The Influences of Quality of Sleep and Mood State on Fatigue in Primary Brain Tumor Patients

Jae Hyun Hwang; Hyoung Sook Park

doi:10.5388/aon.2017.17.2.87

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Hwang and Park: The Influences of Quality of Sleep and Mood State on Fatigue in Primary Brain Tumor Patients

Original Article

Asian Oncol Nurs 2017;17(2):87-96.

Published online: 5 June 2017

DOI: https://doi.org/10.5388/aon.2017.17.2.87

The Influences of Quality of Sleep and Mood State on Fatigue in Primary Brain Tumor Patients

Jae Hyun Hwang, Hyoung Sook Park

College of Nursing, Pusan National University, Yangsan, Korea

^∗ This article is a revision of the first author's master's thesis from Pusan National University.

Address reprint requests to: Park, Hyoung Sook College of Nursing, Pusan National University, 49 BusanDaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongnam 50612, Korea Tel: +82-51-510-8336 Fax: +82-51-510-8308 E-mail: haedang@pusan.ac.kr

Received 20 Mar 20172 May 2017 Accepted 15 Jun 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

The purpose of this study was to identify the influences of sleep quality and mood state on fatigue in primary brain tumor patients.

Methods

The participants were 118 patients with primary brain tumors between May 2015 and March 2016. Data were collected using questionnaires including individual and disease related characteristics, the Pittsburgh Sleep Quality Index, Linear Analogue Self-Assessment scales, and The Fatigue Scale for Cancer Patients developed by Kim Kyeong-hee (2006). Data were analyzed using descriptive statistics, Pearson correlation, and hierarchical multiple regression.

Results

Fatigue had significant correlations with sleep quality (r=.55, p<.001) and mood state (r=.74, p<.001). The influencing factors for fatigue were mood state (β=.46, p<.001) was the best predictor of fatigue, followed by age (β=.17, p=.049), and performance status (β=-.19, p=.011).

Conclusion

The research findings show that understanding of psychological factors such as anxiety, depression, confusion, energy and anger should be given priority for fatigue management in primary brain tumor patients. This study provides base data for managing fatigue in patients with primary brain tumors, and is expected to contribute to the improvement of the health of patients with primary brain tumor.

Keywords: Primary Brain Neoplasms, Sleep, Affect, Fatigue

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Table 1.

Differences in Fatigue according to General Characteristics (N =118)

Characteristics	Categories	n (%) or M ± SD	M ± SD	t or F (p)
Gender	Female	74 (62.7)	73.47 ± 20.63	0.93 (.350)
	Male	44 (37.3)	69.93 ± 18.34
Age (year)	≥50	73 (61.9)	79.95 ± 17.00	6.29 (＜.001)
	＜50	45 (38.1)	59.95 ± 17.43
		53.4 ± 14.8
Religion	None	48 (40.7)	73.02 ± 21.38	0.72 (.579)
	Buddhist	42 (35.6)	74.12 ± 17.85
	Protestant	18 (15.3)	65.22 ± 19.29
	Catholic	5 (4.2)	75.00 ± 28.45
	Other	5 (4.2)	69.40 ± 12.48
Marital status	Unmarried ^a	19 (16.1)	60.32 ± 21.61	11.93 (＜.001)
	Married ^b	89 (75.4)	72.11 ± 18.03	a,b＜ c
	Widowed ^c	10 (8.5)	95.00 ± 10.34
Education	≤ Elementary school ^a	32 (27.1)	82.81 ± 17.05	9.15 (＜.001)
	Middle school ^b	18 (15.3)	80.28 ± 15.42	c,d＜ a
	High school ^c	34 (28.8)	67.91 ± 18.28	d＜ b
	≥ College ^d	34 (28.8)	62.06 ± 19.76
Occupation	Employed	60 (50.8)	65.05 ± 17.49	-4.32 (＜.001)
	Unemployed	58 (49.2)	79.75 ± 19.43

Table 2.

Differences in Fatigue according to Disease related Characteristics (N =118)

Characteristics	Categories	n (%) or M ± SD	M ± SD	t or F (p)
Disease	Meningioma	48 (40.7)	69.73 ± 17.92	1.96 (.105)
	Glioma	33 (28.0)	79.82 ± 21.29
	Pituitary adenoma	16 (13.5)	66.50 ± 19.46
	Schwannoma	15 (12.7)	68.27 ± 21.31
	Others	6 (5.1)	74.17 ± 15.84
Tumor biological characteris	Benign ^a	79 (70.0)	67.85 ± 18.08	6.44 (.002)
	Malignancy ^b	30 (25.4)	82.10 ± 19.38	a＜ b
	Uncertain ^c	9 (7.6)	76.78 ± 24.63
Tumor location	Frontal	32 (27.1)	78.59 ± 21.54	1.44 (.213)
	Crebellopotine	27 (22.9)	66.48 ± 19.14
	Parietal	19 (16.1)	72.84 ± 22.00
	Pituitary	17 (14.4)	70.65 ± 17.94
	Temporal	16 (13.6)	73.38 ± 14.23
	Occipital	7 (5.9)	63.57 ± 19.49
Disease status	Stable	81 (68.6)	67.38 ± 19.21	-4.12 (＜.001)
	Progressive	37 (31.4)	82.59 ± 17.04
Treatment	Surgery only ^a	48 (40.7)	66.56 ± 18.84	3.27 (.024)
	Surgery+CRTx ^b	34 (28.8)	79.88 ± 19.62	a＜ b
	Observation, Medication ^c	26 (22.0)	73.38 ± 18.44
	Radiation only ^d	10 (8.5)	69.50 ± 21.92
Time from diagnosis (year)	≥1	68 (57.6)	72.88 ± 17.59	-0.46 (.643)
	＜1	50 (42.4)	71.16 ± 22.61
KPS	80~100	95 (80.5)	68.27 ± 17.85	-4.69 (＜.001)
	50~70	23 (18.5)	88.17 ± 19.72
		85.93 ± 12.82

CRTx= Chemotherapy and radiotherapy; KPS= Karnofsky perfomance status.

