Sleep complaints in survivors of pediatric brain tumors

Brimeyer, Chasity; Adams, Leah; Zhu, Liang; Srivastava, Deo Kumar; Wise, Merrill S.; Hudson, Melissa M.; Crabtree, Valerie McLaughlin

doi:10.1007/s00520-015-2713-x

Cited by 40 publications

(24 citation statements)

References 41 publications

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“…Medical and psychosocial correlates of SDis in CCS are receiving increasing attention particularly in survivors of pediatric brain tumors and lymphoblastic leukemia . Our findings and those of Ruble et al.…”

supporting

confidence: 76%

Sleep Disturbances in Childhood Cancer Survivors

Russo

Fardell

Signorelli

et al. 2016

Pediatric Blood & Cancer

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To the Editor: We read with interest Ruble and colleagues'[1] study examining sleep-disordered breathing (SDB) symptoms in childhood cancer survivors (CCS). CCS were 3.3 times more likely to be at risk of SDB than the general childhood population. SDB symptoms were strongly associated with stress, poor school performance, and poor quality-of-life (QOL) outcomes.These findings align with data collected from our ongoing study of more than 400 CCS, >5 years postcancer diagnosis and treated at Sydney Children's Hospital, Australia. In our study, parents of CCS age <16 years (n = 130; CCS mean = 12.41; SD = 2.2) completed proxy questionnaires measuring their children's sleep disturbances (SDis; difficulty falling asleep, waking up in the night or earlier than desired, and nonrefreshing sleep). Adult CCS, age >16 also completed the questionnaire (n = 263; mean = 27.57; SD = 8.05).Many parents reported that their child suffered from SDis (44.6%), which occurred more than twice a week for 50% of children with SDis. Parents reported that SDis caused distress or interfered with daily living (53.4%). Lower overall health and energy levels were evident in those with SDis than those with no sleeping problems (U = 1285.5, n 1 = 57, n 2 = 68, P = 0.001 [two-tailed]; U = 1483, n 1 = 58, n 2 = 70, P < 0.01 [two-tailed], respectively). In terms of QOL, CCS with SDis more often described feeling sad (U = 1652.5, n 1 = 58, n 2 = 70, P < 0.05 [two-tailed]), and not being able to do leisure activities in their free time (U = 1601, n 1 = 58, n 2 = 69, P < 0.05 [two-tailed], respectively). Moreover, parents of survivors experiencing SDis reported poorer academic performance (U = 1504.5, n 1 = 58, n 2 = 70, P < 0.01 [two-tailed]) and lower frequency of pleasant recreational time with friends (U = 1521.5, n 1 = 58, n 2 = 69, P = 0.01 [two-tailed]).CCS age >16 years also reported SDis (n = 263; 70.3%). Sixty-nine percent CCS experienced SDis more than twice a week, causing distress or interfering with daily living in 57.1%. CCS with SDis reported lower overall health in the previous month (U = 3775, n 1 = 182, n 2 = 77, P < 0.001 [two-tailed]) and were more likely to report signs of anxiety or depression (U = 2016.5, n 1 = 126, n 2 = 51, P < 0.001 [two-tailed]) than those not experiencing SDis. Self-rated overall health was particularly low in those experiencing SDis more than twice a week (U = 2016.5, n 1 = 126, n 2 = 51, P < 0.001 [two-tailed]).Echoing the results of Ruble et al. survivors' body mass index did not appear to be significantly correlated with SDis (r = −0.07, n.s.). A logistic regression model with age, gender, hospitalization, and health problems predicting CCS likelihood of experiencing SDis was statistically significant, χ 2 (8) = 19.263, P < 0.05, explaining 16.7% (Nagelkerke R 2 ) of variance, and correctly classifying 70.2% of cases. Females were two times more likely to experience SDis. Increasing age and more reported hospitalization and health issues were associated with an increased likelihood of SDis.Medical and ...

