25]	Bollinger T, Bollinger A, Oster H, et al. Sleep, immunity, and circadian clocks: a mechanistic model. Gerontology, 2010, 56(6):574-580. doi:10.1159/000281827. doi: 10.1159/000281827 pmid: 20130392
[26]	Barta JA, Powell CA, Wisnivesky JP. Global Epidemiology of Lung Cancer. Ann Glob Health, 2019, 85(1):8. doi:10.5334/aogh.2419. doi: 10.5334/aogh.2419
[27]	刘威, 周灵, 沈红梅. 晚期非小细胞肺癌患者化疗前后睡眠及生活质量变化及相互关系的研究. 华中科技大学学报(医学版), 2019, 48(1):98-103. doi:10.3870/j.issn.1672-0741.2019.01.019. doi: 10.3870/j.issn.1672-0741.2019.01.019
[28]	Han MK, Arteaga-Solis E, Blenis J, et al. Female Sex and Gender in Lung/Sleep Health and Disease. Increased Understanding of Basic Biological, Pathophysiological, and Behavioral Mechanisms Leading to Better Health for Female Patients with Lung Disease. Am J Respir Crit Care Med, 2018, 198(7):850-858. doi:10.1164/rccm.201801-0168WS. doi: 10.1164/rccm.201801-0168WS URL
[29]	Santhi N, Lazar AS, McCabe PJ, et al. Sex differences in the circadian regulation of sleep and waking cognition in humans. Proc Natl Acad Sci U S A, 2016, 113(19):E2730-E2739. doi:10.1073/pnas.1521637113. doi: 10.1073/pnas.1521637113
[30]	Natale P, Ruospo M, Saglimbene VM, et al. Interventions for improving sleep quality in people with chronic kidney disease. Cochrane Database Syst Rev, 2019, 5(5):CD012625. doi:10.1002/14651858.CD012625. doi: 10.1002/14651858.CD012625
[31]	赵亚楠. 基于下丘脑—垂体—肾上腺轴探讨“通督调神”针法干预慢性失眠症的临床研究. 南京:南京中医药大学, 2020. doi:10.27253/d.cnki.gnjzu.2020.000333. doi: 10.27253/d.cnki.gnjzu.2020.000333
[32]	Verspeek J, Behringer V, Laméris DW, et al. Time-lag of urinary and salivary cortisol response after a psychological stressor in bonobos (Pan paniscus). Sci Rep, 2021, 11(1):7905. doi:10.1038/s41598-021-87163-5. doi: 10.1038/s41598-021-87163-5 pmid: 33846457
[33]	Dai W, Chang S, Pompili C, et al. Early Postoperative Patient-Reported Outcomes After Thoracoscopic Segmentectomy Versus Lobectomy for Small-Sized Peripheral Non-small-cell Lung Cancer. Ann Surg Oncol, 2022, 29(1):547-556. doi:10.1245/s10434-021-10946-7. doi: 10.1245/s10434-021-10946-7
[34]	Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1):289-301.e2. doi:10.1016/j.jtcvs.2020.09.146. doi: 10.1016/j.jtcvs.2020.09.146 URL
[35]	Murakami J, Ueda K, Tanaka T, et al. The Validation of a No-Drain Policy After Thoracoscopic Major Lung Resection. Ann Thorac Surg, 2017, 104(3):1005-1011. doi:10.1016/j.athoracsur.2017.03.030. doi: S0003-4975(17)30444-7 pmid: 28610883
[36]	冯锐, 冯競, 邹宗望, 等. 快速康复外科在早期非小细胞肺癌微创手术中临床应用. 中华肿瘤防治杂志, 2020, 27(8):653-657. doi:10.16073/j.cnki.cjcpt.2020.08.12. doi: 10.16073/j.cnki.cjcpt.2020.08.12
[37]	Wei X, Yu H, Dai W, et al. Discrepancy in the perception of symptoms among patients and healthcare providers after lung cancer surgery. Support Care Cancer, 2022, 30(2):1169-1179. doi:10.1007/s00520-021-06506-0. doi: 10.1007/s00520-021-06506-0
[38]	Nishiura M, Tamura A, Nagai H, et al. Assessment of sleep disturbance in lung cancer patients: relationship between sleep disturbance and pain, fatigue, quality of life, and psychological distress. Palliat Support Care, 2015, 13(3):575-581. doi:10.1017/S1478951513001119. doi: 10.1017/S1478951513001119 pmid: 24524428
[39]	Whibley D, AlKandari N, Kristensen K, et al. Sleep and Pain: A Systematic Review of Studies of Mediation. Clin J Pain, 2019, 35(6):544-558. doi:10.1097/AJP.0000000000000697. doi: 10.1097/AJP.0000000000000697 pmid: 30829737

