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Potter BS, Crabtree VM, Ashford JM, Li Y, Liang J, Guo Y, Wise MS, Skoda ES, Merchant TE, Conklin HM. Performance and symptom validity indicators among children undergoing cognitive surveillance following treatment for craniopharyngioma. Neurooncol Pract 2024; 11:319-327. [PMID: 38737617 PMCID: PMC11085848 DOI: 10.1093/nop/npae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to neuropsychological evaluations, helping ensure findings reflect true abilities or concerns. It is unclear how PVTs and SVTs perform in children who received radiotherapy for brain tumors. Accordingly, we investigated the rate of noncredible performance on validity indicators as well as associations with fatigue and lower intellectual functioning. Methods Embedded PVTs and SVTs were investigated in 98 patients with pediatric craniopharyngioma undergoing proton radiotherapy (PRT). The contribution of fatigue, sleepiness, and lower intellectual functioning to embedded PVT performance was examined. Further, we investigated PVTs and SVTs in relation to cognitive performance at pre-PRT baseline and change over time. Results SVTs on parent measures were not an area of concern. PVTs identified 0-31% of the cohort as demonstrating possible noncredible performance at baseline, with stable findings 1 year following PRT. Reliable digit span (RDS) noted the highest PVT failure rate; RDS has been criticized for false positives in pediatric populations, especially children with neurological impairment. Objective sleepiness was strongly associated with PVT failure, stressing need to consider arousal level when interpreting cognitive performance in children with craniopharyngioma. Lower intellectual functioning also needs to be considered when interpreting task engagement indices as it was strongly associated with PVT failure. Conclusions Embedded PVTs should be used with caution in pediatric craniopharyngioma patients who have received PRT. Future research should investigate different cut-off scores and validity indicator combinations to best differentiate noncredible performance due to task engagement versus variable arousal and/or lower intellectual functioning.
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Affiliation(s)
- Brian S Potter
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Valerie McLaughlin Crabtree
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jason M Ashford
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yimei Li
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jia Liang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yian Guo
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Merrill S Wise
- Mid-South Pulmonary and Sleep Specialists, PC, Memphis, Tennessee, USA
| | - Evelyn S Skoda
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Heather M Conklin
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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Ahmed A, Crabtree VM, Sirrine E, Elliott A, Antoniotti N, Horn S, Turner E, Parris KR. Development and Implementation of a Telemental Health Program for Caregivers in a Children's Hospital Setting. Telemed J E Health 2024; 30:126-133. [PMID: 37311170 DOI: 10.1089/tmj.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Introduction: Caregivers of children with chronic illness, such as hematology-oncology conditions, face numerous stressors, and a subset experience persistent distress and poor psychological outcomes. Many logistical and ethical barriers complicate the provision of mental health care to caregivers in children's hospital settings. Telemental health (TMH) is one method to increase access and reduce barriers. Methods: A partnership was established with an outside TMH agency to provide mental health care to caregivers of children with hematology-oncology conditions. Development and implementation strategies are described, and feasibility was measured on four dimensions. Results: One hundred twenty-seven (n = 127) caregivers were referred for TMH services in the first 28 months of program implementation. Of the total, 63/127 (49%) received TMH services for at least one session. Most caregivers had a child in active medical treatment (89%). A small portion (11%) of caregivers were bereaved or had a child in hospice care. Program feasibility was enhanced by hospital leadership support and availability of staffing, financial, and technology resources. Available resources also contributed to the practicality of program development and swift implementation and integration within the defined hospital system. Discussion: Partnership with an outside TMH agency increased access to care and reduced barriers to treating caregivers in a children's hospital setting. Offering mental health interventions to caregivers aligns with evidence-based standards of care. Future research will elucidate caregiver satisfaction with this modality of treatment and whether use of TMH reduces disparities in caregiver receipt of mental health care in children's hospital settings.
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Affiliation(s)
- Ameena Ahmed
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Erica Sirrine
- Department of Social Work, and St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew Elliott
- Department of Interoperability and Patient Engagement, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Nina Antoniotti
- Psychiatry Division, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sarina Horn
- Psychiatry Division, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Erin Turner
- Department of Social Work, and St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kendra R Parris
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Tucker P, Loew M, Russell K, Tynes BL, Mandrell BN, Witcraft SM, Schwartz LE, Crabtree VM. Sleep health behaviors in pediatric patients with newly diagnosed cancer. J Psychosom Res 2023; 172:111413. [PMID: 37354749 PMCID: PMC10751812 DOI: 10.1016/j.jpsychores.2023.111413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Disrupted sleep and fatigue are common symptoms in children with cancer, but little is known about this population's sleep health behaviors and how they may impact nighttime sleep. We aimed to describe the sleep health behaviors of children with newly diagnosed cancer and to determine if they changed over the next 8 weeks. METHODS Our sample included 169 children with cancer (86 males) who were aged 2-18 years (mean [SD] = 8.14 [4.4] y), with parent proxy report for 140 children (71 male) aged 2-12 years (mean [SD] = 6.67 [3.2] y) and self-report for 78 children (39 male) aged 8-18 years (mean [SD] = 12.0 [2.9] y). Parents and patients completed sleep hygiene questionnaires within 30 days of oncology diagnosis (T1); follow-up questionnaires were collected 8 weeks later (T2). Descriptive analyses characterized the sample by sociodemographic characteristics, cancer diagnosis, treatments received, and prescribed medications. RESULTS Age-related differences were found in sleep health behaviors, with adolescents reporting better overall sleep health behaviors than younger children at both time points. No differences in sleep health behaviors were found at T1 related to diagnosis, treatment, or medications. Some differences in sleep health behaviors were found at T2 related to gender, diagnosis, treatment, and medications. Sleep health behaviors and sleep problems remained relatively stable over 8 weeks. Fatigue was significantly associated with more pre-bedtime worries, insomnia, and lower rates of daytime sleepiness. CONCLUSIONS These findings offer novel descriptive characteristics of sleep health behaviors in a pediatric oncology sample and show relatively stable yet somewhat poor sleep health behaviors across 8 weeks. Better understanding of sleep health behaviors as modifiable factors will help inform targeted interventions.
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Affiliation(s)
- Pippa Tucker
- Graduate School of Professional Psychology, University of Denver, Denver, CO, United States of America.
| | - Megan Loew
- Behavioral Health, Housing, and Deaf & Hard of Hearing Services Administration, Minnesota Department of Human Services, St. Paul, MN, United States of America.
| | - Kathryn Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States of America.
| | - Brooklee L Tynes
- Psychiatric Services, Faith Regional Physician Services, Norfolk, NE, United States of America.
| | - Belinda N Mandrell
- Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, United States of America.
| | - Sara M Witcraft
- Department of Psychology, University of Mississippi, Oxford, MS, United States of America.
| | - Laura E Schwartz
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States of America.
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Al Ghriwati N, Winter M, Semko J, Merchant TE, Crabtree VM. The feasibility and acceptability of mobile ecological momentary assessment to evaluate sleep, family functioning, and affect in patients with pediatric craniopharyngioma. J Psychosoc Oncol 2023; 42:159-174. [PMID: 37526202 DOI: 10.1080/07347332.2023.2231412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
PURPOSE/OBJECTIVES We aimed to assess the feasibility and acceptability of mobile ecological momentary assessment (mEMA) for youth with craniopharyngioma and evaluate daily associations among family functioning, affect, and sleep difficulties. DESIGN/RESEARCH APPROACH Youth completed two mEMA diaries per day for one week. SAMPLE/PARTICIPANTS Thirty-nine youth who underwent surgery and proton radiotherapy (when indicated) for craniopharyngioma. METHODS/METHODOLOGICAL APPROACH Descriptive statistics and multi-level modeling were used to examine feasibility and acceptability of mEMA and daily associations among family functioning, affect, and sleep. FINDINGS Youth reported satisfaction and minimal burden from completing daily mEMA diaries. Poorer family functioning was not related to lower sleep efficiency. CONCLUSIONS/INTERPRETATION mEMA is an acceptable and feasible method for evaluating sleep and related variables in children and adolescents with craniopharyngioma. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY Results highlight the utility of gathering mEMA data in youth at elevated risk for sleep difficulties as a function of their illness/treatment.
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Affiliation(s)
- Nour Al Ghriwati
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Marcia Winter
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Joshua Semko
- Department of Psychology, The University of Mississippi, University, MS, USA
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Semko J, Al Ghriwati N, Winter M, Merchant TE, Crabtree VM. Sleep-related challenges and family functioning in children and adolescents previously treated for craniopharyngioma. J Psychosoc Oncol 2023; 42:32-47. [PMID: 37042637 DOI: 10.1080/07347332.2023.2197433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
PURPOSE We investigated sleep-related challenges and their association with family functioning in children and adolescents previously treated for craniopharyngioma. DESIGN Quantitative approach using psychometrically validated measures. SAMPLE Thirty-nine children and adolescents who had been treated for craniopharyngioma and their primary caregivers. METHODS Caregivers and youth completed measures of family functioning, family routines, daytime sleepiness, and children's sleep patterns. FINDINGS Children and adolescents with craniopharyngioma had significantly higher ratings of self-reported excessive daytime sleepiness, bedtime fears/worries, and restless legs symptoms compared to their relatively healthy peers. Lack of family routines and poor family functioning were related to poor sleep-related outcomes and increased excessive daytime sleepiness. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Providers should consider assessing sleep difficulties in pediatric brain tumor survivors from a family systems perspective. Intervening on family-related factors may help improve sleep and other health-related outcomes, whereas intervening on sleep may help improve family functioning.
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Affiliation(s)
- Joshua Semko
- Department of Psychology, The University of Mississippi, University, MS, USA
| | - Nour Al Ghriwati
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcia Winter
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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van Litsenburg R, Kamara D, Irestorm E, Partanen M, de Vries R, McLaughlin Crabtree V, Daniel LC. Sleep problems during and after paediatric brain tumours. Lancet Child Adolesc Health 2023; 7:280-287. [PMID: 36950977 DOI: 10.1016/s2352-4642(22)00380-7] [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] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 02/16/2023]
Abstract
Brain tumours are among the most common cancer diagnoses in paediatrics. Children with brain tumours are at risk of developing sleep problems because of direct and indirect effects of the tumour and its treatment, in addition to psychosocial and environmental factors. Sleep has an important role in physical and psychological wellbeing, and sleep problems are associated with many adverse outcomes. In this Review, we describe the state of the evidence regarding sleep in people with paediatric brain tumours, prevalence and types of sleep problems, risk factors, and effectiveness of interventions. Evidence shows that sleep problems, particularly excessive daytime sleepiness, are common in people with paediatric brain tumours, with high BMI emerging as a consistent predictor of sleep disruption. Further intervention studies are needed, and clinical evaluation of sleep is warranted for people with paediatric brain tumours.
