口腔颌面部恶性肿瘤患者睡眠障碍发生现状及相关因素分析

doi:10.19439/j.sjos.2026.04.013

摘要/Abstract

摘要： 目的: 调查口腔颌面部恶性肿瘤患者睡眠障碍的发生现状,分析其影响因素,为临床干预提供依据。方法: 采用方便抽样法,于2023年12月—2024年12月在上海交通大学医学院附属第九人民医院招募487例头颈癌患者,通过匹兹堡睡眠指数（Pittsburgh Sleep Quality Index,PSQI）、医院焦虑抑郁量表（Hospital Anxiety and Depression Scale,HADS）及欧洲癌症研究与治疗组织生命质量量表（European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck 35,EORTC QLQ-H&N35）评估睡眠质量、心理状态及症状负担,采用Spearman 秩相关分析和多因素logistic 回归分析探讨其相关性。结果: 84.6%的患者存在睡眠障碍,其中复发组催眠药物使用率显著高于初发组（P<0.05）。复发组PSQI总分与感官、口干呈正相关（P<0.05）,且两组患者PSQI总分均与疼痛、吞咽困难、言语障碍、社交进食、牙问题、张口困难、社会交往、疾病感、使用止痛药呈正相关（P<0.05）,与体重下降呈负相关（P<0.05）。多因素logistic回归分析显示,无业、吸烟、焦虑、口腔疼痛、言语障碍、牙问题和疾病感是首次确诊患者睡眠障碍的危险因素;无业、吞咽障碍和疾病感是复发患者睡眠障碍的危险因素。结论: 口腔颌面部恶性肿瘤患者睡眠障碍发生率高,与心理状态、口腔功能障碍及疾病感知密切相关。临床上需早期干预症状群,以改善患者睡眠质量及生活质量。

关键词: 口腔颌面部恶性肿瘤, 睡眠障碍, 影响因素, 心理症状, Logistic 回归分析

Abstract: PURPOSE: To investigate the current status of sleep disorders in patients with oral and maxillofacial malignant tumors and analyze the influencing factors, so as to provide a basis for clinical intervention. METHODS: A convenience sampling method was used to recruit 487 patients with oral and maxillofacial malignant tumors in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from December 2023 to December 2024. The Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck 35 (EORTC QLQ-H&N35) were used to evaluate sleep quality, psychological state, and symptom burden. Spearman rank correlation analysis and multivariate logistic regression analysis were used to explore the correlation. RESULTS: 84.6% of the patients had sleep disorders, and the use rate of hypnotic drugs in the recurrence group was significantly higher than that in the primary group (P<0.05). The total PSQI score in the recurrence group was positively correlated with sensory perception and dry mouth (P<0.05). The total PSQI scores of the two groups were positively correlated with pain, swallowing, speech, eating during social communication, dental problems, mouth opening, social interaction, disease perception, and the use of painkillers (P<0.05), and negatively correlated with weight loss (P<0.05). Multivariate logistic regression analysis showed that unemployment, smoking, anxiety, oral pain, speech disorders, dental problems, and disease perception were risk factors for sleep disorders in newly diagnosed patients; unemployment, swallowing disorders, and disease perception were risk factors for sleep disorders in recurrent patients. CONCLUSIONS: The incidence of sleep disorders in patients with oral and maxillofacial malignant tumors is high, which is closely related to psychological state, oral dysfunction, and disease perception. Early intervention in symptom clusters is needed clinically to improve sleep quality and quality of life.

Key words: Oral and maxillofacial malignant tumors, Sleep disorders, Influencing factors, Psychological symptoms, Logistic regression analysis

中图分类号:

R739.8

杨盈, 郝桂华, 赵小妹, 甘星, 侯黎莉. 口腔颌面部恶性肿瘤患者睡眠障碍发生现状及相关因素分析[J]. 上海口腔医学, 2026, 35(4): 426-432.

Yang Ying, Hao Guihua, Zhao Xiaomei, Gan Xing, Hou Lili. The prevalence of sleep disorders and related factors in patients with oral and maxillofacial malignant tumors[J]. Shanghai Journal of Stomatology, 2026, 35(4): 426-432.

