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将睡眠健康教育纳入癌症护理:阿曼接受化疗患者失眠的患病率及相关因素

Integrating Sleep Health Education in Cancer Care: Prevalence and Correlates of Insomnia Among Omani Patients Undergoing Chemotherapy.

作者信息

Al-Fahdi Amal, Chan Moon Fai, Al-Jamei Elias, Al-Jamei Alyasa, Al-Azizi Buthaina, Al-Yafai Entesar, Al Balushi Ashwaq, Al-Azri Mohammed

机构信息

Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.

Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.

出版信息

J Cancer Educ. 2025 Mar 18. doi: 10.1007/s13187-025-02605-2.

Abstract

Insomnia is a prevalent and distressing symptom among cancer patients, adversely impacting quality of life (QOL). Factors such as treatment-related side effects, diagnosis-related stress, and coexisting conditions, including anxiety and depression, often exacerbate insomnia. In Oman, the prevalence and contributing factors of insomnia in cancer patients remain underexplored. Additionally, despite the well-documented impact of insomnia on cancer prognosis, sleep education remains an underutilized component of oncology care. This study is aimed at determining the prevalence of insomnia among Omani cancer patients receiving chemotherapy and at identifying associated factors, emphasizing the need for structured sleep education as an essential part of cancer supportive care. A cross-sectional study was conducted from October 2022 to March 2023 at the Sultan Qaboos Comprehensive Cancer Care and Research Centre in Muscat, Oman. Adult Omani cancer patients undergoing chemotherapy during the study period were recruited. Data were collected using Arabic versions of the Pittsburgh Sleep Quality Index (PSQI) and Edmonton Symptom Assessment System-Revised (ESAS-r). A total of 211 patients participated (response rate 85.1%). Most were female (65.9%), married (83.9%), and had stage IV cancer (55.0%). The mean age was 49.6 ± 11.7 years (range 19-81 years). Symptom burden, ranging from mild to severe, was reported by 30.8% of patients based on ESAS-r scores. Insomnia (PSQI score > 5) was identified in 55.0% of participants, with 34.1% reporting sleep disturbances after their diagnosis but prior to the initiation of chemotherapy. Insomnia was associated with pre-diagnosis sleeping problems (odds ratio (OR) = 3.04, p = 0.009), post-diagnosis but pre-chemotherapy sleep problems (OR = 7.34, p < 0.001), a history of smoking (OR = 4.00, p = 0.043), and symptom burden (OR = 3.78, p < 0.001). Multivariate analysis revealed that post-diagnosis/pre-chemotherapy sleep disturbances (OR = 4.09, p = 0.002) and symptom burden (OR = 3.02, p = 0.008) significantly increased the likelihood of insomnia. Insomnia is highly prevalent among Omani cancer patients undergoing chemotherapy, driven by high symptom burden and pre-existing sleep disturbances. Routine sleep assessments should be integrated into oncology care to identify at-risk patients and facilitate early intervention, ultimately improving sleep quality and enhancing QOL. Integrating structured sleep education into oncology training is crucial for effective cancer care. Approaches like CBT-I, digital tools, and hospital workshops equip providers and patients to manage sleep disturbances. Interprofessional education (IPE) boosts provider confidence, enhancing patient outcomes. Future efforts should focus on culturally tailored, evidence-based programs to support symptom management, treatment adherence, and survivorship.

摘要

失眠是癌症患者中普遍存在且令人痛苦的症状,对生活质量(QOL)产生不利影响。与治疗相关的副作用、诊断相关的压力以及并存疾病(包括焦虑和抑郁)等因素常常会加重失眠。在阿曼,癌症患者失眠的患病率及相关因素仍未得到充分研究。此外,尽管失眠对癌症预后的影响已有充分记录,但睡眠教育仍是肿瘤护理中未得到充分利用的一部分。本研究旨在确定接受化疗的阿曼癌症患者中失眠的患病率,并识别相关因素,强调将结构化睡眠教育作为癌症支持性护理重要组成部分的必要性。2022年10月至2023年3月在阿曼马斯喀特的苏丹·卡布斯综合癌症护理与研究中心进行了一项横断面研究。招募了在研究期间接受化疗的成年阿曼癌症患者。使用匹兹堡睡眠质量指数(PSQI)和埃德蒙顿症状评估系统修订版(ESAS-r)的阿拉伯语版本收集数据。共有211名患者参与(应答率85.1%)。大多数为女性(65.9%)、已婚(83.9%),且患有IV期癌症(55.0%)。平均年龄为49.6±11.7岁(范围19 - 81岁)。根据ESAS-r评分,30.8%的患者报告有轻度至重度的症状负担。55.0%的参与者被确定为失眠(PSQI评分>5),34.1%的患者报告在诊断后但在开始化疗前出现睡眠障碍。失眠与诊断前的睡眠问题(比值比(OR)=3.04,p = 0.009)、诊断后但化疗前的睡眠问题(OR = 7.34,p < 0.001)、吸烟史(OR = 4.00,p = 0.043)以及症状负担(OR = 3.78,p < 0.001)相关。多因素分析显示,诊断后/化疗前的睡眠障碍(OR = 4.09,p = 0.002)和症状负担(OR = 3.02,p = 0.008)显著增加了失眠的可能性。在接受化疗的阿曼癌症患者中,失眠非常普遍,其原因是高症状负担和既往存在的睡眠障碍。应将常规睡眠评估纳入肿瘤护理中,以识别高危患者并促进早期干预,最终改善睡眠质量并提高生活质量。将结构化睡眠教育纳入肿瘤学培训对于有效的癌症护理至关重要。认知行为疗法失眠症(CBT-I)、数字工具和医院工作坊等方法可使医护人员和患者有能力管理睡眠障碍。跨专业教育(IPE)可增强医护人员的信心,改善患者预后。未来的努力应集中在针对文化特点的循证项目上,以支持症状管理、治疗依从性和癌症 survivorship。 (注:“survivorship”在医学语境中常指癌症患者的生存状态或 survivorship care plan 等相关概念,这里直接保留英文,因为准确翻译需更多医学背景知识,且在中文语境中可能无完全对应的简洁词汇,具体含义可根据上下文理解。)

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