Skip to main content
SpringerLink
Log in

Sleep disturbances in adult survivors of childhood brain tumors

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

The aims of this study are to compare self-reported sleep quality in adult survivors of childhood brain tumors and a population-based comparison group, to identify treatment-related factors associated with sleep disturbances, and to identify the impact of post-treatment obesity and depression on sleep scores in adult survivors of childhood brain tumors.

Methods

Randomly selected adult survivors of childhood brain tumors (n = 78) and age-, sex-, and zip code-matched population-group members (n = 78) completed the Pittsburgh Sleep Quality Index and the Brief Symptom Inventory. Sleep quality and the effect of demographic, treatment, and post-treatment characteristics were evaluated with linear and logistic regression analyses.

Results

Brain tumor survivors were 2.7 (95 % CI, 1.1, 6.5) times more likely than the comparison group to take greater than 30 min to fall asleep. Females in both groups reported worse sleep quality and impaired daytime functioning. Among survivors, post-treatment obesity was associated with daytime dysfunction.

Conclusions

These results agree with previous studies associating sleep, sex, and obesity and identified longer sleep latency as being a problem among childhood brain tumor survivors. Further study identifying factors contributing to sleep latency, and its impact on quality of life among adult survivors of childhood brain tumors is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CNS:

Central nervous system

QoL:

Quality of life

BMI:

Body mass index

CCSS:

Childhood Cancer Survivor Study

PSQI:

Pittsburgh Sleep Quality Index

POMS:

Profile of mood states

BSI-18:

Brief Symptom Inventory

kg:

Kilograms

m:

Meter

SAS:

Statistical analysis software

95 % CI:

95 % Confidence interval

References

  1. American Brain Tumor. (2008). Association, Facts and Statistics.

  2. Anderson, D. M., et al. (2001). Medical and neurocognitive late effects among survivors of childhood central nervous system tumors. Cancer, 92(10), 2709–2719.

    Article  PubMed  CAS  Google Scholar 

  3. Hudson, M. M., et al. (2003). Health status of adult long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. JAMA: The Journal of the American Medical Association, 290(12), 1583–1592.

    Article  CAS  Google Scholar 

  4. Mostow, E. N., et al. (1991). Quality of life in long-term survivors of CNS tumors of childhood and adolescence. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 9(4), 592–599.

    CAS  Google Scholar 

  5. Pelletier, G., et al. (2002). Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues. Journal of Neuro-Oncology, 57(1), 41–49.

    Article  PubMed  Google Scholar 

  6. Clanton, N. R. et al. (2011). Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer: A report from the childhood cancer survivor study. Cancer, 117(11), 2559–2568.

    Google Scholar 

  7. Mulrooney, D. A., et al. (2008). Fatigue and sleep disturbance in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS). Sleep, 31(2), 271–281.

    PubMed  Google Scholar 

  8. Poretti, A., et al. (2004). Outcome of craniopharyngioma in children: Long-term complications and quality of life. Developmental Medicine and Child Neurology, 46(4), 220–229.

    Article  PubMed  Google Scholar 

  9. van der Klaauw, A. A., et al. (2007). Increased daytime somnolence despite normal sleep patterns in patients treated for nonfunctioning pituitary macroadenoma. The Journal of Clinical Endocrinology and Metabolism, 92(10), 3898–3903.

    Article  PubMed  Google Scholar 

  10. Di Gennaro, G., et al. (2004). Night terrors associated with thalamic lesion. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 115(11), 2489–2492.

    Article  Google Scholar 

  11. Mandrell, B. N. et al. (2012). Excessive daytime sleepiness and sleep-disordered breathing disturbances in survivors of childhood central nervous system tumors. Pediatric blood and cancer, 58(5), 746–751.

    Google Scholar 

  12. Marcus, C. L., et al. (2002). Secondary narcolepsy in children with brain tumors. Sleep, 25(4), 435–439.

    PubMed  Google Scholar 

  13. Szucs, A., et al. (2001). Insomnia and fronto-basal tumor: A case report. European Neurology, 46(1), 54–56.

    Article  PubMed  CAS  Google Scholar 

  14. Zambelis, T., Paparrigopoulos, T., & Soldatos, C. R. (2002). REM sleep behaviour disorder associated with a neurinoma of the left pontocerebellar angle. Journal of Neurology, Neurosurgery and Psychiatry, 72(6), 821–822.

    Article  CAS  Google Scholar 

  15. Constine, L. S., et al. (1993). Hypothalamic-pituitary dysfunction after radiation for brain tumors. The New England Journal of Medicine, 328(2), 87–94.

