141 cases of postoperative patients with gastric cancer were initially screened, and 115 cases were finally included. Figure 1 presents the process of recruiting study participants. General data, gastric cancer data and other symptom data of the included cases were presented in the Table 2.
Table 2 Basic information of included cases (n=115)
|
Group
|
Number
|
Percent
|
Group
|
Number
|
Percent
|
Gender group
|
|
|
N stage
|
|
|
Male
|
73
|
63.48%
|
N0
|
24
|
20.87%
|
Female
|
42
|
36.52%
|
N1
|
34
|
29.57%
|
Age group
|
|
|
N2
|
25
|
21.74%
|
≤60
|
63
|
53.78%
|
N3
|
32
|
27.83%
|
>60
|
52
|
46.22%
|
Surgical methods
|
|
|
KPS group
|
|
|
proximal gastrectomy
|
19
|
16.52%
|
<90
|
35
|
30.43%
|
distal gastrectomy
|
38
|
33.04%
|
≥90
|
80
|
69.57%
|
total gastrectomy
|
58
|
50.43%
|
Lesion site
|
|
|
The number of chemotherapy cycle
|
|
|
gastric cardia
|
22
|
21.36%
|
≤6
|
55
|
52.88%
|
The body of stomach
|
38
|
36.89%
|
>6
|
49
|
47.12%
|
the antrum of stomach
|
43
|
41.75%
|
PSQI score
|
|
|
Degree of differentiation
|
|
|
7-10
|
37
|
32.17%
|
High differentiation
|
4
|
3.81%
|
11-15
|
60
|
52.17%
|
Poor differentiation
|
60
|
57.14%
|
16-21
|
18
|
15.65%
|
Moderate differentiation
|
28
|
26.67%
|
PFS-CV score
|
|
|
Moderate to poor differentiation
|
13
|
12.38%
|
≤4
|
43
|
37.39%
|
Lauren type
|
|
|
>4
|
72
|
62.61%
|
Intestinal type
|
26
|
28.89%
|
HADS score
|
|
|
Diffuse type (stomach type)
|
44
|
48.89%
|
Anxiety subtable
|
|
|
Hybrid
|
20
|
22.22%
|
<8
|
17
|
14.78%
|
Clinical stage
|
|
|
≥8
|
98
|
85.22%
|
Ⅰ
|
6
|
5.22%
|
Depression subtable
|
|
|
Ⅱ
|
41
|
35.65%
|
<8
|
28
|
24.35%
|
Ⅲ
|
68
|
59.13%
|
≥8
|
87
|
75.65%
|
T stage
|
|
|
|
|
|
T1
|
7
|
6.09%
|
|
|
|
T2
|
26
|
22.61%
|
|
|
|
T3
|
48
|
41.74%
|
|
|
|
T4
|
34
|
29.56%
|
|
|
|
3.1 The characteristics
There were 60 cases (52.17%) with a PSQI score of 11-15, 37 cases (32.17%) with a score of 7-10, and 18 cases (15.65%) with a score of 16-21. The average score of the PSQI score was 12.05±3.25. Among them, the “daytime dysfunction” component had the highest score, and the hypnotic drug component had the lowest score. ( see Table 3)
Table 3 PSQI scale components and scores
|
|
score(x̄±S)
|
A. Sleep quality
|
2.09±0.78
|
B、Time to fall asleep
|
2.04±0.73
|
C、Sleep time
|
1.90±0.82
|
D、Sleep efficiency
|
1.68±1.01
|
E、Sleep disorders
|
1.45±0.63
|
F、Hypnotic drugs
|
0.63±1.12
|
G、Daytime dysfunction
|
2.17±0.85
|
Total score
|
11.96±3.31
|
3.2 Related factors
3.2.1 General information
The independent-sample t test was used to compare the PSQI scores of gender and age groups, t=-0.010 and -1.092, P all >0.05. The PSQI score of KPS group was subjected to non-parametric test (Mann-Whitney U test), Z= -0.010, P >0.05; Table 4.
Table 4 Correlation analysis of general data and PSQI score
|
|
n
|
PSQI score
(x̄±S)
|
t
|
P
|
Gender
|
Male
|
73
|
11.96±3.08
|
-0.010
|
0.992▲
|
Female
|
42
|
11.95±3.71
|
Age
|
≤60
|
63
|
11.65±3.66
|
-1.092
|
0.277▲
|
>60
|
52
|
12.33±2.81
|
|
|
|
M(Q25,Q75)
|
Z
|
P
|
KPS
|
<90
|
18
|
12.00(12.00,14.00)
|
-1.706
|
0.088▲
|
≥90
|
40
|
11.00(8.25,14.00)
|
▲P>0.05
|
3.2.2 Relevant data of gastric cancer
Kruskal-Wallis tests were respectively performed on the PSQI scores among the groups of the lesion site, differentiation grade, lauren type, clinical stage, N stage and surgical method, χ2=3.111, 4.664, 2.350, 1.576, 0.715 and 5.292, P all >0.05. One-way ANOVA test was used in the PSQI scores among the group of the T stage, F=0.793, P >0.05; Table 5.