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Affiliation(s)
| | - Dana Kamara
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Elin Irestorm
- Department of Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marita Partanen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Lauren C Daniel
- Department of Psychology, Rutgers University Camden, Camden, NJ, USA
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7
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Chahin S, Morse M, Qaddoumi I, Phipps S, Crabtree VM, Brennan RC, Wilson MW, Rodriguez-Galindo C, Russell KM, Parris K, Goode K, Willard VW. An exploratory study of sleep habits in school-aged survivors of retinoblastoma. Sleep Med 2023; 103:123-130. [PMID: 36780752 PMCID: PMC10006349 DOI: 10.1016/j.sleep.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE/BACKGROUND Retinoblastoma is an ocular cancer diagnosed in early childhood. Previous research has indicated the impact of cancer treatment on sleep, but little is known about how sleep is impacted among survivors of retinoblastoma. The current study aimed to describe sleep habits of school-age survivors of retinoblastoma, to examine associations between sleep and quality of life, and to examine concordance between parent and child reports of sleep habits. PATIENTS/METHODS Sixty-nine survivors of retinoblastoma (Mage = 10.89, SD = 1.07, 50.7% female; 56.5% unilateral disease) and their caregivers participated, providing information on both self- and parent-reported sleep habits, quality of life, and demographic data. RESULTS Greater sleep concerns than national norms were reported by parents (bedtime resistance (t(58) = 2.69, p = .009), greater sleep onset delay (t(66) = 2.46, p = .017), shorter sleep duration (t(57) = 2.12, p = .038), increased daytime sleepiness (t(53) = 6.45, p= <.001)) and children (sleep location (t(61) = 2.39, p = .02), restless legs syndrome (t(62) = -2.21, p = .03), parasomnias (t(64) = 19.19, p=<.001)) . Both children and parents of children who received enucleation endorsed greater sleep concerns across several domains (e.g., electronic use before bed, sleep-disordered breathing). Child- and parent-reported sleep concerns were generally associated with decreased quality of life. Finally, child- and parent-report of sleep habits appeared generally consistent. CONCLUSIONS Survivors of retinoblastoma experience sleep difficulties. As such, assessment and targeted intervention is important to mitigate any effects on quality of life. Future research should examine sleep habits of survivors of retinoblastoma across cultures and developmental periods.
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Affiliation(s)
- Summer Chahin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melanie Morse
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Global Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Rachel C Brennan
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew W Wilson
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Ophthalmology, University of Tennessee, Memphis, TN, USA
| | | | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kendra Parris
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kristin Goode
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Victoria W Willard
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Witcraft SM, Wickenhauser ME, Russell KM, Mandrell BN, Conklin HM, Merchant TE, Crabtree VM. A Latent Profile Analysis of Sleep, Anxiety, and Mood in Youth with Craniopharyngioma. Behav Sleep Med 2022; 20:762-773. [PMID: 34719997 DOI: 10.1080/15402002.2021.1996363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/19/2022]
Abstract
UNLABELLED Craniopharyngioma is a histologically benign brain tumor that arises in the suprasellar region affecting critical neurovascular structures including the hypothalamic-pituitary-adrenal axis and optic pathways. Children with craniopharyngioma often experience excessive daytime sleepiness (EDS) which may be compounded by anxiety and depression. The current study investigated disparate sleep profiles to better understand psychological adjustment among children diagnosed with craniopharyngioma. METHOD Actigraphs recorded nightly sleep data, including measures of sleep onset latency (SOL) and wake after sleep onset (WASO), in a cohort of 80 youth between the ages of 2 and 20 years (median age = 9). Parent reports of behavioral and emotional functioning were included in the analysis. A latent profile analysis examined disparate sleep profiles, and a multinomial logistic regression examined differences of anxiety and depression among the sleep profiles. RESULTS The latent profile analysis revealed three sleep profiles: "healthy sleepers" (68.8%), "night wakers" (21.3%), and "prolonged onset sleepers" (10.0%). Contrary to expectations, sleep profiles were not associated with daytime anxiety (β = 2.26-4.30, p > .05) or depression (β = -5.87-4.74, p > .05). CONCLUSIONS Youth with craniopharyngioma demonstrate poor sleep and EDS. Those with delayed SOL and prolonged WASO are particularly vulnerable to disrupted nighttime sleep, which may significantly compound EDS. Disrupted sleep was not associated with anxiety or depression, which may be related to the overall poor sleep and daytime sleepiness or to timing, as patients were early in their treatment course. Further study should evaluate the factors underlying sleepiness and daytime function in patients with craniopharyngioma.
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Affiliation(s)
- Sara M Witcraft
- Department of Psychology, The University of Mississippi, University, Mississippi, USA
| | - Molly E Wickenhauser
- Department of Psychology, The University of Mississippi, University, Mississippi, USA
| | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Jurbergs N, Elliott DA, Browne E, Sirrine E, Brasher S, Leigh L, Powell B, Crabtree VM. How I approach: Defining the scope of psychosocial care across disciplines in pediatric hematology-oncology. Pediatr Blood Cancer 2022; 69:e29809. [PMID: 35674474 DOI: 10.1002/pbc.29809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
To provide the standard of psychosocial care for children with cancer and hematological disorders and their families, multidisciplinary teams must clearly define their scope and collaborate in ways that optimize the quality and efficiency of care. A new organizational structure was leveraged to delineate roles and scope for each psychosocial discipline at our institution. We developed a document, the scope of psychosocial care (SPC), that serves as a platform for making patient care decisions and provides opportunities for the reevaluation of programming. Herein, we present the process and outcome of the SPC and make recommendations for identifying roles in pediatric psychosocial hematology-oncology.
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Affiliation(s)
- Niki Jurbergs
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Emily Browne
- Transition Oncology Program, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erica Sirrine
- Social Work Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shawn Brasher
- Child Life Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Laurie Leigh
- Formerly of School Program, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brent Powell
- Formerly of Spiritual Care Services, St. Jude Children's Research Hospital, Memphis, Tennessee
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Hawkins E, Powell B, Spears W, Crabtree VM. A strategic approach to integration of spiritual care into the standards for the psychosocial care of children with cancer and their families. Pediatr Blood Cancer 2022; 69:e29659. [PMID: 35466568 DOI: 10.1002/pbc.29659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/18/2022] [Accepted: 02/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Elizabeth Hawkins
- Spiritual Care Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Brent Powell
- Spiritual Care Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Walter Spears
- Spiritual Care Services, Methodist LeBonheur Healthcare, Memphis, Tennessee, USA
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11
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Kamara D, Crabtree VM, Crowley S, Hancock D, Semko J, Merchant T, Mandrell B. 0638 Circadian rhythms among youth with craniopharyngioma. Sleep 2022. [DOI: 10.1093/sleep/zsac079.635] [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
Craniopharyngioma is an intracranial tumor located in the hypothalamic and pituitary region. Despite high survival rates for youth with craniopharyngioma, quality of life is substantially affected. Morbidity includes high rates of sleep disruption, particularly disorders of hypersomnolence. Circadian rhythms may also be affected due to the proximity of the tumor and subsequent treatment to the hypothalamic-pituitary-adrenal axis, though the role of circadian rhythms has been less studied in this patient population. To evaluate circadian rhythms among youth with craniopharyngioma, dim light melatonin onset (DLMO), an established marker of the circadian system, was estimated.
Methods
Fifty-five patients between the ages of 7 and 20 years participated in this study. Data were collected prior to completion of proton therapy (if indicated). Participants provided hourly saliva samples, in their homes, starting 3 hours prior to habitual bedtime until 1 hour following in dim light conditions (<30 lux). DLMO was calculated based on a threshold of 4 pg/ml. Participants also wore actigraphs to measure sleep patterns. We derived bedtime and waketime from actigraphy and calculated phase angles to bedtime and waketime. DLMO timing and phase angles were compared to published norms for healthy youth ages 9 to 17 years.
Results
DLMO could not be estimated for almost half of the sample (n=25), most often due to a melatonin value above the threshold at the first collection time point. Higher grade of hypothalamic involvement and the presence of diabetes insipidus predicted inability to capture DLMO. Subsample analyses of participants with DLMO (n=30) showed later DLMO timing and shorter phase interval to bedtime than the healthy reference sample.
Conclusion
With standard practice for DLMO estimation, we only obtained estimates for slightly more than half our sample. This may reflect circadian rhythm disturbances or advanced circadian phase. Relative to published norms, those with captured DLMO had later DLMO timing and shorter phase angles to bedtime, indicating sleep at an earlier circadian phase. These findings suggest possible circadian rhythm disruption in pediatric craniopharyngioma. Methodological differences among samples may also contribute to findings. Further examination of circadian rhythm disruption and relations with other sleep disturbances is needed.
Support (If Any)
This work was supported by the Cancer Center Support Grant (CA21765) from the National Cancer Institute and ALSAC.
