Supportive Care in Cancer

, Volume 24, Issue 9, pp 3897–3906 | Cite as

The impact of dexamethasone and prednisone on sleep in children with acute lymphoblastic leukemia

  • Lauren C. DanielEmail author
  • Yimei Li
  • Jacqueline D. Kloss
  • Anne F. Reilly
  • Lamia P. Barakat
Original Article



Corticosteroids can affect sleep patterns, mood, and behavior. Two of the most commonly prescribed corticosteroids in acute lymphoblastic leukemia (ALL), dexamethasone and prednisone, may impact sleep differently, but no research has compared these medications in children. The current study tested the hypothesis that dexamethasone and prednisone differentially affect sleep in children with ALL to understand how these medications contribute to health-related quality of life (HRQL).


Parents of 81 children 3–12 years old in maintenance therapy for ALL completed a baseline measure of child sleep (dexamethasone n = 55, prednisone n = 26), and 61 parents returned 28 days of child sleep diaries starting the first day of a 5-day steroid course (dexamethasone n = 43, prednisone n = 18). Parents also completed measures of HRQL and fatigue on the last day of steroids and the last day of the month.


At baseline, parents reported more sleep disturbances in children taking dexamethasone than prednisone. Across the month, children taking dexamethasone experienced poorer sleep quality compared to children taking prednisone. During corticosteroid treatment, children taking dexamethasone also experienced more night awakenings than children taking prednisone. Sleep variables accounted for almost half of the variance in HRQL during time off steroids and also significantly contributed to fatigue during the corticosteroids course and time off corticosteroids.


Sleep is an essential component of HRQL in children taking corticosteroids, and the impact on sleep is more pronounced in children taking dexamethasone compared to prednisone. Screening for sleep disturbances and offering brief interventions to manage steroid-related sleep disruptions may improve HRQL.


Sleep Acute lymphoblastic leukemia Corticosteroid Quality of life 



acute lymphoblastic leukemia


Children’s Sleep Habits Questionnaire


health-related quality of life


Multidimensional Fatigue Scale


Pediatric Quality of Life Inventory



Thank you to Margo Szabo, Colleen Walsh, Maisa Ziadni, and Katie Valosky for the assistance with data collection and to Dayna Kahl and Alex Diguiseppe for the assistance with data management.

Compliance with ethical standards

The study was approved by the appropriate institutional review board. All procedures performed were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no competing interests.

Consent for publication

Informed consent was obtained from all individual participants included in the study.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Funding source

This study is supported by a grant from the American Cancer Society PF-13-238-01-PCSM (PI: Daniel).


