Factors Affecting Sleep Disturbances in Hospitalized Patients with Colorectal Cancer undergoing Chemotherapy: A Retrospective Study

Jihyeon Song; Smi Choi-kwon

doi:10.7475/kjan.2019.31.1.100

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Song and Choi-kwon: Factors Affecting Sleep Disturbances in Hospitalized Patients with Colorectal Cancer undergoing Chemotherapy: A Retrospective Study

Original Article

Korean J Adult Nurs 2019;31(1):100-108.

Published online: 21 February 2019

DOI: https://doi.org/10.7475/kjan.2019.31.1.100

Factors Affecting Sleep Disturbances in Hospitalized Patients with Colorectal Cancer undergoing Chemotherapy: A Retrospective Study

Jihyeon Song¹, Smi Choi-kwon^2,

¹PhD Candidate, College of Nursing, Seoul National University, Seoul, Korea

²Professor, College of Nursing · Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Corresponding author: Choi-kwon, Smi https://orcid.org/0000-0001-7723-1665 College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8830, Fax: +82-2-765-4103, E-mail: smi@snu.ac.kr

Received 19 November 201818 January 2019 Accepted 7 February 2019

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.

Abstract

Purpose

Sleep disturbances related to multiple conditions are common in patients with cancer while undergoing chemotherapy. The quality of life in these patients may be negatively affected due to sleep disturbances. Therefore, by analyzing nursing records, this study aimed to examine factors influencing sleep disturbances among hospitalized patients with colorectal cancer undergoing chemotherapy.

Methods

This study was a retrospective review of nursing records of 231 patients with colorectal cancer who were hospitalized for chemotherapy in 2015. Data were collected from electronic medical records, and analyzed using the independent t-test, x² test, and logistic regression.

Results

Thirty-five (15.2%) patients had sleep disturbances. Nursing records related to sleep (n=85) consisted of 32 (37.6%) assessments and 53 (62.4%) interventions. Pharmacological interventions for sleep disturbances (98.1%) were used more often as compared to non-pharmacological interventions (1.9%). In logistic regression analysis, sleep disturbances were related to the body mass index (Odds Ratio [OR]=0.86, 95% Confidence Interval [CI]=0.76~0.98), targeted therapy(OR=2.62, 95% CI=1.09~6.32), and length of hospital stay (OR=1.08, 95% CI=1.02~1.14).

Conclusion

Sleep disturbances were influenced by body mass index, targeted therapy, and length of hospital stay. Thus, nutritional and psycho-emotional status after metastasis or recurrence should be closely monitored in patients with colorectal cancer undergoing chemotherapy, especially during prolonged hospitalization. Further, in addition to the use of pharmacological interventions, various non-pharma-cological nursing interventions to promote sleep health should be developed.

Keywords: Colorectal neoplasms, Sleep, Hospitalization, Drug therapy

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Table 1.

Differences of General Characteristics between Sleep Disturbance Group and Non-sleep Disturbance Group (N=231)

Characteristics	Categories	Total (n=231)	Sleep disturbance (n=35)	Non-sleep disturbance (n=196)	x² or t	p
Characteristics	Categories	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t	p
Age (year)		60.96±11.65	59.71±11.20	61.18±11.74	-0.68	.494
Gender	Men	135 (58.4)	18 (51.4)	117 (59.7)	0.84	.361
Gender	Women	96 (41.6)	17 (48.6)	79 (40.3)
Smoking	Yes	19 (8.2)	4 (11.4)	15 (7.7)	0.56	.501
Smoking	No	212 (91.8)	31 (88.6)	181 (92.3)
Alcohol consumption	Yes	20 (8.7)	3 (8.6)	17 (8.7)	0.00	1.000
Alcohol consumption	No	211 (91.3)	32 (91.4)	179 (91.3)
BMI (kg/m²)		22.60±3.41	20.96±3.10	22.89±3.39	-3.15	.002
	18.5	29 (12.5)	8 (22.9)	21 (10.7)	11.11	.001
	18.5~＜23.0	106 (45.9)	21 (60.0)	85 (43.4)
	23.0~＜25.0	48 (20.8)	4 (11.4)	44 (22.4)
	≥25.0	48 (20.8)	2 (5.7)	46 (23.5)
Hemoglobin (g/dL)	12	133 (57.6)	22 (62.9)	111 (56.6)	0.47	.493
Hemoglobin (g/dL)	12~＜18	98 (42.4)	13 (37.1)	85 (43.4)
Lymphocyte (%)	17	41 (17.7)	9 (25.7)	32 (16.3)	0.06	.803
	17~＜46	164 (71.0)	20 (57.2)	144 (73.5)
	≥46	26 (11.3)	6 (17.1)	20 (10.2)
Albumin (g/dL)	3.5	47 (20.3)	14 (40.0)	33 (16.8)	9.83	.002
Albumin (g/dL)	3.5~＜5.2	184 (79.7)	21 (60.0)	163 (83.2)
Duration of diagnosis (day)		448.39±689.44	305.14±482.12	473.97±718.18	-1.75	.084

BMI=body mass index.