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Jones AM, Browne EK, Adams K, Potter BS, McLaughlin Crabtree V, Jurbergs N, Heidelberg RE, Webster RT. The Toll of Transition: Caregiver Perceptions of Family Adjustment During the Transition off Pediatric Cancer Therapy. Psychooncology 2022; 31:985-994. [PMID: 35083824 DOI: 10.1002/pon.5888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/29/2021] [Revised: 12/28/2021] [Accepted: 01/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The role of transition-focused psychology appointments in managing the transition off therapy is unclear. The objective of this research was to explore caregiver perceived familial distress and the role of psychology in preparing families for transition. METHODS Fifty-seven caregivers of youth, who finished treatment, completed an online questionnaire through a quality improvement project on experiences of families at transition. Twenty-two percent of caregivers had children who completed a transition-focused psychology consult and 63% completed a cognitive assessment at transition. Retrospective analyses were conducted assessing the association of psychology visits on caregiver perceptions of being informed of and prepared to manage transition-related challenges. RESULTS Most caregivers reported experiencing adjustment concerns for family members. Caregivers of children completing a transition-focused psychology consult or cognitive assessment reported feeling more informed and greater preparedness to manage difficulties. Although decreased distress was not associated with the visit, those who felt more informed and prepared reported lower distress. CONCLUSIONS Caregivers perceive transitioning off therapy as stressful for their family, though they experience decreased familial distress when informed of and prepared to manage transition-related challenges. These findings highlight the importance of psychosocial support at transition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anna M Jones
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Emily K Browne
- Transition Program, St. Jude Children's Research Hospital, Memphis, TN
| | - Kristen Adams
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Brian S Potter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Valerie McLaughlin Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN.,St. Jude Graduate School of Biomedical Sciences, Memphis, TN
| | - Niki Jurbergs
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - R Elyse Heidelberg
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Rachel Tillery Webster
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN.,Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN
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Witcraft SM, Wickenhauser ME, Russell KM, Mandrell BN, Conklin HM, Merchant TE, Crabtree VM. Do Anxiety and Mood Vary among Disparate Sleep Profiles in Youth with Craniopharyngioma? A Latent Profile Analysis. Behav Sleep Med 2022; 20:100-111. [PMID: 33661060 DOI: 10.1080/15402002.2021.1892679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/22/2022]
Abstract
Craniopharyngioma is a histologically benign brain tumor that arises in the suprasellar region affecting critical neurovascular structures including the hypothalamic-pituitary-adrenal axis and optic pathways. Children with craniopharyngioma often experience excessive daytime sleepiness which may be compounded by anxiety and depression. The current study investigated disparate sleep profiles to better understand psychological adjustment among children diagnosed with craniopharyngioma. Method: Actigraphs recorded nightly sleep data, including measures of sleep onset latency and wake after sleep onset, in a cohort of 80 youth between the ages of 2 and 20 years (median age = 9). Parent reports of behavioral and emotional functioning were included in the analysis. A latent profile analysis examined disparate sleep profiles, and a multinomial logistic regression examined differences of anxiety and depression among the sleep profiles. Results: The latent profile analysis revealed three sleep profiles: "variable sleepers" (48.3%), "consistently poor sleepers" (45.4%), and "night wakers" (6.4%). Consistently poor sleepers had lower rates of anxiety (g = .76; p = .009) and depression (g = .81; p = .003) than variable sleepers and had significantly lower rates of anxiety than night wakers (g = .52; p = .05); all other differences were nonsignificant (ps > .05). Discussion: Youth with craniopharyngioma who have nightly variations in sleep may have worse psychological functioning than those with more consistent, albeit poor, sleep patterns. Patients with craniopharyngioma who report variable sleep should be assessed for anxiety and depression to prevent and intervene on emotional difficulties that may be reciprocally related to sleep.
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Affiliation(s)
- Sara M Witcraft
- Department of Psychology, The University of Mississippi, University, Mississippi
| | - Molly E Wickenhauser
- Department of Psychology, The University of Mississippi, University, Mississippi
| | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennesse
| | - Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennesse
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennesse
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennesse
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14
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Klages KL, Berlin KS, Cook JL, Merchant TE, Wise MS, Mandrell BN, Conklin HM, Crabtree VM. Health-related quality of life, obesity, fragmented sleep, fatigue, and psychosocial problems among youth with craniopharyngioma. Psychooncology 2021; 31:779-787. [PMID: 34859518 DOI: 10.1002/pon.5862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/30/2021] [Revised: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Youth with craniopharyngioma experience weight gain, fragmented sleep, excessive daytime sleepiness (EDS), fatigue, and psychosocial problems that negatively impact their overall health-related quality of life (HRQoL). Greater hypothalamic tumor involvement (HI) may be associated with higher rates or severity of these impairments; however, the direct and indirect impact of HI on the physical and psychosocial consequences associated with pediatric craniopharyngioma remain unclear. The purpose of the current study was to examine relations between HI, body mass index (BMI), fragmented sleep, EDS, fatigue, psychosocial problems, and HRQoL among youth with craniopharyngioma. METHODS Eighty-four youth with craniopharyngioma (Mage = 10.27 ± 4.3 years, 53.6% female, 64.3% White) were assessed with actigraphy, nocturnal polysomnography, and multiple sleep latency tests prior to proton therapy, when indicated. Caregivers completed measures of fatigue, psychosocial functioning, and HRQoL. RESULTS Hypothalamic tumor involvement was associated with greater BMI (Est. = 2.97, p = 0.003) and daytime sleepiness (Est. = 2.53, p = 0.01). Greater fatigue predicted more psychosocial problems (Est. = 0.29, p < 0.001) and lower HRQoL (Est. = 0.23, p = 0.001). Psychosocial problems also predicted lower HRQoL (Est. = -0.34, p = 0.004). Fragmented sleep (Est. = 0.03, p = 0.04) and fatigue (Est. = 0.10, p = 0.02) indirectly predicted lower HRQoL through psychosocial problems. CONCLUSIONS Youth with craniopharyngioma with greater HI may benefit from weight reduction interventions and management of excessive sleepiness. Patients should be prospectively monitored for sleep problems, fatigue, and psychosocial problems, as these patients may benefit from interventions targeting fatigue and psychosocial health to improve HRQoL.
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Affiliation(s)
- Kimberly L Klages
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Merrill S Wise
- Mid-South Pulmonary and Sleep Specialists, Memphis, Tennessee, USA
| | - Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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15
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Dunn TJ, Terao MA, Blazin LJ, Spraker-Perlman H, Baker JN, Mandrell B, Sellers J, Crabtree VM, Hoffman JM, Burlison JD. Associations of job demands and patient safety event involvement on burnout among a multidisciplinary group of pediatric hematology/oncology clinicians. Pediatr Blood Cancer 2021; 68:e29214. [PMID: 34227729 DOI: 10.1002/pbc.29214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Workplace burnout can result in negative consequences for clinicians and patients. We assessed burnout prevalence and sources among pediatric hematology/oncology inpatient nurses, ambulatory nurses, physicians (MDs), and advanced practice providers (APPs) by evaluating effects of job demands and involvement in patient safety events (PSEs). METHODS A cross-sectional survey (Maslach Burnout Inventory) measured emotional exhaustion, depersonalization, and reduced personal accomplishment. The National Aeronautics and Space Administration Task Load Index measured mental demand, physical demand, temporal demand, effort, and frustration. Relative weights analyses estimated the unique contributions of tasks and PSEs on burnout. Post hoc analyses evaluated open-response comments for burnout factors. RESULTS Burnout prevalence was 33%, 20%, 34%, and 33% in inpatient nurses, ambulatory nurses, and MD, and APPs, respectively (N = 481, response rate 69%). Reduced personal accomplishment was significantly higher in inpatient nurses than MDs and APPs. Job frustration was the most significant predictor of burnout across all four cohorts. Other significant predictors of burnout included temporal demand (nursing groups and MDs), effort (inpatient nurses and MDs), and PSE involvement (ambulatory nurses). Open-response comments identified time constraints, lack of administrator support, insufficient institutional support for self-care, and inadequate staffing and/or turnover as sources of frustration. CONCLUSIONS All four clinician groups reported substantial levels of burnout, and job demands predicted burnout. The body of knowledge on job stress and workplace burnout supports targeting organizational-level sources versus individual-level factors as the most effective prevention and reduction strategy. This study elaborates on this evidence by identifying structural drivers of burnout within a multidisciplinary context of pediatric hematology/oncology clinicians.
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Affiliation(s)
- Tyler J Dunn
- Department of Pharmacy Administration, University of Mississippi, Oxford, Mississippi, USA
| | - Michael A Terao
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pediatrics, Division of Pediatric Hematology and Oncology, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Lindsay J Blazin
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pediatrics, Division of Pediatric Hematology and Oncology, Indiana University, Indianapolis, Indiana, USA
| | - Holly Spraker-Perlman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Belinda Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Janet Sellers
- Department of Psychosocial Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Valerie McLaughlin Crabtree
- Department of Psychosocial Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - James M Hoffman
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jonathan D Burlison
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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16
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LaRosa KN, MacArthur E, Wang F, Zhang H, Pan H, Brigden J, Pappo A, Wilson MW, Crabtree VM. Light Therapy for QoL/Depression in AYA With Cancer: A Randomized Trial. J Pediatr Psychol 2021; 47:306-317. [PMID: 34625800 DOI: 10.1093/jpepsy/jsab098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/04/2020] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Secondary outcomes from a published feasibility and acceptability trial were examined to explore the effect of bright white light (BWL) on quality of life (QoL) and depressive symptoms compared to dim red light (DRL) control in adolescents and young adults (AYAs) receiving cancer-directed therapy. METHODS Fifty-one AYAs (12-22 years, 51% male) newly diagnosed with cancer were randomized to receive 8 weeks of BWL (n = 26) or DRL (n = 25). The CDI-2 (total score, negative mood/physical symptoms, interpersonal problems, ineffectiveness, and negative self-esteem) and parent- and self-report PedsQL (total score and subscales of physical, emotional, social, and school QoL) were completed at multiple timepoints. RESULTS BWL produced improvements in self-reported total depression (d = -.64; 95% confidence interval [CI] = -1.26, -0.01), negative self-esteem (d = -.80; 95% CI = -1.43, -.14), negative mood/physical symptoms (d = -.73; 95% CI = -1.36, -0.08), ineffectiveness (d = -.43; 95% CI = -1.04, .19), total self-reported QoL (d = .41; 95% CI = -.16, .96), emotional (d = .78; 95% CI = .19, 1.37), school functioning (d = .48; 95% CI = -.09, 1.04), and parent-reported school functioning (d = .66; 95% CI = 0.02, 1.33). BWL reported a greater rate of improvement than DRL for total depression (β = .49, p < .05) and self-esteem (β = .44, p < .05), and parent-reported school functioning (β = -1.68, p < .05). CONCLUSIONS BWL improved QoL and depressive symptoms for AYAs with cancer. These findings will inform larger randomized controlled trials.
