The alerting effects of dexamethasone

Meixner, Renata; Gerhardstein, Rebecca; Day, Ryan; Nykamp, C Keith; Syron, Mary Lou; Rosenthal, León

doi:10.1111/1469-8986.00027

Cited by 12 publications

(9 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This complex effect of the HPA on sleep may explain the apparently contradictory research and clinical findings noted in different studies of the effects of corticosteroids and sleep. Dexamethasone has been shown to increase alertness, leading to insomnia [21], as well as to increase slow-wave sleep and daytime sleepiness [22]. In clinical studies of children with ALL treated with corticosteroids, both insomnia and hypersomnia are reported as adverse side effects attributed to dexamethasone [2–4].…”

Section: Discussionmentioning

confidence: 99%

The effects of Dexamethasone on sleep in young children with Acute Lymphoblastic Leukemia

et al. 2015

View full text Add to dashboard Cite

Purpose Corticosteroids, which are a mainstay in the treatment of acute lymphoblastic leukemia (ALL), have a well-documented adverse effect on sleep. We sought to characterize the effects of dexamethasone on sleep over an entire 28-day treatment cycle using actigraphy, an objective measure of sleep. Methods The sleep of 25 children aged 2–9 years (mean 4.5 years) with ALL treated with dexamethasone were evaluated during maintenance chemotherapy using a within-subject experimental design, actigraphy, and standardized questionnaires to assess sleep, sleep problems, and fatigue. Results During the five days of dexamethasone treatment, sleep time increased during the night (535 vs. 498 min; p = 0.004) and daytime napping increased the following day (14 vs. 0 min; p = 0.002), and the number of wake episodes during the night was lower (14 vs. 20; p = ≤ 0.001). However, when assessed individually, sleep-onset time, efficiency, and wake after sleep onset during the night were unchanged during dexamethasone treatment; when the cumulative effect of all of these factors was assessed, there was a statistically and clinically significant increase in nighttime sleep duration during dexamethasone treatment. Conclusions During the five days of treatment with dexamethasone, an increase in nighttime sleep as well as daytime napping was observed in young children with ALL. The increases in sleep duration return to baseline one day after the discontinuation of dexamethasone.

show abstract

Section: Discussionmentioning

confidence: 99%

The effects of Dexamethasone on sleep in young children with Acute Lymphoblastic Leukemia

et al. 2015

View full text Add to dashboard Cite

show abstract

“…1991). In adults, glucocorticoids acutely increase sleep latency (Meixner et al . 2003), with reduced alpha activity and increased theta activity (Wolkowitz et al .…”

Section: Discussionmentioning

confidence: 99%

Maternal dexamethasone and EEG hyperactivity in preterm fetal sheep

Davidson

Quaedackers

George

et al. 2011

The Journal of Physiology

View full text Add to dashboard Cite

Non-technical summary Long-acting glucocorticoids such as dexamethasone are commonly given to women at risk of preterm labour. While they significantly improve survival of the prematurely born infant, their effects on preterm brain activity is surprisingly unclear. We found that, in sheep, a conventional clinical course of maternal dexamethasone treatment was associated with dramatic, evolving low-frequency hyperactivity of the fetal EEG. This activity reflected a striking shift to less-frequent but higher amplitude EEG waveforms, and unexpectedly, EEG waveforms whose duration and pattern were highly consistent with seizure activity. After resolution of hyperactivity, the EEG showed changes consistent with maturation of sleep architecture, and reassuringly there was no histological evidence of brain injury 5 days after first exposure. The long-term implications are uncertain, but these effects may contribute to improved neonatal outcomes.Abstract Maternal treatment with synthetic corticosteroids such as dexamethasone (DEX) significantly reduces neonatal morbidity and mortality, but its effects on the fetal brain remain unclear. In this study we evaluated the effects of DEX on EEG activity in preterm fetal sheep. Ewes at 103 days gestation received two intramuscular injections of DEX (12 mg, n = 8) or saline vehicle (n = 7) 24 h apart. Fetal EEG activity was recorded from 6 h before until 120 h after the first injection (DEX-1). DEX-1 was associated with a marked transient rise in total EEG power, maximal at 12 h (P < 0.001), with a relative increase in delta and reduced theta, alpha and beta activity, resolving by 24 h. Continuous EEG records showed a shift to larger but less frequent transient waveforms (P < 0.001). Unexpectedly, evolving epileptiform activity, consistent with electrographic and clinical seizures, developed from 178 ± 44 min after DEX-1. Similar but smaller changes were seen after the second injection. Following the injections, total power returned to control values, but the proportion of alpha activity progressively increased vs. controls (P < 0.001), with reduced interburst interval duration and number (P < 0.001). No histological neural injury or microglial activation was seen. In summary, exposure to maternal dexamethasone was associated with dramatic, evolving low-frequency hyperactivity on fetal cortical EEG recordings, followed by sustained changes consistent with maturation of fetal sleep architecture. We postulate that these effects may contribute to improved neonatal outcomes. Abbreviations DEX-1 and -2, first and second dexamethasone injections; IBI, interburst interval; HPA, hypothalamic-pituitary-adrenal; REM, rapid-eye movement.

show abstract

“…The demonstration of reduced memory performance with pharmacological reduction of cortisol levels (Lupien et al, 2002), suggests that a misalignment in the cortisol rhythm resulting in lower levels during the waking episode could contribute to the observed impairment in cognitive efficiency in the workplace (Å kerstedt, 1995). Indeed, the administration of exogenous glucocorticoids has resulted in reduced subjective ratings of fatigue in emergency room physicians on night shifts (Whitcomb et al, 2000) and increased objective measures of vigilance as assessed via polysomnography during repeated nap opportunities (Meixner et al, 2003). Thus, an appropriate alignment of peak cortisol levels with the start of the night shift (as achieved by the treatment group) seems to be an advantage for workers.…”

Section: Discussionmentioning

confidence: 99%

Controlled Exposure to Light and Darkness Realigns the Salivary Cortisol Rhythm in Night Shift Workers

James

Walker

Boivin

2004

Chronobiology International

View full text Add to dashboard Cite

The efficacy of a light/darkness intervention designed to promote circadian adaptation to night shift work was tested in this combined field and laboratory study. Six full-time night shift workers (mean age AE SD:37.1 AE 8.1 yrs) were provided an intervention consisting of an intermittent exposure to full-spectrum bright white light ($2000 lux) in the first 6 h of their 8 h shift, shielding from morning light by tinted lenses (neutral gray density, 15% visual light transmission), and regular sleep/darkness episodes in darkened quarters beginning 2 h after the end of each shift. Five control group workers (41.1 AE 9.9 yrs) were observed in the presence of a regular sleep/darkness schedule only. Constant routines (CR) performed before and after a sequence of $12 night shifts over 3 weeks revealed that treatment group workers displayed significant shifts in the time of peak cortisol expression and realignment of the rhythm with the nightoriented schedule. Smaller phase shifts, suggesting an incomplete adaptation to the shift work schedule, were observed in the control group. Our observations support the careful control of the pattern of light and darkness exposure for the adaptation of physiological rhythms to night shift work.

show abstract

The alerting effects of dexamethasone

Cited by 12 publications

References 42 publications

The effects of Dexamethasone on sleep in young children with Acute Lymphoblastic Leukemia

The effects of Dexamethasone on sleep in young children with Acute Lymphoblastic Leukemia

Maternal dexamethasone and EEG hyperactivity in preterm fetal sheep

Controlled Exposure to Light and Darkness Realigns the Salivary Cortisol Rhythm in Night Shift Workers

Contact Info

Product

Resources

About