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Daniel LC, Wang H, Brinkman TM, Ruble K, Zhou ES, Palesh O, Stremler R, Howell R, Mulrooney DA, Crabtree VM, Mostoufi-Moab S, Oeffinger K, Neglia J, Yasui Y, Armstrong GT, Krull K. Mechanisms of sleep disturbances in long-term cancer survivors: a childhood cancer survivor study report. JNCI Cancer Spectr 2024; 8:pkae010. [PMID: 38366608 PMCID: PMC10932943 DOI: 10.1093/jncics/pkae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Sleep problems following childhood cancer treatment may persist into adulthood, exacerbating cancer-related late effects and putting survivors at risk for poor physical and psychosocial functioning. This study examines sleep in long-term survivors and their siblings to identify risk factors and disease correlates. METHODS Childhood cancer survivors (≥5 years from diagnosis; n = 12 340; 51.5% female; mean [SD] age = 39.4 [9.6] years) and siblings (n = 2395; 57.1% female; age = 44.6 [10.5] years) participating in the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI). Multivariable Poisson-error generalized estimating equation compared prevalence of binary sleep outcomes between survivors and siblings and evaluated cancer history and chronic health conditions (CHC) for associations with sleep outcomes, adjusting for age (at diagnosis and current), sex, race/ethnicity, and body mass index. RESULTS Survivors were more likely to report clinically elevated composite PSQI scores (>5; 45.1% vs 40.0%, adjusted prevalence ratio [PR] = 1.20, 95% CI = 1.13 to 1.27), symptoms of insomnia (38.8% vs 32.0%, PR = 1.26, 95% CI = 1.18 to 1.35), snoring (18.0% vs 17.4%, PR = 1.11, 95% CI = 1.01 to 1.23), and sleep medication use (13.2% vs 11.5%, PR = 1.28, 95% CI = 1.12 to 1.45) compared with siblings. Within cancer survivors, PSQI scores were similar across diagnoses. Anthracycline exposure (PR = 1.13, 95% CI = 1.03 to 1.25), abdominal radiation (PR = 1.16, 95% CI = 1.04 to 1.29), and increasing CHC burden were associated with elevated PSQI scores (PRs = 1.21-1.48). CONCLUSIONS Among survivors, sleep problems were more closely related to CHC than diagnosis or treatment history, although longitudinal research is needed to determine the direction of this association. Frequent sleep-promoting medication use suggests interest in managing sleep problems; behavioral sleep intervention is advised for long-term management.
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Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Rutgers University Camden, Camden, NJ, USA
| | - Huiqi Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kathy Ruble
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Eric S Zhou
- Division of Sleep Medicine and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Dana Farber Cancer Institute, Boston, MA, USA
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - Robyn Stremler
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Rebecca Howell
- Department of Radiation Physics, MD Anderson, Houston, TX, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sogol Mostoufi-Moab
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Oeffinger
- Department of Medicine, Duke University and Duke Cancer Institute, Durham, NC, USA
| | - Joseph Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kevin Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Loew M, Niel K, Burlison JD, Russell KM, Karol SE, Talleur AC, Christy LANN, Johnson LM, Crabtree VM. A quality improvement project to improve pediatric medical provider sleep and communication during night shifts. Int J Qual Health Care 2020; 31:633-638. [PMID: 30423134 DOI: 10.1093/intqhc/mzy221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/15/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Abstract
QUALITY PROBLEM OR ISSUE Night-shift medical providers frequently experience limited sleep resulting in fatigue, often because of paging activity. Streamlined medical-specific communication interventions are known to improve sleep and communication among these providers. INITIAL ASSESSMENT We found that non-urgent paging communication occurred frequently during night-shifts, leading to provider sleep disturbances within our institution. We tested a quality improvement (QI) intervention to improve paging practices and determined its effect on provider sleep. CHOICE OF SOLUTION We used a Plan-Do-Study-Act QI model aimed at improving clinician sleep and paging communications. IMPLEMENTATION We initially conducted focus groups of nurses and physician trainees to inform the creation of a standardized paging intervention. We collected actigraphy and sleep log data from physicians, nurse practitioners, and physician trainees and performed electronic collection of paging frequency data. EVALUATION Data were collected between December 2015 and March 2017 from pediatric residents, pediatric hematology/oncology (PHO) fellows, hospitalist medicine nocturnists and nurses working during night-shift hours in PHO inpatient units. We collected baseline data before implementation of the QI intervention and at 1 month post-implementation. Although objective measures and provider reports demonstrated improved medical-specific communication paging practices, provider sleep was not affected. LESSONS LEARNED Provider-based standardization of paging communication was associated with improved medical-specific communication between nurses and providers; however, provider sleep was not affected. The strategies used in this intervention may be transferable to other clinics and institutions to streamline medical-specific communication.
