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.

Additional Metadata
Keywords actigraphy, acute lymphoblastic leukemia, parenting, pediatric, questionnaires, sleep
Persistent URL dx.doi.org/10.1002/pbc.28165, hdl.handle.net/1765/124150
Journal Pediatric Blood & Cancer
Citation
Steur, L.M.H. (Lindsay M. H.), Grootenhuis, M.A, van Someren, E.J.W, Van Eijkelenburg, N.K.A. (Natasha K. A.), van der Sluis, I.M, Dors, N, … van Litsenburg, R.R. (2020). High prevalence of parent-reported sleep problems in pediatric patients with acute lymphoblastic leukemia after induction therapy. Pediatric Blood & Cancer. doi:10.1002/pbc.28165