The Interplay of Sleep Quality, Pain, and Socio-demographic Factors in Patients with Oral Squamous Cell Carcinoma: A Cross-sectional Study

Abstract

Background: Sleep disturbances and pain are debilitating comorbidities in cancer patients. Objectives: This study aimed to comprehensively assess sleep quality and pain and explore their association with a wide range of demographic and clinical factors in patients with oral squamous cell carcinoma (OSCC) in Ahvaz, Iran. Methods: A cross-sectional study was conducted on 75 OSCC patients through census sampling in 2025. Sleep quality and pain were measured using the Pittsburgh Sleep Quality Index (PSQI) and a Visual Analogue Scale (VAS), respectively. Demographic, socio-economic, and clinical data were collected via interviews and medical records. Data were analyzed using descriptive statistics, Mann-Whitney U, Kruskal-Wallis H, and Spearman's correlation tests, with a significance level of P < 0.05. Results: The mean PSQI score was 9.64 ± 3.60, indicating severe sleep disturbance, with 84% of participants classified as poor sleepers (PSQI > 5). The mean pain score was 6.5 ± 2.1. Employment status was a significant factor, with employed patients reporting worse subjective sleep quality (P = 0.036) and morning dysfunction (P = 0.038) compared to retirees. A significant difference was also found in sleep efficiency across different age groups (P = 0.040). No other demographic factors (gender, marital status, insurance type, residence, socio-economic status (SES), comorbidity, time since diagnosis) showed a significant association with sleep quality components. A strong positive correlation was found between the global PSQI score and pain intensity (rs = 0.68, P < 0.001). Conclusions: The study highlights the significant impact of employment status and age on sleep quality among OSCC patients, with employed individuals and certain age groups experiencing more severe disturbances. The strong correlation between sleep quality and pain intensity underscores the need for integrated management strategies addressing both sleep and pain to improve patient outcomes.