参考文献

[1] Bray F, Laversanne M, Sung H, et al.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263.
[2] Chamoli A, Gosavi AS, Shirwadkar UP, et al.Overview of oral cavity squamous cell carcinoma: risk factors, mechanisms, and diagnostics[J]. Oral Oncol, 2021, 121:105451.
[3] Chow LQM.Head and neck cancer[J]. N Engl J Med, 2020, 382(1): 60-72.
[4] Gillison ML, Chaturvedi AK, Anderson WF, et al.Epidemiology of human papillomavirus-positive head and neck squamous cell carcinoma[J]. J Clin Oncol, 2015, 33(29): 3235-3242.
[5] Hu ZY, Feng XQ, Fu MR, et al.Symptom patterns, physical function and quality of life among head and neck cancer patients prior to and after surgical treatment: a prospective study[J]. Eur J Oncol Nurs, 2020, 46:101770.
[6] Partinen M.Epidemiology of sleep disorders[J]. Handb Clin Neurol, 2011, 98: 275-314.
[7] Senaratna CV, Perret JL, Lodge CJ, et al.Prevalence of obstructive sleep apnea in the general population: a systematic review[J]. Sleep Med Rev, 2017, 34: 70-81.
[8] Cheng WH, Teo RH, Cheng LJ, et al.Global prevalence of sleep disturbances among breast cancer survivors: a systematic review with meta-analysis[J]. Sleep Health, 2023, 9(5):704-716.
[9] Hu Y, Xiao LD, Tang C, et al.Prevalence and risk factors of sleep disturbances among patients with lung cancer: systematic review and meta-analysis[J]. Support Care Cancer, 2024, 32(9): 619-644.
[10] 国家统计局.我国中年人群年龄范围,老年人群年龄范围 [EB/OL]. [2023-11-07]. http://www.stats.gov.cn/hd/lyzx/zxgk/202207/t20220704_1858761.html.
[11] 国家统计局.就业和工资 [EB/OL].[2019-12-02].?https://www.stats.gov.cn/sj/zbjs/202302/t20230202_1897107.html.
[12] Ng R, Sutradhar R, Yao Z, et al.Smoking, drinking, diet and physical activity-modifiable lifestyle risk factors and their associations with age to first chronic disease[J]. Int J Epidemiol, 2020, 49(1): 113-130.
[13] Zhang Y, Zhang YJ, An N, et al.The effects of light-to-moderate alcohol consumption on the cognitive function of community nondemented male elderly: a cohort study[J]. Behav Neurol, 2021:5681913.
[14] Mo YL, Li L, Qin L, et al.Cognitive function, mood, and sleep quality in patients treated with intensity-modulated radiation therapy for nasopharyngeal cancer: a prospective study[J]. Psychooncology, 2014, 23(10): 1185-1191.
[15] Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research[J]. Psychiatry Res, 1989, 28(2):193-213.
[16] 隆莉芝, 袁玲, 严婷婷, 等. 头颈癌患者报告结局的研究进展[J]. 护理学报, 2019, 26(21): 26-30.
[17] Palesh OG, Roscoe JA, Mustian KM, et al.Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program[J]. J Clin Oncol, 2010, 28(2): 292-298.
[18] Vaughn CB, Freudenheim JL, Nie J, et al.Sleep and breast cancer in the Western New York exposures and breast cancer (WEB) study[J]. J Clin Sleep Med, 2018, 14(1): 81-86.
[19] Whisenant M, Wong B, Mitchell SA, et al.Symptom trajectories are associated with co-occurring symptoms during chemotherapy for breast cancer[J]. J Pain Symptom Manage, 2019, 57(2): 183-189.
[20] Leysen L, Lahousse A, Nijs J, et al.Prevalence and risk factors of sleep disturbances in breast cancer survivors: systematic review and meta-analyses[J]. Support Care Cancer, 2019, 27(12): 4401-4433.
[21] Santoso AMM, Jansen F, De Vries R, et al.Prevalence of sleep disturbances among head and neck cancer patients: a systematic review and meta-analysis[J]. Sleep Med Rev, 2019, 47: 62-73.
[22] Schlieve T, Kolokythas A.Complications from surgical treatment of oral cancer[C]//Radosevich J. Head & neck cancer: current perspectives, advances, and challenges[M]. Dordrecht: Springer, 2013:721-749.
[23] Santoso AMM, Jansen F, Lissenberg-Witte BI, et al.Poor sleep quality among newly diagnosed head and neck cancer patients: prevalence and associated factors[J]. Support Care Cancer, 2021, 29(2): 1035-1045.
[24] Zhou J, Jolly S.Obstructive sleep apnea and fatigue in head and neck cancer patients[J]. Am J Clin Oncol, 2015, 38(4): 411-414.
