Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors

作者全名：Lan, Ailin; Li, Han; Shen, Meiying; Li, Daxue; Shu, Dan; Liu, Yang; Tang, Haozheng; Li, Kang; Peng, Yang; Liu, Shengchun

作者地址：[Lan, Ailin; Li, Han; Shen, Meiying; Shu, Dan; Liu, Yang; Tang, Haozheng; Li, Kang; Peng, Yang; Liu, Shengchun] Chongqing Med Univ, Affiliated Hosp 1, Dept Breast & Thyroid Surg, Chongqing, Peoples R China; [Lan, Ailin] Chongqing Med Univ, Affiliated Hosp 1, Dept Crit Care Med, Chongqing, Peoples R China; [Li, Daxue] Chongqing Med Univ, Women & Childrens Hosp, Dept Breast & Thyroid Surg, Chongqing, Peoples R China

通信作者：Li, K; Peng, Y; Liu, SC (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Breast & Thyroid Surg, Chongqing, Peoples R China.

来源：BMC MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001238679800001

JCR分区：Q1

影响因子：7

年份：2024

卷号：22

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Depression; Sleep; Cancer survivors; Mortality; NHANES

摘要：Background Depression and sleep disturbances are associated with increased risks of various diseases and mortality, but their impacts on mortality in cancer survivors remain unclear. The objective of this study was to characterize the independent and joint associations of depressive symptoms and sleep disturbances with mortality outcomes in cancer survivors.Methods This population-based prospective cohort study included cancer survivors aged >= 20 years (n = 2947; weighted population, 21,003,811) from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 cycles. Depressive symptoms and sleep disturbances were self-reported. Depressive symptoms were assessed using the Patient Health Questionnaire 9 (PHQ-9). Death outcomes were determined by correlation with National Death Index records through December 31, 2019. Primary outcomes included all-cause, cancer-specific, and noncancer mortality.Results During the median follow-up of 69 months (interquartile range, 37-109 months), 686 deaths occurred: 240 participants died from cancer, 146 from heart disease, and 300 from other causes. Separate analyses revealed that compared with a PHQ-9 score (0-4), a PHQ-9 score (5-9) was associated with a greater risk of all-cause mortality (hazard ratio [HR], 1.28; 95% CI, 1.03-1.59), and a PHQ-9 score (>= 10) was associated with greater risk of all-cause mortality (HR, 1.37; 95% CI, 1.04-1.80) and noncancer mortality (HR, 1.45; 95% CI, 1.01-2.10). Single sleep disturbances were not associated with mortality risk. In joint analyses, the combination of a PHQ-9 score >= 5 and no sleep disturbances, but not sleep disturbances, was associated with increased risks of all-cause mortality, cancer-specific mortality, and noncancer mortality. Specifically, compared with individuals with a PHQ-9 score of 0-4 and no sleep disturbances, HRs for all-cause mortality and noncancer mortality in individuals with a PHQ-9 score of 5-9 and no sleep disturbances were 1.72 (1.21-2.44) and 1.69 (1.10-2.61), respectively, and 2.61 (1.43-4.78) and 2.77 (1.27-6.07), respectively, in individuals with a PHQ-9 score >= 10 and no sleep disturbances; HRs for cancer-specific mortality in individuals with a PHQ-9 score >= 5 and no sleep disturbances were 1.95 (1.16-3.27).Conclusions Depressive symptoms were linked to a high risk of mortality in cancer survivors. The combination of a PHQ-9 score (>= 5) and an absence of self-perceived sleep disturbances was associated with greater all-cause mortality, cancer-specific mortality, and noncancer mortality risks, particularly in individuals with a PHQ-9 score (>= 10).

基金机构：Natural Science Foundation of Chongqing Municipality [CSTB2022NSCQ-MSX0940]; Chongqing Talent Program [CSTC2021YCJH-BGZXM0129]

基金资助正文：This work was supported by the Natural Science Foundation of Chongqing Municipality (Grant/Award Numbers: CSTB2022NSCQ-MSX0940) and the Chongqing Talent Program (Grant/Award Numbers: CSTC2021YCJH-BGZXM0129). Funding agencies were not involved in the design and conduct of the study, in the collection, analysis, and interpretation of data, or the preparation, review, or approval of the manuscript.