A call to action for expanded sleep research in pediatric oncology: A position paper on behalf of the International Psycho‐Oncology Society Pediatrics Special Interest Group

Abstract

Sleep and circadian rhythms are closely related to physical and psychosocial well‐being. However, sleep and circadian rhythm disruptions are often overlooked in children with cancer, as they are frequently considered temporary side effects of therapy that resolve when treatment ends. Yet, evidence from adult oncology suggests a bidirectional relationship wherein cancer and its treatment disrupt sleep and circadian rhythms, which are associated with negative health outcomes such as poor immune functioning and lower survival rates. A growing body of research demonstrates that sleep problems are prevalent among children with cancer and can persist into survivorship. However, medical and psychosocial outcomes of poor sleep and circadian rhythmicity have not been explored in this context. It is essential to increase our understanding because sleep and circadian rhythms are vital components of health and quality of life. In children without cancer, sleep and circadian disturbances respond well to intervention, suggesting that they may also be modifiable in children with cancer. We present this paper as a call to (a) incorporate sleep or circadian rhythm assessment into pediatric cancer clinical trials, (b) address gaps in understanding the bidirectional relationship between sleep or circadian rhythms and health throughout the cancer trajectory, and (c) integrate sleep and circadian science into oncologic treatment.

Clinical validity of the PROMIS pediatric sleep short forms in children receiving treatment for cancer

“…5 Existing research relies on sleep measures developed for use with caregivers of healthy pediatric populations, [6][7][8][9] which may limit the ability to accurately capture the prevalence and impact of disrupted sleep experienced in the context of cancer. 10 Much of the existing literature in pediatric oncology focuses on sleep as a facet of cancer-related fatigue, 11 despite sleepiness and fatigue being overlapping but distinct symptoms that can have different diagnostic implications and treatment approaches. 12 Sleep can be measured using polysomnography (overnight sleep study), actigraphy (a watch-sized device that measures motion to determine when the child is asleep), or sleep diaries completed by patients or caregivers;…”

“…14 The patient-reported outcomes measurement information system (PROMIS) offers well-validated, theoretically based, and rigorously developed assessment tools that measure universally experienced health concepts, and thus are meant to be used across health conditions (www.healthmeasures.net). PROMIS sleep health measures for children (ages 8-17 years) and caregiver-proxy reports (for ages [5][6][7][8][9][10][11][12][13][14][15][16][17] were recently developed and tested for validity against polysomnography in children presenting to a pediatric sleep program, 15 and clinical validity was tested using the 8-item short forms in children with asthma, autism, and eczema. 16 The development process followed PROMIS methodology to establish an item-bank for qualitative assessment, followed by validity testing, and item-response theory analysis.…”

“…In response to recent calls for the systematic study of sleep 10 and symptom burden 20,21 in pediatric cancer, the current study assessed the reliability and clinical validity of the PROMIS pediatric sleep scales…”

The importance of specialized sleep investigations in children with a suprasellar tumor

“…Physical activity: transport, sport, school. **For examples and additional information of suitable sleep questionnaires or actigraphy, see: Table 1 https://doi.org/10.1002/pon.5242 [ 50 ]. ^Alarm symptoms: falling a sleep during activities or snoring, apnea, or gasping during sleep …”

Efficacy of melatonin in non-intensive care unit patients with COVID-19 pneumonia and sleep dysregulation

“…Shortened sleep and poor sleep quality have also been identified as risk factors for cognitive decline, neurodegenerative disease, mood changes and depression, as well as other neuropsychiatric conditions (27,28). There is also mounting evidence linking sleep disruption to immune function and cancer (29)(30)(31).…”