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Sleep behavior of infants with infantile hemangioma treated with propranolol-a cohort study
Martin Theiler1,2,3, Nicole Knöpfel4,5,6, Susanne von der Heydt7
1Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland. martin.theiler@kispi.uzh.ch.
Insights
Propranolol treatment for infantile hemangiomas may cause mild, measurable sleep changes in infants, including decreased nighttime sleep efficiency. Behavioral development remains unaffected, supporting its use as a first-line therapy.
Area of Science:
- Pediatric pharmacology
- Neonatal neurology
- Sleep medicine
Background:
- Sleep disturbances are commonly reported in infants receiving propranolol for infantile hemangiomas.
- These sleep issues may indicate central nervous system effects and often lead to treatment cessation.
- Objective data on sleep patterns in this population are limited.
Purpose of the Study:
- To objectively assess the sleep behavior of infants with infantile hemangiomas treated with propranolol.
- To compare sleep patterns of propranolol-treated infants to a healthy, untreated control group.
- To evaluate the impact of propranolol on sleep efficiency, nighttime awakenings, and daytime sleep behavior.
Main Methods:
- A cohort study involving term-born infants, with 54 in the propranolol-treated group and 54 in the control group.
- Objective sleep assessment using ankle actigraphy and a 24-hour diary over 7-10 days at 3 and 6 months of age.
- Secondary outcomes included total sleep, daytime sleep, and parent-reported sleep quality and behavioral development via BISQ and ASQ.
Main Results:
- No significant group differences in sleep parameters were observed at 3 months of age.
- At 6 months, the propranolol group showed reduced sleep efficiency and a trend towards increased nighttime awakenings.
- Treated infants had shorter daytime waking periods, but total 24-hour sleep remained unaffected.
Conclusions:
- Propranolol demonstrates a mild, measurable impact on objective infant sleep parameters, specifically decreasing sleep efficiency.
- Parent-reported sleep quality and behavioral development were not negatively affected by propranolol treatment.
- The findings support the continued use of propranolol as a first-line therapy for infantile hemangiomas, despite minor sleep alterations.
Abstract:
Sleep problems are frequently reported in infants treated with propranolol for infantile hemangiomas, possibly serving as a marker for a negative impact on central nervous system function. In this cohort study, we objectively investigate the sleep behavior of infants with infantile hemangiomas on propranolol compared to a healthy, untreated control group. Sleep of propranolol-treated infants and controls was investigated using ankle actigraphy and a 24-h diary for 7-10 days at ages 3 and 6 months. The main outcome measures were the Number of Nighttime Awakenings and Sleep Efficiency. The main secondary outcome measures included 24-hour Total Sleep, daytime sleep behavior, and parent-rated infant sleep quality and behavioral development based on the Brief Infant Sleep Questionnaire (BISQ) and the age-appropriate Ages-and-Stages Questionnaire (ASQ), respectively. Fifty-four term-born infants were included in each cohort. No group difference in any investigated parameter was seen at age 3 months. At age 6 months, the propranolol group exhibited a decrease in Sleep Efficiency and a trend towards an increased Number of Nighttime Awakenings compared to the control group. Treated infants at 6 months also had shorter daytime waking periods. 24-hour Total Sleep was unaffected by propranolol. No negative impact of propranolol on subjective sleep quality and behavioral development was noted.Conclusion: Propranolol exerts a measurable yet mild impact on objectively assessed infants' sleep measures. Behavioral developmental scores were unaffected. Our results support propranolol as first-line therapy for complicated infantile hemangiomas. What is Known: • Sleep disorders are frequently reported in infants with infantile hemangiomas treated with propranolol and often lead to treatment discontinuation. • Investigations of the sleep pattern in this patient group using objective measures are lacking. What is New: • The sleep pattern of propranolol-treated infants is assessed using actigraphy and a 24-h sleep diary and compared to healthy, untreated controls. • Propranolol leads to a decreased sleep efficiency at night and an increased demand of daytime sleep, yet effects are mild overall.
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