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Affiliation(s)
- Megan Loew
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-101, Memphis, TN, USA
| | - Kristin Niel
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-101, Memphis, TN, USA
| | - Jonathan D Burlison
- Department of Pharmaceutical Sciences, St. Jude Children's Hospital, 262 Danny Thomas Place, MS-313, Memphis, TN, USA
| | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-101, Memphis, TN, USA
| | - Seth E Karol
- Department of Cancer Center Administration, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-313, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-135, Memphis, TN, USA
| | - Aimee C Talleur
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-1130, Memphis, TN, USA
| | - Leigh A N N Christy
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-101, Memphis, TN, USA
| | - Liza-Marie Johnson
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-135, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-101, Memphis, TN, USA
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3
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LaRosa KN, Crowley SJ, Hancock D, Caples M, Merchant TE, Crabtree VM, Mandrell B. 0994 Assessment Of Sleep-wake And Circadian Rhythm Disruption In Children And Adolescents Diagnosed With Craniopharyngioma. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Patients with craniopharyngioma are at increased risk for hypersomnia/narcolepsy and circadian rhythm disruption, secondary to hypothalamic-pituitary involvement of the tumor. We assessed youth with craniopharyngioma to determine presence of the dim light melatonin onset (DLMO) and concurrent sleep disturbance.
Methods
Fifty-two patients (7-21 years; 51% female) enrolled on our institutional protocol for craniopharyngioma that included surgery, proton therapy, or both. In-home salivary melatonin was collected after surgery and hourly beginning 3 h before to 1 h after habitual bedtime to determine the DLMO, which was defined as the time that melatonin exceeded a 4 pg/mL threshold. Polysomnography and a next day multiple sleep latency test (MSLT) were also conducted.
Results
Hypersomnia/narcolepsy was indicated in 86% of patients. DLMO was detected in 29 (56%) patients and averaged 21:04 (±1:14). All but 2 patients with a DLMO had a concurrent sleep diagnosis (18 hypersomnia, 8 narcolepsy, 1 insomnia). In those we could not compute a DLMO, melatonin was above the 4 pg/mL threshold in 19 (37%), suggesting that the DLMO was likely earlier than the sampling window. Two (4%) did not reach threshold, suggesting that the DLMO was later than the window. For patients in which DLMO was not computed, all but 4 had a concurrent sleep diagnosis (7 hypersomnia, 9 narcolepsy, 1 MSLT not completed). Three (6%) participants showed a pattern of melatonin decreasing before bedtime (2 hypersomnia, 1 narcolepsy). Sleep disorder diagnosis was not associated with whether a DLMO was detected or not.
Conclusion
DLMO did not occur within the sampling window in 44% of patients with the majority due to the DLMO likely occurring before sampling started. Simultaneous assessment of both sleep-wake disturbance and circadian phase could provide more informed sleep interventions for excessive sleepiness and circadian misalignment in this patient population.
Support
This study was supported by cancer center grant (CA21765) from the National Cancer Institute, and ALSAC.
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Affiliation(s)
- K N LaRosa
- St. Jude Children’s Research Hospital, Memphis, TN
| | | | - D Hancock
- St. Jude Children’s Research Hospital, Memphis, TN
| | - M Caples
- St. Jude Children’s Research Hospital, Memphis, TN
| | - T E Merchant
- St. Jude Children’s Research Hospital, Memphis, TN
| | - V M Crabtree
- St. Jude Children’s Research Hospital, Memphis, TN
| | - B Mandrell
- St. Jude Children’s Research Hospital, Memphis, TN
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4
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Crabtree VM, Zhang H, Wang F, Brigden J, MacArthur E, Russell K, Wilson MW, Pappo A. 0809 Feasibility and Acceptability of Light Therapy to Increase Energy in Adolescents and Young Adults Newly Diagnosed with Cancer. Sleep 2019. [DOI: 10.1093/sleep/zsz067.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hui Zhang
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Fang Wang
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane Brigden
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | - Alberto Pappo
- St. Jude Children's Research Hospital, Memphis, TN, USA
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5
