The impact of dexamethasone and prednisone on sleep in children with acute lymphoblastic leukemia

Abstract

Purpose Corticosteroids can affect sleep patterns, mood, and behavior. Two of the most commonly prescribed corticosteroids in acute lymphoblastic leukemia (ALL), dexamethasone and prednisone, may impact sleep differently, but no research has compared these medications in children. The current study tested the hypothesis that dexamethasone and prednisone differentially affect sleep in children with ALL to understand how these medications contribute to health-related quality of life (HRQL). Methods Parents of 81 children 3–12 years old in maintenance therapy for ALL completed a baseline measure of child sleep (dexamethasone n = 55, prednisone n = 26), and 61 parents returned 28 days of child sleep diaries starting the first day of a 5-day steroid course (dexamethasone n = 43, prednisone n = 18). Parents also completed measures of HRQL and fatigue on the last day of steroids and the last day of the month. Results At baseline, parents reported more sleep disturbances in children taking dexamethasone than prednisone. Across the month, children taking dexamethasone experienced poorer sleep quality compared to children taking prednisone. During corticosteroid treatment, children taking dexame thasone also experienced more night awakenings than children taking prednisone. Sleep variables accounted for almost half of the variance in HRQL during time off steroids and also significantly contributed to fatigue during the corticosteroids course and time off corticosteroids. Conclusions Sleep is an essential component of HRQL in children taking corticosteroids, and the impact on sleep is more pronounced in children taking dexamethasone compared to prednisone. Screening for sleep disturbances and offering brief interventions to manage steroid-related sleep disruptions may improve HRQL.

Sleep quality is associated with psychosocial functioning and health‐related quality of life in pediatric transplant recipients

“…The prevalence of adolescents who endorsed experiencing sleep onset problems (ie, Falling Asleep subscale) at least Quite often was also consistent with previous reports in adolescent liver transplant recipients . A number of key factors may be contributing to these findings, including stressors related to having a chronic medical condition, following strict medication‐taking schedules that interfere with sleep, or experiencing sleep‐related side effects from immunosuppressant medications (eg, steroids, tacrolimus) associated with sleep disturbances and insomnia . Though not assessed, patients may also maintain dysregulated sleep schedules including napping and irregular wake/sleep times that can make falling asleep more difficult.…”

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

“…Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer and it requires an intensive treatment regimen of frequent chemotherapy administrations over the course of 2‐3 years . During maintenance treatment, a relatively stable phase in which most children resume their daily activities, sleep problems are common and often include a behavioral component . Sleep duration is often adequate, but nighttime awakenings are frequent and sleep onset latency (defined as the minutes between bedtime and the first minute of sleep) is longer .…”

“…Some risk factors for sleep problems in childhood cancer patients have previously been identified, such as glucocorticoid treatment, younger age, sex, and co‐sleeping . In young and severely ill children, patient‐reported outcomes (PROs) often depend on parental reports.…”

“…[11][12][13] Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer and it requires an intensive treatment regimen of frequent chemotherapy administrations over the course of 2-3 years. 14 4,15,16 Sleep duration is often adequate, but nighttime awakenings are frequent and sleep onset latency (defined as the minutes between bedtime and the first minute of sleep) is longer. 17,18 This indicates that the total minutes of sleep is sufficient but sleep is fragmented.…”

“…Some risk factors for sleep problems in childhood cancer patients have previously been identified, such as glucocorticoid treatment, younger age, sex, and co-sleeping. 4,13,15,16,18 In young and severely ill children, patient-reported outcomes (PROs) often depend on parental reports. The potential influence of parental functioning and parenting behaviors on these outcomes is often not taken into account.…”