Table 2.
Characteristics of all included studies
| Study | Country | Design | Prevalence of sleep disturbances | Sample size (N) | Age (mean years ± SD) | Inclusion criteria | Sleep outcome; Cut-off | Risk factors for sleep disturbances | Other factors included in multivariate analysis | Quality assessment score |
|---|---|---|---|---|---|---|---|---|---|---|
| Su 2022 [14] | China | Cross-sectional | 63% (126/200) | 200 | 58.60 ± 6.92 | Radical resection of LC or received chemotherapy ≥ 1 cycle | AIS > 4 | Tumor stage, pain, anxiety, and depression | Gender, times of chemotherapy | 6; medium |
| Chen 2022 [23] | China | Cross-sectional | 49% (50/102) | 102 | NR | NR | PSQI > 7 | Tumor stage III or IV, distant metastasis, low serum 25 (OH) D3 expression | / | 6; medium |
| Tan 2021 [15] | China | Cross-sectional | 63% (252/400) | 400 | NR | Radical resection of LC or received chemotherapy ≥ 1 cycle | AIS > 6 | Tumor stage, pain, anxiety, and depression | Gender, times of chemotherapy | 6; medium |
| Liu 2021 [30] | China | Cross-sectional | 78.57% (110/140) | 140 | NR | Primary LC; Tumor stage was III or IV; Receiving chemotherapy | PSQI > 5 | NR | / | 7; medium |
| Lin 2021 [29] | China | Cross-sectional | NR | 154 | NR | Primary bronchogenic carcinoma; Without surgical treatment and the time from the end of the last chemotherapy > 14 d | PSQI ≥ 7 | Anxiety, times of chemotherapy, adverse reactions of chemotherapy, Acceptance-resignation coping mode | Occupation, education level, payment method, family monthly income; comorbid chronic diseases; depression | 7; medium |
| Li 2021 [26] | China | Cross-sectional | NR | 150 | 62.33 ± 7.49 | Newly diagnosed LC and hospitalized | PSQI ≥ 7 | IES-R total score and intrusion dimension | Avoidance and hyperarousal dimension | 7; medium |
| Zhang 2020 [40] | China | Cross-sectional | 40.5% (64/158) | 158 | NR | Newly diagnosed LC | AIS > 6 | Tumor stage, pain, anxiety, and depression | Gender, education level, payment method, religious affiliation or not, age, pathological type | 6; medium |
| Liu 2020 [31] | China | Cross-sectional | 89% (421/473) | 473 | 63.60 ± 9.4 | Admitted for treatment of primary LC | PSQI > 7 | NR | / | 6; medium |
| Lian 2020 [27] | China | Cross-sectional | NR | 106 | Not reported | Hospitalized patients with LC |
PSQI Cut-off unknown |
Smoking history, tumor stage, economic status, and KPS score | Gender, residence, marital status, educational level, history of alcohol consumption | 6; medium |
| An 2020 [11] | China | Cross-sectional | After chemotherapy 31.81% (35/110) | 110 | NR | Primary bronchogenic carcinoma without metastasis agreed to chemotherapy | SRSS ≥ 30 | Surgical resection and education level | pathological type, Chemotherapy cycle | 7; medium |
| Liu 2019 [32] | China |
Prospective observational |
Before chemotherapy:59.7% (37/62) After the first chemotherapy: 69.4% (43/62) After second chemotherapy: 79% (49/62) |
62 | 57.59 ± 9.0 | Stage IIIB/IV non-small cell LC; prepared for chemotherapy | PSQI ≥ 5 | NR | / | 5; medium |
| Zhang 2019 [39] | China | Cross-sectional | 37.5% (84/224) | 224 | 57.25 ± 9.96 | Diagnosed LC; Initial admission for antineoplastic therapy | AIS > 6 | NR | / | 6; medium |
| Chen 2018 [24] | China | Cross-sectional |
47.83% (44/92) |