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Affiliation(s)
- Kayla N LaRosa
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Erin MacArthur
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane Brigden
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alberto Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew W Wilson
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN, USA
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17
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Crabtree VM, LaRosa KN, MacArthur E, Russell K, Wang F, Zhang H, Pan H, Brigden J, Schwartz LE, Wilson M, Pappo A. Feasibility and Acceptability of Light Therapy to Reduce Fatigue in Adolescents and Young Adults Receiving Cancer-Directed Therapy. Behav Sleep Med 2021; 19:492-504. [PMID: 32746639 DOI: 10.1080/15402002.2020.1797744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/26/2022]
Abstract
OBJECTIVE/BACKGROUND Fatigue is one of the most consistent and distressing symptoms reported by adolescent/young adult (AYA) oncology patients. Bright white light (BWL) is used to treat fatigue in adult oncology but has not been explored in AYA oncology patients. The purpose of the current study was to determine the feasibility and acceptability of BWL for AYA who were receiving cancer-directed therapy. PARTICIPANTS 51 AYA patients with newly diagnosed solid tumors, including lymphoma. METHODS Participants were randomized to dim red light (DRL, n = 25) or BWL (n = 26) from devices retrofitted with adherence monitors for 30 minutes upon awakening daily for 8 weeks. Side effects were assessed via modified Systematic Assessment for Treatment-Emergent Effects (SAFTEE). Participants completed the PedsQL Multidimensional Fatigue Scale. RESULTS Of patients approached, 73% consented and participated. Mean adherence was 57% of days on study with 30.68 average daily minutes of usage. BWL did not cause more extreme treatment-emergent effects over DRL. Patients in the BWL group demonstrated significant improvement on all fatigue outcomes by both self-report and parent proxy report, which was not observed in the DRL group. CONCLUSIONS This is the first study to evaluate the feasibility and acceptability of light therapy to reduce fatigue in AYA patients receiving cancer-directed therapy. These findings demonstrate the feasibility and acceptability of the intervention and provide preliminary evidence of the potential benefits of BWL, which warrants further study in a confirmatory efficacy trial.ClinicalTrials.gov Identifier Number: NCT02429063.
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Affiliation(s)
| | - Kayla N LaRosa
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erin MacArthur
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kathryn Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jane Brigden
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Laura E Schwartz
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew Wilson
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Alberto Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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18
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Blazin LJ, Terao MA, Spraker-Perlman H, Baker JN, McLaughlin Crabtree V, Mandrell BN, Gattuso J, Sellers J, Dunn TJ, Lu Z, Hoffman JM, Burlison JD. Never Enough Time: Mixed Methods Study Identifies Drivers of Temporal Demand That Contribute to Burnout Among Physicians Who Care for Pediatric Hematology-Oncology Patients. JCO Oncol Pract 2021; 17:e958-e971. [PMID: 33720755 PMCID: PMC8462670 DOI: 10.1200/op.20.00754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/17/2020] [Revised: 11/12/2020] [Accepted: 01/27/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment because of chronic occupational stress. Approximately one third of pediatric hematology-oncology physicians experience burnout. The goal of this mixed methods study was to determine the prevalence and drivers of burnout among physicians caring for pediatric hematology-oncology patients at our institution. MATERIALS AND METHODS This mixed methods, cross-sectional study was conducted at a large academic cancer center. Validated survey instruments were used to measure burnout, job demands, experience with patient safety events, and workplace culture. Quantitative data informed development of a semistructured interview guide, and physicians were randomly selected to participate in individual interviews. Interviews were transcribed and analyzed via content analysis based on a priori codes. RESULTS The survey was distributed to 132 physicians, and 53 complete responses were received (response rate 40%). Of the 53 respondents, 15 (28%) met criteria for burnout. Experiencing burnout was associated with increased temporal demand. Twenty-six interviews were conducted. Qualitative themes revealed that frequent meetings, insufficient support staff, and workflow interruptions were key drivers of temporal demand and that temporal demand contributed to burnout through emotional exhaustion and reduced personal accomplishment. CONCLUSION Nearly one-third of participating physicians met criteria for burnout, and burnout was associated with increased temporal demand. Qualitative interviews identified specific drivers of temporal demand and burnout, which can be targeted for intervention. This methodology can be easily adapted for broad use and may represent an effective strategy for identifying and mitigating institution-specific drivers of burnout.
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Affiliation(s)
- Lindsay J. Blazin
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
- Department of Pediatrics, Division of Pediatric Hematology Oncology, Indiana University, Indianapolis, IN
| | - Michael A. Terao
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
- Department of Pediatrics, Division of Pediatric Adolescent and Young Adult Hematology and Oncology, Medstar Georgetown University Hospital, Washington, DC
| | - Holly Spraker-Perlman
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Justin N. Baker
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | | | - Belinda N. Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Jami Gattuso
- Department of Pediatric Medicine, Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Janet Sellers
- Department of Psychosocial Services, St Jude Children's Research Hospital, Memphis, TN
| | - Tyler J. Dunn
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN
- Department of Pharmacy Administration, University of Mississippi, Oxford, MS
| | - Zhaohua Lu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - James M. Hoffman
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN
- Office of Quality and Patient Care, St Jude Children's Research Hospital, Memphis, TN
| | - Jonathan D. Burlison
- Office of Quality and Patient Care, St Jude Children's Research Hospital, Memphis, TN
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19
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Heidelberg RE, Douglas C, Turner E, Elliott A, Crabtree VM, Allen JM. Psychosocial collaboration fosters connection in times of isolation. J Psychosoc Oncol 2021; 39:340-343. [PMID: 33687316 DOI: 10.1080/07347332.2021.1894525] [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: 10/22/2022]
Affiliation(s)
- R Elyse Heidelberg
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Celeste Douglas
- Child Life Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Erin Turner
- Department of Social Work, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew Elliott
- Division of Psychiatry, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Jennifer M Allen
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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20
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LaRosa KN, Crabtree VM, Jurbergs N, Harman J. Behavioral sleep intervention to reduce bedsharing prior to stem cell transplant. J Clin Sleep Med 2021; 17:333-335. [PMID: 33100267 DOI: 10.5664/jcsm.8916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep disturbance is common in young children who are otherwise healthy and even more so in children with cancer. To address sleep disturbance in early childhood, caregivers may use bedsharing to reduce stress. Although bedsharing is not typically discouraged in children over the age of 1 year, it may present a safety and infection control concern for youth preparing for stem cell transplantation. METHODS We highlight the successful application of evidence-based sleep interventions to eliminate bedsharing before admission to the stem cell transplantation unit through 3 case examples of patients who were 2 years of age or younger diagnosed with cancer and preparing for stem cell transplantation. RESULTS The behavioral sleep interventions included sleep hygiene education, gradual fading, unmodified extinction, and graduated extinction. CONCLUSIONS When medically indicated and tailored to family preferences, behavioral interventions can effectively and efficiently eliminate bedsharing for young children preparing for stem cell transplantation.
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Affiliation(s)
- Kayla N LaRosa
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Niki Jurbergs
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jennifer Harman
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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21
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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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22
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Daniel LC, Litsenburg RR, Rogers VE, Zhou ES, Ellis SJ, Wakefield CE, Stremler R, Walter L, Crabtree VM. A call to action for expanded sleep research in pediatric oncology: A position paper on behalf of the International Psycho‐Oncology Society Pediatrics Special Interest Group. Psychooncology 2019; 29:465-474. [PMID: 31654575 PMCID: PMC9539613 DOI: 10.1002/pon.5242] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/14/2019] [Accepted: 09/18/2019] [Indexed: 12/21/2022]
Abstract
Sleep and circadian rhythms are closely related to physical and psychosocial well‐being. However, sleep and circadian rhythm disruptions are often overlooked in children with cancer, as they are frequently considered temporary side effects of therapy that resolve when treatment ends. Yet, evidence from adult oncology suggests a bidirectional relationship wherein cancer and its treatment disrupt sleep and circadian rhythms, which are associated with negative health outcomes such as poor immune functioning and lower survival rates. A growing body of research demonstrates that sleep problems are prevalent among children with cancer and can persist into survivorship. However, medical and psychosocial outcomes of poor sleep and circadian rhythmicity have not been explored in this context. It is essential to increase our understanding because sleep and circadian rhythms are vital components of health and quality of life. In children without cancer, sleep and circadian disturbances respond well to intervention, suggesting that they may also be modifiable in children with cancer. We present this paper as a call to (a) incorporate sleep or circadian rhythm assessment into pediatric cancer clinical trials, (b) address gaps in understanding the bidirectional relationship between sleep or circadian rhythms and health throughout the cancer trajectory, and (c) integrate sleep and circadian science into oncologic treatment.
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Affiliation(s)
- Lauren C. Daniel
- Faculty of Arts and SciencesRutgers University Camden Camden New Jersey
| | - Raphaele R.L. Litsenburg
- Princess Máxima Center for Pediatric Oncology Utrecht and Amsterdam UMCVU University Medical Center Amsterdam Amsterdam Netherlands
| | - Valerie E. Rogers
- Family & Community HealthUniversity of Maryland Baltimore School of Nursing Baltimore Maryland
| | - Eric S. Zhou
- Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Sarah J. Ellis
- School of Women's and Children's HealthUNSW Sydney Kensington New South Wales Australia
- School of PsychologyThe University of Sydney Australia
| | - Claire E. Wakefield
- School of Women's and Children's HealthUNSW Sydney Kensington New South Wales Australia
- Kids Cancer CentreSydney Children's Hospital Randwick New South Wales Australia
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of NursingUniversity of Toronto, and The Hospital for Sick Children Toronto Ontario Canada
| | - Lisa Walter
- The Ritchie CentreHudson Institute of Medical Research and the Department of PaediatricsMonash University Melbourne Victoria Australia
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23
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Crabtree VM, Klages KL, Sykes A, Wise MS, Lu Z, Indelicato D, Merchant TE, Avent Y, Mandrell BN. Sensitivity and Specificity of the Modified Epworth Sleepiness Scale in Children With Craniopharyngioma. J Clin Sleep Med 2019; 15:1487-1493. [PMID: 31596214 PMCID: PMC6778340 DOI: 10.5664/jcsm.7982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Children with craniopharyngioma are at risk for excessive daytime sleepiness (EDS). Multiple Sleep Latency Testing (MSLT) is the gold standard for objective evaluation of EDS; however, it is time and resource intensive. We compared the reliability, sensitivity, and specificity of the modified Epworth Sleepiness Scale (M-ESS) and MSLT in monitoring EDS in children with craniopharyngioma. METHODS Seventy patients (ages 6 to 20 years) with craniopharyngioma completed the M-ESS and were evaluated by polysomnography and MSLT. Evaluations were made after surgery, if performed, and before proton therapy. RESULTS MSLT revealed that 66 participants (81.8%) had EDS, as defined by a mean sleep latency (MSL) < 10 minutes, with only 28.8% reporting EDS on the M-ESS by using a cutoff score of 10. The M-ESS demonstrated adequate internal consistency and specificity (91.7%) but poor sensitivity (33.3%) with the established cutoff score of 10. A cutoff score of 6 improved the sensitivity to 64.8% but decreased the specificity to 66.7%. CONCLUSIONS Patients with craniopharyngioma are at high risk for EDS, as documented objectively on the MSLT, but they frequently do not recognize or accurately report their sleepiness. Future sleep studies should investigate whether specific items or alternative self- and parent-reported measures of sleepiness may have greater clinical utility in monitoring sleepiness in this population.
