Evaluating perioperative self-reported sleep quality in patients with a gynecologic malignancy

Abstract

Purpose: This study aims to evaluate patient-reported peri-operative sleep quality and identify demographic, clinical, and psychosocial factors associated with poor sleep perioperatively among individuals with gynecologic malignancies. Methods: This prospective study included patients with confirmed gynecologic malignancies who underwent surgery between September 2020 and October 2023 and were admitted to the hospital for at least one overnight stay. Preoperative sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while postoperative sleep quality was measured with the Richards-Campbell Sleep Questionnaire (RCSQ). "Good" sleep was defined as a PSQI score < 5 or an RCSQ score > 50. Statistical analyses were conducted using t-tests, Pearson's χ2, or Fisher's exact tests, as appropriate. Results: The mean age of participants was 58.6 years (SD 13.2); 68.9% identified as white, 50% had ovarian cancer, and 54.6% had advanced-stage disease. Pre-operatively, 56.1% of patients reported poor sleep, most commonly due to overnight awakenings from nocturia (67.4%) and vasomotor symptoms (28%). Poor sleep was more common among patients with cervical or vulvar cancer (p = 0.02), those using sleep medications preoperatively (p = 0.002), and those with co-morbid anxiety and depression (p = 0.06). Good post-operative sleep on post-operative day 1 and on day of discharge was associated with increased use of opioid medications (p = 0.007 and 0.02, respectively). Overall, sleep quality significantly declined during hospitalization (p < 0.001). Conclusion: Poor perioperative sleep in patients with gynecologic cancers was linked to cancer type, mental health, pain management, and the hospital environment with sleep deteriorating during hospitalizations. Addressing these factors may offer meaningful opportunities to improve sleep.