Kevser Arkan, Gül Çavuşoğlu Çolak, Pınar Birol İlter, Sedat Akgöl
Southern Clinics of Istanbul Eurasia - 2025;36(4):360-365
Objective: This study aimed to prospectively evaluate the factors influencing sleep quality in patients undergoing surgical interventions for gynecological malignancies, with a particular focus on the impact of surgical menopause. Methods: This prospective cohort study included 142 patients who underwent surgical procedures for endometrial, ovarian, or cervical cancer at a tertiary care institution. Participants were divided into two cohorts: Those who underwent surgical menopause (SM group, n=68) and those who did not (non-SM group, n=74). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) both preoperatively and three months postoperatively. Preoperative anxiety and depression levels were measured using the Hospital Anxiety and Depression Scale (HADS). Demographic, clinical, and surgical data were collected systematically. Multiple linear regression analysis was performed to identify independent associated factor of poor postoperative sleep quality, as indicated by changes in the PSQI score. Results: The mean global PSQI score significantly worsened from 5.1+/-2.8 at baseline to 8.9+/-4.1 at 3 months postoperatively (p<0.001). The deterioration in sleep quality was significantly greater in the SM group than in the non-SM group (mean PSQI change: +5.6 vs. +2.1, p<0.001). In the multivariate regression model, surgical menopause (beta=3.12, p<0.001), adjuvant chemotherapy (beta=1.89, p=0.002), higher baseline HADS anxiety score (beta=0.25, p=0.005), and higher postoperative pain score (VAS) (beta=0.31, p=0.018) were identified as independent associated factor of a greater increase in the PSQI score (worse sleep quality). Conclusion: Postoperative sleep quality significantly deteriorated following gynecologic cancer surgery, with surgical menopause identified as the most significant independent associated factor of this decline. Furthermore, pre-existing anxiety, adjuvant chemotherapy, and postoperative pain substantially contributed to this deterioration. These findings highlight the necessity of routine screening of sleep quality and the implementation of targeted interventions, including the management of menopausal symptoms, provision of psychological support, and effective pain control within this vulnerable patient cohort.
