title: Sleep status of cervical cancer patients and predictors of poor sleep quality during adjuvant therapy.
abstract: OBJECTIVE
  This study was designed to detect the prevalence of poor sleep quality in cervical cancer patients before and after adjuvant therapy, determine whether the prevalence of poor sleep quality in cervical cancer patients is higher than that in the general population, and analyze the factors associated with poor sleep quality.
  
  
  METHODS
  A total of 76 stages I and II cervical cancer patients and 116 female residents completed the Pittsburgh Sleep Quality Index (PSQI). Patient Neurotoxicity Questionnaire (PNQ), Distress Thermometer (DT), Multidimensional Fatigue Inventory, and Hospital Anxiety and Depression Scale were used to measure the patients' chemotherapy-induced peripheral neurotoxicity (CIPN), psychological distress, fatigue, anxiety, and depression. Data on social support and exercise were collected by the questionnaire. Logistic regression was used to identify the factors associated with poor sleep quality.
  
  
  RESULTS
  Prevalence rates of poor sleep quality were 27.59 % for female residents, 52.63 % for patients before adjuvant therapy, and 64.50 % for patients after adjuvant therapy. The distributions of the PSQI scores of the patients before (Z = 3.814, P < 0.001) and after (Z = 5.957, P < 0.001) adjuvant therapy were different from those of the residents. The difference in the PSQI scores before and after adjuvant therapy among cervical cancer patients was significant (P = 0.007). The factors associated with poor sleep quality were high DT score (P = 0.045), depression (P = 0.028), anxiety (P = 0.027), high PNQ grade (P = 0.016), and chemotherapy + radiotherapy treatment (P = 0.017). Exercise was a protective factor for poor sleep quality (P =0.019).
  
  
  CONCLUSIONS
  The prevalence of poor sleep quality in stages I and II cervical cancer patients was approximately twice than that of women in the communities. Cancer treatment considerably affected sleep quality. Psychological distress, depression, anxiety, and high grade of CIPN during adjuvant therapy were factors associated with poor sleep quality. Exercise during adjuvant therapy could reduce the risk of poor sleep quality.
authors.affiliation: Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, 350004, Fujian Province, China, tianjunfjmu@126.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Tian
authors.forename: Gui Lin
authors.initials: GL
authors.lastname: Chen
authors.forename: Hai Rong
authors.initials: HR
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000523:psychology; D003131:Combined Modality Therapy; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000523:psychology*