| Objective: Evidence for a role of pre-diagnosis sleep status on ovarian cancer(OC)survival has been limited.This study intends to use the Ovarian Cancer Follow-Up Study(OOPS)database to explore if pre-diagnosis night bedtime,wake-up time,night sleep duration,total sleep duration,daytime napping duration,sleep quality and sleep pattern are associated with risk of all-cause death of OC,providing sleep guidance for the survival of OC patients.Methods: The prospective cohort study included OC patients aged 18-75 years who were diagnosed and treated at Shengjing Hospital of China Medical University during2015 to 2020.Baseline information on sleep status over the past year before OC diagnosed was measured using a validated 19-item Pittsburgh Sleep Quality Index(PSQI)questionnaire that was collected by a trained interviewer.Other information was also collected at recruitment through in-person interviews,including demographics and living habits,and obtained clinical information of the subjects through Hospital Information System.Anthropometric indicators such as height and weight were also collected.Vital status of patients was obtained through follow-up and medical records until March 31,2021.In this study,variance analysis and chi-square test were used to compare the differences among OC patients with different sleep quality.Kaplan-Meier technique was used to estimate the crude survival probability of OC patients and draw the survival curve.Cox proportional hazards regression models was used to respectively evaluate the hazard ratios(HR)and 95% confidence intervals(CI)for the associations of pre-diagnosis night bedtime,wake-up time,daytime napping duration,night sleep duration,total sleep duration,sleep quality and sleep pattern with survival,and the nonlinear relationship was assessed using restricted cubic spline model.Subgroup analysis was performed based on age at diagnosis,body mass index,menopausal status,parity,histological type and residual lesions and the interaction between sleep status and survival of OC was further analyzed.Results: A total of 669 newly diagnosed OC patients from the Ovarian Cancer Follow-Up Study were included until December 2020.During the follow-up period(median: 37.57 months,interquartile: 25.00 to 50.17 months),123(18.39%)OC patients died.The results showed that OC patients who went to bed after 22:00 were associated with a lower OS survival rate than those who went to bed before 22:00(HR:2.13,95%CI: 1.42-3.18);OC patients with poor sleep quality were associated with reduced survival compared with OC patients with better sleep quality(HR: 2.43,95%CI: 1.64-3.62);Compared with patients with OC who went to bed and got up early,patients with OC who went to bed and got up late were associated with lower survival rates,with HR(95%CI)of 2.26(1.37-3.72)and 1.93(1.09-3.42),respectively.Compared with OC patients sleeping 7-7.5 h/day,OC patients sleeping ≥7.5 h/day at night were associated with improved survival(HR: 0.40,95%CI: 0.24-0.67);OC patients with total sleep duration ≥8 hours/day were associated with improved survival compared with OC patients with total sleep duration 7.5-8 hours/day(HR:0.53,95%CI: 0.29-0.98).Further,the multiplicative interaction effects were significant between residual lesions and wake-up time,sleep pattern,and between total sleep duration and menopausal status,parity.The additive interaction effect was significant between residual lesions and night bedtime.Subgroup analysis showed that late nighttime bedtime was associated with decreased survival in OC patients with serous type and residual lesions,and the corresponding HR(95%CI)were2.35(1.45-3.80)and 4.31(2.00-9.26),respectively;In the residual group,late wake-up time was associated with improved survival in OC patients(HR: 2.33,95%CI:1.17-4.65);In the >50 year old group,the birth time ≤1 group and the no lesion residual group,longer night sleep duration was associated with the reduction and improvement of survival rate in OC patients.The corresponding HR(95%CI)were0.38(0.20-0.73),0.38(0.19-0.73)and 0.40(0.20-0.79),respectively;In the >50 years old group,BMI <24 kg/m2 group and serous group,longer total sleep duration was associated with improved OS survival rate in OC patients.The corresponding HR(95%CI)were 0.35(0.16-0.74),0.31(0.15-0.66)and 0.35(0.17-0.72),respectively;Daytime napping duration was associated with lower OS survival in OC patients with >50 years old,BMI<24 kg/m2 and no residual lesions.The corresponding HR(95%CI)were 1.75(1.06-2.90),2.23(1.14-4.38)and 1.70(1.01-2.86),respectively.In the BMI <24 kg/m2 group and the birth ≤1 group,poor sleep quality was associated with reduced OS survival in OC patients,and the corresponding HR(95%CI)were3.13(1.87-5.26)and 2.82(1.73-4.61),respectively.Additionally,the result of restrict cubic spline showed there was a significant nonlinear association between PSQI score and OS(P nonlinear <0.05).Conclusion: Pre-diagnosis longer total and night sleep duration were associated with better OS,whereas later sleeping time,poor sleep quality,and bad sleep patterns were associated with poor OS among OC survivors. |
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