Concurrence of sleep problems and distress: prevalence and determinants in parents of children with cancer

Abstract

Background : Parents of children with cancer are at risk for sleep problems. If these problems persist, an important perpetuating factor might be ongoing parental distress. Objective : The aim of this study is to assess the prevalence of sleep problems and the concurrence with distress in parents of children treated for cancer, and to identify predictors of this symptom clustering. Method : Parents completed the Medical Outcomes Study (MOS) Sleep Scale and Distress Thermometer for Parents (DT-P). Clinically relevant sleep problems were defined as a score >1SD above the norm and clinical distress as a thermometer score above the established cut-off of 4. Four parent categories were constructed: neither sleep problems nor distress; no distress but sleep problems; no sleep problems but distress; both sleep problems and distress. Predictive determinants (sociodemographic, medical, psychosocial) for each category were assessed with multilevel multinomial logistic regression. Results : Parents (202 mothers and 150 fathers) of 231 children with different cancers participated. Mean time since diagnosis was 3.3 ± 1.4 years (90% off-treatment). The prevalence of sleep problems was 37%. Fifty percent of parents reported neither sleep problems nor distress, 9% had only sleep problems, 13% only distress, and 28% reported both. Compared to parents without sleep problems or distress, parents who reported both were more likely to report parenting problems (OR 4.4, [2.2–9.1]), chronic illness (OR 2.8, [1.2–6.5]), insufficient social support (OR 3.7, [1.5–9.1]), pre-existent sleep problems (OR 6.2, [2.0–18.6]) and be female (OR 1.8, [1.1–4.2]). Conclusions : Sleep problems are common in parents of children treated for cancer, and occur mostly in the presence of clinical distress. Future research must show which interventions are most effective in this group: mainly targeted at sleep improvement or with prominent roles for stress management or trauma processing.

High prevalence of parent‐reported sleep problems in pediatric patients with acute lymphoblastic leukemia after induction therapy

“…Parental distress levels were high and significantly associated with parent‐reported child sleep in the univariate analysis. Parental distress was not retained in the multivariable model, but this is most likely the result of the high correlation between parental sleep and distress, which has been previously described …”

“…Parental distress was not retained in the multivariable model, but this is most likely the result of the high correlation between parental sleep and distress, which has been previously described. 21 Parent-reported sleep problems were mainly predicted by parental sleep and parenting factors in our model. The correlation between parental and child sleep has previously been described during ALL maintenance treatment.…”

“…The potential influence of parental functioning and parenting behaviors on these outcomes is often not taken into account . However, sleep problems are common in parents of pediatric cancer patients, with prevalence rates up to 71% in the hospital setting . Many parents report elevated levels of distress shortly after diagnosis and during treatment .…”

“…15,19 However, sleep problems are common in parents of pediatric cancer patients, with prevalence rates up to 71% in the hospital setting. 17,[19][20][21][22][23][24][25] Many parents report elevated levels of distress shortly after diagnosis and during treatment. 26 Furthermore, altered parenting strategies have been described.…”

Parental functioning during maintenance treatment for childhood acute lymphoblastic leukemia: Effects of treatment intensity and dexamethasone pulses

“…For distress, the previously established cut‐off of 4 or higher was used to indicate clinical levels of distress. For sleep and QoL, SD cut‐offs were used, which have been described in previous literature 33 . Parents with SLP‐9, MCS, or PCS scores > 1 SD above the Dutch reference's mean were considered to have clinically relevant sleep problems or impaired (physical/mental) QoL, respectively.…”