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Khan RB, Merchant TE, Sadighi ZS, Bello MS, Lu Z, Sykes A, Wise MS, Crabtree VM, Zabrowski J, Simmons A, Clark ME, Mandrell BN. Prevalence, risk factors, and response to treatment for hypersomnia of central origin in survivors of childhood brain tumors. J Neurooncol 2017; 136:379-384. [PMID: 29116485 DOI: 10.1007/s11060-017-2662-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/29/2017] [Indexed: 11/25/2022]
Abstract
Daytime sleepiness is recognized in childhood brain tumor survivors. Our objective was to determine prevalence, risk factors for PSG/MLST proven hypersomnia/narcolepsy, and response to stimulants in childhood brain tumor survivors. Standard PSG/MSLT criteria were used to diagnose hypersomnia/narcolepsy. Medical records of brain tumor survivors having undergone a PSG/MSLT were reviewed for the diagnostic code of hypersomnia/narcolepsy. Survivors with hypersomnia/narcolepsy were matched with 2-3 survivors without reported hypersomnia/narcolepsy by age at tumor diagnosis, gender, and time from tumor diagnosis. Between January 2000 to April 2015, 39 of the 2336 brain tumor patients treated at our institution were diagnosed with hypersomnia/narcolepsy for a prevalence rate of 1670/100,000. Hypersomnia/narcolepsy was diagnosed at a median of 6.1 years (range 0.4-13.2) from tumor diagnosis and 4.7 years (range - 1.5 to 10.4) from cranial radiation. Midline tumor location (OR 4.6, CI 1.7-12.2, p = 0.002) and anti-epilepsy drug (AED) use (OR 11, CI 2.4-54) correlated with hypersomnia/narcolepsy while radiation dose > 30 Gray trended towards significance (OR 1.8, CI 0.9-3.6); posterior fossa tumor location reduced the risk (OR 0.1, CI 0.04-0.5, p = 0.002). AED use also correlated with midline tumor location. Thirty-seven survivors were treated with stimulants and reported improved wakefulness and school performance [response rate CI 0.97 (0.86-0.99) and 0.83 (0.65-0.94)]. Prevalence of hypersomnia/narcolepsy among childhood brain tumor survivors was higher than the general population. Tumor location and radiation dose were possible risk factors, and stimulants were reported to be beneficial.
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Affiliation(s)
- Raja B Khan
- Division of Neurology, Departments of Pediatrics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 135, Memphis, TN, 38105, USA.
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Zsila S Sadighi
- Division of Neurology, Departments of Pediatrics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 135, Memphis, TN, 38105, USA
| | - Mercedes S Bello
- Division of Neurology, Departments of Pediatrics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 135, Memphis, TN, 38105, USA
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Merrill S Wise
- Methodist Healthcare Sleep Disorder Center, 5050 Poplar Avenue, Memphis, TN, 38157, USA
| | - Valerie M Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Jennifer Zabrowski
- Division of Neurology, Departments of Pediatrics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 135, Memphis, TN, 38105, USA
| | - Andrea Simmons
- Division of Neurology, Departments of Pediatrics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 135, Memphis, TN, 38105, USA
| | - Mary E Clark
- Division of Nursing Research, Department of Pediatrics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Belinda N Mandrell
- Division of Nursing Research, Department of Pediatrics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
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6
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Zhou ES, Vrooman LM, Manley PE, Crabtree VM, Recklitis CJ. Adapted Delivery of Cognitive-Behavioral Treatment for Insomnia in Adolescent and Young Adult Cancer Survivors: A Pilot Study. Behav Sleep Med 2017; 15:288-301. [PMID: 27077226 DOI: 10.1080/15402002.2015.1126597] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adolescent and young adult cancer survivors (AYACS) are at risk for the development of insomnia, though it remains vastly undertreated. Limited research has evaluated cognitive-behavioral treatment for insomnia (CBT-I) in AYACS. The present study piloted adapted CBT-I designed to improve treatment accessibility by delivering a three-session intervention in person and via videoconference. AYACS with insomnia (N = 12) enrolled in the study. Ten AYACS completed the intervention, with six in person and four via videoconference. Sleep variables improved immediately postintervention and were sustained at two-month follow-up. Within sample effect sizes of the adapted intervention for sleep, variables were large, and there were no noted differences on sleep outcomes between the in-person and videoconference participants. These pilot findings indicate that an adapted CBT-I intervention is feasible and promising in AYACS populations.
