Nationwide database analysis of insomnia, depression, and sleeping pill prescriptions in hepatocellular carcinoma patients

To clarify the status of insomnia and depression and the prescription of sleeping pills in hepatocellular carcinoma (HCC) patients before and after HCC diagnosis and treatment. Patients’ data from a Japanese health insurance claims database were analyzed retrospectively to determine the incidence of insomnia and depression and their association with sleeping pill prescriptions during the 6 months before and after HCC diagnosis and treatment. A total of 9,109 HCC patients (median age at diagnosis = 71.5 years, 68.1% male) were analyzed. The incidences of insomnia and depression increased significantly after HCC diagnosis. Insomnia was reported in 15.0% of patients before diagnosis, and it increased to 27.6% after diagnosis. Similarly, depression was reported in 6.3% and 11.3% before and after diagnosis, respectively. The incidences of insomnia and depression before diagnosis were higher in patients with concomitant liver diseases including hepatitis, cirrhosis, and hepatic encephalopathy. However, the rate of sleeping pill prescription was significantly lower in patients with concomitant liver diseases after diagnosis. The incidence of fracture was higher in insomnia or depression patients than others and in patients treated with sleeping pills than without before and after diagnosis. HCC patients had increased risks of insomnia and depression after diagnosis. The high risk of fracture in HCC patients with insomnia and depression and treated with sleeping pills suggests that it is difficult to optimize the management of HCC patients, especially those with concomitant liver diseases.

本研究旨在明确肝细胞癌（hepatocellular carcinoma, HCC）患者在确诊及接受治疗前后的失眠、抑郁患病情况与安眠药物处方现状。本研究回顾性分析日本健康保险索赔数据库中的患者数据，以探究肝细胞癌患者确诊及接受治疗前后6个月内的失眠、抑郁患病率，及其与安眠药物处方的相关性。本研究共纳入9109例肝细胞癌患者进行分析，患者确诊时的中位年龄为71.5岁，男性占比68.1%。肝细胞癌患者确诊后，失眠与抑郁的患病率均显著升高：确诊前，15.0%的患者存在失眠症状，确诊后该比例升至27.6%；类似地，确诊前抑郁患病率为6.3%，确诊后升至11.3%。合并肝炎、肝硬化及肝性脑病等肝脏疾病的患者，确诊前的失眠与抑郁患病率更高。但确诊后，合并肝脏疾病患者的安眠药物处方率却显著降低。无论确诊前后，存在失眠或抑郁症状的患者、以及接受安眠药物治疗的患者，其骨折发生率均高于对应对照人群。肝细胞癌患者确诊后，失眠与抑郁的发病风险显著升高。合并失眠、抑郁且接受安眠药物治疗的肝细胞癌患者骨折风险较高，这提示临床难以优化肝细胞癌患者的管理方案，尤其是合并肝脏疾病的患者。