[25] Zeng LN, Zong QQ, Yang Y, et al.Gender difference in the prevalence of insomnia: a meta-analysis of observational studies[J]. Front Psychiatry, 2020, 11: 577429.
[26] Sun GW, Yang YL, Yang XB, et al.Preoperative insomnia and its association with psychological factors, pain and anxiety in Chinese colorectal cancer patients[J]. Support Care Cancer, 2020, 28(6): 2911-2919.
[27] Mong JA, Cusmano DM.Sex differences in sleep: impact of biological sex and sex steroids[J]. Philos Trans R Soc Lond B Biol Sci, 2016, 371(1688): 20150110.
[28] Fekih-Romdhane F, Achouri L, Hakiri A, et al.Hopelessness is associated with poor sleep quality after breast cancer surgery among Tunisian women[J]. Curr Probl Cancer, 2020, 44(1): 100504.
[29] Miroševic Š, Prins JB, Selic P, et al.Prevalence and factors associated with unmet needs in post-treatment cancer survivors: a systematic review[J]. Eur J Cancer Care (Engl), 2019, 28(3): e13060.
[30] Herndon JE 2nd, Kornblith AB, Holland JC, et al. Patient education level as a predictor of survival in lung cancer clinical trials[J]. J Clin Oncol, 2008, 26(25): 4116-4123.
[31] Van Beek FE, Jansen F, Mak L, et al.The course of symptoms of anxiety and depression from time of diagnosis up to 2 years follow-up in head and neck cancer patients treated with primary (chemo)radiation[J]. Oral Oncol, 2020, 102: 104576.
[32] Rogers SN, Mepani V, Jackson S, et al.Health-related quality of life, fear of recurrence, and emotional distress in patients treated for thyroid cancer[J]. Br J Oral Maxillofac Surg, 2017, 55(7): 666-673.
[33] Götze H, Taubenheim S, Dietz A, et al.Fear of cancer recurrence across the survivorship trajectory: results from a survey of adult long-term cancer survivors[J]. Psychooncology, 2019, 28(10): 2033-2041.
[34] Wang X, Ma X, Yang M, et al.Proportion and related factors of depression and anxiety for inpatients with lung cancer in China: a hospital-based cross-sectional study[J]. Support Care Cancer, 2022, 30(6): 5539-5549.
[35] Aggeli P, Fasoi G, Zartaloudi A, et al.Posttreatment anxiety, depression, sleep disorders, and associated factors in women who survive breast cancer[J]. Asia Pac J Oncol Nurs, 2021, 8(2):147-155.
[36] Hanna EY, Mendoza TR, Rosenthal DI, et al.The symptom burden of treatment-naive patients with head and neck cancer[J]. Cancer, 2015, 121(5): 766-773.
[37] Macfarlane TV, Wirth T, Ranasinghe S, et al.Head and neck cancer pain: systematic review of prevalence and associated factors[J]. J Oral Maxillofac Res, 2012, 3(1): e1.
[38] Wei Y, Blanken TF, Van Someren EJW.Insomnia really hurts: effect of a bad night's sleep on pain increases with insomnia severity[J]. Front Psychiatry, 2018, 9: 377.
[39] Hammermüller C, Hinz A, Dietz A, et al.Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population[J]. BMC Cancer, 2021, 21(1): 94-105.
[40] Parsons A, Dewan K.Dysphagia and dysphonia after head and neck cancer[J]. Oral Dis, 2025, 31(9): 2753-2760.
[41] Lin A, Helgeson ES, Treister NS, et al.The impact of head and neck radiotherapy on salivary flow and quality of life: results of the ORARAD study[J]. Oral Oncol, 2022, 127: 105783.
[42] Fenech AL, Humphris GM, Laurenceau JP, et al.Anxiety, depression, and fear of cancer recurrence in head and neck cancer[J]. Health Psychol, 2024, 43(11): 803-812.
[43] 余琳, 范慧芳, 李晓丽, 等. 头颈癌术后病人病耻感现状及影响因素[J]. 护理研究, 2024, 38(5): 915-920.
[44] Tang MF, Chiu HY, Xu X, et al.Walking is more effective than yoga at reducing sleep disturbance in cancer patients: a systematic review and meta-analysis of randomized controlled trials[J]. Sleep Med Rev, 2019, 47: 1-8.
[45] Han J, Cheng HL, Bi LN, et al.Mind-body therapies for sleep disturbance among patients with cancer: a systematic review and meta-analysis[J]. Complement Ther Med, 2023, 75: 102954.