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Sleep in Hospitalized Children With Cancer: A Cross-Sectional Study
Chani Traube1,2, Lynne Rosenberg3, Francesca Thau3
1Departments of Pediatrics, chr9008@med.cornell.edu.
Insights
Most hospitalized children with cancer experience inadequate sleep. Hospital factors like noise, alarms, child worries, and benzodiazepines contribute to poor sleep, highlighting areas for potential intervention.
Area of Science:
- Pediatric Oncology
- Sleep Medicine
- Clinical Research
Background:
- Hospitalized children with cancer often face sleep disruption.
- In-hospital sleep disturbances may negatively impact patient outcomes.
Purpose of the Study:
- To characterize sleep quality and quantity in hospitalized pediatric cancer patients.
- To evaluate the association between subjective and objective sleep measures.
- To identify hospital-associated risk factors for poor sleep.
Main Methods:
- Cross-sectional study involving 56 children (0-18 years) on a pediatric oncology ward.
- Parental sleep questionnaires and actigraphy were used to assess sleep.
- Data included demographics, clinical information, and hospital-associated factors.
Main Results:
- 66% of participants reported inadequate sleep.
- Actigraphy showed a median total sleep time of 477 minutes.
- Noise, alarms, child's worries, and benzodiazepine use were linked to inadequate sleep.
Conclusions:
- Inadequate sleep is prevalent in hospitalized children with cancer.
- Subjective and objective sleep measures correlated well.
- Modifiable hospital factors present targets for sleep improvement interventions.
Objectives:
Many children with cancer have repeated and prolonged hospitalizations, and in-hospital sleep disruption may negatively affect outcomes. Our objective for this study was to characterize sleep quality and quantity in hospitalized children with cancer by using parental surveys and actigraphy, to evaluate the association between subjective and objective sleep measures, and to describe hospital-associated risk factors related to poor sleep.
Methods:
Cross-sectional study of children aged 0 to 18 years old admitted to a pediatric oncology ward. Parents completed a baseline sleep questionnaire describing their child's sleep at home before hospitalization, followed by daily questionnaires describing their child's sleep for up to 3 nights while in the hospital. A subgroup of children aged 5 to 18 years wore actigraphs during the same time period. Demographic and clinical data were extracted from the electronic medical record. The primary outcome was inadequate sleep, defined by the total sleep duration adjusted for age.
Results:
Among 56 participants over 135 hospital nights, 66% (n = 37) reported inadequate sleep. Actigraphy was completed on 39 nights (29%), with a median total sleep time of 477 (interquartile range 407-557) minutes. There was a strong correlation between subjective questionnaire measures and actigraphic measures (r = 0.76). No patient-specific demographic factors were related to inadequate sleep. A multivariable model indicated the following hospital-related factors were associated with inadequate sleep: noise (adjusted odds ratio [aOR] 3.0; confidence interval [CI] 1.2-7.7), alarms (aOR 3.1; CI 1.2-8.3), child's worries (aOR 2.8; CI 1.1-7.2), and receipt of benzodiazepines (aOR 2.9; CI 1.2-7.5).
Conclusions:
A majority of children experienced inadequate sleep during hospitalization. Subjective report of sleep duration correlated well with objective measures of sleep by actigraphy. Several potentially modifiable factors were independently associated with poor sleep. Further interventional studies are required to test approaches to optimize sleep in hospitalized children with cancer.
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