Aims
People at increased risk of colorectal cancer (CRC) due to a personal or family history of colorectal neoplasia undergo regular surveillance colonoscopy. The psychological burden of ongoing surveillance may affect health-related quality of life (HRQoL). Sleep disturbances and physical inactivity are common, modifiable risk factors of HRQoL. This study examined whether sleep quality and physical activity were independently associated with HRQoL in individuals undergoing CRC surveillance, and whether physical activity moderates the sleep-HRQoL relationship.
Methods
This cross-sectional analysis included 1,980 participants in a hospital CRC surveillance program. HRQoL was measured using the EQ-5D-5L, with sleep assessed with the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Obstructive Sleep Apnea (OSA50). Physical activity was assessed using the International Physical Activity Questionnaire. Multivariable linear regression estimated adjusted associations with HRQoL, and sleep-by-physical-activity interaction terms tested moderation effects.
Results
The mean age of the cohort was 66 years (SD= 10.3) and 47.9% were male. Mean HRQoL was 0.81(SD= 0.20). Overall, 58.6% had poor sleep quality, 34.7% met criteria for clinical insomnia and 17.4% reported sedentary behaviour. In adjusted models, poorer sleep quality (β= −0.048, 95% CI −0.069 to −0.027), subthreshold insomnia (β= −0.037, 95% CI −0.066 to −0.007), clinical insomnia (β= −0.098, 95% CI −0.133 to −0.063) and sedentary behaviour (β= −0.058, 95% CI −0.083 to −0.034) were associated with lower HRQoL. High OSA risk was not associated with HRQoL (β= −0.007, p= 0.55). Physical activity did not moderate the sleep-HRQoL relationship (p= 0.04, non-significant after Bonferroni correction).
Conclusions
Poorer sleep, particularly clinical insomnia, and sedentary behaviour are independently associated with lower HRQoL and physical activity does not offset the impact of poor sleep on HRQoL. These findings extend observations from cancer-survivor populations to adults undergoing CRC surveillance. Sleep and activity thus represent distinct, modifiable targets to improve HRQoL.