92 | 62.39 ± 5.6 | Diagnosed LC | AIS > 6 | NR | / | 6; medium |
| Zhang 2018 [38] | China | Cross-sectional | 63.29% (100/158) | 158 | NR | Primary bronchogenic carcinoma received chemotherapy ≥ 1 cycle | PSQI > 7 | NR | / | 6; medium |
| Wei 2016 [36] | China |
Prospective Observational |
Before radiotherapy: 33.3% (19/57) 2 weeks radiotherapy: 36.8% (21/57) Radiotherapy 4 weeks: 39.1% (23/57) Completion of radiotherapy: 52.6% (30/57) |
57 | 59.22 ± 8.08 | LC, Receiving thoracic radiotherapy | PSQI > 7 |
Before radiotherapy: anxiety, pain, fatigue, and cough Radiotherapy for 2 weeks: advanced age, depression, anorexia, dyspnea, and constipation Radiotherapy for 4 weeks: concurrent chemotherapy, fatigue, anorexia, dry mouth, CD3 + , CD3 + CD4 + At the end of radiotherapy: anxiety, fatigue, dry mouth, IL-6 |
Before radiotherapy: Depression, constipation; Radiotherapy for 2 weeks: anxiety, pain, diabetes, chemotherapy history, fatigue, weight loss, cough; Radiotherapy for 4 weeks: cough, anxiety, depression; At the end of radiotherapy: depression |
5; medium |
| Gu 2016 [20] | China | Cross-sectional | 89% (89/100) | 100 | 66.28 ± 7.40 | Diagnosed LC; Received chemotherapy for more than 2 weeks |
PSQI Cut-off unknown |
Age, education level, payment method, tumor stage, and presence or absence of complications | // | 7; medium |
| Wei 2015 [37] | China | Cross-sectional | 68. 4% (106 /155) | 155 | 59. 6 ± 8. 6 | Diagnosed LC; Received chemotherapy | PSQI > 7 | NR | / | 6; medium |
| Wang 2015 [35] | China | Cross-sectional | 68% (68/100) | 100 | NR | Diagnosed LC; Received thoracotomy under general anesthesia | PSQI > 7 | NR | / | 7; medium |
| Lin 2015 [28] | China | Cross-sectional | 55.14% (59/107) | 107 | 55.63 ± 6.7 | Diagnosed LC; Received chemotherapy ≥ 1 cycle | PSQI > 7 | NR | / | 6; medium |
| Sha 2012 [33] | China | Cross-sectional | 46.1% (70/152) | 152 | 57.09 | ICU stay time ≥ 7 days, LC undergoing thoracotomy under general anesthesia | PSQI > 7 | Unfamiliar environment, physical discomfort, and pain caused by diseases | Nocturnal therapeutic care, nurse's footsteps, cough, dyspnea, foreign body sensation from intubation, excessive daytime sleep, worry about condition, emotional boredom, missing loved ones | 7; medium |
| Teng 2011 [34] | China | Cross-sectional | 59.4% (57/96) | 96 | 69.2 ± 8.9 | Age > 60 years old; Diagnosed LC | PSQI ≥ 8 | NR | / | 7; medium |
| Li 2011 [ 25 ] | China | Cross-sectional | 45.9% (45/98) | 98 | 31–88; mean 58.8 | Hospitalized primary bronchogenic carcinoma | PSQI > 7 | Marital status and KPS score | NR | 9; high |
| Chen 2008 [ 44 ] | Taiwan, China | Cross-sectional | 52% (60/115) | 115 | 59.4 ± 10.7 | Diagnosed with stage III or IV LC; planning to receive chemotherapy | PSQI > 5 | NR | / | 7; medium |
| Dean 2013 [45] | USA | Cross-sectional | 80% (28/35) | 35 | 63.5 ± 9.7 | Diagnosis of SCLC or NSC LC received chemotherapy ≥ 1 cycle | PSQI > 5 | NR | / | 7; medium |
| Dean 2015 [10] | USA |
Prospective observational |
baseline:76% DS: 21% baseline, 33% at pre-second chemotherapy, and 35% at pre-third chemotherapy (10/29) |
29 | 66.6 ± 9.5 | Diagnosis of inoperable NSCLC; scheduled to receive chemotherapy |
PSQI > 5 daytime sleepiness: ESS > 10 |
NR | / | 5; medium |
| Halle 2017 [21] | Norway |
Prospective observational |
