Excessive daytime sleepiness and sleep‐disordered breathing disturbances in survivors of childhood central nervous system tumors

Abstract

Background Improvements in treatment and management for pediatric central nervous system (CNS) tumors have increased survival rates, allowing clinicians to focus on long-term sequelae, including sleep disorders. The objective of this study was to describe a series of CNS tumor survivors who had sleep evaluations that included polysomnography with attention to sleep disorder in relation to the tumor site. Procedure We report on 31 patients who had retrievable reports including an overnight polysomnography (PSG); 17 also underwent multiple sleep latency tests (MSLT) to characterize their sleepiness. Results Mean age at tumor diagnosis was 7.4 years, mean age at sleep referral 14.3 years, and a mean time between tumor diagnosis and sleep referral of 6.9 years. The most common tumor location was the suprasellar region, the most common reason for sleep referral was excessive daytime sleepiness (EDS), and the most common sleep diagnosis was obstructive sleep apnea (n = 14) followed by central sleep apnea (n=4), hypersomnia due to medical condition (n= 4) and narcolepsy (n=3). Twenty-six of the 31 subjects were obese/overweight, and among those with the concurrent complaint of EDS, the mean sleep latency on MSLT was 3.16 minutes, consistent with excessive sleepiness. Conclusions Suprasellar region tumor survivors who are obese or overweight are more likely to have complaints of EDS and are at greater risk of sleep-disordered breathing. Sleep-related symptoms may not be recognized and referral initiated until years after CNS diagnosis. A periodic and thorough sleep history should be taken when caring for CNS tumor survivors.

Sleep complaints in survivors of pediatric brain tumors

“…This is in contrast to previous studies that have found higher rates of sleep complaints in survivors of centrally located brain tumors [4,8,13]. Of note, these previous studies have focused on children referred to sleep disorders centers, which may reflect a referral bias whereby providers are anticipating sleep disturbance in children with tumors of the central brain region and may be less likely to query the daytime sleepiness of children with hemispheric or infratentorial tumors.…”

“…Accordingly, endocrinopathies, sensory and motor deficits, pain, cognitive decline, heart failure, stroke, and epilepsy are among the commonly reported late effects of treatment in brain tumor survivors [1,2,7]. In addition, child survivors have rated the long-term treatment effects of fatigue and sleepiness as their most distressing symptom, and symptoms may go unrecognized until years after diagnosis [8]. The disrupted sleep patterns, significant fatigue, and excessive daytime sleepiness (EDS) experienced during and after treatment are potentially remediable conditions that contribute to substantial morbidity.…”

“…Because sleep is critical for neural recovery and tissue renewal, sleep problems in children with brain tumors are particularly salient as they have been shown to be related to tumor growth in mouse models [5,8,11] and may impair neurocognitive healing. Furthermore, fatigue and EDS resulting from sleep disruptions interfere with children's ability to engage in activities and social routines, negatively affecting their psychosocial functioning and adjustment posttreatment [1,2,8,12].…”

Sleep and fatigue in pediatric oncology: A review of the literature

“…Indirect sleep disorders also occur as a consequence of brain tumours in children when the tumour results in injury to either the respiratory control centre of the medulla leading to central sleep apnoea, or to the glossopharyngeal, vagus and hypoglossal nerves innervating the pharyngeal dilator muscles, leading to obstructive sleep apnoea [15,59]. Both central and obstructive sleep apnoea cause sleep disruption and fragmentation [60,61].…”

“…Children with neoplasms of the CNS also commonly had more than one sleep problem, usually both EDS and SDB. A further study of 31 CNS tumour survivors who were referred for assessment of sleep disorders, on average 6.9 y following tumour diagnosis (mean age at diagnosis was 7.4 y), identified that EDS remained the most common reason for referral [59]. Of the sleep disorders diagnosed, obstructive sleep apnoea was the most common (14 children), followed by central sleep apnoea (four children), hypersomnia (four children) and narcolepsy (three children).…”