{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T05:50:58Z","timestamp":1774677058955,"version":"3.50.1"},"reference-count":46,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T00:00:00Z","timestamp":1658966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tri-Service General Hospital Research Foundation","award":["TSGH-B-111018"],"award-info":[{"award-number":["TSGH-B-111018"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: Sleep disorders, depression, and cancer have become increasingly prevalent worldwide. However, it is unknown whether coexistence of sleep disorders and depression influences the risk of cancer development. Therefore, we conducted a nationwide population-based study to examine this association among patients in Taiwan. Materials and Methods: A total of 105,071 individuals diagnosed with cancer and 420,284 age- and sex-matched patients without a diagnosis of cancer between 2000 and 2015 were identified from Taiwan\u2019s National Health Insurance Research Database. The underlying chronic diseases of patients that may developed cancer were gathered and studied as the predictor. A multivariate Cox proportional odds model was used to estimate the crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) to estimate the interaction effect between sleep disorders and depression on the risk of cancer. Results: After adjusting for age, sex, comorbidities, and other covariates, the cancer group was associated with increased exposure to sleep disorders than the non-cancer group (aOR = 1.440, 95% CI = 1.392\u20131.489, p &lt; 0.001). In addition, patients with both sleep disorders and depression were at an even higher risk for cancer than the general population (aOR = 6.857, p &lt; 0.001). Conclusions: This retrospective cohort study shows that patients with both sleep disorders and depression are at a higher risk of cancer. Clinically, a meticulous cancer risk evaluation is recommended for patients with both sleep disorders and depression.<\/jats:p>","DOI":"10.3390\/ijerph19159266","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T20:49:28Z","timestamp":1659041368000},"page":"9266","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Combination of Sleep Disorders and Depression Significantly Increases Cancer Risk: A Nationwide Large-Scale Population-Based Study"],"prefix":"10.3390","volume":"19","author":[{"given":"Fang-Chin","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4423-4231","authenticated-orcid":false,"given":"Chih-Hsiung","family":"Hsu","sequence":"additional","affiliation":[{"name":"Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan"},{"name":"Teaching Office, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4576-9900","authenticated-orcid":false,"given":"Chi-Hsiang","family":"Chung","sequence":"additional","affiliation":[{"name":"School of Public Health, National Defense Medical Center, Taipei 114, Taiwan"},{"name":"Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"},{"name":"Taiwanese Injury Prevention and Safety Promotion Association, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ta-Wei","family":"Pu","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pi-Kai","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzu-Chiao","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu-Wen","family":"Jao","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao-Yang","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3286-0780","authenticated-orcid":false,"given":"Wu-Chien","family":"Chien","sequence":"additional","affiliation":[{"name":"School of Public Health, National Defense Medical Center, Taipei 114, Taiwan"},{"name":"Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"},{"name":"Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Je-Ming","family":"Hu","sequence":"additional","affiliation":[{"name":"Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan"},{"name":"Division of Colon and Rectal Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"},{"name":"School of Medicine, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,28]]},"reference":[{"key":"ref_1","first-page":"203","article-title":"NREM and REM Sleep: Complementary Roles in Recovery after Wakefulness","volume":"20","author":"Vyazovskiy","year":"2014","journal-title":"Neurosci. Rev. J. Bringing Neurobiol. Neurol. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S1389-9457(01)00158-7","article-title":"Prevalence and consequences of insomnia disorders in the general population of Italy","volume":"3","author":"Ohayon","year":"2002","journal-title":"Sleep Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.sleep.2005.08.008","article-title":"Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors","volume":"7","author":"Morin","year":"2006","journal-title":"Sleep Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1093\/sleep\/29.12.1543","article-title":"Insomnia among Japanese adolescents: A nationwide representative survey","volume":"29","author":"Kaneita","year":"2006","journal-title":"Sleep"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"20","DOI":"10.3988\/jcn.2009.5.1.20","article-title":"Epidemiology of insomnia in korean adults: Prevalence and associated factors","volume":"5","author":"Cho","year":"2009","journal-title":"J. Clin. