目的 调查肺癌放疗期间睡眠障碍发生情况及危险因素,并提出预防建议。方法 选取2025年1月至2025年4月本院206例肺癌放疗患者,采用匹兹堡睡眠质量指数量表（Pittsburgh Sleep Quality Index,PSQI）调查其放疗期间睡眠障碍发生情况,采用疼痛视觉模拟评分（Visual Analog Scale for Pain,VAS）法评估患者疼痛,采用焦虑自评量表（Self-Rating Anxiety Scale,SAS）与抑郁自评量表（Depression Self-Rating Scale,SDS）评估患者焦虑、抑郁心理,按照睡眠障碍情况分为睡眠障碍组与无睡眠障碍组,比较两组临床资料,构建Logistic回归模型分析肺癌放疗期间睡眠障碍发生的危险因素。结果 放疗前睡眠障碍50例（24.27%）,放疗2周睡眠障碍70例（33.98%）,放疗4周睡眠障碍74例（35.92%）,放疗6周睡眠障碍78例（37.86%）;睡眠障碍组≥60岁、糖尿病、焦虑、抑郁、同步化疗、癌因性疲乏患者占比显著高于无睡眠障碍组,睡眠障碍组疼痛VAS评分显著高于无睡眠障碍组;Logistic回归分析显示,≥60岁、糖尿病、焦虑、抑郁、疼痛VAS评分、同步化疗、癌因性疲乏为肺癌放疗期间睡眠障碍发生的危险因素。结论 肺癌患者存在较高睡眠障碍发生风险,放疗开展可提高睡眠障碍发生率,高龄、糖尿病、焦虑、抑郁、疼痛VAS评分、同步化疗、癌因性疲乏等属于睡眠障碍发生主要危险因素,临床可对这些因素采取针对性干预措施。
Abstract
Objective To investigate the incidence and risk factors of sleep disorders during radiotherapy for lung cancer and propose preventive suggestions. Methods A total of 206 patients who underwent radiotherapy for lung cancer from January to April 2025 were enrolled in the study. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the incidence of sleep disorders during radiotherapy. The Visual Analog Scale (VAS) was used to evaluate pain intensity. The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate psychological states. Patients were divided into the sleep disorder group and the non-sleep disorder group. Clinical data were compared between groups, and a logistic regression model was used to identify risk factors for sleep disorders during radiotherapy. Results The incidence of sleep disorders was 24.27% (50 cases) before radiotherapy, 33.98% (70 cases) after 2 week of radiotherapy, 35.92% (74 cases) after 4 week of radiotherapy, and 37.86% (78 cases) after 6 weeks of radiotherapy. The proportions of patients ≥60 years old, with diabetes, anxiety, depression, concurrent chemotherapy, and cancer-related fatigue in the sleep disorder group were significantly higher than those in the non-sleep disorder group (P<0.05). Age and pain VAS score of the sleep disorder group were significantly higher than those of the non-sleep disorder group (P<0.05). Logistic regression analysis showed that age ≥60 years, diabetes, anxiety, depression, pain VAS score, concurrent chemotherapy, and cancer-related fatigue were independent risk factors for sleep disorders during radiotherapy for lung cancer (P<0.05). Conclusion Lung cancer patients have a relatively high risk of sleep disorders and radiotherapy increases the incidence of sleep disorders. Advanced age, diabetes, anxiety, depression, VAS score of pain, concurrent chemotherapy, and cancer-related fatigue are main risk factors for sleep disorders. Targeted interventions addressing these factors are recommended for clinical practice.
关键词
肺癌 /
放疗 /
睡眠障碍 /
危险因素
Key words
lung cancer /
radiotherapy /
sleep disorder /
risk factor
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] LI Y, WU X, YANG P, et al.Machine Learning for Lung Cancer Diagnosis, Treatment, and Prognosis[J]. Genomics Proteomics Bioinformatics, 2022, 20(5): 850-866.
[2] 乔玲, 牛倩倩, 郑梦瑶. 血清miR-28-3p、miR-23a与非小细胞肺癌射频消融治疗患者预后生存的关系[J]. 分子诊断与治疗杂志, 2023, 15(9): 1574-1578.
[3] 杨枫, 袁红梅. 非小细胞肺癌核心技术主题识别及技术演化态势分析[J]. 中国新药杂志, 2025, 34(3): 236-243.
[4] 李祥, 陈娟, 张超. 培美曲塞联合紫杉醇、顺铂化疗方案对晚期肺癌肿瘤标志物水平的影响[J]. 西北药学杂志, 2023, 38(4): 114-117.
[5] LEVY A, MERCIER O, LE PÉCHOUX C. Indications and parameters around postoperative radiation therapy for lung cancer[J]. J Clin Oncol, 2022, 40(6): 556-566.
[6] LEE KN, OWEN D.Advances in stereotactic body radiation therapy for lung cancer[J]. Cancer J, 2024, 30(6): 401-406.
[7] LEE H, KIM HH, KIM KY, et al.Associations among sleep-disordered breathing, sleep quality, and lung cancer in Korean patients[J]. Sleep Breath, 2023, 27(4): 1619-1628.
[8] PEERI NC, TAO MH, DEMISSIE S, et al.Sleep Duration, chronotype, and Insomnia and the Risk of Lung Cancer: United Kingdom Biobank Cohort[J]. Cancer Epidemiol Biomarkers Prev, 2022, 31(4): 766-774.
