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

Abstract

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.

Keywords: CNS tumor; actigraphy; adolescents; chemotherapy; children; sleep.

Conflict of interest statement

CONFLICT OF INTEREST

Dr. Sonia Ancoli-Israel is a consultant for Eisai Inc., Eli Lilly and Co., Merck, Pfizer and Purdue Pharma, although has no conflicts of interest related to this research. All other authors have no conflicts of interest to disclose.

© 2019 Wiley Periodicals, Inc.

Figures

Figure 1

Alignment of timing of the StJude SJMB03 CNS cancer treatment protocolflow depicted across the top of the figureand the pilot sleep interventionflow depicted below SJMB03 protocol days-5 through 0

Figure 2

Actogram of child undergoing high dose chemotherapyEach row depicts one dayfrom 9 PM21 00to 9 PM the following dayBlack vertical lines indicate frequency and vigor of activity across time broken red