    Article  PubMed  CAS  Google Scholar 

  16. Heikens, J., et al. (1998). Long-term neuro-endocrine sequelae after treatment for childhood medulloblastoma. European Journal of Cancer, 34(10), 1592–1597.

    Article  PubMed  CAS  Google Scholar 

  17. Arii, J., et al. (2001). A hypersomnolent girl with decreased CSF hypocretin level after removal of a hypothalamic tumor. Neurology, 56(12), 1775–1776.

    Article  PubMed  CAS  Google Scholar 

  18. Nishino, S., et al. (2000). Hypocretin (orexin) deficiency in human narcolepsy. Lancet, 355(9197), 39–40.

    Article  PubMed  CAS  Google Scholar 

  19. Selbach, O., & Haas, H. L. (2006). Hypocretins: The timing of sleep and waking. Chronobiology International, 23(1–2), 63–70.

    Article  PubMed  CAS  Google Scholar 

  20. Taheri, S., Zeitzer, J. M., & Mignot, E. (2002). The role of hypocretins (orexins) in sleep regulation and narcolepsy. Annual Review of Neuroscience, 25, 283–313.

    Article  PubMed  CAS  Google Scholar 

  21. Gurney, J. G., et al. (2003). Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood Cancer Survivor Study. Cancer, 97(3), 663–673.

    Article  PubMed  Google Scholar 

  22. Lustig, R. H., et al. (2003). Risk factors for the development of obesity in children surviving brain tumors. The Journal of Clinical Endocrinology and Metabolism, 88(2), 611–616.

    Article  PubMed  CAS  Google Scholar 

  23. Rosen, G. M., et al. (2003). Sleep in children with neoplasms of the central nervous system: Case review of 14 children. Pediatrics, 112(1 Pt 1), e46–e54.

    PubMed  Google Scholar 

  24. Armitage, R. (2000). The effects of antidepressants on sleep in patients with depression. Canadian Journal of Psychiatry. Revue canadienne de psychiatrie, 45(9), 803–809.

    PubMed  CAS  Google Scholar 

  25. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.) text rev. Washington, American Psychiatric Association.

  26. Piccinelli, M., & Wilkinson, G. (2000). Gender differences in depression. Critical review. The British Journal of Psychiatry: The Journal of Mental science, 177, 486–492.

    Article  CAS  Google Scholar 

  27. Baldwin, D. S., & Papakostas, G. I. (2006). Symptoms of fatigue and sleepiness in major depressive disorder. The Journal of Clinical Psychiatry, 67(Suppl 6), 9–15.

    PubMed  Google Scholar 

  28. Zebrack, B. J., et al. (2004). Psychological outcomes in long-term survivors of childhood brain cancer: A report from the childhood cancer survivor study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 22(6), 999–1006.

    Article  Google Scholar 

  29. Ness, K. K., et al. (2010). Physical performance limitations among adult survivors of childhood brain tumors. Cancer, 116(12), 3034–3044.

    Article  PubMed  Google Scholar 

  30. Buysse, D. J., et al. (1991). Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep, 14(4), 331–338.

    PubMed  CAS  Google Scholar 

  31. Derogatis, L. (2000). BSI-18, administration, scoring and procedures manual. Mineappolis: National Computer Systems.

  32. Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13(3), 595–605.

    Article  PubMed  CAS  Google Scholar 

  33. Recklitis, C. J., et al. (2006). Factor structure of the brief symptom inventory-18 in adult survivors of childhood cancer: Results from the childhood cancer survivor study. Psychological Assessment, 18(1), 22–32.

    Article  PubMed  Google Scholar 

  34. Packer, R. J., et al. (2003). Long-term neurologic and neurosensory sequelae in adult survivors of a childhood brain tumor: Childhood cancer survivor study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 21(17), 3255–3261.

    Article  Google Scholar 

  35. Fisher, R. (1922). On the interpretation of Χ2 from contingency tables, and the calculation of P. Journal of the Royal Statistical Society, 85(1), 87–94.

    Article  Google Scholar 

  36. Lichstein, K. L., et al. (2003). Quantitative criteria for insomnia. Behaviour Research and Therapy, 41(4), 427–445.

    Article  PubMed  CAS  Google Scholar 

  37. Geisler, P., et al. (2006). The influence of age and sex on sleep latency in the MSLT-30—a normative study. Sleep, 29(5), 687–692.

    PubMed  Google Scholar 

  38. Baldwin, C. M., et al. (2004). Associations between gender and measures of daytime somnolence in the Sleep Heart Health Study. Sleep, 27(2), 305–311.

    PubMed  Google Scholar 

  39. Breslau, N., et al. (1996). Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young adults. Biological Psychiatry, 39(6), 411–418.