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Affiliation(s)
| | - Kimberly Lauren Klages
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, The University of Memphis, Memphis, Tennessee
| | - April Sykes
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Merrill S. Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, Tennessee
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Daniel Indelicato
- University of Florida Health Proton Therapy Institute, Jacksonville, Florida
| | - Thomas E. Merchant
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yvonne Avent
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Belinda N. Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Sullivan CE, King AR, Holdiness J, Durrell J, Roberts KK, Spencer C, Roberts J, Ogg SW, Moreland MW, Browne EK, Cartwright C, Crabtree VM, Baker JN, Brown M, Sykes A, Mandrell BN. Reducing Compassion Fatigue in Inpatient Pediatric Oncology Nurses. Oncol Nurs Forum 2019; 46:338-347. [PMID: 31007264 DOI: 10.1188/19.onf.338-347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To develop an evidence-based compassion fatigue program and evaluate its impact on nurse-reported burnout, secondary traumatic stress, and compassion satisfaction, as well as correlated factors of resilience and coping behaviors. SAMPLE & SETTING The quality improvement pilot program was conducted with 59 nurses on a 20-bed subspecialty pediatric oncology unit at the St. Jude Children's Research Hospital in Memphis, Tennessee. METHODS & VARIABLES Validated measures of compassion fatigue and satisfaction (Professional Quality of Life Scale V [ProQOLV]), coping (Brief COPE), and resilience (Connor-Davidson Resilience Scale-2) were evaluated preprogram and at two, four, and six months postprogram, with resilience and coping style measured at baseline and at six months postprogram. RESULTS Secondary traumatic stress scores significantly improved from baseline to four months. Select coping characteristics were significantly correlated with ProQOLV subscale scores. IMPLICATIONS FOR NURSING Ongoing organizational support and intervention can reduce compassion fatigue and foster compassion satisfaction among pediatric oncology nurses.
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LaRosa KN, Niel K, Klages KL, Merchant TE, Wise MS, Witcraft S, Hancock D, Caples M, Mandrell B, Crabtree VM. 0808 Comparison of Actigraphy to Polysomnography in the Measurement of Nocturnal Sleep in Children with Craniopharyngioma. Sleep 2019. [DOI: 10.1093/sleep/zsz067.806] [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: 11/12/2022] Open
Affiliation(s)
- Kayla N LaRosa
- Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kristin Niel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | | | - Donna Hancock
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mary Caples
- St. Jude Children's Research Hospital, Memphis, TN, USA
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Graef DM, Crabtree VM, Srivastava DK, Li C, Pritchard M, Hinds PS, Mandrell B. Sleep and mood during hospitalization for high-dose chemotherapy and hematopoietic rescue in pediatric medulloblastoma. Psychooncology 2018; 27:1847-1853. [PMID: 29663636 DOI: 10.1002/pon.4737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/16/2017] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Disrupted sleep is common in pediatric cancer, which is associated with psychological distress and may impact neural recovery. Information regarding sleep during pediatric brain tumor treatment is limited. This study aimed to describe objective sleep-wake patterns and examine the sleep-mood relation in youth hospitalized for intensive chemotherapy and stem cell rescue. METHODS Participants included 37 patients (M age = 9.6 ± 4.2 years) enrolled on a medulloblastoma protocol (SJMB03) and their parents. Respondents completed a mood disturbance measure on 3 days, and patients wore an actigraph for 5 days as an objective estimate of sleep-wake patterns. General linear mixed models examined the relation between nocturnal sleep and next-day mood, as well as mood and that night's sleep. RESULTS Sleep duration was deficient, sleep efficiency was poor, and daytime napping was common, with large between-subjects variability. There were minimal mood concerns across all days. The sleep and next-day mood relationship was nonsignificant (P > .05). Greater parent-reported child mood disturbance on day 2 was associated with decreased same-night sleep (P < .001) and greater patient-reported mood disturbance was associated with greater same-night sleep latency (P = .036). CONCLUSIONS Patients with medulloblastoma are vulnerable to disturbed sleep during hospitalization, and mood may be an important correlate to consider. Sleep and mood are modifiable factors that may be targeted to maximize daytime functioning.
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Affiliation(s)
- Danielle M Graef
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michele Pritchard
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Memphis, TN, USA.,Department of Pediatrics, George Washington University Washington, District of Columbia, Washington, DC, USA
| | - Belinda Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
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Crabtree VM, Moore JB, Jacks DE, Cerrito P, Topp RV. A Transtheoretical, Case Management Approach to the Treatment of Pediatric Obesity. J Prim Care Community Health 2018; 1:4-7. [DOI: 10.1177/2150131909357069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The percentage of obese children in the United States has increased dramatically over the past three decades, particularly among ethnic/ racial minorities. This study sought to examine the impact of a clinical case-management intervention based upon the Transtheoretical Model (TTM) to reduce obesity and increase physical activity in children. Methods: Nineteen obese African-American children ages 8-12 were recruited from two pediatric clinics and were randomized to either a 12-week intervention group or a control group. Dependent variables included body mass index (BMI) percentile, physical activity, and stage of change for the child and parent. Results: In comparison to the control group, the intervention group demonstrated significant decreases in BMI and improvements in daily vigorous physical activity. The children in the intervention group demonstrated movement toward action/maintenance stages of change. Conclusions: A 12-week TTM-based case management intervention can have a favorable impact on obesity and physical activity in African-American child.
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Affiliation(s)
| | - Justin B. Moore
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Dean E. Jacks
- Department of Health and Sport Sciences, University of Louisville, Louisville, KY, USA
| | - Patricia Cerrito
- Department of Mathematics, University of Louisville, Louisville, KY, USA
| | - Robert V. Topp
- School of Nursing, University of Louisville, Louisville, KY, USA
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Mandrell BN, Avent Y, Walker B, Loew M, Tynes BL, Crabtree VM. In-home salivary melatonin collection: Methodology for children and adolescents. Dev Psychobiol 2018; 60:118-122. [PMID: 29152732 PMCID: PMC5748004 DOI: 10.1002/dev.21584] [Citation(s) in RCA: 14] [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: 05/19/2017] [Accepted: 09/05/2017] [Indexed: 11/09/2022]
Abstract
In-home salivary collection quality and adherence to a prescribed collection methodology for evaluation of dim light melatonin onset (DLMO) is unknown in children. Primary aims of this study were to 1) describe a novel family centered methodology for in-home salivary collection; 2) determine the acceptance and feasibility of this methodology; 3) measure adherence to collection instructions; and 4) identify patterns between participants' age and quality of samples collected. After receiving instructional handouts from the study team, families utilized in-home salivary melatonin collection. Participants (N = 64) included 39 children (21 female, mean age 9.5 ± 1.61 years) and 25 adolescents (11 female, mean age 15.9 ± 2.12 years) with craniopharyngioma. Participants were 90% adherent to collection schedule, and 89% of the samples collected were of sufficient quantity and quality, with no differences found between age (child vs. adolescent) and melatonin sample quantity and quality. In-home saliva collection provides an acceptable and feasible method to collect salivary melatonin and biomarkers in children and adolescents.
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Affiliation(s)
| | - Yvonne Avent
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Breya Walker
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Megan Loew
- St. Jude Children's Research Hospital, Memphis, Tennessee
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Abstract
Given the genuine gaps in the availability of clinical sleep services for children, sleep coaching as a field has emerged and appears to be significantly increasing. Sleep coaches are typically individuals who provide individualized services, often via the Internet or phone, to families of infants and young children (and increasingly to older children, adolescents, and adults as well) with sleep problems. At this time, there is no universally accepted definition of sleep coach, nor are there clear guidelines regarding educational background, training requirements, scope of practice, or credentialing. To start to address the needs of families seeking the services of a sleep coach, educational materials were developed for parents and health care providers regarding issues to consider. Furthermore, there is a need going forward that (1) the designation sleep coach or consultant be clear and well defined, with a clear standard of care and scope of practice; (2) there is a standard core body of knowledge included in all training programs; (3) a certification process is developed for sleep coaches that is reputable and has recognizable and clear standards; and (4) that care for sleep problems in infants and young children are available to diverse populations, irrespective of socioeconomic status.
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Affiliation(s)
- Jodi A Mindell
- 1 Saint Joseph's University and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - David Ingram
- 5 Children's Mercy Hospital, Kansas City, MO, USA
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Rach AM, Crabtree VM, Brinkman TM, Zeltzer L, Marchak JG, Srivastava D, Tynes B, Lai JS, Robison LL, Armstrong GT, Krull KR. Predictors of fatigue and poor sleep in adult survivors of childhood Hodgkin's lymphoma: a report from the Childhood Cancer Survivor Study. J Cancer Surviv 2016; 11:256-263. [PMID: 27837445 DOI: 10.1007/s11764-016-0583-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 07/20/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Survivors of pediatric Hodgkin's lymphoma (HL) are at risk for a number of debilitating late effects. Excessive fatigue and poor sleep quality are primary complaints of HL survivors. Understanding the emotional and physical factors that influence fatigue and sleep quality may provide opportunities for intervention to improve health-related quality of life for HL survivors. METHODS Data from 751 adult survivors of childhood HL who participated in the Childhood Cancer Survivor Study (CCSS) from 2000-2002 were analyzed. Multivariable logistic regression analyses investigated the demographic, psychological, and physical variables that predicted clinically significant levels of poor sleep quality, fatigue, and excessive daytime sleepiness. RESULTS Survivors' self-reported level of emotional distress, pain, and physical functioning limitations did not differ from population norms. Clinically elevated levels of emotional distress (OR 8.38, 95% CI 4.28-16.42) and pain (OR 3.73, 95% CI 2.09-6.67) increased the risk for endorsing elevated levels of fatigue. Survivors with elevated levels of emotional distress (OR 6.83, 95% CI 2.71-15.90) and pain (OR 5.27, 95% CI 1.78-15.61) were more likely to report poor sleep quality. Pain (OR 2.11, 95% CI 1.39-3.34) was related to excessive daytime sleepiness. CONCLUSIONS Emotional and physical factors are associated with elevated levels of fatigue, excessive daytime sleepiness, and poor sleep quality in survivors of pediatric HL. This is consistent with findings from research conducted with non-cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS These results suggest that interventions designed to target sleep and fatigue difficulties in the general population may be well suited for pediatric HL survivors as well.