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Affiliation(s)
- Eric S Zhou
- a David B. Perini Jr. Quality of Life Clinic , Dana-Farber Cancer Institute , Boston , Massachusetts.,b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts
| | - Lynda M Vrooman
- a David B. Perini Jr. Quality of Life Clinic , Dana-Farber Cancer Institute , Boston , Massachusetts.,b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts.,c Department of Pediatrics, Boston Children's Hospital , Boston , Massachusetts
| | - Peter E Manley
- b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts.,c Department of Pediatrics, Boston Children's Hospital , Boston , Massachusetts.,d Pediatric Neuro-Oncology Clinic, Dana-Farber Cancer Institute , Boston , Massachusetts
| | - Valerie M Crabtree
- e Department of Psychology, St. Jude Children's Research Hospital , Memphis , Tennessee
| | - Christopher J Recklitis
- a David B. Perini Jr. Quality of Life Clinic , Dana-Farber Cancer Institute , Boston , Massachusetts.,b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts
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7
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Allen JM, Graef DM, Ehrentraut JH, Tynes BL, Crabtree VM. Sleep and Pain in Pediatric Illness: A Conceptual Review. CNS Neurosci Ther 2016; 22:880-893. [PMID: 27421251 DOI: 10.1111/cns.12583] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep disruption is a common comorbidity of pediatric pain. Consequences of pain and disrupted sleep, evidence for the pain-sleep relation, and how aspects of illness, treatment, and pharmacological pain management may contribute to or exacerbate these issues are presented. AIMS This conceptual review explored the relation between pain and sleep in children diagnosed with chronic medical or developmental conditions. The goal of this review is to expand upon the literature by examining common themes in sleep disturbances associated with painful conditions across multiple pediatric illnesses. Populations reviewed include youth with intellectual and developmental disabilities (IDD), migraines, cystic fibrosis (CF), sickle cell disease (SCD), cancer, juvenile idiopathic arthritis (JIA), juvenile fibromyalgia (JFM), and functional gastrointestinal disorders (FGIDs). RESULTS Consistent evidence demonstrates that children with medical or developmental conditions are more vulnerable to experiencing pain and subjective sleep complaints than healthy peers. Objective sleep concerns are common but often under-studied. Evidence of the pain-sleep relationship exists, particularly in pediatric SCD, IDD, and JIA, with a dearth of studies directly examining this relation in pediatric cancer, JFM, CF, and FGIDs. Findings suggest that assessing and treating pain and sleep disruption is important when optimizing functional outcomes. CONCLUSION It is essential that research further examine objective sleep, elucidate the pain-sleep relationship, consider physiological and psychosocial mechanisms of this relationship, and investigate nonpharmacological interventions aimed at improving pain and sleep in vulnerable pediatric populations.
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Affiliation(s)
- Jennifer M Allen
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Danielle M Graef
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Brooklee L Tynes
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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8
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Jacola LM, Conklin HM, Scoggins MA, Ashford JM, Merchant TE, Mandrell BN, Ogg RJ, Curtis E, Wise MS, Indelicato DJ, Crabtree VM. Investigating the Role of Hypothalamic Tumor Involvement in Sleep and Cognitive Outcomes Among Children Treated for Craniopharyngioma. J Pediatr Psychol 2016; 41:610-22. [PMID: 27189690 PMCID: PMC4913761 DOI: 10.1093/jpepsy/jsw026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Despite excellent survival prognosis, children treated for craniopharyngioma experience significant morbidity. We examined the role of hypothalamic involvement (HI) in excessive daytime sleepiness (EDS) and attention regulation in children enrolled on a Phase II trial of limited surgery and proton therapy. METHODS Participants completed a sleep evaluation (N = 62) and a continuous performance test (CPT) during functional magnetic resonance imaging (fMRI; n = 29) prior to proton therapy. RESULTS EDS was identified in 76% of the patients and was significantly related to increased HI extent (p = .04). There was no relationship between CPT performance during fMRI and HI or EDS. Visual examination of group composite fMRI images revealed greater spatial extent of activation in frontal cortical regions in patients with EDS, consistent with a compensatory activation hypothesis. CONCLUSION Routine screening for sleep problems during therapy is indicated for children with craniopharyngioma, to optimize the timing of interventions and reduce long-term morbidity.
