Department of Oncology/ Medical Center for Overseas Patients, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China.
Department of Ultrasound and Electrocardiogram, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
BMJ Support Palliat Care. 2022 Jul;12(e2):e194-e200. doi: 10.1136/bmjspcare-2018-001684. Epub 2020 Apr 6.
To investigate the clinical implications of sleep quality, anxiety and depression in patients with advanced lung cancer (LC) and their family caregivers (FCs).
A total of 98 patients with advanced LC and their FCs (n=98) were recruited from the Oncology Department in Nanfang Hospital. The Pittsburgh Sleep Quality Index (PSQI), consisting of seven components that evaluate subjective sleep quality, sleep latency, duration of sleep, sleep efficiency, sleep disturbances, sleep medication usage and daytime dysfunction, was used to assess sleep quality. Using the tool of Zung Self-rating Anxiety Scale (SAS) and Zung Self-rating Depression Scale (SDS), we tested the patients' status of anxiety and depression, respectively.
The prevalences of poor sleep quality, anxiety and depression in patients were 56.1%, 48.9% and 56.1%, respectively, while those in FCs were 16.3%, 32.6% and 25.5%, respectively. Patients had higher PSQI, SAS and SDS scores than did FCs (p<0.05). Significant correlations were found between the patients' and FCs' scores of PSQI/SAS/SDS (p<0.05). Multivariate Cox regression analyses indicated that sleep disturbances in patients (HR 0.413, 95% CI 0.21 to 0.80, p=0.01) and the global PSQI score of FCs (HR 0.31, 95% CI 0.14 to 0.71, p=0.00) were independent risk factors for patients' first-line progression-free survival (PFS). Moreover, patients' sleep latency (HR 2.329, 95% CI 1.36 to 3.96, p=0.00) and epidermal growth factor receptor mutations (HR 1.953, 95% CI 1.12 to 3.38, p=0.01) were significant prognostic factors for their overall survival (OS).
We demonstrated that presence of sleep disturbances in patients with advanced LC and the global PSQI Score of their FCs may be risk predictors for patients' poor first-line PFS. Patients' sleep latency was a potential risk factor for their OS.
探讨晚期肺癌患者及其家属的睡眠质量、焦虑和抑郁的临床意义。
共招募 98 例晚期肺癌患者及其家属（共 98 例），均来自南方医院肿瘤科。采用匹兹堡睡眠质量指数（PSQI）评估睡眠质量，该指数包括 7 个组成部分，评估主观睡眠质量、睡眠潜伏期、睡眠时间、睡眠效率、睡眠障碍、睡眠药物使用和日间功能障碍。采用zung 焦虑自评量表（SAS）和 zung 抑郁自评量表（SDS）评估患者的焦虑和抑郁状态。
患者中睡眠质量差、焦虑和抑郁的患病率分别为 56.1%、48.9%和 56.1%，而家属中分别为 16.3%、32.6%和 25.5%。与家属相比，患者的 PSQI、SAS 和 SDS 评分更高（p<0.05）。患者与家属的 PSQI/SAS/SDS 评分之间存在显著相关性（p<0.05）。多变量 Cox 回归分析表明，患者的睡眠障碍（HR 0.413，95%CI 0.21 至 0.80，p=0.01）和家属的整体 PSQI 评分（HR 0.31，95%CI 0.14 至 0.71，p=0.00）是患者一线无进展生存期（PFS）的独立危险因素。此外，患者的睡眠潜伏期（HR 2.329，95%CI 1.36 至 3.96，p=0.00）和表皮生长因子受体突变（HR 1.953，95%CI 1.12 至 3.38，p=0.01）是总生存期（OS）的显著预后因素。
我们表明，晚期肺癌患者存在睡眠障碍和家属的整体 PSQI 评分可能是患者一线 PFS 预后不良的危险因素。患者的睡眠潜伏期是 OS 的潜在危险因素。
