{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T07:49:33Z","timestamp":1780386573828,"version":"3.54.1"},"reference-count":52,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T00:00:00Z","timestamp":1743292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>This exploratory cross\u2010sectional observational study sought to characterize sleep quality and evaluate its association with sociodemographic, clinicopathological, behavioral, and psychological variables in patients with head and neck squamous cell carcinoma (HNSCC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>Sleep problems from 132 HNC patients were assessed before starting oncological treatment through the questionnaires Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and STOP\u2010Bang. Anxiety and depression symptoms were evaluated using the Hospital Anxiety and Depression Scale. Univariate analysis and multivariate logistic regression were performed to evaluate factors associated with sleep problems in HNSCC patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>About 50% of the HNSCC patients reported poor overall sleep quality on the PSQI. Insomnia, excessive daytime sleepiness, and high risk of apnea were observed in 19%, 15%, and 54% of HNSCC patients, respectively. Our results showed that pain was associated with overall poor PSQI sleep quality and lower PSQI sleep efficiency, while the presence of regional metastasis was linked to overall PSQI good sleep. No other clinicopathological or behavioral (i.e., alcohol and tobacco use) variables were related to sleep outcomes. Higher occurrence of anxiety symptoms was related to poor overall PSQI sleep quality, decreased PSQI sleep efficiency, PSQI daytime dysfunction, and ISI insomnia. Moreover, higher occurrence of depression symptoms was associated with lower PSQI sleep latency and PSQI duration, and the occurrence of ESS excessive daytime sleepiness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pain, anxiety, and depressive symptoms were associated with poor sleep quality and sleep problems in HNSCC patients before starting treatment. No sociodemographic or behavioral (i.e., alcohol and tobacco use) variables were related to sleep outcomes. Likewise, tumor location, T classification, and clinical staging were not linked to sleep quality and disorders in HNSCC patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.28147","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T22:49:20Z","timestamp":1743461360000},"page":"2290-2312","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Associations of Pain, Anxiety, and Depressive Symptoms With Sleep Outcomes in Patients With Head and Neck Squamous Cell Carcinoma: A Cross\u2010Sectional Observational Study"],"prefix":"10.1002","volume":"47","author":[{"given":"Giseli Mitsuy","family":"Kayahara","sequence":"first","affiliation":[{"name":"Psychosomatic Research Center, Oral Oncology Center S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"},{"name":"Department of Diagnosis and Surgery S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna Am\u00e9lia Moreira","family":"Sarafim\u2010Costa","sequence":"additional","affiliation":[{"name":"Psychosomatic Research Center, Oral Oncology Center S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus Vin\u00edcius","family":"Branco de Oliveira","sequence":"additional","affiliation":[{"name":"Unimed Hospital of Ara\u00e7atuba  Ara\u00e7atuba S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ant\u00f4nio Mendes","family":"Fontanelli","sequence":"additional","affiliation":[{"name":"Unimed Hospital of Ara\u00e7atuba  Ara\u00e7atuba S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Ye","sequence":"additional","affiliation":[{"name":"Translational Research Center, NYU Pain Research Center, Department of Molecular Pathobiology College of Dentistry, New York University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4434-6057","authenticated-orcid":false,"given":"Vitor Bonetti","family":"Valente","sequence":"additional","affiliation":[{"name":"Psychosomatic Research Center, Oral Oncology Center S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"},{"name":"Department of Diagnosis and Surgery S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eder Ricardo","family":"Biasoli","sequence":"additional","affiliation":[{"name":"Psychosomatic Research Center, Oral Oncology Center S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"},{"name":"Department of Diagnosis and Surgery S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5748-9412","authenticated-orcid":false,"given":"Glauco Issamu","family":"Miyahara","sequence":"additional","affiliation":[{"name":"Psychosomatic Research Center, Oral Oncology Center S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"},{"name":"Department of Diagnosis and Surgery S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1225-7749","authenticated-orcid":false,"given":"Daniel Galera","family":"Bernab\u00e9","sequence":"additional","affiliation":[{"name":"Psychosomatic Research Center, Oral Oncology Center S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"},{"name":"Department of Diagnosis and Surgery S\u00e3o Paulo State University (Unesp), School of Dentistry  Ara\u00e7atuba S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-04849-3"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2023.12.004"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12035-008-8026-z"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms20112780"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2016.06.041"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552\u2010019\u201001156\u20104"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.27441"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2017.85"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/10732748231160129"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13081855"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05577-9"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20924"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12529\u2010018\u20109715\u20102"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2021.105211"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31597"},{"key":"e_1_2_7_18_1","unstructured":"L. d. S.Castro \u201cAdapta\u00e7\u00e3o e valida\u00e7\u00e3o do \u00edndice de gravidade de ins\u00f4nia (IGI): caracteriza\u00e7\u00e3o populacional valores normativos e aspectos associados \u201d2011104 f. Disserta\u00e7\u00e3o (Mestrado) \u2010 Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo. S\u00e3o Paulo 2011."},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1806-37132009000900009"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1806\u201037562017000000139"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/13548500500524088"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1781(89)90047-4"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2010.04.020"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.860"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/34.5.601"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2021.01.045"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.12891"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/14.6.540"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0b013e32832a96e2"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-05244-8"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-89101995000500004"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2020.101770"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep34206"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.02.013"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674370204700905"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1159\/000518108"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-022-07483-8"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03480090092034"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00443"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4305"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpnec.2022.100110"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PSY.0000040950.22044.10"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2017.05.008"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpsycho.2023.07.006"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0202515"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsycho.2006.11.002"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/34.2.171"},{"key":"e_1_2_7_49_1","doi-asserted-by":"crossref","DOI":"10.1200\/JCO.2000.18.4.743","article-title":"Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life","volume":"18","author":"Bower J. E.","year":"2000","journal-title":"Journal of Clinical Oncology"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951518000779"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.14423\/SMJ.0000000000001529"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol\u20102014\u2010051563"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980020004553"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.28147","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T02:33:18Z","timestamp":1752719598000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.28147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,30]]},"references-count":52,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1002\/hed.28147"],"URL":"https:\/\/doi.org\/10.1002\/hed.28147","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,30]]},"assertion":[{"value":"2024-03-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}