Savard Josée, Villa Julie, Ivers Hans, Simard Sébastien, Morin Charles M
Laval University Research Center, 11 Côte du Palais, Québec, Québec, Canada, G1R 2J6.
J Clin Oncol. 2009 Nov 1;27(31):5233-9. doi: 10.1200/JCO.2008.21.6333. Epub 2009 Sep 8.
This study aimed to assess the prevalence, natural course, and risk factors of insomnia comorbid with cancer over a 2-month period.
All patients scheduled to receive a curative surgery for a first diagnosis of nonmetastatic cancer were approached to participate in the study on the day of their preoperative visit. As part of a larger population-based longitudinal study, 991 cancer patients completed various self-report scales and an insomnia diagnostic interview at the perioperative phase (T1) and 2 months later (T2).
At T1, 28.5% of the patients met the diagnostic criteria for an insomnia syndrome, and 31.0% had insomnia symptoms; these rates decreased to 26.2% and 22.2%, respectively, at T2. The highest rates of insomnia were found in breast cancer patients, whereas the lowest rates were obtained in prostate cancer patients. Findings indicated an incidence rate of 18.6%, a persistence rate of 68.0%, and a remission rate of 32.0%. Female sex and the presence of an arousability trait (predisposing factors), a diagnosis of head and neck cancer, the administration of surgery, and an increase in anxiety symptoms between T1 and T2 (precipitating factors), and higher baseline levels and increases between T1 and T2 in dysfunctional beliefs about sleep, sleep monitoring, and maladaptive sleep behaviors (maintenance factors) were all associated with an increased risk for insomnia incidence.
This study confirms the high prevalence of insomnia comorbid with cancer during the 2 months after the perioperative visit and identifies several factors that might be involved in its development.
本研究旨在评估2个月期间癌症合并失眠的患病率、自然病程及危险因素。
所有计划接受首次诊断为非转移性癌症的根治性手术的患者在术前访视当天被邀请参与本研究。作为一项基于人群的大型纵向研究的一部分，991例癌症患者在围手术期（T1）和2个月后（T2）完成了各种自我报告量表及失眠诊断访谈。
在T1时，28.5%的患者符合失眠综合征的诊断标准，31.0%有失眠症状；在T2时，这些比例分别降至26.2%和22.2%。失眠发生率最高的是乳腺癌患者，而前列腺癌患者发生率最低。研究结果显示发病率为18.6%，持续率为68.0%，缓解率为32.0%。女性、存在易唤醒特质（ predisposing factors）、头颈部癌症诊断、接受手术以及T1至T2期间焦虑症状增加（ precipitating factors），以及关于睡眠、睡眠监测的功能失调信念和适应不良睡眠行为的更高基线水平及T1至T2期间的增加（维持因素）均与失眠发病风险增加相关。
本研究证实围手术期访视后2个月内癌症合并失眠的高患病率，并确定了可能参与其发生发展的几个因素。