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"338","DOI":"10.4088\/PCC.v09n0502","article-title":"Morbidity associated with sleep disorders in primary care: A longitudinal cohort study","volume":"9","author":"Wallander","year":"2007","journal-title":"Prim. Care Companion J. Clin. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.jsmc.2008.02.001","article-title":"Insomnia: Prevalence, Impact, Pathogenesis, Differential Diagnosis, and Evaluation","volume":"3","author":"Mai","year":"2008","journal-title":"Sleep Med. Clin."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/sleep\/30.2.213","article-title":"Comorbidity of chronic insomnia with medical problems","volume":"30","author":"Taylor","year":"2007","journal-title":"Sleep"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1007\/s10549-012-2144-z","article-title":"Association of sleep duration and breast cancer OncotypeDX recurrence score","volume":"134","author":"Thompson","year":"2012","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1002\/cncr.25507","article-title":"Short duration of sleep increases risk of colorectal adenoma","volume":"117","author":"Thompson","year":"2011","journal-title":"Cancer"},{"key":"ref_11","first-page":"1417","article-title":"Experimental chronic jet lag promotes growth and lung metastasis of Lewis lung carcinoma in C57BL\/6 mice","volume":"27","author":"Wu","year":"2012","journal-title":"Oncol. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.annepidem.2013.09.002","article-title":"The risk of cancer among patients with sleep disturbance: A nationwide retrospective study in Taiwan","volume":"23","author":"Hu","year":"2013","journal-title":"Ann. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.cpr.2005.04.004","article-title":"Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders","volume":"25","author":"Smith","year":"2005","journal-title":"Clin. Psychol. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.puhe.2017.04.026","article-title":"Depression and cancer risk: A systematic review and meta-analysis","volume":"149","author":"Jia","year":"2017","journal-title":"Public Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jacc.2010.03.034","article-title":"Anxiety and risk of incident coronary heart disease: A meta-analysis","volume":"56","author":"Roest","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2763","DOI":"10.1093\/eurheartj\/ehl338","article-title":"Depression as an aetiologic and prognostic factor in coronary heart disease: A meta-analysis of 6362 events among 146 538 participants in 54 observational studies","volume":"27","author":"Nicholson","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S1470-2045(11)70002-X","article-title":"Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies","volume":"12","author":"Mitchell","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1745-0179-3-29","article-title":"A meta-analysis on depression and subsequent cancer risk","volume":"3","author":"Oerlemans","year":"2007","journal-title":"Clin. Pract. Epidemiol. Ment. Health CP EMH"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2018062","DOI":"10.4178\/epih.e2018062","article-title":"Data resource profile: The National Health Insurance Research Database (NHIRD)","volume":"40","author":"Lin","year":"2018","journal-title":"Epidemiol. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1002\/pds.2087","article-title":"Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan","volume":"20","author":"Cheng","year":"2011","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/jnci\/djp467","article-title":"Population-based case-control study of Chinese herbal products containing aristolochic acid and urinary tract cancer risk","volume":"102","author":"Lai","year":"2010","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40675-016-0034-3","article-title":"Sleep Disorders and Cancer","volume":"2","author":"Almendros","year":"2016","journal-title":"Curr. Sleep Med. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.7150\/jca.12490","article-title":"Risk of Cancer in Patients with Insomnia, Parasomnia, and Obstructive Sleep Apnea: A Nationwide Nested Case-Control Study","volume":"6","author":"Fang","year":"2015","journal-title":"J. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/S1470-2045(03)01156-2","article-title":"Depression may increase cancer risk","volume":"4","author":"Nelson","year":"2003","journal-title":"Lancet Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3109\/09540261.2013.875891","article-title":"The biology of depression in cancer and the relationship between depression and cancer progression","volume":"26","author":"Sotelo","year":"2014","journal-title":"Int. Rev. Psychiatry"},{"key":"ref_26","first-page":"3403","article-title":"Effect of Melatonin on Mammary Carcinogenesis in Intact and Pinealectomized Rats in Varying Photoperiods","volume":"44","author":"Shah","year":"1984","journal-title":"Cancer Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11174","DOI":"10.1158\/0008-5472.CAN-05-1945","article-title":"Melatonin-depleted blood from premenopausal women exposed to light at night stimulates growth of human breast cancer xenografts in nude rats","volume":"65","author":"Blask","year":"2005","journal-title":"Cancer Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12931-018-0727-x","article-title":"Intermittent hypoxia promotes melanoma lung metastasis via oxidative stress and inflammation responses in a mouse model of obstructive sleep apnea","volume":"19","author":"Li","year":"2018","journal-title":"Respir. