Chang Wen-Pei, Lin Chia-Chin
a Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare , New Taipei City , Taiwan.
b School of Nursing, College of Nursing, Taipei Medical University , Taipei , Taiwan.
Chronobiol Int. 2017;34(4):451-461. doi: 10.1080/07420528.2017.1293678. Epub 2017 Mar 10.
Studies on the diurnal sleep-wake rhythm of patients with lung cancer have mostly examined patients cross-sectionally, whereas the effects of lung cancer treatment over time have rarely been considered. Through long-term longitudinal tracking of patients with lung cancer, this study examined changes in their sleep-wake rhythm, sleep quality, anxiety, depressive symptoms, fatigue and quality of life (QoL) at various treatment stages. In addition, factors affecting their QoL were explored. Hierarchical linear modeling was adopted to analyze a convenience sample of 82 patients with lung cancer. The changes in their sleep-wake rhythm, sleep, mood (anxiety, depressive symptoms and fatigue) and QoL were observed at five time points: prior to treatment and at weeks 6, 12, 24 and 48 after the start of the treatment. The effects of sex, age, cancer stage, treatment type, comorbidities and time were controlled to determine the predictors of patients' QoL. The results showed that patients' sleep-wake rhythms were poor before treatments. Compared with baseline, the sleep-wake rhythms of the patients significantly improved at week 48, and anxiety significantly improved at weeks 6, 12, 24 and 48. By contrast, their fatigue became exacerbated at weeks 8 and 48. Moreover, QoL improved significantly from week 6 until the end of the treatment period. QoL was negatively affected by poor sleep quality (β = -0.69, p = 0.00) and depressive symptoms (β = -2.59, p < 0.001) and positively affected by regular sleep-wake rhythms (β = 0.23, p = 0.001). Therefore, clinical health-care professionals should focus more attention to the fatigue levels of patients with lung cancer before, during and after treatment. Health-care professionals may also need to provide such patients with health education regarding sleep hygiene and with emotional support to assist them in maintaining regular sleep-wake rhythms in order to improve their QoL.
关于肺癌患者昼夜睡眠 - 觉醒节律的研究大多是横断面研究，而肺癌治疗随时间的影响很少被考虑。通过对肺癌患者的长期纵向跟踪，本研究考察了他们在不同治疗阶段睡眠 - 觉醒节律、睡眠质量、焦虑、抑郁症状、疲劳和生活质量（QoL）的变化。此外，还探讨了影响其生活质量的因素。采用分层线性模型对82例肺癌患者的便利样本进行分析。在五个时间点观察他们的睡眠 - 觉醒节律、睡眠、情绪（焦虑、抑郁症状和疲劳）和生活质量的变化：治疗前以及治疗开始后的第6、12、24和48周。控制性别、年龄、癌症分期、治疗类型、合并症和时间的影响，以确定患者生活质量的预测因素。结果显示，患者在治疗前睡眠 - 觉醒节律较差。与基线相比，患者的睡眠 - 觉醒节律在第48周显著改善，焦虑在第6、12、24和48周显著改善。相比之下，他们的疲劳在第8周和第48周加剧。此外，生活质量从第6周直到治疗期结束显著改善。睡眠质量差（β = -0.69，p = 0.00）和抑郁症状（β = -2.59，p < 0.001）对生活质量有负面影响，而规律的睡眠 - 觉醒节律（β = 0.23，p = 0.001）对生活质量有正面影响。因此，临床医护人员应在肺癌患者治疗前、治疗期间和治疗后更加关注他们的疲劳水平。医护人员可能还需要为这些患者提供有关睡眠卫生的健康教育和情感支持，以帮助他们维持规律的睡眠 - 觉醒节律，从而提高他们的生活质量。
