Introduction
Sleep problems are known to be highly prevalent in pediatric cancer
patients and can be caused by biological and/or psychosocial factors
such as treatment toxicity, pain, and anxiety1,2. In
the short term, sleep problems can lead to distress, cognitive problems,
and lower quality of life in pediatric cancer
patients2-6. In the long term, it is clear from
studies in the general population, that sleep problems are associated
with obesity, cardiovascular disease and lower life
expectancy2. Sleep also plays a critical role in
neuroimmune function and neuronal recovery in pediatric cancer patients.
Moreover, fragmented sleep has increasingly been linked to tumor growth
in mice7-9. Children with a brain tumor are especially
prone to develop sleep problems. Neurosurgery, hydrocephalus, cranial
radiation therapy and hypothalamic damage may further contribute to the
onset of disturbances in sleeping patterns1,10,11.
Currently, little is known about the prevalence and extent of sleep
problems in children with a newly diagnosed brain tumor. Previous
studies have mainly focused on patients with all types of cancer
diagnoses, causing heterogeneity, or included only patients with
hematologic malignancies, the most common type of pediatric
cancer12. In addition, most studies focus on sleep at
the end of treatment or further into survivorship. Multiple physical,
psychological, and therapeutic factors related to the period around
diagnosis may impact sleep, such as high levels of distress or the
requirement of one or multiple hospitalizations, which are characterized
by frequent nightly awakenings13,14. Poor sleeping
habits and maladaptive strategies may emerge in this period and persist
over the course of the disease. Lastly, sleep is most often assessed by
questionnaires only, which provide information on sleep behaviors and
consequences of disrupted sleep. However, questionnaires do not measure
sleep duration and sleep efficiency, and do not correlate well with
polysomnography, the gold standard for measuring
sleep15. Some questionnaire studies only assess
parent-reported sleep16,17, and this inherently poses
some reporting bias. Using several modes of sleep assessment is
important as it provides complementary information and contributes to
our understanding of sleep15,17,18.
Sleep in the early phases of treatment in pediatric brain tumor patients
has thus far not been studied comprehensively, even though this has been
strongly recommended by researchers and
clinicians6,7,19. Identifying which children are at
risk to develop sleep problems is important, in order to provide
effective, targeted sleep interventions in a timely manner, with the aim
to improve long-term negative health outcomes associated with poor
sleep. In adult cancer patients, treatment of sleep problems by using
non-pharmacological interventions such as cognitive behavioural therapy
has shown favorable results20,21. In contrast, in
children with central nervous system tumors, a multicomponent sleep
intervention consisting of cognitive and behavioral interventions
modestly improved sleep outcomes22. Therefore, more
insight into disrupted sleep and contributing factors in the earliest
phase after brain tumor diagnosis is needed.
We performed a prospective, observational study into sleep shortly after
primary pediatric brain tumor diagnosis. Our primary goal was to
describe patient and parent reported sleep problems and daytime
consequences, and sleep estimates within three months after diagnosis.
Secondly, we defined biological and psychological risk factors of poor
sleep. This study is part of a larger longitudinal study into sleep,
post-traumatic stress, and neurocognitive functioning (SuSPeCT-study).