[9] 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南 (2023版)[J]. 中华肿瘤杂志, 2023, 45(7): 539-574.
[10] 路桃影, 李艳, 夏萍, 等. 匹兹堡睡眠质量指数的信度及效度分析[J]. 重庆医学, 2014, 43(3): 260-263.
[11] WILLIAMSON TJ, GARON EB, IRWIN MR, et al.Sleep disturbance as a mediator of lung cancer stigma on psychological distress and physical symptom burden[J]. Psychosom Med, 2024, 86(4): 334-341.
[12] CAO Q, ZHANG Q, LI X C, et al.Impact of sleep status on lung adenocarcinoma risk: a prospective cohort study[J]. Eur Rev Med Pharmacol Sci, 2022, 26(20): 7641-7648.
[13] WANG H, LIANG Y, LU D, et al.The effect of targeted nursing on the quality of sleep and life in lung cancer patients undergoing chemotherapy[J]. Am J Transl Res, 2021, 13(5): 4825-4834.
[14] 吴绒, 侯丽华, 任亚如. 老年食管癌患者放疗期间生活质量的动态观察[J]. 中华老年多器官疾病杂志, 2025, 24(2): 93-98.
[15] 张炎改, 余春华, 李俊英. 肺癌初治患者睡眠障碍影响因素分析及与生活质量的相关性研究[J]. 四川医学, 2020, 41(3): 252-256.
[16] ZHAO Y, LIU L, LI GH, et al.Ethnic disparities in the prevalence of diabetes and its association with sleep disorder among older adults in rural southwest China[J]. Ethn Health, 2024, 29(4-5): 435-446.
[17] KIM MJ, PARK C, ZHU B, et al.Subjective cognitive decline in diabetes: associations with psychological, sleep, and diabetes-related factors[J]. J Adv Nurs, 2021, 77(2): 693-702.
[18] 谭磊, 田小华, 钟欣怡, 等. 肺癌初治患者睡眠障碍调查及与生活质量和睡眠卫生意识的关系研究[J]. 现代生物医学进展, 2021, 21(14): 2693-2697, 2716.
[19] LEUNG P, LI SH, GRAHAM BM.The relationship between repetitive negative thinking, sleep disturbance, and subjective fatigue in women with generalized anxiety disorder[J]. Br J Clin Psychol, 2022, 61(3): 666-679.
[20] DING W, XU Y, DING W, et al.Research progress on melatonin, 5-HT, and orexin in sleep disorders of children with autism spectrum disorder[J]. Biomol Biomed, 2025, 25(3): 525-533.
[21] CROUSE JJ, CARPENTER JS, SONG YJC, et al.Circadian rhythm sleep-wake disturbances and depression in young people: implications for prevention and early intervention[J]. Lancet Psychiatry, 2021, 8(9): 813-823.
[22] MOSTAFA AM, HAFEZ SM, ABDULLAH NM, et al.Fatigue, depression, and sleep disorders are more prevalent in patients with metabolic-associated fatty liver diseases[J]. Eur J Gastroenterol Hepatol, 2024, 36(5): 665-673.
[23] WANG G, LIU Z.Depression is a mediating variable between sleep disorders and frailty[J]. Int Urol Nephrol, 2024, 56(7): 2443-2444.
[24] CROWDER SL, LI X, HIMBERT C, et al.Relationships among physical activity, sleep, and cancer-related fatigue: Results results from the international ColoCare study[J]. Ann Behav Med, 2024, 58(3): 156-166.
[25] CHARTOGNE M, RAHMANI A, LANDRY S, et al.Neuromuscular, psychological, and sleep predictors of cancer-related fatigue in cancer patients[J]. Clin Breast Cancer, 2021, 21(5): 425-432.
[26] 邵佩佩, 陈华青, 顾豆, 等. 疼痛对老年恶性肿瘤患者癌性疲乏、生命质量的影响及其控制不佳的影响因素分析[J]. 转化医学杂志, 2025, 14(11): 56-61.
[27] POZZAR RA, HAMMER MJ, PAUL SM, et al.Distinct sleep disturbance profiles among patients with gynecologic cancer receiving chemotherapy[J]. Gynecol Oncol, 2021, 163(2): 419-426.
[28] CASTELLI L, ELTER T, WOLF F, et al.Sleep problems and their interaction with physical activity and fatigue in hematological cancer patients during onset of high dose chemotherapy[J]. Support Care Cancer, 2022, 30(1): 167-176.
[29] WU IHC, BALACHANDRAN DD, FAIZ SA, et al.Characteristics of cancer-related fatigue and concomitant sleep disturbance in cancer patients[J]. J Pain Symptom Manage, 2022, 63(1): e1-e8.
[30] 刘龙艳, 王会哲, 卢双动. 循证理念下的个体化综合干预对肝癌介入治疗患者癌因性疲乏、焦虑抑郁的影响[J]. 国际精神病学杂志, 2025, 52(4): 1319-1322.
[31] 付思佳, 屈琳琳. 基于虚拟现实技术的正念干预对老年乳腺癌化疗患者生活质量和癌因性疲乏的影响研究[J]. 老年医学与保健, 2025, 31(1): 42-46, 52.
基金
山东省医药卫生科技发展计划项目“IL-37调控肿瘤相关巨噬细胞在非小细胞肺癌血管生成中的作用机制研究”（202103020759）
PDF(2117 KB)