  1. 1.
    Pound CM, Clark C, Ni A, Athale U, Lewis V, Halton JM (2012) Corticosteroids, behavior, and quality of life in children treated for acute lymphoblastic leukemia; a multicentered trial. J Pediatr Hematol Oncol 34(7):517–23. doi: 10.1097/MPH.0b013e318257fdac CrossRefPubMedGoogle Scholar
  2. 2.
    Pui C-HCH (2008) Acute lymphoblastic leukaemia. Lancet 371(9617):1030–43. doi: 10.1016/S0140-6736(08)60457-2 CrossRefPubMedGoogle Scholar
  3. 3.
    Eiser C, Davies H, Jenney M, Stride C, Glaser A (2006) HRQOL implications of treatment with dexamethasone for children with acute lymphoblastic leukemia (ALL). Pediatr Blood Cancer 46(1):35–9. doi: 10.1002/pbc.20432 CrossRefPubMedGoogle Scholar
  4. 4.
    Bostrom BC, Sensel MR, Sather HN, Gaynon PS, La MK, Johnston K et al (2003) Dexamethasone versus prednisone and daily oral versus weekly intravenous mercaptopurine for patients with standard-risk acute lymphoblastic leukemia: a report from the Children’s Cancer Group. Blood 101(10):3809–17CrossRefPubMedGoogle Scholar
  5. 5.
    Ahmed SF, Tucker P, Mushtaq T, Wallace AM, Williams DM, Hughes IA (2002) Short-term effects on linear growth and bone turnover in children randomized to receive prednisolone or dexamethasone. Clin Endocrinol (Oxf) 57(2):185–91. doi: 10.1046/j.1365-2265.2002.01580.x CrossRefGoogle Scholar
  6. 6.
    Mattano Jr LA, Devidas M, Nachman JB, Sather HN, Hunger SP, Steinherz PG et al. Effect of alternate-week versus continuous dexamethasone scheduling on the risk of osteonecrosis in paediatric patients with acute lymphoblastic leukaemia: results from the CCG-1961 randomised cohort trial. Lancet Oncol. 2012;13(9):906–15. doi: 10.1016/S1470-2045(12)70274-7.
  7. 7.
    te Winkel ML, Pieters R, Hop WCJ, de Groot-Kruseman HA, Lequin MH, van der Sluis IM et al (2011) Prospective study on incidence, risk factors, and long-term outcome of osteonecrosis in pediatric acute lymphoblastic leukemia. J Clin Oncol. doi: 10.1200/jco.2011.37.3217 Google Scholar
  8. 8.
    Warris LT, van den Heuvel-Eibrink MM, den Hoed MAH, Aarsen FK, Pieters R, van den Akker ELT (2014) Does dexamethasone induce more neuropsychological side effects than prednisone in pediatric acute lymphoblastic leukemia? A systematic review. Pediatr Blood Cancer 61(7):1313–8. doi: 10.1002/pbc.24988 CrossRefPubMedGoogle Scholar
  9. 9.
    Hart CN, Palermo TM, Rosen CL, Hart CN, Palermo TM, Rosen CL (2005) Health-related quality of life among children presenting to a pediatric sleep disorders clinic. Behav Sleep Med 3(1):4–17CrossRefPubMedGoogle Scholar
  10. 10.
    Buckhalt J, El-Sheikh M, Keller P (2007) Children’s sleep and cognitive functioning: Race and socioeconomic status as moderators of effects. Child Dev 78:213–31CrossRefPubMedGoogle Scholar
  11. 11.
    Lavigne J, Arend R, Rosenbaum D, Smith A, Weissbluth M, Binns H (1999) Sleep and behavior problems among preschoolers. J Dev Behav Pediatr 20:164–9CrossRefPubMedGoogle Scholar
  12. 12.
    Smaldone A, Honig J, Byrne M (2007) Sleepless in America: inadequate sleep and relationships to health and well-being of our nation’s children. Pediatrics 119(Supplement 1):S29–S37CrossRefPubMedGoogle Scholar
  13. 13.
    Meltzer LJ, Mindell JA (2007) Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: a pilot study. J Fam Psychol 21(1):67–73. doi: 10.1037/0893-3200.21.1.67 CrossRefPubMedGoogle Scholar
  14. 14.
    Moldofsky H (1995) Sleep and the immune system. Int J Immunopharmacol 17(8):649–54CrossRefPubMedGoogle Scholar
  15. 15.
    Everson CA (1993) Sustained sleep deprivation impairs host defense. Am J Physiol 265(5 Pt 2):R1148–54PubMedGoogle Scholar
  16. 16.
    Hui L, Hua F, Diandong H, Hong Y, Hui L, Hua F et al (2007) Effects of sleep and sleep deprivation on immunoglobulins and complement in humans. Brain Behav Immun 21(3):308–10CrossRefPubMedGoogle Scholar
  17. 17.
    Lewandowski AS, Toliver-Sokol M, Palermo TM (2011) Evidence-based review of subjective pediatric sleep measures. J Pediatr Psychol 36(7):780–93. doi: 10.1093/jpepsy/jsq119 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Drigan R, Spirito A, Gelber RD (1992) Behavioral effects of corticosteroids in children with acute lymphoblastic leukemia. Med Pediatr Oncol 20(1):13–21. doi: 10.1002/mpo.2950200104 CrossRefPubMedGoogle Scholar
  19. 19.
    Harris JC, Carel CA, Rosenberg LA, Joshi P, Leventhal BG (1986) Intermittent high dose corticosteroid treatment in childhood cancer: behavioral and emotional consequences. J Am Acad Child Psychiatry 25(1):120–4, doi: 10.1016/S0002-7138(09)60608-7 CrossRefPubMedGoogle Scholar
  20. 20.
    Hinds PS, Hockenberry MJ, Gattuso JS, Srivastava DK, Tong X, Jones H et al (2007) Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia. Cancer 110(10):2321–30CrossRefPubMedGoogle Scholar
  21. 21.
    Rosen G, Harris AK, Liu M, Dreyfus J, Krueger J, Messinger YH. The effects of dexamethasone on sleep in young children with acute lymphoblastic leukemia. Sleep Med. 2015;16(4):503–9. doi: 10.1016/j.sleep.2014.11.002.
  22. 22.
    Sung L, Yanofsky R, Klaassen RJ, Dix D, Pritchard S, Winick N et al (2011) Quality of life during active treatment for pediatric acute lymphoblastic leukemia. Int J Cancer 128(5):1213–20. doi: 10.1002/ijc.25433 CrossRefPubMedGoogle Scholar
  23. 23.
    Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A, American Academy of Sleep Medicine (2006) Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep 29(10):1263–76PubMedGoogle Scholar
  24. 24.
    Hollingshead A (1975) Four factor index of social statusGoogle Scholar
  25. 25.
    Barratt W. The Barratt simplified measure of social status measuring SES. Indiana State University. 2006.
  26. 26.
    Owens JA, Spirito A, McGuinn M (2000) The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 23(8):1043–51PubMedGoogle Scholar
  27. 27.
    Acebo C, Sadeh A, Seifer R, Tzischinsky O, Hafer A, Carskadon MA (2005) Sleep/wake patterns derived from activity monitoring and maternal report for healthy 1- to 5 year-old children. Sleep 28:1568–77PubMedGoogle Scholar
  28. 28.
    Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P (2002) The PedsQL™ in pediatric cancer. Cancer 94(7):2090–106. doi: 10.1002/cncr.10428 CrossRefPubMedGoogle Scholar
  29. 29.
    Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–91CrossRefPubMedGoogle Scholar
  30. 30.
    Buckhalt JA, El-Sheikh M, Keller P (2007) Children’s sleep and cognitive functioning: race and socioeconomic status as moderators of effects. Child Dev 78(1):213–31. doi: 10.1111/j.1467-8624.2007.00993.x CrossRefPubMedGoogle Scholar
  31. 31.
    Sadeh A, Gruber R, Raviv A (2002) Sleep, neurobehavioral functioning, and behavior problems in school-age children. Child Dev 73(2):405–17. doi: 10.1111/1467-8624.00414 CrossRefPubMedGoogle Scholar
  32. 32.
    Gregory AM, Caspi A, Eley TC, Moffitt TE, O’Connor TG, Poulton R (2005) Prospective longitudinal associations between persistent sleep problems in childhood and anxiety and depression disorders in adulthood. J Abnorm Child Psychol 33(2):157–63CrossRefPubMedGoogle Scholar
  33. 33.
    Shanahan L, Copeland WE, Angold A, Bondy CL, Costello EJ. Sleep problems predict and are predicted by generalized anxiety/depression and oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 2014;53(5):550–8. doi: 10.1016/j.jaac.2013.12.029.
  34. 34.
    Fauci A (1976) Mechanisms of corticosteroid action on lymphocyte subpopulations. II. Differential effects of in vivo hydrocortisone, prednisone and dexamethasone on in vitro expression of lymphocyte function. Clin Exp Immunol 24(1):54PubMedPubMedCentralGoogle Scholar
  35. 35.
    Sayers G, Travis R (1970) Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs. The pharmacological basis of therapeutics. Macmillan, New York, pp 1604–42Google Scholar
  36. 36.
    Moghadam-Kia S, Werth VP (2010) Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol 49(3):239–48. doi: 10.1111/j.1365-4632.2009.04322.x CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Born J, DeKloet ER, Wenz H, Kern W, Fehm HL (1991) Gluco- and antimineralocorticoid effects on human sleep: a role of central corticosteroid receptors. Am J Physiol Endocrinol Metab 260(2):E183–E8Google Scholar
  38. 38.
    Fehm H, Benkowitsch R, Kern W, Fehm-Wolfsdorf G, Pauschinger P, Born J (1986) Influences of corticosteroids, dexamethasone and hydrocortisone on sleep in humans. Neuropsychobiology 16(4):198–204CrossRefPubMedGoogle Scholar
  39. 39.
    Feinberg M, Carroll B, King D, Greden J (1984) The effect of dexamethasone on sleep: preliminary results in eleven patients. Biol Psychiatry 19(5):771–5PubMedGoogle Scholar
  40. 40.
    Vallance K, Yang J, Li J, Crabtree VM, Hinds PS, Mandrell BN (2011) Disturbed sleep in pediatric patients with leukemia: the potential role of interleukin-6 (−174GC) and tumor necrosis factor (−308GA) polymorphism. Oncol Nurs Forum 38(5):E365–72CrossRefPubMedGoogle Scholar
  41. 41.
    Wolfson A, Lacks P, Futterman A (1992) Effects of parent training on infant sleeping patterns, parents’ stress, and perceived parental competence. J Consult Clin Psychol 60(1):41–8CrossRefPubMedGoogle Scholar
  42. 42.
    Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L et al (2015) National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health 1(1):40–3. doi: 10.1016/j.sleh.2014.12.010 CrossRefGoogle Scholar
  43. 43.
    Boergers J, Koinis-Mitchell D (2010) Sleep and culture in children with medical conditions. J Pediatr Psychol 35(9):915–26. doi: 10.1093/jpepsy/jsq016 CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Owens JA, Dalzell V. Use of the ‘BEARS’ sleep screening tool in a pediatric residents’ continuity clinic: a pilot study. Sleep Med. 2005;6(1):63–9. doi: 10.1016/j.sleep.2004.07.015.

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Lauren C. Daniel
    • 1
    Email author
  • Yimei Li
    • 1
    • 2
  • Jacqueline D. Kloss
    • 3
  • Anne F. Reilly
    • 1
    • 2
  • Lamia P. Barakat
    • 1
    • 2
  1. 1.Division of OncologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Perelman School of Medicine of the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of PsychologyDrexel UniversityPhiladelphiaUSA

Personalised recommendations