Mediating Effect of Depression on Relationship Between Sleep Disturbance and Locomotive Syndrome in Geriatric Cancer Patients

Yao Chen,1,* Hu-Nan Wang,2,3,* Ying Chen,1 Xue-Fen Liang,4 Hai-Wa Xu,4 Rui-Rong Wu,1 Li-Hua Dong,4 Hui Su,1 Yu-Ling Yang1 1Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214122, People’s Republic of China; 2Laboratory of Oncology Precision Diagnosis and Treatment, Wuxi Medical College of Jiangnan University, Wuxi, 214122, Jiangsu Province, People’s Republic of China; 3Department of Cancer Diagnosis and Treatment Center, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214122, People’s Republic of China; 4Department of Oncology, Donghai County People’s Hospital, Lianyungang, Jiangsu Province, 222300, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yu-Ling Yang, Department of Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, 214122, Jiangsu Province, People’s Republic of China, Tel +86-139-1249-7649, Email yulingzxc@163.com Hui Su, Department of Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, Jiangsu Province, 214122, People’s Republic of China, Tel +86-137-7145-1810, Email 13771451810@163.comObjective: To investigate the mediating role of depression between sleep disturbance and locomotive syndrome (LS) in geriatric cancer patients, and to provide a basis for interventions targeting motor function impairment in this population.Methods: A convenience sample of 600 geriatric cancer patients was recruited in this cross-sectional study. General information questionnaires, the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire Depression Scale (PHQ-9), and the Geriatric Locomotive Function Scale (GLFS-25) were administered to measure depression, sleep disturbance, and LS. Multivariate logistic regression was used to evaluate the impact of sleep disturbance on LS. Bootstrap sampling was performed to analyze the mediating effect of depression scores this relationship.Results: Valid questionnaires were obtained from 584 geriatric cancer patients. Sleep disturbances affected 216 patients (37.0%), including 66 (11.3%) with moderate-to-severe disturbances, while 259 (44.3%) had LS. After controlling for confounding factors, multivariate logistic regression showed that geriatric cancer patients with mild and moderate-to-severe sleep disturbances had 1.42-fold (95% CI: 1.23~1.67, P=0.001) and 1.81-fold (95% CI: 1.31~2.45, P< 0.001) higher risks of LS, respectively. Mediator analysis revealed that depression partially mediated the relationship between sleep disturbances and LS, with an effect size of 0.043 (95% CI: 0.032~0.055, P< 0.001), accounting for 21.15% of the total effect.Conclusion: Depression, sleep disturbance, and LS are closely related. Sleep disturbance was directly and indirectly associated with LS through depression. Healthcare providers should pay attention to sleep disturbances and depression in geriatric cancer patients. For patients whose sleep quality cannot be effectively improved, alleviating depressive symptoms may help reduce the incidence of LS.