目的:肺癌患者的睡眠问题最多。了解肺癌人群睡眠障碍的患病率和危险因素对于减轻症状负担和提高他们的生活质量至关重要。本系统综述旨在确定肺癌患者睡眠障碍的患病率和危险因素。
方法:对七个电子数据库进行系统筛选,研究肺癌患者睡眠障碍的患病率或危险因素。进行亚组分析以调查研究中的显著异质性(I2>50%)。
结果:37项研究合格。合并患病率为0.61(95%CI=[0.54-0.67],I2=96%,p<0.00001)。七个危险因素进行了荟萃分析。老年人之间存在显着差异(OR=1.23;95%CI=[1.09-1.39],p=0.0006,I2=39%),低教育水平(OR=1.17;95CI=[1.20-2.66],p=0.004,I2=42%),疲劳(OR=1.98;95CI=[1.23-3.18],p=0.005,I2=31%),疼痛(OR=2.63;95%CI=[1.35-5.14],p=0.005,I2=91%),III或IV期肿瘤(OR=2.05;95CI=[1.54-2.72],p<0.00001,I2=42%),焦虑(OR=1.62;95CI=[1.22-2.14],p=0.0008,I2=78%),和抑郁(OR=4.02;95%CI=[1.39-11.61],p=0.01,I2=87%)。在纳入的研究相继退出后,疼痛(OR=3.13;95%CI=[2.06-4.75],p<0.00001,I2=34%)和抑郁(OR=5.47;95%CI=[2.65-11.30],p<0.00001)显示异质性显著降低。同时,焦虑症状的异质性保持不变。
结论:结果显示,超过60%的肺癌患者经历了睡眠障碍。该人群中睡眠障碍的患病率相对较高,这表明需要采取措施减少睡眠障碍。发现睡眠障碍与各种因素之间存在显着关联,包括年龄,教育水平,疲劳,疼痛,癌症阶段,焦虑,和抑郁症。在这些因素中,抑郁症是最显著的。未来的研究应集中于识别高风险个体,并根据这些风险因素制定跨学科干预措施。
OBJECTIVE: Patients with lung cancer endure the most sleep problems. Understanding the prevalence and risk factors of sleep disturbances in lung cancer populations is critical in reducing symptom burden and improving their quality of life. This systematic
review aimed to determine the prevalence and risk factors of sleep disturbances in patients with lung cancer.
METHODS: Seven electronic databases were systematically screened for studies on the prevalence or risk factors of sleep disturbances in patients with lung cancer. Subgroup analyses were conducted to investigate significant heterogeneity (I2 > 50%) across studies.
RESULTS: Thirty-seven studies were found eligible. The pooled prevalence was 0.61 (95% CI = [0.54-0.67], I2 = 96%, p < 0.00001). Seven risk factors were subject to meta-analyses. Significant differences were found for old age (OR = 1.23; 95% CI = [1.09-1.39], p = 0.0006,I2 = 39%), a low education level (OR = 1.17; 95%CI = [1.20-2.66], p = 0.004, I 2 = 42%), fatigue (OR = 1.98; 95%CI = [1.23-3.18], p = 0.005, I 2 = 31%), pain (OR = 2.63; 95% CI = [1.35-5.14], p = 0.005, I 2 = 91%), tumor stage of III or IV (OR = 2.05; 95%CI = [1.54-2.72], p < 0.00001, I 2 = 42%), anxiety (OR = 1.62; 95%CI = [1.22-2.14], p = 0.0008, I2 = 78%), and depression (OR = 4.02; 95% CI = [1.39-11.61], p = 0.01, I2 = 87%). After the included studies were withdrawn one after the other, pain (OR = 3.13; 95% CI = [2.06-4.75], p < 0.00001, I 2 = 34%) and depression (OR = 5.47; 95% CI = [2.65-11.30], p < 0.00001) showed a substantial decrease of heterogeneity. Meanwhile, the heterogeneity of anxiety symptoms remained unchanged.
CONCLUSIONS: Results showed that sleep disturbances were experienced in more than 60% of patients with lung cancer. The comparatively high prevalence of sleep disturbances in this population emphasizes the need to adopt measures to reduce them. Significant associations were found between sleep disturbances and various factors, including age, education level, fatigue, pain, cancer stage, anxiety, and depression. Among these factors, depression emerged as the most significant. Future research should concentrate on identifying high-risk individuals and tailored interdisciplinary interventions based on these risk factors.