Prevalence and risk factors of sleep disturbances among patients with lung cancer: systematic review and meta-analysis

Purpose: Patients with lung cancer endure the most sleep problems. Understanding the prevalence and risk factors of sleep disturbances in lung cancer populations is critical in reducing symptom burden and improving their quality of life. This systematic review aimed to determine the prevalence and risk factors of sleep disturbances in patients with lung cancer. Methods: Seven electronic databases were systematically screened for studies on the prevalence or risk factors of sleep disturbances in patients with lung cancer. Subgroup analyses were conducted to investigate significant heterogeneity (I² > 50%) across studies. Results: Thirty-seven studies were found eligible. The pooled prevalence was 0.61 (95% CI = [0.54–0.67], I² = 96%, p < 0.00001). Seven risk factors were subject to meta-analyses. Significant differences were found for old age (OR = 1.23; 95% CI = [1.09–1.39], p = 0.0006,I² = 39%), a low education level (OR = 1.17; 95%CI = [1.20–2.66], p = 0.004, I² = 42%), fatigue (OR = 1.98; 95%CI = [1.23–3.18], p = 0.005, I² = 31%), pain (OR = 2.63; 95% CI = [1.35–5.14], p = 0.005, I² = 91%), tumor stage of III or IV (OR = 2.05; 95%CI = [1.54–2.72], p < 0.00001, I ² = 42%), anxiety (OR = 1.62; 95%CI = [1.22–2.14], p = 0.0008, I² = 78%), and depression (OR = 4.02; 95% CI = [1.39–11.61], p = 0.01, I² = 87%). After the included studies were withdrawn one after the other, pain (OR = 3.13; 95% CI = [2.06–4.75], p < 0.00001, I² = 34%) and depression (OR = 5.47; 95% CI = [2.65–11.30], p < 0.00001) showed a substantial decrease of heterogeneity. Meanwhile, the heterogeneity of anxiety symptoms remained unchanged. Conclusion: Results showed that sleep disturbances were experienced in more than 60% of patients with lung cancer. The comparatively high prevalence of sleep disturbances in this population emphasizes the need to adopt measures to reduce them. Significant associations were found between sleep disturbances and various factors, including age, education level, fatigue, pain, cancer stage, anxiety, and depression. Among these factors, depression emerged as the most significant. Future research should concentrate on identifying high-risk individuals and tailored interdisciplinary interventions based on these risk factors.