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supporting

confidence: 76%

Sleep Disturbances in Childhood Cancer Survivors

Russo

Fardell

Signorelli

et al. 2016

Pediatric Blood & Cancer

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“…Most survivors achieved the recommended amount of sleep per night for their age group, replicating a study with pediatric brain tumor survivors. 37 It is noteworthy that survivors' sleep significantly decreased over time according to their mothers, which mirrors findings of continued poor sleep quality as survivors mature. 20,21 We found a greater decrease in sleep duration among brain tumor survivors relative to other diagnoses, according to self-report.…”

Section: Discussionmentioning

confidence: 73%

Trajectories of health behaviors across early childhood cancer survivorship

et al. 2018

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Objective: The majority of childhood cancer survivors develop at least one late effect subsequent to treatment (e.g., cardiovascular disease, obesity). Consistent engagement in recommended health behaviors may mitigate some of these conditions. Researchers have identified early survivorship as a teachable moment, yet few studies have examined positive health behaviors during this period. Methods: Families of children with cancer (ages 5–17) were initially recruited following a diagnosis or relapse of cancer. Three years post-diagnosis, survivors (n=82, Mage=13.3, SD=3.7) and their mothers (n=103, Mage=41.1, SD=7.6) completed a questionnaire assessing exercise, dietary, and sleep patterns among survivors. A follow-up assessment was conducted two years later. Mixed models tested change in health behavior over time. Results: At three- and five-years post-diagnosis, mother and self-report indicated that few survivors engaged in appropriate levels of low-intensity exercise, fruit/vegetable intake, and dairy consumption. However, most survivors engaged in recommended levels of high intensity exercise, fast food restriction, and sleep. Health behaviors remained stable over time, except for mother report of sleep duration, which decreased (b=−0.6, p<.001). Brain tumor diagnosis predicted a larger decrease in self-report of sleep duration compared to other diagnoses (p=.04). Income predicted fast food intake such that higher income was associated with decreased intake over time, whereas lower income was associated with increased intake (p=.04). Conclusions: During early survivorship, several health behaviors fell short of expectations for exercise and diet and did not improve upon reaching five years post-diagnosis. Providers should evaluate survivors’ health behaviors, including sleep, early and often, intervening when necessary.

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“…Despite improvements in survival, morbidity remains high . Sleep disturbances are frequently reported during treatment and survivorship . Damage to the circadian pacemaker in the hypothalamus during surgery and irradiation of the hypothalamic–pituitary axis disturb secretion of hormones regulating sleep and wake such as melatonin .…”

Section: Introductionmentioning

confidence: 99%

A pilot randomized controlled trial to improve sleep and fatigue in children with central nervous system tumors hospitalized for high‐dose chemotherapy

Rogers

Zhu

Ancoli‐Israel

et al. 2019

Pediatric Blood & Cancer

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Objectives To determine whether a sleep intervention compared with standard of care (SOC) was successful in preserving nighttime sleep in children with central nervous system cancers hospitalized for high‐dose chemotherapy (HDCT) and autologous stem cell rescue, and to explore associations between sleep and fatigue during treatment. Methods An unblinded, randomized, controlled, multicomponent intervention (NCT00666614) including evidence‐based cognitive and behavioral strategies to improve sleep was implemented in 33 children (age 4–12 years) and adolescents (age 13–19 years) during hospitalization. Children wore an actigraph to measure sleep and wake, and reported fatigue scores daily. Parents concurrently kept a sleep diary and reported fatigue scores for their children. Results The mean age was 9.5 ± 3.9 years, 81.8% were white, and 60.6% were male. Sleep in all children was seriously disturbed throughout the study. Children in the intervention group maintained their longest nighttime sleep across the study, while it declined in children receiving SOC (P = 0.009 for interaction). There were few other differences in sleep between groups. Controlling for age and baseline fatigue, higher nighttime activity score, and lower percent sleep were significantly associated with higher next‐day adolescent‐reported fatigue (P < 0.05); longest sleep was significantly positively associated with next‐day child‐reported fatigue (P = 0.018). Conclusion In this sample of children undergoing HDCT, a multicomponent sleep intervention modestly preserved nighttime sleep duration, although overall sleep was poor in both groups. Sleep is an integral component of health, and may influence outcomes of children receiving HDCT. Further investigation into methods of preserving sleep in children undergoing intensive cancer therapy is warranted.

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Sleep complaints in survivors of pediatric brain tumors

Cited by 40 publications

References 41 publications

Sleep Disturbances in Childhood Cancer Survivors

Sleep Disturbances in Childhood Cancer Survivors

Trajectories of health behaviors across early childhood cancer survivorship

A pilot randomized controlled trial to improve sleep and fatigue in children with central nervous system tumors hospitalized for high‐dose chemotherapy

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