Systematic Review: Sleep Disorders Based on Objective Data in Children and Adolescents Treated for a Brain Tumor

Abstract

BackgroundTumors of the central nervous system (CNS) are the most common solid childhood malignancy. Over the last decades, treatment developments have strongly contributed to the improved overall 5-year survival rate, which is now approaching 75%. However, children now face significant long-term morbidity with late-effects including sleep disorders that may have detrimental impact on everyday functioning and quality of life. The aims of this study were to (1) describe the symptoms that lead to polysomnographic evaluation; (2) describe the nature of sleep disorders diagnosed in survivors of childhood CNS tumor using polysomnography (PSG); and (3) explore the association between tumor location and diagnosed sleep disorder.MethodsAn extensive literature search following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA) was conducted. Inclusion criteria were children and adolescents diagnosed with a CNS tumor age <20 years having a PSG performed after end of tumor treatment. The primary outcome was sleep disorder confirmed by PSG.ResultsOf the 1,658 studies identified, 11 met the inclusion criteria. All the included articles were appraised for quality and included in the analysis. Analyses indicated that sleep disorders commonly occur among childhood CNS tumor survivors. Symptoms prior to referral for PSG were excessive daytime sleepiness (EDS), fatigue, irregular breathing during sleep and snoring. The most common sleep disorders diagnosed were sleep-related breathing disorders (i.e., obstructive sleep apnea) and central disorders of hypersomnolence (i.e., narcolepsy).ConclusionOur findings point to the potential benefit of systematically registering sleep disorder symptoms among CNS tumor patients together with tumor type and treatment information, so that at-risk patients can be identified early. Moreover, future rigorous and larger scale controlled observational studies that include possible modifiable confounders of sleep disorders such as fatigue and obesity are warranted.Clinical Trial Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021243866, identifier [CRD42021243866].

Sleep Disturbance and Its Association With Sluggish Cognitive Tempo and Attention in Pediatric Brain Tumor Survivors

“…Characterization of risks for sleep disturbances in PBT survivors remains incomplete. Thus, it is important to further investigate biological [e.g., tumor-related factors such as tumor type and location ( Helligsoe et al, 2022 ) or treatment modalities], environmental, family-related, psychological, and behavioral factors that are most strongly associated with the onset and perpetuation of sleep problems in PBT survivors. The construct and measurement of SCT is evolving ( Becker et al, 2019 ), and as measurement methods advance future researchers can incorporate more refined metrics to assess SCT in PBT survivors.…”

Mechanisms of sleep disturbances in long-term cancer survivors: a childhood cancer survivor study report

“…Within survivors, two separate multivariable Poisson regression with robust sandwich variance estimates were used to estimate prevalence ratios of the sleep outcomes. One model included demographics and cancer diagnosis (CNS tumors were the reference group to test the hypothesis that CNS diagnoses confer additional risk for sleep) ( 16 , 17 ), and the other model included demographics and treatment exposures; this approach reduced confounding between diagnosis and treatments. Inverse probability weighting was applied to multivariable models to account for undersampling of acute lymphoblastic leukemia survivors in the CCSS expansion cohort (diagnosed 1987-1999).…”

“…Several possible underlying mechanisms leading to sleep disturbances after cancer treatment are tested in the current study of survivors diagnosed from 1970 to 2000: (1) cancer history and its hypothesized influence on mental health elevates the risk of developing or perpetuating insomnia ( 15 ), tested by comparing insomnia symptoms between survivors and siblings; (2) hypothalamic damage from treatment or tumor location may alter the circadian regulation of sleep ( 16 , 17 ), tested by comparing risk of delayed bedtimes in those with and without central nervous system (CNS) related diagnoses and therapies; (3) respiratory distress because of excess weight ( 18 ) or treatment-related changes to the upper airway ( 19 ) and/or pulmonary functioning ( 20 ) (ie, head/neck or thoracic radiation) may increase risk of sleep disordered breathing, tested by examining the contribution of body mass index (BMI) to sleep outcomes, the frequency of snoring, and the contribution of pulmonary-directed therapies on snoring and sleep quality; or (4) CHC burden and cancer-related late effects ( 21 , 22 ), such as pain, that disrupt sleep quality. These mechanisms likely interact to exacerbate sleep disturbances for some survivors.…”

Comprehensive assessment of sleep in newly diagnosed pediatric brain tumor patients

“…Sleep in the early phases of treatment in pediatric brain tumor patients has thus far not been studied comprehensively, even though this has been strongly recommended by researchers and clinicians 6,7,19 . Identifying which children are at risk to develop sleep problems is important, in order to provide effective, targeted sleep interventions in a timely manner, with the aim to improve long-term negative health outcomes associated with poor sleep.…”