Table 2.

Differences of Disease and Chemotherapy-related Characteristics between Sleep Disturbance Group and Non-sleep Disturbance Group (N=231)

Characteristics	Categories	Total (n=231)	Sleep disturbance (n=35)	Non-sleep disturbance (n=196)	x² or t	p
Characteristics	Categories	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t	p
Type of chemotherapies
Targeted therapies	Yes	38 (16.5)	10 (28.6)	28 (14.3)	4.41	.036
Targeted therapies	No	193 (83.5)	25 (71.4)	168 (85.7)
Alkylating agents	Yes	115 (49.8)	15 (42.9)	100 (51.0)	0.79	.374
Alkylating agents	No	116 (50.2)	20 (57.1)	96 (49.0)
Plants derivatives	Yes	102 (44.2)	17 (48.6)	85 (43.4)	0.33	.568
Plants derivatives	No	129 (55.8)	18 (51.4)	111 (56.6)
Antimetabolites	Yes	219 (94.8)	32 (91.4)	187 (95.4)	0.96	.399
Antimetabolites	No	12 (5.2)	3 (8.6)	9 (4.6)
Goal of therapies	Palliative	198 (85.7)	33 (94.3)	165 (84.2)	2.48	.116
Goal of therapies	Adjuvant	33 (14.3)	2 (5.7)	31 (15.8)
Number of therapies (line of therapies)	1	175 (75.8)	23 (65.7)	152 (77.6)	0.35	.552
	2	32 (13.8)	9 (25.7)	23 (11.7)
	3	15 (6.5)	2 (5.7)	13 (6.6)
	≥4	9 (3.9)	1 (2.9)	8 (4.1)
Length of hospital stay (day)		5.15±7.99	10.14±16.14	4.26±4.95	2.14	.039
Patient room type	Private room	11 (4.8)	2 (5.7)	9 (4.6)	0.08	.675
Patient room type	Semi-private room	220 (95.2)	33 (94.3)	187 (95.4)
Toxicity assessment
Nausea	Yes	15 (6.5)	4 (11.4)	11 (5.6)	1.66	.254
Nausea	No	216 (93.5)	31 (88.6)	185 (94.4)
Vomiting	Yes	13 (5.6)	3 (8.6)	10 (5.1)	0.67	.423
Vomiting	No	218 (94.4)	32 (91.4)	186 (94.9)

Table 3.

Differences of Physical Symptoms between Sleep Disturbance Group and Non-sleep Disturbance Group (N=231)

Characteristics	Categories	Total (n=231)	Sleep disturbance (n=35)	Non-sleep disturbance (n=196)	x² or t	p
Characteristics		n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t	p
Pain (including medication status)	Yes	134 (58.0)	23 (65.7)	111 (56.6)	1.01	.316
Pain (including medication status)	No	97 (42.0)	12 (34.3)	85 (43.4)
Pain (only score)	≥1	72 (31.2)	14 (40.0)	58 (29.6)	1.50	.221
Pain (only score)	0	159 (68.8)	21 (60.0)	138 (70.4)
Use of analgesics	Yes	110 (47.6)	20 (57.1)	90 (45.9)	1.50	.221
Use of analgesics	No	121 (52.4)	15 (42.9)	106 (54.1)

Table 4.

Medication Records of Analgesics and Hypnotics

Medications	Classification	Name of medicine	Number of medication records (%)	Number of patients (%)
Analgesics	Opioid analgesics	Codeine phosphate hydrate	400 (53.4)	75 (44.1)
		Fentanyl citrate
		Morphine sulfate hydrate
		Oxycodone hydrochloride
		Pethidine hydrochloride
	Nonopioid analgesics	Acetaminophen	321 (42.9)	87 (51.2)
		Propacetamol hydrochloride
		Tramadol hydrochloride
	Anti-inflammatory analgesics	Aceclofenac	28 (3.7)	8 (4.7)
		Celecoxib
		Ibuprofen
		Ketorolac tromethamine
		Naproxen
	Total		749 (100.0)	170 (100.0)^†
Hypnotics^‡	Benzodiazepines	Alprazolam	25 (48.1)	4 (21.1)
	Benzodiazepines	Clonazepam
	Zolpidem (non-benzodiazepines)	Zolpidem tartrate	27 (51.9)	15 (78.9)
	Total		52 (100.0)	19 (100.0)

^† Of the 110 patients, 53 (48.2%) took painkillers in more than two categories;

^‡ The average of medication period: 2.2 days.

Table 5.

Factors Affecting Sleep Disturbances in Hospitalized Patients with Colorectal Cancer undergoing Chemotherapy (N=231)

Variables	Unstadardized B	SE	Standardized β	p	OR	95% CI
BMI (kg/m²)	-0.15	0.07	-.51	.024	0.86	0.76~0.98
Targeted therapies	0.96	0.45	.36	.032	2.62	1.09~6.32
Length of hospital stay (day)	0.07	0.03	.58	.011	1.08	1.02~1.14

BMI=body mass index; CI=confidence interval; OR=odds ratio; SE=standard error.

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