Table 3.

Quality of Sleep, Mood State and Fatigue of the Subjects

Characteristics	Categories	n (%)	M ± SD	Range
Quality of sleep	Subjective sleep quality		1.46 ± 0.71	0~3
	Very good	5(4.2)
	Good Bad	6439(54.2)(33.1)
	Very bad	10(8.5)
	Sleep latency		0.96 _± 0.86	0~3
	0	38(32.2)
	1~2	55(46.6)
	3~4	17(14.4)
	5~6	8(6.8)
	Sleep duration (hr)		1.22 ± 0.99	0~3
	≥7	33(28.0)
	6~＜7	41(34.7)
	5~＜6	29(24.6)
	＜5	15(12.7)
	Habitual sleep efficiency (%)		0.97 _± 0.92	0~3
	≥85	43(36.5)
	75~84	45(38.1)
	65~74	21(17.8)
	＜65	9(7.6)
	Sleep disturbances		1.66 ± 0.60	0~3
	0	0(0.0)
	1~9	48(40.7)
	10~18	62(52.5)
	19~27	8(6.8)
	Use of sleeping medication		0.40 _± 0.91	0~3
	None	96(81.4)
	Less than once a weak	7(5.9)
	One or twice a weak	5(4.2)
	3≥ times a weeks	10(8.5)
	Daytime dysfunction		1.52 ± 0.85	0~3
	0	10(8.5)
	1~2	55(46.6)
	3~4	35(29.7)
	5~6	18(15.2)
	Total		8.18 _± 3.86	0~21
Mood states	Anxiety		53.69 ± 25.19	0~100
	Energy		52.84 ± 24.35	0~100
	Depression		45.62 ± 24.43	0~100
	Anger		36.33 _± 21.42	0~100
	Confusion		36.31 ± 22.69	0~100
	Total		224.79 ± 85.43	0~500
Fatigue	Physical		18.84 ± 5.05	6~30
	Cognitive		9.23 ± 3.04	3~15
	Behavioral/Social		21.67 _± 7.82	8~40
	Emotional		12.55 ± 4.18	5~25
	Spiritual		9.85 ± 3.84	4~20
	Total		72.14 ± 19.64	26~130

Table 4.

The Correlations Between Quality of Sleep, Mood State and Fatigue (N =118)

Variables	Fatigue
Variables	r	p
Quality of sleep	.55	＜.001
Mood state (total)	.74	＜.001
Anxiety	.70	＜.001
Confusion	.59	＜.001
Depression	.65	＜.001
Energy	.50	＜.001
Anger	.24	.009

Table 5.

Factors Influencing Fatigue of the Subject (N =118)

Variables		Model 1				Model 2				Model 3
Variables		B	β	t	p	B	β	t	p	B	β	t	p
(Constant)		78.97		5.29	＜.001	74.59		5.47	＜.001	59.86		4.89	＜.001
Age	≥50	10.97	.27	2.49	.014	10.33	.25	2.57	.011	7.07	.17	1.98	.049
Marital status	Married	1.85	.04	0.39	.693	0.66	.01	0.15	.877	2.11	.04	0.56	.574
(Never married₌0)	Divorced/widowed	11.56	.16	1.61	.110	6.77	.09	1.02	.308	4.09	.05	0.70	.483
Education	≤ Elementary school	0.37	.00	0.06	.947	-3.00	-.06	-0.57	.567	-3.38	-.07	-0.74	.460
(≥ College=0)	Meddle school	4.45	.08	.82	.410	3.61	.06	0.73	.463	0.33	.00	.07	.939
	High school	-1.42	-.030	-0.34	.732	-1.64	-.03	-0.43	.663	-2.08	-.04	-0.63	.529
Occupation	Unemployed	3.36	.08	0.99	.323	2.69	.06	0.87	.384	2.56	.06	0.94	.345
Tumor biological ch	ar-Malignancy	6.68	.14	1.68	.095	6.14	.13	1.70	.092	3.35	.07	1.04	.298
acteristic (Benign=0)	Uncertain	4.48	.06	0.81	.415	8.51	.11	1.68	.096	5.52	.07	1.23	.219
Disease status	Progressive disease	7.70	.18	2.10	.038	2.85	.06	0.81	.416	0.79	.01	0.26	.796
Treatment history	Radiation only	-0.21	-.00	-0.03	.969	0.77	.01	0.15	.875	-3.42	-.04	-0.77	.438
(Surgery only=0)	Surgery+CRTx	7.17	.16	1.86	.066	3.70	.08	1.03	.305	2.85	.06	0.90	.367
	Observation, medication	3.76	.07	0.88	.377	4.82	.10	1.25	.214	2.21	.04	0.64	.518
Performance status		-0.29	-.19	-2.02	.045	-0.35	-.22	-2.65	.009	-0.30	-.19	-2.58	.011
Quality of sleep						1.78	.34	4.70	＜.001	0.68	.13	1.77	.080
Mood state										0.10	.46	5.64	＜.001
R² (adj R²)		R²=.50, Adj.R²=.44			R²=.59, Adj.R²=.53			R²=.69, Adj.R²=.64
∆ R²						Δ R²=.08			Δ R²=.09
F (p)		F=7.58, p＜.001			F=10.00, p＜.001			F=14.20, p＜.001

CRTx= Chemotherapy and radiotherapy.

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