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Affiliation(s)
- Amanda M Rach
- UVA Neurocognitive Assessment Lab, The University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Valerie McLaughlin Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, 38105, USA
| | - Tara M Brinkman
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, MS 735, Room S6047, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Lonnie Zeltzer
- Division of Pediatric Hematology-Oncology, David Geffen School of Medicine at UCLA, 22-464 MDCC, 10833 LeConte Ave, Los Angeles, CA, 90095, USA
| | | | - Deokumar Srivastava
- Biostatistics, St. Jude Children's Research Hospital, MS 768, Room 6010, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Brooklee Tynes
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, 38105, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University, 633 N St. Clair 19th Floor, Chicago, IL, 60611, USA
| | - Leslie L Robison
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, MS 735, Room S6010, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Gregory T Armstrong
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, MS 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Kevin R Krull
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Ms 735, Room S6037, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
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Graef DM, Phipps S, Parris KR, Martin-Elbahesh K, Huang L, Zhang H, Crabtree VM. Sleepiness, Fatigue, Behavioral Functioning, and Quality of Life in Survivors of Childhood Hematopoietic Stem Cell Transplant. J Pediatr Psychol 2016; 41:600-9. [PMID: 26985065 DOI: 10.1093/jpepsy/jsw011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 08/22/2015] [Accepted: 01/24/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine subjective fatigue and sleepiness as predictors of functional outcomes in long-term pediatric hematopoietic stem cell transplant (HSCT) survivors. METHODS Participants included 76 survivors assessed 5-14 years post-HSCT. Self-report and parent-proxy (i.e., N = 38) measures of fatigue, excessive daytime sleepiness (EDS), emotional and behavioral functioning, executive functioning, and quality of life (QOL) were completed. Health-related correlates were obtained from medical records. RESULTS Survivors exhibited significant fatigue for self (M = 69.21 ± 20.14) and parent-proxy (M = 72.15 ± 20.79) report. EDS was endorsed for 20-33% of survivors, depending on the respondent. EDS was not significant for parent-proxy outcomes, but was associated with poorer self-reported QOL and internalizing problems (p < .0016). Fatigue was associated with poorer functioning across all domains (p's < .0016). CONCLUSIONS A substantial number of pediatric HSCT survivors exhibit sleepiness and fatigue. Fatigue is associated with statistically and clinically greater functional difficulties, highlighting the importance of examining sleep and fatigue and considering interventions to improve alertness.
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Affiliation(s)
| | | | | | | | - Lu Huang
- Department of Biostatistics, St. Jude Children's Research Hospital
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital
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Brimeyer C, Adams L, Zhu L, Srivastava DK, Wise M, Hudson MM, Crabtree VM. Sleep complaints in survivors of pediatric brain tumors. Support Care Cancer 2015; 24:23-31. [PMID: 25895632 DOI: 10.1007/s00520-015-2713-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 03/23/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Pediatric brain tumor survivors have increased risk of sleep problems, particularly excessive daytime sleepiness (EDS). Few studies have examined sleep disturbances in this population. METHODS 153 children and adolescents ages 8-18 and their parents completed questionnaires (Modified Epworth Sleepiness Scale, Kosair Children's Hospital Sleep Questionnaire, Children's Report of Sleep Patterns, Children's Sleep Hygiene Scale) during clinic visits. Participants were at least 5 years from diagnosis and 2 years post-treatment. Group differences in age at diagnosis, body mass index, type of treatment received, and tumor location were examined. RESULTS One-third of adolescents and one-fifth of children reported EDS. Children and parents had fair concordance (kappa coefficient = .64) in their report of EDS, while adolescents and parents had poor concordance (kappa coefficient = .37). Per parents, most children slept 8 to 9 h per night. Poor bedtime routines were reported for children, while adolescents endorsed poor sleep stability. Extended weekend sleep was reported across age groups. A BMI in the obese range was related to higher parent-reported EDS in children. Sleep-disordered breathing was associated with elevated BMI in adolescents. CONCLUSIONS While survivors reported achieving recommended amounts of sleep each night, 20 to 30% reported EDS. Poor concordance among parent and adolescent report highlights the importance of obtaining self-report when assessing sleep concerns. Obesity is a modifiable factor in reducing symptoms of EDS in this population. Finally, the lack of association between EDS and brain tumor location, BMI, or treatment received was unexpected and warrants further investigation.
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Affiliation(s)
- Chasity Brimeyer
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, USA
- Jane B. Pettit Pain Management and Headache Center, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Leah Adams
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Liang Zhu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Merrill Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN, USA
| | - Melissa M Hudson
- Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Valerie McLaughlin Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, USA.
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Meltzer LJ, Brimeyer C, Russell K, Avis KT, Biggs S, Reynolds AC, Crabtree VM. The Children's Report of Sleep Patterns: validity and reliability of the Sleep Hygiene Index and Sleep Disturbance Scale in adolescents. Sleep Med 2014; 15:1500-7. [PMID: 25441749 DOI: 10.1016/j.sleep.2014.08.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/21/2014] [Accepted: 08/23/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sleep is critical for adolescent health and well-being. However, there are a limited number of validated self-report measures of sleep for adolescents and no well-validated measures of sleep that can be used across middle childhood and adolescence. The Children's Report of Sleep Patterns (CRSP) has been validated in children aged 8-12 years. The purpose of this study was to examine the psychometric properties of the CRSP, a multidimensional, self-report sleep measure for adolescents. METHODS The participants included 570 adolescents 13-18 years, 60% female, recruited from pediatricians' offices, sleep clinics, children's hospitals, schools, and the general population. A multi-method, multi-reporter approach was used to validate the CRSP. Along with the CRSP, a subset of the sample completed the Adolescent Sleep Hygiene Scale (ASHS), with a different subset of adolescents undergoing polysomnography. RESULTS The CRSP demonstrated good reliability and validity. Group differences on the CRSP were found for adolescents presenting to a sleep or medical clinic (vs. a community sample), for older adolescents (vs. younger adolescents), for those who regularly napped (vs. infrequently napped), and for those with poor sleep quality (vs. good sleep quality). Self-reported sleep quality in adolescents was also associated with higher apnea-hypopnea index scores from polysomnography. Finally, the CRSP Sleep Hygiene Indices were significantly correlated with indices of the ASHS. CONCLUSIONS The CRSP is a valid and reliable measure of adolescent sleep hygiene and sleep disturbances. With a parallel version for middle childhood, the CRSP likely provides clinicians and researchers the ability to measure self-reported sleep across development.
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Affiliation(s)
- Lisa J Meltzer
- National Jewish Health, 1400 Jackson Street, G311, Denver, CO 80206, USA.
| | - Chasity Brimeyer
- St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 101, Memphis, TN 38105, USA
| | - Kathryn Russell
- St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 101, Memphis, TN 38105, USA
| | - Kristin T Avis
- University of Alabama, 1600 7th Avenue South, ACC 620, Birmingham, AL 35233, USA
| | - Sarah Biggs
- Monash Institute of Medical Research-Prince Henry's Institute, 27-31 Wright St, Clayton, Melbourne, VIC 3168, Australia; Department of Paediatrics, Monash University,Wellington Rd, Melbourne, VIC 3800, Australia
| | - Amy C Reynolds
- University of South Australia, City East Campus, Frome Road, Adelaide, SA 5000, USA
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Meltzer LJ, Avis KT, Biggs S, Reynolds AC, Crabtree VM, Bevans KB. The Children's Report of Sleep Patterns (CRSP): a self-report measure of sleep for school-aged children. J Clin Sleep Med 2013; 9:235-45. [PMID: 23493949 DOI: 10.5664/jcsm.2486] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES (1) Present preliminary psychometrics for the Children's Report of Sleep Patterns (CRSP), a three-module measure of Sleep Patterns, Sleep Hygiene, and Sleep Disturbance; and (2) explore whether the CRSP provides information about a child's sleep above and beyond parental report. METHODS A multi-method, multi-reporter approach was used to validate the CRSP with 456 children aged 8-12 years (inclusive). Participants were recruited from pediatricians' offices, sleep clinics/laboratories, children's hospitals, schools, and the general population. Participants completed measures of sleep habits, sleep hygiene, anxiety, and sleepiness, with actigraphy and polysomnography used to provide objective measures of child sleep. RESULTS The CRSP demonstrated good reliability and validity. Differences in sleep hygiene and sleep disturbances were found for children presenting to a sleep clinic/laboratory (vs. community population); for younger children (vs. older children); and for children who slept less than 8 hours or had a sleep onset later than 22:00 on actigraphy. Further, significant associations were found between the CRSP and child-reported anxiety or sleepiness. Notably, approximately 40% of parents were not aware of child reported difficulties with sleep onset latency, night wakings, or poor sleep quality. CONCLUSIONS The three modules of the CRSP can be used together or independently, providing a reliable and valid self-report measure of sleep patterns, sleep hygiene, and sleep disturbances for children ages 8-12 years. Children not only provide valid information about their sleep, but may provide information that would not be otherwise captured in both clinical and research settings if relying solely on parental report.
