Preoperative insomnia and its association with psychological factors, pain and anxiety in Chinese colorectal cancer patients

  • Guang-Wei Sun
  • Yi-Long Yang
  • Xue-Bin Yang
  • Yin-Yin Wang
  • Xue-Jiao Cui
  • Ying LiuEmail author
  • Cheng-Zhong XingEmail author
Original Article



Sleep disturbances are common in cancer patients, but little is known about preoperative insomnia and its associated factors in colorectal cancer (CRC) patients. The aim of this study was to clarify the relationship between preoperative insomnia and its associated factors (i.e., pain, anxiety, self-esteem, and coping styles) in CRC patients.


A cross-sectional study was conducted in consecutive CRC inpatients (N = 434), who were required to complete the questionnaires about insomnia, pain, anxiety, self-esteem, and coping styles (acceptance/resignation, confrontation, avoidance) before the day of surgery. Hierarchical regression analyses were conducted to explore the relationships between preoperative anxiety and its associated factors.


Based on the cutoff value of Athens Insomnia Scale (scores ≥ 6) in Chinese cancer patients, the prevalence of insomnia was 38.2% before surgery. Pain (β = 0.087, p = 0.015) and anxiety (β = 0.372, p < 0.001) were positively associated with preoperative insomnia, while self-esteem (β = − 0.479, p < 0.001) and confrontation coping (β = − 0.124, p = 0.003) showed protective effects on preoperative insomnia when putting them together into hierarchical regression. The associated factors together accounted for an additional variance of preoperative insomnia (47.6%).


In line with previous findings, the detrimental effects of pain and anxiety on preoperative insomnia were also observed in our study. More importantly, our main new findings were that self-esteem and confrontation coping played important roles in alleviating preoperative insomnia among CRC patients. Clinicians should take these results into account when developing cancer care management to relieve preoperative insomnia.


Colorectal cancer Preoperative insomnia Pain Anxiety Self-esteem Coping styles 



The authors would like to thank all the staffs who contributed to this study.

Funding information

This work was supported by grants from the National Natural Science Foundation of China (Project No.: 81472853) and Basic Research Projects of the Higher Education Department of Liaoning Province (Project No.: LQNK201732).

Compliance with ethical standards

Ethical approval

The study design was approved by the Committee on Human Experimentation of China Medical University and complied with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Patients were well informed about the purpose and contents of our study by investigators. Written informed consent was obtained from all inpatients included in this study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Guang-Wei Sun
    • 1
  • Yi-Long Yang
    • 2
  • Xue-Bin Yang
    • 3
  • Yin-Yin Wang
    • 3
  • Xue-Jiao Cui
    • 4
  • Ying Liu
    • 5
    Email author
  • Cheng-Zhong Xing
    • 1
    Email author
  1. 1.Department of AnorectalThe First Affiliated Hospital of China Medical UniversityShenyangPeople’s Republic of China
  2. 2.Department of Social Medicine, School of Public HealthChina Medical UniversityShenyangPeople’s Republic of China
  3. 3.Dalian Seventh People’s HospitalDalianPR China
  4. 4.Psychological ClinicThe Second Hospital of Dalian Medical UniversityDalianPeople’s Republic of China
  5. 5.Department of PsychiatryThe First Affiliated Hospital of China Medical UniversityShenyangPeople’s Republic of China

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