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1016\/j.sleep.2012.08.012","article-title":"Obesity and intermittent hypoxia increase tumor growth in a mouse model of sleep apnea","volume":"13","author":"Almendros","year":"2012","journal-title":"Sleep Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5271\/sjweh.1194","article-title":"Nightshift work and risk of breast cancer and other cancers\u2014A critical review of the epidemiologic evidence","volume":"34","author":"Kolstad","year":"2008","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"163","DOI":"10.5271\/sjweh.2899","article-title":"Shift work and cancer\u2014Considerations on rationale, mechanisms, and epidemiology","volume":"36","author":"Costa","year":"2010","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.2119\/molmed.2012.00077","article-title":"Circadian rhythm disruption in cancer biology","volume":"18","author":"Savvidis","year":"2012","journal-title":"Mol. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.mrgentox.2007.07.013","article-title":"Protective action of melatonin against oxidative DNA damage: Chemical inactivation versus base-excision repair","volume":"634","author":"Sliwinski","year":"2007","journal-title":"Mutat. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s00424-011-1044-0","article-title":"Sleep and immune function","volume":"463","author":"Besedovsky","year":"2012","journal-title":"Pflug. Arch. Eur. J. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.ygyno.2015.10.004","article-title":"Depression and risk of epithelial ovarian cancer: Results from two large prospective cohort studies","volume":"139","author":"Huang","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.jpsychores.2015.07.011","article-title":"Do depressive symptoms predict cancer incidence?: 17-year follow-up of the Whitehall II study","volume":"79","author":"Archer","year":"2015","journal-title":"J. Psychosom. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/S0006-3223(03)00566-3","article-title":"Depression and cancer: Mechanisms and disease progression","volume":"54","author":"Spiegel","year":"2003","journal-title":"Biol. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.psyneuen.2005.02.010","article-title":"Depression and cortisol responses to psychological stress: A meta-analysis","volume":"30","author":"Burke","year":"2005","journal-title":"Psychoneuroendocrinology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1038\/sj.mp.4002055","article-title":"Brain interleukin-1 mediates chronic stress-induced depression in mice via adrenocortical activation and hippocampal neurogenesis suppression","volume":"13","author":"Goshen","year":"2008","journal-title":"Mol. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/PSY.0b013e3181907c1b","article-title":"Associations of depression with C-reactive protein, IL-1, and IL-6: A meta-analysis","volume":"71","author":"Howren","year":"2009","journal-title":"Psychosom. Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Gelfo, V., Romaniello, D., Mazzeschi, M., Sgarzi, M., Grilli, G., Morselli, A., Manzan, B., Rihawi, K., and Lauriola, M. (2020). Roles of IL-1 in Cancer: From Tumor Progression to Resistance to Targeted Therapies. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21176009"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1590\/S0100-879X2002000500011","article-title":"Immune and hormonal activity in adults suffering from depression","volume":"35","author":"Nunes","year":"2002","journal-title":"Braz. J. Med. Biol. Res. = Rev. Bras. De Pesqui. Med. E Biol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"9595","DOI":"10.1158\/0008-5472.CAN-05-2138","article-title":"Sleep duration and breast cancer: A prospective cohort study","volume":"65","author":"Verkasalo","year":"2005","journal-title":"Cancer Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1093\/ije\/dyp178","article-title":"Light-at-night, circadian disruption and breast cancer: Assessment of existing evidence","volume":"38","author":"Stevens","year":"2009","journal-title":"Int. J. Epidemiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1176\/appi.ajp.161.7.1197","article-title":"Sleep disturbance and risk for alcohol-related problems","volume":"161","author":"Crum","year":"2004","journal-title":"Am. J. Psychiatry"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1001\/archinte.1995.00430070088011","article-title":"Cigarette smoking and sleep disturbance","volume":"155","author":"Phillips","year":"1995","journal-title":"Arch. Intern. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9266\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:58:39Z","timestamp":1760140719000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,28]]},"references-count":46,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["ijerph19159266"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19159266","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,28]]}}}