维度	PSQI得分分布[例(构成比,%)]				PSQI得分 [分,M(Q₁,Q₃)]
维度	0分	1分	2分	3分	PSQI得分 [分,M(Q₁,Q₃)]
主观睡眠质量	23(14.8)	75(48.4)	46(29.7)	11(7.1)	1.00(1.00,2.00)
入睡时间	22(14.2)	54(34.8)	41(26.5)	38(24.5)	2.00(1.00,2.00)
睡眠时间	57(36.8)	35(22.6)	45(29.0)	18(11.6)	1.00(0.00,2.00)
睡眠效率	43(27.7)	36(23.3)	33(21.3)	43(27.7)	1.00(0.00,3.00)
睡眠障碍	4(2.6)	65(41.9)	66(42.6)	20(12.9)	2.00(1.00,2.00)
催眠药物	136(87.7)	3(2.0)	5(3.2)	11(7.1)	0.00(0.00,0.00)
日间功能障碍	28(18.1)	50(32.3)	49(31.5)	28(18.1)	1.00(1.00,2.00)

项目	非睡眠障碍组(67例)		睡眠障碍组(88例)		χ²值	P值
项目	例数	构成比/发生率(%)	例数	构成比/发生率(%)	χ²值	P值
年龄组(岁)					6.228	0.044
0~44	22	32.8	15	17.0
45~64	26	38.8	49	55.7
≥65	19	28.4	24	27.3
性别					6.575	0.010
男性	35	52.2	28	31.8
女性	32	47.8	60	68.2
体质量指数^a	23.98±3.14		23.46±2.92		t=1.053	0.294
文化程度					9.000	0.029
小学及以下	8	11.9	17	19.3
初中	11	16.4	28	31.8
高中/中专	18	26.9	20	22.7
大专及以上	30	44.8	23	26.1
家族史	16	23.9	19	21.6	0.114	0.736
合并症
慢性阻塞性肺疾病	2	3.0	10	11.4	3.739	0.053
糖尿病	8	11.9	7	8.0	0.691	0.406
高血压	23	34.3	24	27.3	0.896	0.344
吸烟史	24	35.8	24	27.3	1.300	0.254
油烟接触史					9.274	0.010
二手烟	30	44.8	39	44.3
环境油烟史	16	23.9	37	42.1
手术方式					7.416	0.025
肺叶切除术	36	53.7	60	68.2
肺段切除术	18	26.9	9	10.2
其他	13	19.4	19	21.6
留置胸管时间(d)					4.355	0.037
≤7	64	95.5	75	85.2
>7	3	4.5	13	14.8
疼痛	35	52.2	72	81.8	15.568	0.001
咳嗽	49	73.1	77	87.5	5.161	0.023

编码	变量	赋值
Y	睡眠障碍	无=0,有=1
X₁	年龄	0~44岁=1,45~64岁=2,≥65岁=3
X₂	性别	男性=1,女性=2
X₃	文化程度	小学及以下=1,初中=2,高中/中专=3,大专及以上=4
X₄	油烟接触史	无=1,二手烟=2,环境油烟=3
X₅	手术方式	肺叶切除术=1,肺段切除术=2,其他=3
X₆	留置胸管时间	≤7d=1,>7d=2
X₇	疼痛	无=0,有=1
X₈	咳嗽	无=0,有=1