    Article  PubMed  CAS  Google Scholar 

  40. Hara, C., Lopes Rocha F., & Lima-Costa M. F. (2004). Prevalence of excessive daytime sleepiness and associated factors in a Brazilian community: The Bambui study. Sleep Medicine, 5(1):31–36.

    Google Scholar 

  41. Hublin, C., et al. (1996). Daytime sleepiness in an adult, Finnish population. Journal of Internal Medicine, 239(5), 417–423.

    Article  PubMed  CAS  Google Scholar 

  42. Stradling, J. R., et al. (2000). Prevalence of sleepiness and its relation to autonomic evidence of arousals and increased inspiratory effort in a community based population of men and women. Journal of Sleep Research, 9(4), 381–388.

    Article  PubMed  CAS  Google Scholar 

  43. Young, T. B. (2004). Epidemiology of daytime sleepiness: Definitions, symptomatology, and prevalence. The Journal of Clinical Psychiatry, 65(Suppl 16), 12–16.

    PubMed  Google Scholar 

  44. Muller, H. L., et al. (2002). Melatonin secretion and increased daytime sleepiness in childhood craniopharyngioma patients. The Journal of Clinical Endocrinology and Metabolism, 87(8), 3993–3996.

    Article  PubMed  CAS  Google Scholar 

  45. Holbrook, A. M., et al. (2000). Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ: Canadian Medical Association Journal = journal de l’Association medicale canadienne, 162(2):225–233.

    Google Scholar 

  46. Morin, C. M., et al. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998–2004). Sleep, 29(11), 1398–1414.

    PubMed  Google Scholar 

  47. Morin, C. M., et al. (1999). Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review. Sleep, 22(8), 1134–1156.

    PubMed  CAS  Google Scholar 

  48. National Institutes of Health. (2005). NIH State-of-the-Science conference statement on manifestations and management of chronic insomnia in adults. In NIH consensus state sci statements.

  49. Nowell, P. D., et al. (1997). Benzodiazepines and zolpidem for chronic insomnia: A meta-analysis of treatment efficacy. JAMA: The Journal of the American Medical Association, 278(24), 2170–2177.

    Article  CAS  Google Scholar 

  50. Ritterband, L. M., et al. (2011). Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia. Psycho-oncology. doi:10.1002/pon.1969.

  51. Wade, A. G., et al. (2010). Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: A randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety. BMC Medicine, 8, 51.

    Article  PubMed  Google Scholar 

  52. Buscemi, N., et al. (2005). The efficacy and safety of exogenous melatonin for primary sleep disorders. A meta-analysis. Journal of General Internal Medicine, 20(12), 1151–1158.

    Article  PubMed  Google Scholar 

  53. Buscemi, N., et al. (2006). Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: Meta-analysis. BMJ, 332(7538), 385–393.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was funded by the American Cancer Society—RSGPB-06-210-01-CPPB and by additional funding at St. Jude Children’s Research Hospital provided by ALSAC, and the University of Minnesota’s Masonic Cancer Center.

Conflict of interest

The authors of this manuscript have no conflicts to disclose.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, University of Memphis, School of Public Health, 3820 Desoto Avenue, Browning Hall Room 227, Memphis, TN, 38152, USA

    Vikki G. Nolan

  2. School of Public Health, University of Memphis, Memphis, TN, USA

    Lauren A. DeSain

  3. School of Nursing, University of Minnesota Medical School, Minneapolis, MN, USA

    Roxanna Gapstur & Cynthia R. Gross

  4. College of Pharmacy, University of Minnesota Medical School, Minneapolis, MN, USA

    Cynthia R. Gross

  5. Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA

    Joseph P. Neglia

  6. Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA

    Marilyn Stovall

  7. Departments of Oncology, St. Jude Children’s Research, Memphis, TN, USA

    Amar Gajjar

  8. Department of Psychology, St. Jude Children’s Research, Memphis, TN, USA

    James L. Klosky

  9. Department of Radiological Sciences, St. Jude Children’s Research, Memphis, TN, USA

    Thomas E. Merchant

  10. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Kirsten K. Ness

Authors
  1. Vikki G. Nolan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roxanna Gapstur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cynthia R. Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lauren A. DeSain
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joseph P. Neglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amar Gajjar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James L. Klosky
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas E. Merchant
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marilyn Stovall
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kirsten K. Ness
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vikki G. Nolan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nolan, V.G., Gapstur, R., Gross, C.R. et al. Sleep disturbances in adult survivors of childhood brain tumors. Qual Life Res 22, 781–789 (2013). https://doi.org/10.1007/s11136-012-0208-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-012-0208-5

Keywords

Search

Navigation