60.9% at baseline, 68.5% at Month 1, 55.4% at Month 5, 51.3% at Month 9, and 49.7% at Month 12 |
264 | 65.8 (± 8.5) | Scheduled for surgery for primary LC | GSDS total sum score ≥ 43 | NR | / | 5; medium |
| Lou 2017 [48] | China | Cross-sectional | 62.5% (80/128) | 128 | 60.60 ± 9.82 | advanced LC (stage III or IV) | PSQI > 5 | NR | / | 6; medium |
| Papadopoulos 2019 [ 41 ] | Greece | Cross-sectional | 58.2% (69/119) | 119 | 64 | Diagnosed LC; received chemotherapy ≥ 1 cycle | PSQI > 5 |
anxiety and stress symptoms and positive coping practices |
Gender, age, pain, Charlson Comorbidity Index, cancer stage, use of concomitant medications, history of brain metastases, sleep hygiene practices, recent surgery or radiation therapy, dyspnea, chemotherapy type, cough, depression, negative coping, comfort/ support seeking coping, social support | 9; high |
| Belloumi 2020 [42] | Tunisia | prospective study |
Before chemotherapy: 15.6% (10/64) After chemotherapy 45.3% (29/64) |
64 | 62:9 ± 8:18 | NSCLC with histological proof; stage III or IV; chemotherapy course | PSQI > 5 | therapeutic management delays (Mean delay to histological confirmation; Mean delay to treatment onset) | Chemotherapy complications, depressive humor, anxious humor | 5; medium |
| Mercadante 2021 [13] | Italy |
Cross-sectional secondary analysis |
83.2% (151/182) | 182 | 69.9 ± 10.8 | Diagnosed LC | AIS ≥ 6 | drowsiness, HADS-A, HADS-D, and time from diagnosis | Poor karnofsky level, nausea | 7; medium |
| Takemura 2021 [49] | Hong Kong, China | Cross-sectional | 49.4% (81/164) | 164 | 61.16 ± 8.80 | Diagnosed with stage IIIB or IV NSCLC | PSQI > 5 | Timed up and go (TUGT) | NR | 7; medium |
| He 2022 [17] | China | Cross-sectional | 48.9% (48/98) | 98 | 57 | Diagnosed advanced LC (stage III/IV); untreated before the evaluation | PSQI > 7 | NR | / | 6; medium |
| Lee 2022 [47] | Korea | Cross-sectional |
Poor sleep quality:45% (31/69) DS:10% (7/69) clinical insomnia: 4% |
69 | 68.0 ± 9.8 | Diagnosed LC |
PSQI > 5 ESS > 10 ISI > 14 |
NR | / | 6; medium |
| Vena 2006 [50] | USA | Cross-sectional |
Poor sleep quality: 88%(38/43) DS:44%(19/44) |
43 | 62.70 ± 9.87 | Primary diagnosis of stage IIIB or IV NSCLC or extensive SCLC |
PSQI ≥ 5 ESS > 10 |
NR | / | 6; medium |
| Gooneratne 2007 [46] | USA | Cross-sectional | 56.6% (43/76) | 76 | 73.6 ± 6.7 | At least 5 years post-diagnosis of LC | PSQI > 5 | NR | / | 6; medium |
| Le Guen 2007 [12] | France | Cross-sectional |
Poor sleep quality: 96%(28/29) DS:42%(12/29) |
29 | 59 ± 12 | Newly diagnosed LC |
PSQI ≥ 5 ESS ≥ 10 |
NR | / | 6; medium |
| Chang 2017 [43] | Taiwan | Cross-sectional | NR | 40 | 66.92 ± 11.01 | Diagnosed LC; not received related treatment | PSQI > 8 | the diurnal cortisol slope and BFI score | HADS-A, HADS-D, salivary melatonin, diurnal melatonin, salivary cortisol | 9; high |
AIS: Athens Insomnia Scale; PSQI: Pittsburgh Sleep Quality Index; SRSS: Self-Rating Scale of Sleep; ESS: Epworth Sleepiness Scale; GSDS: General Sleep Disturbance Scale; BFI: Brief Fatigue Inventory; IES-R: Impact of Event Scale-Revised; HADS-A: Hospital anxiety and depression scale-Anxiety; HADS-D: Hospital anxiety and depression scale-Depression; NR: Not Reported; LC: lung cancer; SCLC: small cell lung cancer; NSCLC: non-small cell lung cancer; DS: daytime sleepiness