High occurrence of sleep problems in survivors of a childhood brain tumor with neurocognitive complaints: The association with psychosocial and behavioral executive functioning

Abstract

Background: Survivors of childhood brain tumors are prone to sleep and neurocognitive problems.Effective interventions to improve neurocognitive functioning are largely lacking. In general, sleep problems are negatively related to neurocognitive functioning, but this relationship is unclear in survivors of childhood brain tumors. Therefore, the occurrence of sleep problems, potential risk factors, and the relation between sleep and executive functioning were evaluated. Procedure: Baseline data of a randomized controlled trial on the effectiveness of neurofeedback were used. Childhood brain tumor survivors 8-18 years of age with parent-reported neurocognitive complaints ≥2 years after treatment were eligible. Parents completed the Sleep Disturbance Scale for Children. Executive functioning was assessed by parents and teachers (Behavior Rating Inventory of Executive Functioning). Multiple linear regression analyses were used to examine sociodemographic and medical characteristics and emotional difficulties and hyperactivity/inattention (Strength and Difficulties Questionnaire) as potential risk factors for sleep problems, and to assess the association between sleep and executive functioning. Results: Forty-eight percent of survivors (n = 82, 7.0 ± 3.6 years post diagnosis, age 13.8 ± 3.2 years) had sleep problems and scored significantly worse than the norm on the subscales Initiating and Maintaining Sleep, Excessive Somnolence, and the total scale (effect sizes 0.58-0.92). Emotional problems and/or hyperactivity/inattention were independent potential risk factors. Sleep problems were associated with worse parent-reported executive functioning. Conclusions: Sleep problems occur among half of childhood brain tumor survivors with neurocognitive problems, and are associated with worse executive functioning. Future studies should focus on the development of sleep interventions for this population, to improve sleep as well as executive functioning. K E Y W O R D S executive functioning, pediatric hematology/oncology, sleep Abbreviations: ADHD/ADD, attention deficit (hyperactivity) disorder; BRIEF, Behavior Rating Inventory of Executive Functioning; DA, disorders of arousal; CBT, cognitive behavioral therapy;

Neurodevelopmental Consequences of Pediatric Cancer and Its Treatment: The Role of Sleep

“…Another work highlighted that sleep disturbances arise in half of children with neoplasms and neurocognitive problems, with worsening of executive functions, and underlined the importance of the inclusion of CBT of sleep disturbances in the treatment protocols of children with neoplastic problems [16]. The importance of CBT in these children was also demonstrated in another recent study, which assessed sleep disturbances such as insomnia, obstructive sleep apnea syndrome, excessive daytime sleepiness and circadian rhythm disturbances in children with tumors; a positive outcome on psychological disorders was also reported [66].…”

“…Studies on the treatment of sleep disorders in children with oncological problems and neurodevelopmental disorders are very few and concern the usefulness of CBT and melatonin; in the latter case, the greatest evidence is provided by studies conducted on adults [ 15 , 16 , 53 , 54 , 60 , 62 , 63 , 64 ]. Further studies in this regard could be very useful for improving the therapeutic outcome and quality of life in children with cancer and cognitive problems.…”

“…Duplicates were also excluded, and the reference list of the retrieved articles was reviewed and pertinent articles published during the same time period specified above were added to the final list of papers. However, only four articles [13][14][15][16] dealt with cancer, neurodevelopmental disorders and sleep at the same time; for this reason, the following sections of this paper discuss the topic by using all pertinent articles that approached various aspects of the problem, even if not focusing on the very specific topic of our search.…”

A call to action for expanded sleep research in pediatric oncology: A position paper on behalf of the International Psycho‐Oncology Society Pediatrics Special Interest Group

“…52 In brain tumor survivors, total sleep problems were moderately related to parent reports of executive functioning. 53 Adult survivors of childhood cancer with poor sleep are more vulnerable to neuropsychological consequences of poor sleep than sibling controls. 54 Studies focused on identifying and mitigating neurocognitive late effects (subjective report, actigraphy, and/or polysomnography) should also consider sleep as a correlate of neurocognitive functioning as well as an intervention target to improve functioning.…”

“…Neurocognitive functioning is also affected by poor sleep and OSA . In brain tumor survivors, total sleep problems were moderately related to parent reports of executive functioning . Adult survivors of childhood cancer with poor sleep are more vulnerable to neuropsychological consequences of poor sleep than sibling controls .…”