がん化学療法を受ける患者の睡眠の特徴と影響要因

Characteristics and Influencing Factors of Sleep in Patients Receiving Cancer Chemotherapy

要旨

　【目的】がん化学療法を受ける患者の睡眠の特徴と影響要因を明らかにした．

　【方法】化学療法中のがん患者を対象にPSQI-Jを用いて自己記述調査を行った．影響要因はPSQI総得点による睡眠不良の有無と各変数を比較し，有意差を認めた5項目と年齢，性別を独立変数にし，変数増加法で重回帰分析を行った．

　【結果】対象者は64名，平均年齢56.4±7.2歳，消化器がんが81.3％，Stage IVが64.1％を占めた．鎮痛薬内服が31.3％，ステロイド薬内服が37.5％，睡眠薬内服が12.5％であった．PSQI総得点は平均5.2（±2.9）点で，睡眠不良が37.5％を占めた．睡眠不良の人は，入眠の所要時間が34.4±24.7分，実睡眠時間は5.9±1.2時間，睡眠の効率は84.5±12.6％で有意差を認めた．身体症状は末梢神経障害が42.2％，食欲低下が37.5％，倦怠感が35.9％，痛みが17.2％に出現した．痛み，味覚障害のある患者は，実睡眠時間が有意に短く睡眠不良であった．ステロイド薬と睡眠薬の内服，痛みや味覚障害はPSQI総得点の影響要因として抽出された（調整済みR²＝0.432）

　【考察】がん化学療法はステロイド薬内服，痛みや味覚障害により睡眠が障害されやすく，睡眠薬は入眠を促す効果が不十分で，睡眠不良の患者には痛みの症状緩和を図る必要性が示唆された．

　Objective: We clarified the characteristics and influencing factors of sleep in patients receiving cancer chemotherapy.

　Methods: We conducted a self-description survey on the sleep of cancer patients receiving chemotherapy using PSQI-J. Multiple regression analysis was performed using the variable increase method with age, sex, and five items of influencing factors that showed significant differences between the presence or absence of poor sleep based on the total score of PSQI and each variable as independent variables.

　Results: Among 64 subjects with average of 56.4 ± 7.2 years, 52 (81.3%) had gastrointestinal cancer and 41 (64.1%) had stage IV cancer. The use of oral medication was 31.3% for analgesics, 37.5% for steroids, and 12.5% for sleeping pills. The PSQI total score was an average of 5.2 ± 2.9 points. Those with poor sleep had 34.4 ± 24.7 minutes for sleep onset time, 5.9 ± 1.2 hours for actual sleep time, and 84.5 ± 12.6% for sleep efficiency with significant differences. Side effect symptoms were peripheral neuropathy in 42.2%, loss of appetite in 37.5%, fatigue in 35.9%, and pain in 17.2%. Patients with pain and taste disorder had short sleep time and poor sleep with statistical significance. Oral administration of steroids and sleeping pills, pain, and taste disorders were extracted as influencing factors of the PSQI total score (adjusted R² = 0.432).

　Discussion: In cancer chemotherapy, sleep is likely to be disrupted due to oral administration of steroids, pain, and taste disorders. Sleeping pills are not effective in promoting sleep onset. These analyses suggest that it is necessary to alleviate pain symptoms in patients with poor sleep.