Non-pharmacological sleep interventions for pediatric cancer patients and survivors: a systematic review protocol

Abstract

Background Sleep disturbances constitute a common complication in pediatric cancer patients and survivors and are frequently severe enough to warrant treatment. Suboptimal sleep has been associated with decreased emotional well-being and cognitive functioning and increased behavioral problems. Standardized guidelines for non-pharmacological sleep interventions for adults with cancer exist, but no standard of care intervention or standard guidelines are available to guide such intervention in pediatric cancer patients and survivors. Therefore, effective behavioral interventions for improving sleep quality need to be identified. The objective of the review is to evaluate the effect of non-pharmacological sleep interventions on sleep quality in pediatric cancer patients and survivors. Methods The review will consider studies that include children and adolescents between 0 and 18 years diagnosed with cancer or who have a history of cancer who have non-respiratory sleep disturbance. We will include experimental and quasi-experimental studies evaluating non-pharmacological interventions such as psychological interventions, technical/device interventions, interventions targeting physical activity, and complementary and alternative medicine interventions (e.g., yoga, massage, music). Interventions involving medications, ingestible supplements, products purported to work through absorption, and medical devices will be excluded. Primary outcome will be sleep quality as measured by methods including retrospective ratings, daily sleep diary, and validated questionnaires. Secondary outcomes will include total sleep time, sleep onset latency, wake after sleep onset, daytime sleepiness, and daytime sleep duration (naps) as measured by retrospective ratings, daily sleep diary, validated questionnaires, and/or actigraphy. Databases will include MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, CINAHL (Ebsco), and PsycINFO (Ovid) and will be queried from database inception to present. Two reviewers will independently screen all citations, full-text articles, and extract data. The study methodological quality will be assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Data will be extracted and findings pooled and synthesized using a meta-aggregation approach via the JBI System for the Unified Management, Assessment, and Review of Information (SUMARI). If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., methodological quality, study design, outcome measures). Discussion This systematic review will synthesize and consolidate evidence on existing non-pharmacological interventions to improve sleep in pediatric cancer patients and survivors. Findings may help inform practitioners working with pediatric cancer patients and survivors experiencing sleep disturbances and is intended to identify gaps and opportunities to improve methodical quality of further non-pharmacological sleep intervention research in this population toward developing an eventual standard of care. Systematic review registration PROSPERO CRD42020200397.

Prevalence of Sleep Disturbances in Pediatric Cancer Patients and Their Diagnosis and Management

“…There are no official guidelines on preventative or treatment methods for sleep disturbances in pediatric cancer patients and survivors; in addition, no approaches have been evaluated in large randomized controlled trials, and no systematic research has examined specific interventions associated with individual or combined risk factors [ 134 ]. Given the mosaic of potential etiologies for sleep disturbance in these patients, additional research is necessary to disentangle the independent contributions of factors, including cancer-specific risks, treatment-related factors, environmental and behavioral contributors, and psychological components.…”

“…Although no large randomized controlled trials have evaluated the management of sleep issues in the pediatric cancer population, small pilot studies have evaluated various modalities in the inpatient setting as potential interventions to manage and improve sleep, such as massage and physical activity [ 138 , 139 ]. Complementary and alternative methods (CAMs), such as massage, yoga, hypnosis, and acupuncture, have been used in adult and pediatric cancer patients, yet their effectiveness and safety in pediatric cancer patients have not been widely evaluated [ 134 , 140 , 141 ]. Such methods, especially non-pharmacological approaches, represent another avenue that may have a role in managing and preventing sleep issues in pediatric cancer patients, but there is a lack of current research on this issue [ 134 ].…”

“…Complementary and alternative methods (CAMs), such as massage, yoga, hypnosis, and acupuncture, have been used in adult and pediatric cancer patients, yet their effectiveness and safety in pediatric cancer patients have not been widely evaluated [ 134 , 140 , 141 ]. Such methods, especially non-pharmacological approaches, represent another avenue that may have a role in managing and preventing sleep issues in pediatric cancer patients, but there is a lack of current research on this issue [ 134 ].…”

“…Methods such as weight loss, positive pressure therapy, and adenotonsillectomy have been shown to provide relief from OSA, a form of SDB, in the general population [ 158 , 159 , 160 , 161 ]; because of their wide acceptance, these methods should be explored in the pediatric cancer population. Overall, there is an apparent need to focus on the safety and efficacy of pharmacological and non-pharmacological interventions in treating sleep disturbances in the pediatric cancer population [ 134 ]. Outside of physical activity, the current literature is inconclusive on medication and supportive care techniques for pediatric cancer patients, leaving a significant portion of this population vulnerable to the downstream effects of disturbed sleep.…”

Actigraphy-Based Characteristics of Sleep in Paediatric Cancer Patients in Remission and a Comparison with Their Healthy Peers in the Recovery Stay

“…[8][9][10] The disease has a negative impact on the sleep patterns and sleep quality of the children who are treated. [11][12][13] Reduced sleep quality is a significant negative factor affecting the quality of life in this target group even many years after diagnosis and treatment. [14][15][16][17][18] Reduced sleep time, increased wakefulness during the night, and reduced sleep efficiency have been demonstrated for almost all types of cancer in childhood.…”