Construction and validation of a nomogram to identify risk of sleep disorders in gastrointestinal tumor patients undergoing chemotherapy.

OBJECTIVES

This study aimed to identify risk factors for sleep disorders in gastrointestinal cancer patients undergoing chemotherapy and to construct a predictive nomogram model, validated both internally and externally.

METHODS

A prospective study was conducted (ChiCTR2400085854), involving 308 patients from Jiangnan University Affiliated Central Hospital (Oct 2023-Aug 2024) for model development. Sleep quality and symptom burden were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Memorial Symptom Assessment Scale-Chinese version (MSAS-Ch). Independent risk factors were identified by multivariate logistic regression. A nomogram was constructed using R software and validated internally with 1000 bootstrap resamples and externally with 103 patients (Aug-Dec 2024). Model performance was evaluated by AUC, calibration curves, and decision curve analysis (DCA).

RESULTS

The incidence of sleep disorders was 53.8%. Significant influencing factors included longer disease duration, more severe depression, pain, fatigue, and diarrhea, as well as lower social support and physical activity (all < 0.05). Internal validation showed good discrimination (AUC = 0.897, 95% CI: 0.862-0.931) and calibration. External validation confirmed robust performance (AUC = 0.896, 95% CI: 0.837-0.954) with consistent calibration. DCA demonstrated favorable clinical value.

CONCLUSIONS

Sleep disorders are prevalent among gastrointestinal cancer patients undergoing chemotherapy. The developed nomogram demonstrates high predictive accuracy and is a practical tool to identify high-risk patients.