Associations of Pain, Anxiety, and Depressive Symptoms With Sleep Outcomes in Patients With Head and Neck Squamous Cell Carcinoma: A Cross-Sectional Observational Study

Abstract

Background: This exploratory cross-sectional observational study sought to characterize sleep quality and evaluate its association with sociodemographic, clinicopathological, behavioral, and psychological variables in patients with head and neck squamous cell carcinoma (HNSCC). Patients and Methods: Sleep problems from 132 HNC patients were assessed before starting oncological treatment through the questionnaires Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and STOP-Bang. Anxiety and depression symptoms were evaluated using the Hospital Anxiety and Depression Scale. Univariate analysis and multivariate logistic regression were performed to evaluate factors associated with sleep problems in HNSCC patients. Results: About 50% of the HNSCC patients reported poor overall sleep quality on the PSQI. Insomnia, excessive daytime sleepiness, and high risk of apnea were observed in 19%, 15%, and 54% of HNSCC patients, respectively. Our results showed that pain was associated with overall poor PSQI sleep quality and lower PSQI sleep efficiency, while the presence of regional metastasis was linked to overall PSQI good sleep. No other clinicopathological or behavioral (i.e., alcohol and tobacco use) variables were related to sleep outcomes. Higher occurrence of anxiety symptoms was related to poor overall PSQI sleep quality, decreased PSQI sleep efficiency, PSQI daytime dysfunction, and ISI insomnia. Moreover, higher occurrence of depression symptoms was associated with lower PSQI sleep latency and PSQI duration, and the occurrence of ESS excessive daytime sleepiness. Conclusion: Pain, anxiety, and depressive symptoms were associated with poor sleep quality and sleep problems in HNSCC patients before starting treatment. No sociodemographic or behavioral (i.e., alcohol and tobacco use) variables were related to sleep outcomes. Likewise, tumor location, T classification, and clinical staging were not linked to sleep quality and disorders in HNSCC patients.