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Witcher LA, Gozal D, Molfese DM, Salathe SM, Spruyt K, Crabtree VM. Sleep hygiene and problem behaviors in snoring and non-snoring school-age children. Sleep Med 2012; 13:802-9. [PMID: 22647496 DOI: 10.1016/j.sleep.2012.03.013] [Citation(s) in RCA: 9] [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: 10/05/2011] [Revised: 03/17/2012] [Accepted: 03/22/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The effects of sleep-disordered breathing, sleep restriction, dyssomnias, and parasomnias on daytime behavior in children have been previously assessed. However, the potential relationship(s) between sleep hygiene and children's daytime behavior remain to be explored. The primary goal of this study was to investigate the relationship between sleep hygiene and problematic behaviors in non-snoring and habitually snoring children. METHODS Parents of 100 5- to 8-year-old children who were reported to snore "frequently" to "almost always," and of 71 age-, gender-, and ethnicity-matched children who were reported to never snore participated in this study. As part of a larger, ongoing study, children underwent nocturnal polysomnography and parents were asked to complete the Children's Sleep Hygiene Scale (CSHS) and the Conners' Parent Rating Scales-Revised (CPRS-R:L). RESULTS In the snoring group, strong negative correlations (r=-.39, p<.001) between the CSHS overall sleep hygiene score and the CPRS-R:L DSM-IV total scores emerged. Additionally, several subscales of the CSHS and CPRS-R:L were significantly correlated (p-values from <.000 to .004) in snoring children. No significant correlations were observed between the CSHS and the CPRS-R:L in the non-snoring children. CONCLUSIONS Parental reports of behavioral patterns in snoring children indicate that poorer sleep hygiene is more likely to be associated with behavior problems, including hyperactivity, impulsivity, and oppositional behavior. In contrast, no significant relationships between sleep hygiene and problem behaviors emerged among non-snoring children. These results indicate that children at risk for sleep disordered breathing are susceptible to daytime behavior impairments when concurrently coupled with poor sleep hygiene practices.
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Affiliation(s)
- Lisa A Witcher
- Missouri Department of Mental Health, Kansas City, MO 64108, USA
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Mandrell BN, Wise M, Schoumacher RA, Pritchard M, West N, Ness KK, Crabtree VM, Merchant TE, Morris B. Excessive daytime sleepiness and sleep-disordered breathing disturbances in survivors of childhood central nervous system tumors. Pediatr Blood Cancer 2012; 58:746-51. [PMID: 22009579 PMCID: PMC3519925 DOI: 10.1002/pbc.23311] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 07/25/2011] [Indexed: 11/08/2022]
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 (PSG) with attention to sleep disorder in relation to the tumor site. PROCEDURE We report on 31 patients who had retrievable reports including an overnight 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.
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Affiliation(s)
- Belinda N Mandrell
- Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
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Meltzer LJ, Biggs S, Reynolds A, Avis KT, Crabtree VM, Bevans KB. The Children's Report of Sleep Patterns--Sleepiness Scale: a self-report measure for school-aged children. Sleep Med 2012; 13:385-9. [PMID: 22326832 PMCID: PMC3402071 DOI: 10.1016/j.sleep.2011.12.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 12/15/2011] [Accepted: 12/29/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To establish the psychometric properties of a self-report measure of daytime sleepiness for school-aged children. METHODS Three hundred eighty-eight children aged 8-12years (inclusive) from paediatrician's offices, sleep clinic/labs, children's hospitals, schools, and the general population were recruited. A multi-method approach was used to validate the Children's Report of Sleep Patterns--Sleepiness Scale (CRSP-S), including self-report measures (questions about typical sleep), parent-report measures (Children's Sleep Habits Questionnaire [CSHQ], proxy version of CRSP-S, Children's Sleep Hygiene Scale [CSHS], morningness-eveningness) and objective measures (actigraphy and polysomnography [PSG]). RESULTS The CRSP-S was shown to be internally consistent (Cronbach's alpha = 0.77) and the scale's unidimensionality was supported by a one-factor confirmatory factor analysis. A Rasch-Masters Partial Credit model demonstrated that items cover a broad range of sleepiness experiences with minimal redundancy, gaps in coverage, or bias against age, gender, or clinical groups. Test-retest reliability was 0.82. Construct and convergent validity were demonstrated with actigraphy, parental reports of children's sleepiness, sleep disturbances, sleep hygiene, circadian preference, and comparison of groups of children (e.g., sleep clinic/lab vs. school children). CONCLUSIONS The CRSP-S is a reliable and valid self-report measure of sleepiness for school-aged children. As an adjunct to parental report measures and objective measures of sleep, the CRSP-S provides a brief and psychometrically robust measure of children's sleepiness. Children who endorse sleepiness should have a more detailed screening for underlying sleep disruptors or causes of insufficient sleep.
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Affiliation(s)
- Lisa J. Meltzer
- National Jewish Health, 1400 Jackson Street, G311, Denver, CO 80206, Tel: (303) 398-1837, Fax: (303) 270-2141
| | - Sarah Biggs
- Monash Institute of Medical Research, The Ritchie Centre, 27-31 Wright St, Clayton 3168, Victoria, Australia
| | - Amy Reynolds
- University of South Australia, City East Campus, Frome Road, Adelaide SA 5000
| | - Kristin T. Avis
- University of Alabama at Birmingham, 1600 7th Avenue South, ACC 620, Birmingham, AL 35233
| | | | - Katherine B. Bevans
- Children’s Hospital of Philadelphia, 3535 Market Street, 14 Floor, Philadelphia, PA 19104
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Vallance K, Yang J, Li J, Crabtree VM, Hinds PS, Mandrell BN. Disturbed Sleep in Pediatric Patients With Leukemia: The Potential Role of Interleukin-6 (-174GC) and Tumor Necrosis Factor (-308GA) Polymorphism. Oncol Nurs Forum 2011; 38:E365-72. [DOI: 10.1188/11.onf.e365-e372] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hinds PS, Yang J, Gattuso JS, Hockenberry M, Jones H, Zupanec S, Li C, Crabtree VM, Mandrell BN, Schoumacher RA, Vallance K, Sanford S, Srivastava DK. Psychometric and clinical assessment of the 10-item reduced version of the Fatigue Scale-Child instrument. J Pain Symptom Manage 2010; 39:572-8. [PMID: 20303031 PMCID: PMC2941159 DOI: 10.1016/j.jpainsymman.2009.07.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 07/31/2009] [Accepted: 07/31/2009] [Indexed: 10/19/2022]
Abstract
Fatigue is one of the most debilitating conditions associated with cancer and anticancer therapy. The lack of reliable and valid self-report instruments has prevented accurate assessment of fatigue in pediatric oncology patients. The purpose of this study was to identify the most sensitive and specific score, that is, the "cut score," on the Fatigue Scale-Child (FS-C) to identify those children with high cancer-related fatigue in need of clinical intervention. We first used Rasch methods to identify the items on the FS-C that distinguished children with high cancer-related fatigue from other children; our findings indicated that the FS-C needed to be reduced from 14 items to 10 items. We then assessed the 10-item FS-C for its psychometric properties and applied the receiver operating characteristics curve analysis to the FS-C responses from 221 children (aged 7-12 years) receiving anticancer treatment. The cut score identified with 75% sensitivity and 73.5% specificity was 12; 73 (33%) patients scored 12 or higher. Findings from this validated instrument provide a needed guide for clinicians to interpret fatigue scores and provide clinical interventions for this debilitating condition to their pediatric patients with cancer.
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Affiliation(s)
- Pamela S Hinds
- Department of Nursing Research, Children's National Medical Center, George Washington University, Washington, DC 20010, USA.
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Abstract
This article reviews the normal development of sleep in infants, children, and adolescents, with specific focus on both the subjective and objective aspects of sleep. Notably, sleep duration decreases substantially from infancy through adolescence with increased consolidation of sleep to the nighttime period only. Sleep architecture exhibits developmental changes with decreases in slow-wave sleep and increases in stage 2 sleep from childhood through adolescence. Although the development of sleep is a dramatic and relatively rapid process during the first decades of life, changes in sleep continue across the life span.
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Affiliation(s)
- Valerie McLaughlin Crabtree
- Department of Behavioral Medicine, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN 38105, USA.
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Gozal D, Sans Capdevila O, McLaughlin Crabtree V, Serpero LD, Witcher LA, Kheirandish-Gozal L. Plasma IGF-1 levels and cognitive dysfunction in children with obstructive sleep apnea. Sleep Med 2009; 10:167-73. [DOI: 10.1016/j.sleep.2008.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/26/2007] [Accepted: 01/03/2008] [Indexed: 01/21/2023]
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Abstract
More examples for clinicians are needed on the implementation of data-driven intervention approaches for autism spectrum disorders (ASDs). The purpose of this case study is to present a feasible data-driven approach using a pre- and postdesign of an outpatient social skills group for children with ASD who were clinically referred rather than research recruited for services. Measurement tools with ecological validity are described, as are the treatment outcomes. Challenges included the generation of meaningful and obtainable outcomes with social validity and the development of feasible methods to evaluate clinical outcomes. Practical issues related to implementation are described that can increase researchers' understanding of the practitioner environment, and suggestions are made for data-driven methods for service delivery monitoring, accountability, and scalability.
