Insomnia screening protocol and postoperative outcomes among patients with gastrointestinal cancer: a propensity score-matched analysis

PURPOSE: The occurrence of insomnia was prevalent in patients with gastrointestinal cancers (GICs). This study aimed to evaluate the effectiveness of perioperative insomnia screening for early detection and treatment among these patients. METHODS: A retrospective analysis was performed using prospectively collected data from 438 patients who underwent insomnia screening using the Insomnia Severity Index (ISI), followed by specialized treatments. Propensity-score matching was conducted at a 1:1 ratio to control for potential confounding factors. Primary endpoint was the reduction in ISI scores at 1 week postoperatively. Secondary outcomes included postoperative analgesics, gastrointestinal function, Multidimensional Fatigue Inventory (MFI), Hospital Anxiety and Depression scale (HADS) and European Quality of Life Five-dimension (EQ-5D) scores. RESULTS: There were 29.9% of patients with a mean ISI score of 8.19 ± 1.32 in the screening cohort at postoperative 1-week, which was lower than the control cohort with a mean difference (MD) of 9.77 (95% confidence interval (CI): 8.56-10.90 (p < 0.001). Significant differences were observed in the mean scores of MFI (MD = 23.67 (95%CI: 14.07-33.26), p < 0.001 for 1-week and 27.05 (95%CI: 17.19-36.89), p < 0.001 for 3-month) and HADS (MD = 17.62 (95%CI: 11.32-23.92), p < 0.001 for 1-week and 14.59 (95%CI: 9.63-19.54), p < 0.001) between cohorts. The screening cohort demonstrated better outcomes compared to the control cohort in postoperative analgesic consumption (p = 0.012) and time to first flatus (p = 0.022)/defecation (p < 0.001). Patients undergoing screening exhibited significantly greater improvements in EQ-5D scores over time compared to controls (all p < 0.001). Infectious complications were fewer in screening cohort than controls. CONCLUSIONS: The introduce of screening combined with specialized treatments for insomnia in patients with GICs effectively reduced sleep disturbances, resulting in significantly faster operative recovery and greater improvements in patients' psychological distress and quality of life within a 3-month follow-up.