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

Abstract

Objective To assess sleep problems (prevalence and predictors) in pediatric patients with acute lymphoblastic leukemia (ALL) after the most intensive phase of therapy (induction). Methods Patients (≥2 years) treated according to the Dutch ALL‐11 protocol were included. Sleep was measured using parent‐reports and self‐reports (Children's Sleep Habits Questionnaire; CSHQ) and actigraphy. Parental sleep (Medical Outcome Study Sleep Scale) and distress and parenting problems (Distress Thermometer for Parents) were assessed with questionnaires. Z‐scores were calculated for total CSHQ scores using age‐appropriate scores of healthy Dutch children. The prevalence of sleep problems (defined as a Z‐score > 1) in patients with ALL was compared to healthy children (chi‐square tests). Actigraphic sleep estimates were collected in healthy Dutch children (n = 86, 2‐18 years) for comparison with patients (linear regression). Determinants of parent‐reported child sleep (total CSHQ Z‐score) were identified with regression models. Results Responses were collected for 124 patients (response rate 67%), comprising 123 parent‐reports, 34 self‐reports, and 69 actigraphy assessments. Parents reported sleep problems in 38.0% of the patients compared to 15.2% in healthy children (P < .001). Patients reported fewer sleep problems themselves: 12.1% compared to 15.8% in healthy children (P = .33). Total time in bed (B (95% CI): 22.89 (9.55‐36.22)) and total sleep time (B (95% CI):16.30 (1.40‐31.19)), as derived from actigraphy, were significantly longer in patients. More parent‐reported child sleep problems were predicted by parenting problems, more parental sleep problems, bedroom sharing, and child's sleep medication use (explained variance: 27.4%). Conclusions Systematic monitoring of child and parental sleep and implementation of effective interventions may be a gateway to improve quality of survival in pediatric ALL.

Clinical validity of the PROMIS pediatric sleep short forms in children receiving treatment for cancer

“…Anemia is related to fatigue in adult cancers, 35 but results from pediatric oncology are consistent with our findings that sleep did not differ between those with low blood counts 36 Concordance between patients and caregivers was moderate to low, consistent with the sleep clinic clinical sample, 15 other studies of child sleep in pediatric oncology, 37,38 and studies examining other patient-reported outcome measures of health-related quality of life. 39 The higher rates of sleep problems reported by caregivers relative to patients may be related to patient response shifts that occur as patients adapt to new health circumstances, altering the evaluation of health-related quality of life to view detriments as less significant than caregivers.…”

“…39 The higher rates of sleep problems reported by caregivers relative to patients may be related to patient response shifts that occur as patients adapt to new health circumstances, altering the evaluation of health-related quality of life to view detriments as less significant than caregivers. 40 Alternatively, Steur and colleagues 37 have suggested previously that patients may report fewer sleep symptoms than caregivers because of repressive coping styles, 41 in which patients minimize symptom experiences as a means of coping. These discrepancies, although expected, highlight the need to use both Daytime impairment (SRI) may be more likely to vary by demographic characteristics such as age and sex than nighttime sleep disturbances (SD).…”

Risk factors for steroid‐induced adverse psychological reactions and sleep problems in pediatric acute lymphoblastic leukemia: A systematic review

“…These children are treated with more chemotherapy compared to lower risk groups, which could explain a higher occurrence of sleep problems as well. Furthermore, the distress associated with being confronted with ALL and subsequent treatment regimen can cause both APRs and sleep problems on its own 66,67 …”

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

“…One hundred fifty‐one families provided written informed consent (response rate 67%) 25 . Parents of 121 pediatric patients with ALL participated at this time point.…”

“…Results of this study were derived from the nationwide, longitudinal ALL11 add‐on SLeep in children with Acute lymphoblastic leukemia And their Parents (SLAAP) study ( SLEEP ). A detailed description of the study is described elsewhere 25 . Pediatric patients from 2 years of age and their parents were eligible, if sufficiently fluent in Dutch to complete questionnaires independently, and if the child was being treated according to the DCOG ALL11 protocol in one of the participating pediatric oncology centers in the Netherlands.…”