Lymph node dissection, pain, and psychological factors: association with sleep quality during the perioperative period in oral cancer patients.

backgroundAlthough sleep quality among cancer patients has received considerable attention, it remains understudied in those with oral cancer, particularly during the perioperative period. The aim of this study was to evaluate sleep quality during the perioperative period in oral cancer patients and explore its correlates, so as to provide a basis for developing targeted clinical nursing interventions.

methodsA total of 218 oral cancer patients who received surgical treatment at our hospital were enrolled. Poor sleep quality was defined as a Pittsburgh Sleep Quality Index (PSQI) score of ≥ 8. We collected data covering sociodemographic data, lifestyle, clinical characteristics, and psychological variables (e.g., stress, self-esteem, illness perception, and psychological needs) to examine their correlations with sleep quality. The study evaluated sleep quality during the perioperative period using the PSQI administered at hospital discharge and analyzed its correlations with these associated factors.

resultsOf the 218 patients with oral cancer, 202 (92.70%) exhibited poor sleep quality, as defined by a PSQI score ≥ 8. The median (IQR) PSQI score was 15 (4) out of a total possible score of 21. Difficulty falling asleep, poor subjective sleep quality, severe daytime dysfunction, and sleep duration shorter than five hours were reported in 50.9% to 76.1% of patients. Sleep quality showed significant correlations with residence, tracheotomy, neck dissection, frequency of sputum suction, days of intensive care, pain score on postoperative day 7 (VAS 7d), perceived stress, and psychological needs (p < 0.05). Regression analysis indicated that neck dissection, pain score on day 7, and perceived stress were associated with higher PSQI scores, indicating poorer sleep quality (p < 0.05). However, the association with neck dissection should be interpreted with caution due to the small non-dissection comparison group (n = 20) and the lack of adjustment for key clinical confounders.

conclusionsPoor sleep quality during the perioperative period was observed in 92.70% of oral cancer patients. Neck dissection, postoperative day 7 pain and perceived stress showed significant crude correlations with sleep quality during the perioperative period. Notably, the neck dissection comparison group was limited to only 20 patients, and multiple key clinical confounders were unavailable for adjustment; thus this correlation must be interpreted cautiously. Clinically, greater attention should be given to such patients. Postoperative pain and perceived stress may serve as promising targets for future interventional studies aiming to improve sleep quality during the perioperative period in this population. CLINICAL TRIAL NUMBER: Not applicable.