Sleep–wake rhythm disruption is associated with cancer-related fatigue in pediatric acute lymphoblastic leukemia. Issue 6 (31st December 2019)

• Record Type: Journal Article
• Authors: Steur, Lindsay M H; Kaspers, Gertjan J L; Van Someren, Eus J W; Van Eijkelenburg, Natasha K A; Van der Sluis, Inge M; Dors, Natasja; Van den Bos, Cor; Tissing, Wim J E; Grootenhuis, Martha A; Van Litsenburg, Raphaële R L
• Is Part Of: Sleep. Volume 43:Issue 6(2020)
• Publication Date: 2019-12-31
• Subjects: actigraphy -- acute lymphoblastic leukemia -- cancer-related fatigue -- physical activity -- children sleep–wake rhythms; Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz320
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Study Objectives: To compare sleep–wake rhythms, melatonin, and cancer-related fatigue in pediatric patients with acute lymphoblastic leukemia (ALL) to healthy children and to assess the association between sleep–wake outcomes and cancer-related fatigue. Methods: A national cohort of ALL patients (2–18 years) was included. Sleep–wake rhythms were measured using actigraphy and generated the following variables: Interdaily stability (IS): higher IS reflects higher stability; intradaily variability (IV): lower IV indicates less fragmentation; L5 and M10 counts: activity counts during the five least and 10 most active hours, respectively; and relative amplitude (RA): the ratio of L5 and M10 counts (higher RA reflects a more robust rhythm). The melatonin metabolite, 6-sulfatoxymelatonin (aMT6s), was assessed in urine. Cancer-related fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Using regression models sleep–wake rhythms, aMT6s, and cancer-related fatigue were compared to healthy children and associations between sleep–wake outcomes and cancer-related fatigue were assessed in ALL patients. Results: In total, 126 patients participated (response rate: 67%). IS, RA, and M10 counts were lower in patients compared to healthy children ( p < 0.001). aMT6s levels were comparable to healthy children ( p = 0.425). Patients with ALL were more fatigued compared to healthy children ( p < 0.001). Lower IS, RA and M10 counts and higher IV were significantly associated with more parent-reported cancer-related fatigue. Associations between sleep–wake rhythms and self-reported cancer-related fatigue were not statistically significant. Conclusions: Sleep–wake rhythm impairment is associated with more cancer-related fatigue in pediatric ALL patients. Interventions aimed to improve sleep hygiene and encourage physical activity may reduce cancer-related fatigue.