Short Sleep Duration and Its Correlates among Cancer Survivors in Korea: the Korea National Health and Nutrition Examination Surveys

  • Yoon, Hyung-Suk (Department of Biomedical Sciences, Seoul National University Graduate School) ;
  • Yang, Jae Jeong (Department of Biomedical Sciences, Seoul National University Graduate School) ;
  • Song, Minkyo (Department of Biomedical Sciences, Seoul National University Graduate School) ;
  • Lee, Hwi-Won (Department of Biomedical Sciences, Seoul National University Graduate School) ;
  • Lee, Yunhee (Department of Biomedical Sciences, Seoul National University Graduate School) ;
  • Lee, Kyoung-Mu (Department of Environmental Health, Korea National Open University) ;
  • Lee, Sang-Ah (Department of Preventive Medicine, Kangwon National University) ;
  • Lee, Jong-koo (JW Lee Center for Global Medicine, Seoul National University College of Medicine) ;
  • Kang, Daehee (Department of Biomedical Sciences, Seoul National University Graduate School)
  • 발행 : 2015.06.26


Background: Though a large proportion of cancer survivors are assumed to be commonly affected by sleep disturbance, few studies have focused on short sleep problems and its correlates among Korean cancer survivors. The purpose of this study was to evaluate the prevalence of short sleep in adult cancer survivors from a nationwide population-based sample and to identify risk factors for short sleep duration. Materials and Methods: Based on the fourth and fifth Korea National Health and Nutrition Examination Surveys (2007-2012), 1,045 cancer survivors and 33,929 non-cancer controls were analyzed. The prevalence of short sleep was compared between these two groups. Associations between short sleep and its correlates were evaluated using multiple logistic regression among cancer survivors: odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated after adjusting for sociodemographic factors, lifestyle factors, psychological conditions, and cancer-related factors. Results: About 8.1% of cancer survivors slept for less than 5 hours per day (6.2% men and 9.3% women), whereas this was the case for only 3.7% of non-cancer controls. Cancer survivors who had the lowest household income level showed a significantly higher likelihood for short sleep (adjusted OR 2.82, 95%CI 1.06-7.54). Self-reported poor health and depressive symptoms were found to be associated with significantly increased likelihood for short sleep in cancer survivors (adjusted OR 3.60, 95%CI 1.40-9.26 and adjusted OR 2.00, 95%CI 1.17-3.42). Gastric cancer survivors had a 3.97-fold increased risk for short sleep (95%CI 1.60-9.90). Conclusions: The prevalence of short sleep occurs at a high rate among the Korean cancer survivors, which may indicate a poorer quality of life and a higher risk of future complications in survivorship. Targeted interventions that can assist cancer survivors to cope with sleep disturbances as well as ensuring psychological stability are warranted to reduce the latent disease burden.