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Affiliation(s)
| | | | | | | | | | | | | | - Elizabeth Curtis
- Indiana University School of Medicine, Indiana University-Purdue University
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9
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Moore JB, Jacks DE, Bibeau WS, Valdes XL, Jones VF, Crabtree VM, Wedig RT, Topp R, Bartholomew JB. Comparison of Energy Expenditure Measured by Accelerometry and Energy Intake in Overweight African American Children. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-01993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Jacks DE, Moore JB, Bibeau WS, Valdes XL, Jones VF, Crabtree VM, Wedig RT, Topp R, Bartholomew JB. Moderate Intensity Physical Activity and Fitness are Predictors of Body Mass Index in Overweight African American Children. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-02802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Montgomery-Downs HE, Crabtree VM, Gozal D. Actigraphic recordings in quantification of periodic leg movements during sleep in children. Sleep Med 2005; 6:325-32. [PMID: 15978516 DOI: 10.1016/j.sleep.2005.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Revised: 02/02/2005] [Accepted: 02/04/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Periodic limb movement disorder (PLMD) has recently emerged as a relatively frequent and markedly underdiagnosed condition in children that induces arousals and sleep fragmentation and leads to poor learning and behavioral problems. Because a cost-effective and widely available alternative to pediatric polysomnography is needed for diagnosis of limb movement disorders, this study sought to examine whether periodic leg movements in children could be reliably identified using recently developed actigraphy software. METHODS Bilateral actigraphs were worn around the feet by 99 children ages 4-12 years during standard clinical overnight polysomnography, which included bilateral anterior tibial electromyogram (EMG). Left and right leg movements were scored independently for comparison purposes. RESULTS Agreement between tibial EMG and actigraphy-derived events were initially low, with movement indices being overestimated by actigraphy. This agreement was improved when a correction factor based on the average number of movements during arousals as measured by EMG was applied. However, the correction factor itself was found to differ substantially for patients who were diagnosed with PLMD compared to other patients. CONCLUSIONS A novel actigraphic approach currently used for detection of PLM events during sleep in adults is insufficiently accurate to permit reliable estimates in children.
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Affiliation(s)
- Hawley E Montgomery-Downs
- Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, 571 South Floyd Street, Suite 439, Louisville, KY 40202, USA
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12
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Abstract
Sleep-disordered breathing in children has been associated with cognitive impairment. The purpose of this study was to examine the impact of tonsillectomy and adenoidectomy (T&A) on sleep, respiration and cognitive function in children of pre-school age with obstructive sleep apnoea (OSA) from a low-income community population. Altogether, 19 children attending state-funded pre-school programmes underwent overnight polysomnography and cognitive assessment before and following surgical treatment for OSA; 19 matched controls were also assessed. Following T&A, OSA subjects' delta sleep increased, rapid eye movement sleep decreased, and respiratory and arousal indices improved. There were no significant differences in OSA subjects' post-operative sleep or respiratory measures compared to controls. Prior to T&A, cognitive scores were significantly lower in OSA subjects versus controls; following T&A, OSA subjects' scores improved compared to pre-operative scores and did not differ from those of matched controls. Following tonsillectomy and adenoidectomy, at-risk pre-schoolers recruited directly from the community showed normalised sleep and respiratory patterns and improved cognitive scores. These findings, in this uniquely vulnerable population, which is unlikely to seek evaluation and treatment for obstructive sleep apnoea, underscore the potential value of outreach screening programmes for sleep-disordered breathing, particularly among low-income groups of pre-school age.
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Affiliation(s)
- H E Montgomery-Downs
- Division of Pediatric Sleep Medicine, Dept of Pediatrics, University of Louisville, Louisville, KY, USA
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Carter BD, Kronenberger WG, Baker J, Grimes LM, Crabtree VM, Smith C, McGraw K. Inpatient pediatric consultation-liaison: a case-controlled study. J Pediatr Psychol 2003; 28:423-32. [PMID: 12904454 DOI: 10.1093/jpepsy/jsg032] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To conduct a prospective case-controlled study of pediatric inpatients referred for consultation in a tertiary care children's medical center. METHOD Referrals (n = 104) were matched with nonreferrals (n = 104) for age (4 to 18 years), gender, and illness type/severity and completed parent- and self-report (dependent on age) behavioral rating scales to assess for adjustment/functioning. Nurses completed in-hospital ratings of behavioral/adjustment difficulties. Goal attainment and satisfaction ratings were obtained from the referring physicians, parents/guardians, and the consultant. RESULTS Referrals exhibited more behavior/adjustment/coping difficulties than nonreferrals by parent, nurse, and self report. Frequently employed interventions included coping-strategies intervention, cognitive and behavioral therapies, and case management. Referring physician and consultant ratings of goal attainment were high, as were physician ratings of satisfaction and parent/guardian ratings of overall helpfulness. CONCLUSIONS Pediatric inpatients referred by their physicians had significantly more internalizing and externalizing disturbances than their nonreferred hospitalized peers. Many of the behavioral and adjustment problems that lead to in-hospital consultation referral were evident in global behavior difficulties prior to hospitalization. Referring pediatricians, parents/guardians, and consultants rate the outcome as benefiting the patients via assisting in the overall management of their health concerns, coping, and adjustment.
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Affiliation(s)
- Bryan D Carter
- University of Louisville School of Medicine, Kentucky 40202, USA.
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