Nilsson Mats, Oliva Delmy, Andersson Bengt-Åke, Lewin Freddi, Jensen Lasse D
Futurum, Academy of Health and Care, Region Jönköping County, Jönköping, Sweden.
Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Asia Pac J Oncol Nurs. 2025 May 28;12:100733. doi: 10.1016/j.apjon.2025.100733. eCollection 2025 Dec.
Sleep disruption is common among patients with cancer, negatively impacting treatment outcomes, survival, and quality of life. However, it is often overlooked in cancer care. This study aimed to explore shared characteristics of sleep disruption in patients with cancer to facilitate simple and accurate identification in routine clinical practice. A secondary aim was to identify potential biomarkers in urine, serum, or leukocytes associated with sleep disruption before and/or after oncological therapy.
Ninety cancer patients scheduled for either adjuvant or palliative oncological therapy at Ryhov County Hospital, Jönköping, Sweden, were consecutively enrolled. Of these, 72 completed all questionnaires and provided urine and blood samples at both baseline and three-month follow-up. Data were collected using the 12-item Medical Outcomes Study Sleep Scale (MOS-SS) and the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Biomarker analysis was conducted on urine and blood samples, and data were analyzed using ordinal factor and Rasch modeling.
Two distinct factors-Sleep Quality (SQ) and Daytime Sleepiness (DTS)-emerged from the MOS-SS, effectively capturing key aspects of sleep disruption. Both SQ and DTS were strongly associated with sleep-related impairments identified via the EORTC QLQ-C30 and clinical history, but showed no correlation with urinary melatonin or cortisol, serum inflammatory cytokines, or Bmal1 and Per2 gene expression in blood leukocytes. Neither SQ nor DTS was significantly influenced by patient age, body mass index (BMI), or oncological therapy. However, women reported significantly lower DTS compared to men ( < 0.05), while SQ remained unaffected by sex. A simplified scoring tool for SQ and DTS was developed for practical use in clinical oncology settings.
This study identifies SQ and DTS as robust measures of sleep quality and daytime sleepiness in cancer patients. These new factors derived from the MOS-SS can support the early detection and management of sleep disruption in routine oncological care.
睡眠障碍在癌症患者中很常见，会对治疗效果、生存率和生活质量产生负面影响。然而，它在癌症护理中常常被忽视。本研究旨在探索癌症患者睡眠障碍的共同特征，以便在常规临床实践中进行简单准确的识别。第二个目的是确定在肿瘤治疗前后与睡眠障碍相关的尿液、血清或白细胞中的潜在生物标志物。
连续招募了90名计划在瑞典延雪平的里霍夫县医院接受辅助或姑息性肿瘤治疗的癌症患者。其中，72名患者完成了所有问卷，并在基线和三个月随访时提供了尿液和血液样本。使用12项医学结局研究睡眠量表（MOS-SS）和30项欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-C30）收集数据。对尿液和血液样本进行生物标志物分析，并使用有序因子和拉施模型分析数据。
从MOS-SS中出现了两个不同的因素——睡眠质量（SQ）和日间嗜睡（DTS），有效地捕捉了睡眠障碍的关键方面。SQ和DTS均与通过EORTC QLQ-C30和临床病史确定的睡眠相关损害密切相关，但与尿褪黑素或皮质醇、血清炎症细胞因子或血液白细胞中的Bmal1和Per2基因表达无关。SQ和DTS均未受到患者年龄、体重指数（BMI）或肿瘤治疗的显著影响。然而，女性报告的DTS明显低于男性（P<0.05），而SQ不受性别影响。开发了一种用于SQ和DTS的简化评分工具，以便在临床肿瘤学环境中实际使用。
本研究确定SQ和DTS是癌症患者睡眠质量和日间嗜睡的有力指标。这些源自MOS-SS的新因素可支持在常规肿瘤护理中早期发现和管理睡眠障碍。