연구 과제번호 : 의생명과학사업단


  1. Akyuz RG, Ugur O, Elcigil A (2013). Sleep quality in lung cancer patients. Asian Pac J Cancer Prev, 14, 2909-13.
  2. Ali T, Choe J, Awab A, et al (2013). Sleep, immunity and inflammation in gastrointestinal disorders. World J Gastroenterol, 19, 9231-9.
  3. Ancoli-Israel S (2009). Recognition and treatment of sleep disturbances in cancer. J Clin Oncol, 27, 5864-6.
  4. Andrykowski MA, Aarts MJ, van de Poll-Franse LV, et al (2013). Low socioeconomic status and mental health outcomes in colorectal cancer survivors: disadvantage? advantage?... or both? Psychooncology, 22, 2462-9.
  5. Baker F, Denniston M, Smith T, et al (2005). Adult cancer survivors: how are they faring? Cancer, 104, 2565-76.
  6. Bardwell WA, Profant J, Casden DR, et al (2008). The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancer. Psychooncology, 17, 9-18.
  7. Choi KH, Park SM, Lee K, et al (2013). Prevalence, awareness, control, and treatment of hypertension and diabetes in korean cancer survivors: a cross-sectional analysis of the fourth and fifth Korea national health and nutrition examination surveys. Asian Pac J Cancer Prev, 14, 7685-92.
  8. Davidson JR, MacLean AW, Brundage MD, et al (2002). Sleep disturbance in cancer patients. Soc Sci Med, 54, 1309-21.
  9. Fathollahzade A, Rahmani A, Dadashzadeh A, et al (2015). Financial distress and its predicting factors among iranian cancer patients. Asian Pac J Cancer Prev, 16, 1621-5.
  10. Garland SN, Johnson JA, Savard J, et al (2014). Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat, 10, 1113-24.
  11. Irwin MR (2013). Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. Curr Psychiatry Rep, 15, 404.
  12. Irwin MR, Olmstead RE, Ganz PA, et al (2013). Sleep disturbance, inflammation and depression risk in cancer survivors. Brain Behav Immun, 30, 58-67.
  13. Kweon S, Kim Y, Jang MJ, et al (2014). Data resource profile: the Korea national health and nutrition examination survey (KNHANES). Int J Epidemiol, 43, 69-77.
  14. Lee BN, Dantzer R, Langley KE, et al (2004). A cytokine-based neuroimmunologic mechanism of cancer-related symptoms. Neuroimmunomodulation, 11, 279-92.
  15. Lee JY, Park NH, Song YS, et al (2013). Prevalence of the metabolic syndrome and associated factors in korean cancer survivors. Asian Pac J Cancer Prev, 14, 1773-80.
  16. Maneerattanaporn M, Chey WD (2009). Sleep disorders and gastrointestinal symptoms: chicken, egg or vicious cycle? Neurogastroenterol Motil, 21, 97-9.
  17. Miller AH, Ancoli-Israel S, Bower JE, et al (2008). Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol, 26, 971-82.
  18. Mulrooney DA, Ness KK, Neglia JP, et al (2008). Fatigue and sleep disturbance in adult survivors of childhood cancer: a report from the childhood cancer survivor study (CCSS). Sleep, 31, 271-81.
  19. National Cancer Information Center. 2014. Cancer Statistics in Korea [Online]. Available: [Accessed February 22 2015].
  20. Palesh O, Peppone L, Innominato PF, et al (2012). Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer. Nat Sci Sleep, 4, 151-62.
  21. Sarna L, Brecht ML (1997). Dimensions of symptom distress in women with advanced lung cancer: a factor analysis. Heart Lung, 26, 23-30.
  22. Sarna L, Padilla G, Holmes C, et al (2002). Quality of life of long-term survivors of non-small-cell lung cancer. J Clin Oncol, 20, 2920-9.
  23. Savard J, Ivers H, Villa J, et al (2011). Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol, 29, 3580-6.
  24. Savard J, Morin CM (2001). Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol, 19, 895-908.
  25. Savard J, Simard S, Blanchet J, et al (2001). Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep, 24, 583-90.
  26. Schultz PN, Klein MJ, Beck ML, et al (2005). Breast cancer: relationship between menopausal symptoms, physiologic health effects of cancer treatment and physical constraints on quality of life in long-term survivors. J Clin Nurs, 14, 204-11.
  27. Sharp L, Carsin AE, Timmons A (2013). Associations between cancer-related financial stress and strain and psychological well-being among individu among individuals living with cancer. Psychooncol, 4, 745-55
  28. Song HY, Kwon JA, Choi JW, et al (2014). Gender differences in marital disruption among patients with cancer: results from the Korean National Health and Nutrition Examination Survey (KNHANES). Asian Pac J Cancer Prev, 15, 6547-52.
  29. Theobald DE (2004). Cancer pain, fatigue, distress, and insomnia in cancer patients. Clin Cornerstone, 6, 15-21.
  30. Zhou ES, Recklitis CJ (2014). Insomnia in adult survivors of childhood cancer: a report from project REACH. Support Care Cancer, 22, 3061-9.

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