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

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Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

ALL:

acute lymphoblastic leukemia

CSHQ:

Children’s Sleep Habits Questionnaire

HRQL:

health-related quality of life

MFS:

Multidimensional Fatigue Scale

PedsQL:

Pediatric Quality of Life Inventory

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Division of Oncology, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd., CTRB 10-300, Philadelphia, PA, 19104, USA

    Lauren C. Daniel, Yimei Li, Anne F. Reilly & Lamia P. Barakat

  2. Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA

    Yimei Li, Anne F. Reilly & Lamia P. Barakat

  3. Department of Psychology, Drexel University, Philadelphia, PA, USA

    Jacqueline D. Kloss

Authors
  1. Lauren C. Daniel
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  2. Yimei Li
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Corresponding author

Correspondence to Lauren C. Daniel.

Ethics declarations

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).

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Daniel, L.C., Li, Y., Kloss, J.D. et al. The impact of dexamethasone and prednisone on sleep in children with acute lymphoblastic leukemia. Support Care Cancer 24, 3897–3906 (2016). https://doi.org/10.1007/s00520-016-3234-y

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  • DOI: https://doi.org/10.1007/s00520-016-3234-y

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