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Sans Capdevila O, Crabtree VM, Kheirandish-Gozal L, Gozal D. Increased morning brain natriuretic peptide levels in children with nocturnal enuresis and sleep-disordered breathing: a community-based study. Pediatrics 2008; 121:e1208-14. [PMID: 18450864 DOI: 10.1542/peds.2007-2049] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [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: 11/24/2022] Open
Abstract
INTRODUCTION Habitual snoring and obstructive sleep apnea have been associated with bed-wetting in children, and effective obstructive sleep apnea treatment may improve enuresis. OBJECTIVES The purpose of this work was to assess whether habitual snoring is associated with increased incidence of enuresis and whether severity of obstructive sleep apnea correlates with enuretic frequency and to evaluate brain natriuretic peptide levels. METHODS Parental surveys of 5- to 7-year-old children were reviewed for habitual snoring and enuresis. Enuresis was also assessed in a cohort of 378 children with habitual snoring undergoing overnight polysomnographic evaluation, and brain natriuretic peptide plasma levels were determined in 20 children with obstructive sleep apnea, 20 with habitual snoring without obstructive sleep apnea, and 20 nonsnoring children, matched for enuresis. RESULTS There were 17,646 surveys completed (50.6% boys; 18.3% black). A total of 1976 (11.2%) of these children were habitual snoring (53% boys; 25.2% black). A total of 531 habitual snoring children also had enuresis (26.9%), with a predominant representation of boys (472 boys [87.5%]). Among the 15670 nonsnoring children, enuresis was reported in 1821 children (11.6%), of whom 88.8% were boys. However, enuresis among 378 children with habitual snoring did not correlate with the magnitude of sleep respiratory disturbances. Indeed, enuresis was reported in 33 of 149 children with obstructive sleep apnea (obstructive apnea hypopnea index: >2 per hour of total sleep time; 53% boys) as compared with 36 habitual snoring children with enuresis (62% boys) and obstructive apnea hypopnea index <2 per hour of total sleep time. Brain natriuretic peptide levels were elevated among children with enuresis and were marginally increased among children with obstructive sleep apnea. CONCLUSIONS Habitual snoring is associated with increased prevalence of enuresis, and brain natriuretic peptide levels are increased in enuretic children with further increases with obstructive sleep apnea. However, the prevalence of enuresis is not modified by severity of sleep disturbance. Even mild increases in sleep pressure because of habitual snoring may raise the arousal threshold and promote enuresis, particularly among prone children, that is, those with elevated brain natriuretic peptide levels.
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Affiliation(s)
- Oscar Sans Capdevila
- Division of Pediatric Sleep Medicine and Kosair Children's Hospital Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky 40202, USA
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Abstract
OBJECTIVE Childhood sleep-disordered breathing has an adverse impact on cognitive development, behavior, quality of life, and use of health care resources. Early viral infections and other immune-mediated responses may contribute to development of the chronic inflammation of the upper airway and hypertrophic upper airway lymphadenoid tissues underlying childhood sleep-disordered breathing. Breastfeeding provides immunologic protection against such early exposures. Therefore, we sought to explore whether sleep-disordered breathing severity would differ for children who were breastfed as infants. METHODS The parents or guardians of 196 habitually snoring children (mean +/- SD: 6.7 +/- 2.9 years old) who were undergoing overnight polysomnography at Kosair Children's Hospital Sleep Medicine and Apnea Center completed a retrospective survey on the method(s) used to feed the child as an infant. RESULTS Among habitually snoring children, those who were fed breast milk for at least 2 months had significantly reduced sleep-disordered breathing severity on every measure assessed, including apnea-hypopnea index, oxyhemoglobin desaturation nadir, and respiratory arousal index. Breastfeeding for longer than 5 months did not contribute additional benefits. CONCLUSIONS Our findings support the notion that breastfeeding may provide long-term protection against the severity of childhood sleep-disordered breathing. Future research should explore mechanism(s) whereby infant-feeding methods may affect the pathophysiology of development of childhood sleep-disordered breathing.
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Affiliation(s)
- Hawley Evelyn Montgomery-Downs
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, PO Box 6040, Morgantown, WV 26506-6040, USA.
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Abstract
BACKGROUND Obstructive sleep apnea (OSA) in children is associated with severity-dependent changes in neurocognitive functioning. However, the severity of OSA accounts for only approximately 40% of the variance in cognitive performance. Thus, genetic determinants of individual susceptibility may also contribute to the morbidity of OSA. Considering the unique susceptibility of apolipoprotein E (ApoE) knock-out mice to an experimental model of OSA, we examined whether the APOE epsilon4 allele contributes to increased neurocognitive morbidity in pediatric OSA. METHODS Consecutive habitually snoring and nonsnoring 5- to 7-year-old children underwent overnight polysomnography, neurocognitive testing, and a blood draw the next morning. Children were divided into OSA or no OSA, and OSA children were further subdivided into those with > or =2 abnormal cognitive subtest scores and those with normal cognitive scores. The presence of the APOE epsilon4 allele was determined from blood genomic DNA. RESULTS Among all children without OSA, APOE epsilon4 was present in 3 of 199 children, whereas in those with OSA, APOE epsilon4 was found in 16 of 146 children (p < 0.0002). Furthermore, 16 of 74 children with OSA and cognitive scores <85% had the APOE epsilon4 allele compared with 3 of 72 children with OSA with abnormal cognitive scores (p < 0.002). CONCLUSIONS APOE epsilon4 allele is more frequent in children with obstructive sleep apnea and particularly in those who develop neurocognitive deficits, suggesting that the APOE epsilon4 allele is associated with not only increased odds of having sleep-disordered breathing, but also with an increased risk for neurocognitive dysfunction.
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Affiliation(s)
- David Gozal
- Kosair Children's Hospital Research Institute and Division of Pediatric Sleep Medicine, University of Louisville, Louisville, KY 40202, USA.
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Gozal D, Crabtree VM, Sans Capdevila O, Witcher LA, Kheirandish-Gozal L. C-reactive protein, obstructive sleep apnea, and cognitive dysfunction in school-aged children. Am J Respir Crit Care Med 2007; 176:188-93. [PMID: 17400731 PMCID: PMC1994211 DOI: 10.1164/rccm.200610-1519oc] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [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] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) in children is associated with substantial neurobehavioral and cognitive dysfunction. However, not all children with OSA exhibit altered cognitive performance. OBJECTIVES To assess the magnitude of the systemic inflammatory response, as measured by high-sensitivity C-reactive protein (hsCRP) serum levels which may identify children with OSA at higher susceptibility for cognitive morbidity. METHODS Habitually snoring children and nonsnoring children (total, 278; age range, 5-7 yr) were recruited from the community, and underwent overnight polysomnography and neurocognitive testing and a blood draw the next morning. Snoring children were divided into OSA and no-OSA groups, and children with OSA were further subdivided into those with two or more abnormal cognitive subtests and into those with normal cognitive scores. Serum levels of hsCRP were also measured. MEASUREMENTS AND MAIN RESULTS Among snoring children without OSA, mean hsCRP was 0.19+/-0.07 mg/dl compared with 0.36+/-0.11 mg/dl in those with OSA (p<0.01). Furthermore, hsCRP was 0.48+/-0.12 mg/dl in children with OSA and cognitive deficits, compared with 0.21+/-0.08 mg/dl in children with OSA and normal cognitive scores (p<0.002). CONCLUSIONS hsCRP levels are higher in children with OSA, and particularly in those who develop neurocognitive deficits, suggesting that the magnitude of the inflammatory responses elicited by OSA is a major determinant of increased risk for neurocognitive dysfunction.
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Affiliation(s)
- David Gozal
- Kosair Children's Hospital Research Institute, Department of Pediatrics, University of Louisville School of Medicine, 570 South Preston Street, Suite 204, Louisville, KY 40202, USA.
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Pigeon WR, Crabtree VM, Scherer MR. The future of behavioral sleep medicine. J Clin Sleep Med 2007; 3:73-9. [PMID: 17557458] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Behavioral Sleep Medicine is a relatively new discipline with roots in Behavioral Medicine and a specific focus on behavioral aspects of Sleep Medicine. While cognitive behavioral therapy for insomnia is most closely identified with Behavioral Sleep Medicine, the discipline and its practitioners offer a wider array of interventions for pediatric and adult sleep disorders. Despite the existence of these evidenced-based behavioral strategies for the major sleep disorders, it is the exception, rather than the norm, when behavioral sleep medicine is fully integrated into a sleep medicine practice. A brief history of Behavioral Sleep Medicine, challenges to achieving greater integration, progress made to date, and suggestions for the immediate future are presented.
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Affiliation(s)
- Wilfred R Pigeon
- Sleep & Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd. Rochester, NY 14642, USA.
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Ivanenko A, Crabtree VM, Obrien LM, Gozal D. Sleep complaints and psychiatric symptoms in children evaluated at a pediatric mental health clinic. J Clin Sleep Med 2006; 2:42-8. [PMID: 17557436] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
STUDY OBJECTIVES To examine the association of sleep problems with psychiatric symptoms in children evaluated at a university-based outpatient child psychiatry clinic. METHODS Parents of 174 children attending psychiatric services completed a 47-item Childhood Sleep Questionnaire and the Behavioral Assessment System for Children. Psychiatric diagnosis was obtained through retrospective chart review. Sleep characteristics were compared among 4 diagnostic subcategories: attention-deficit/hyperactivity disorder (ADHD) alone (n=29), ADHD with comorbid mood and anxiety disorders (ADHD+; n=50), mood and anxiety disorders alone (n=67), and other psychiatric disorders (n= 28). Data from sleep habits survey of 174 community children without reported psychiatric history served as controls. RESULTS Children with psychiatric disorders had a significantly higher prevalence of sleep complaints compared with nonpsychiatric controls. Children with ADHD had frequent nocturnal awakenings, bad dreams, and bedtime struggles. In addition, the presence of leg jerks during sleep was particularly frequent in patients with ADHD compared with any other psychiatric disorder. More frequent nighttime awakenings were present in children with mood and anxiety disorders. Sleep duration and sleep latency strongly correlated with aggression, hyperactivity, and depression. Restless sleep scores highly correlated with all psychiatric symptoms. CONCLUSIONS Sleep problems are highly prevalent among children with psychiatric disorders. Children with ADHD and comorbid anxiety or mood disorders are more likely to report sleep disturbances. Restless sleep, long sleep latency, short sleep duration, and frequent nocturnal awakenings correlate with the severity of psychiatric symptoms.
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Affiliation(s)
- Anna Ivanenko
- Department of Psychiatry and Behavioral Neurosciences, Loyola University of Chicago, 2160 S. First Avenue Building 105 Room 1942, Maywood, IL 60153, USA.
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Ivanenko A, Crabtree VM, O&rsquo LM, Brien, Gozal D. Sleep Complaints and Psychiatric Symptoms in Children Evaluated at a Pediatric Mental Health Clinic. J Clin Sleep Med 2006. [DOI: 10.5664/jcsm.26434] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [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]
Affiliation(s)
- Anna Ivanenko
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, Maywood, IL
| | - Valerie McLaughlin Crabtree
- Division of Sleep Medicine, Kosair Children’s Hospital Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY
| | - Louise Margaret O&rsquo
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, Maywood, IL
| | - Brien
- Division of Sleep Medicine, Kosair Children’s Hospital Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY
| | - David Gozal
- Division of Sleep Medicine, Kosair Children’s Hospital Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY
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