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Physical activity (PA) and sleep among children and adolescents with cancer
Andrea D Orsey1, Dorothy B Wakefield, Michelle M Cloutier
1Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, Hartford, Connecticut; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.
Insights
Children with cancer often experience poor sleep. Increased physical activity (PA) was linked to better sleep quantity and efficiency in pediatric oncology patients, suggesting PA as a way to improve sleep.
Area of Science:
- Pediatric Oncology
- Sleep Medicine
- Exercise Physiology
Background:
- Sleep and physical activity impairments are common in adult cancer patients, but data in pediatric oncology populations are limited.
- This study investigated the relationship between physical activity and sleep in children undergoing cancer treatment.
Purpose of the Study:
- To examine the association between physical activity levels and sleep parameters in pediatric oncology patients.
- To determine if physical activity can be a factor in improving sleep quality and quantity in this population.
Main Methods:
- A prospective study involving 36 children (ages 8-18) with cancer.
- Actigraphy was used over 7 days to assess physical activity and sleep variables (total sleep time, wake after sleep onset, sleep efficiency).
- Sleep diaries and fatigue instruments were also utilized to gather additional data.
Main Results:
- Pediatric oncology patients exhibited significantly impaired sleep compared to healthy children, with reduced total sleep time and efficiency, and increased wake after sleep onset.
- Higher levels of physical activity, measured by actigraphy, were significantly associated with improved sleep quantity (P=0.005) and efficiency (P=0.001).
- Fatigue correlated with self-reported sleep quality but not with actigraphy-measured sleep disturbances.
Conclusions:
- Pediatric oncology patients frequently experience disrupted sleep patterns.
- Increased physical activity is a significant factor associated with better sleep quantity and efficiency in children with cancer.
- Physical activity represents a potentially modifiable intervention to enhance sleep in pediatric oncology patients.
Background:
Although sleep and physical activity often are impaired among adult cancer patients, there is limited data among pediatric oncology populations. We conducted a prospective study to investigate the relationship between physical activity (PA) and sleep among children with cancer.
Procedure:
Between 11/12/09 and 02/06/12, PA while awake and sleep variables were assessed by actigraphy collected over 7 days in 36 children (age range 8-18 years) with cancer (23 leukemia/lymphoma, 5 brain tumor, 8 solid tumor). Sleep diaries were used to determine sleep time, sleep quality, and morning mood. Fatigue was assessed at study initiation using fatigue instruments.
Results:
Participants had impaired sleep based upon normative data compiled from multiple studies of more than 1,700 healthy children from 1 to 18 years of age [1], including decreased total sleep time (mean 6.6 hours, standard deviation (SD) 1.3 hours), increased wake after sleep onset (WASO; mean 2 hours, SD 1.4 hours), increased awakenings during sleep (mean 28.3 wake bouts, SD 7.8 bouts), and decreased sleep efficiency (mean 74.2%, SD 13.3%). Fatigue correlated with self-reported sleep quality but not with disturbances in sleep as measured by actigraphy. In longitudinal models that controlled for age, diagnosis group, gender, race, and steroid use, higher average activity, as measured by actigraphy, was associated with improved sleep quantity (P = 0.005) and efficiency (P = 0.001).
Conclusion:
Pediatric oncology patients demonstrate impaired sleep. Greater PA was significantly associated with improved sleep quantity and efficiency in pediatric oncology participants. As a potentially modifiable factor, PA may offer a mechanism to improve sleep in pediatric oncology patients.