The PSQI scores of the number of chemotherapy cycles grouped (≤6 cycles, >6 cycles) were subjected to non-parametric test (Mann-Whitney U test), Z= -4.447, P=0.000; Supplementary Table 1.
Table 5 Correlation analysis between gastric cancer data and PSQI score
|
|
|
n
|
PSQI score
M(Q25,Q75)
|
χ2
|
P
|
Lesion site
|
Gastric cardia
|
22
|
11 (8, 12)
|
3.111
|
0.211▲
|
Body of stomach
|
38
|
12.5 (8, 16)
|
Antrum of stomach
|
43
|
12 (11, 14)
|
Differentiation grade
|
High differentiation
|
4
|
12 (12, 12)
|
4.664
|
0.198▲
|
Poor differentiation
|
60
|
11 (9, 13.75)
|
Moderate differentiation
|
28
|
13.5 (8, 16)
|
Moderate to poor differentiation
|
13
|
11 (8, 12.5)
|
Lauren type
|
Intestinal type
|
26
|
12 (9.75, 16.25)
|
2.350
|
0.309▲
|
Diffuse type (stomach type)
|
44
|
12 (10,14)
|
Hybrid
|
20
|
11 (8,13)
|
Clinical stage
|
Ⅰ
|
6
|
13 (11, 16)
|
1.576
|
0.455▲
|
Ⅱ
|
41
|
12 (9, 13.5)
|
Ⅲ
|
68
|
12 (10, 14)
|
N stage
|
N0
|
24
|
12 (10.25, 15.25)
|
0.715
|
0.870▲
|
N1
|
34
|
12 (9, 14)
|
N2
|
25
|
12 (9.5, 14)
|
N3
|
32
|
12 (10, 14.75)
|
Surgical methods
|
proximal gastrectomy
|
19
|
11 (7, 12)
|
5.292
|
0.071▲
|
distal gastrectomy
|
38
|
12 (11, 14)
|
total gastrectomy
|
58
|
12 (8.75, 14.25)
|
|
|
n
|
(x̄±S)
|
F
|
P
|
T stage
|
T1
|
4
|
12.25±0.96
|
0.793
|
0.503▲
|
T2
|
13
|
12.92±3.82
|
T3
|
24
|
12.21±3.40
|
T4
|
17
|
11.12±2.89
|
▲P>0.05
|
3.3.3 Fatigue, depression and anxiety
The Pearson correlation coefficients between the total PSQI score and the final score of the PFS-CV scale, between the total PSQI score and the HADS scale (depression subscale) score, and between the total PSQI score and the HADS scale (anxiety subscale) score were respectively 0.428, 0.261 and 0.060. P=0.000, 0.005 and 0.527; Supplementary Figure 1, Supplementary Figure 2 and Supplementary Figure 3.
3.4 Risk factors
The PSQI score was used as the dependent variable and assigned a value: 0= “PSQI score<11 points (sleep quality is general)”; 1= “PSQI score ≥11 points” (sleep quality is poor or very poor). The above related factors with P<0.05 [the number of cycles of chemotherapy, the PFS-CV scale, the HADS scale (depression subscale)] were used as independent variables and assigned values: 0="The number of chemotherapy cycles≤6", 1="The number of chemotherapy cycles>6"; 0="PFS-CV scale ≤4 points", 1="PFS-CV scale >4 points"; 0 = "HADS Scale (depression subscale) <8 points", 1 = "HADS Scale (depression subscale) ≥ 8 points". A multivariate binary unconditional logistic regression model was established, and the forward method was used to select and eliminate independent variables. The regression analysis showed that the number of chemotherapy cycles and fatigue were significant risk factors for the reduction of sleep quality in patients with insomnia (P<0.05).
Compared with the number of chemotherapy cycles ≤ 6, when the number of previous chemotherapy cycles after gastric cancer surgery is greater than 6, the risk of reduced sleep quality is increased (OR=3.640,95% CI: 1.416-9.357, P=0.007). Compared with patients with no or mild fatigue, patients with moderate or severe fatigue after gastric cancer surgery have an increased risk of sleep quality (OR=4.390,95% CI:1.843-10.460, P=0.001; Supplementary Table 2).