title: Gender differences in sleep disruption and fatigue on quality of life among persons with ostomies.
abstract: OBJECTIVE
  The aim of this study is to examine differences in sleep disruption and fatigue of men and women colorectal cancer (CRC) survivors with intestinal ostomies and associated health-related quality of life (HR-QOL).
  
  
  METHODS
  Participants in this cross-sectional study of long-term (> 5 years) CRC survivors received care at Kaiser Permanente. Measures included the City of Hope QOL Ostomy questionnaire with narrative comments for ostomy-related "greatest challenges." The Short Form-36 Version 2 (SF-36v2) health survey provided physical (PCS) and mental composite scale (MCS) scores to examine generic HR-QOL. The "sleep disruption" and "fatigue" items from the ostomy questionnaire (scale from 0 to 10 with higher scores indicating better HR-QOL) were dependent variables, while independent variables included age, ethnicity, education, partnered status, body mass index, and time since surgery. Data were analyzed using chi-square for nominal variables, Student t-tests for continuous variables, and logistic regression with significance set at p < 0.05.
  
  
  RESULTS
  On the ostomy-specific measure, women (n = 118) compared to men (n = 168) reported more sleep disruption (p < 0.01), adjusted for age, and greater levels of fatigue (p < 0.01), adjusted for time since surgery. Women's PCS and MCS scores indicated poorer HR-QOL compared to men, and differences were clinically meaningful. Qualitative narrative comments suggested that sleep disruption could stem from ostomy-associated fear of or actual leakage during sleep.
  
  
  CONCLUSIONS
  Although women CRC survivors with ostomies report more sleep disruption and fatigue, which is reflected in their reduced physical and mental health scores on the SF-36v2 compared to men with ostomies, their stated reasons for disrupted sleep are similar to their male counterparts. These findings can provide a foundation for gender-relevant ostomy interventions to improve sleep and HR-QOL in this patient population.
authors.affiliation: Office of World Health Promotion and Disease Prevention, Arizona State University, College of Nursing & Healthcare Innovation, Phoenix, AZ 85004, USA. carol.baldwin@asu.edu
authors.forename: Carol M
authors.initials: CM
authors.lastname: Baldwin
authors.forename: Marcia
authors.initials: M
authors.lastname: Grant
authors.forename: Christopher
authors.initials: C
authors.lastname: Wendel
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.forename: Carmit
authors.initials: C
authors.lastname: McMullen
authors.forename: Robert S
authors.initials: RS
authors.lastname: Krouse
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000534:rehabilitation; D003125:Colostomy / Q000009:adverse effects* / Q000523:psychology / Q000534:rehabilitation; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D011788:Quality of Life; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology