The impact of dexamethasone and prednisone on sleep in children with acute lymphoblastic leukemia
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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.
KeywordsSleep 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.
The authors have no financial relationships relevant to this article to disclose.
This study is supported by a grant from the American Cancer Society PF-13-238-01-PCSM (PI: Daniel).
- 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
- 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:http://dx.doi.org/ 10.1016/S1470-2045(12)70274-7.
- 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
- 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:http://dx.doi.org/ 10.1016/j.sleep.2014.11.002.
- 24.Hollingshead A (1975) Four factor index of social statusGoogle Scholar
- 25.Barratt W. The Barratt simplified measure of social status measuring SES. Indiana State University. 2006. http://wbarratt.indstate.edu/socialclass
- 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:http://dx.doi.org/ 10.1016/j.jaac.2013.12.029.
- 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
- 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
- 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:http://dx.doi.org/ 10.1016/j.sleep.2004.07.015.