Sleep problems and impact of obstructive hydrocephalus in newly diagnosed pediatric brain tumor patients

Abstract

Background: Pediatric brain tumor patients are at risk of developing sleep problems. Previous studies were conducted in longer-term survivors or without comprehensive sleep evaluations, therefore it remains unclear whether and when problems arise. Insights can facilitate timely interventions. The aim is to examine sleep problems and contributing factors shortly after diagnosis. Methods: Children 6–16 years with a primary brain tumor (diagnosed ≤3 months) were recruited for a prospective study. Sleep was measured at home using wrist-worn actigraphy and questionnaires (PROMIS Sleep Disturbance and Sleep Related Impairment, self- and parent-reports). Mean PROMIS scores, prevalence of sleep problems (established by cut-off scores) and actigraphic outcomes were compared to norms (t-test, chi-square, linear regression). Risk factors were explored with multivariable linear regression models. Results: Sixty-nine children (68% male, mean age 11.6 ± 2.8 years, 53 ± 28 days after diagnosis) participated. Parents reported more child sleep disturbances (mean T = 53.7, P < .01) compared to norms. Rates of self- and parent-reported severe sleep disturbances were elevated (11% versus 5% in norms, P < .04). Parents also reported higher rates of moderate child sleep disturbance (31%) and sleep related impairment (42%) than norms (25%, P < .03). Actigraphy was comparable to healthy controls. Obstructive hydrocephalus was associated with longer sleep times (B=41.04, 95%CI 11.41;70.68) and shorter time since diagnosis with self-reported sleep disturbances (B=−.11, 95%CI −0.19;−0.03). Conclusion: Sleep problems are more frequently reported shortly after pediatric brain tumor diagnosis, compared to healthy controls. Attention for sleep around brain tumor diagnosis and impact of obstructive hydrocephalus is important, as sleep is vital for recovery and health-related quality of life.