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Au CT, Voutsas G, Katz SL, Chan A, Narang I. Poor sleep quality and its associated neurocognitive function in children with obesity with or without obstructive sleep apnea. Sleep Breath 2024; 28:477-487. [PMID: 37490247 DOI: 10.1007/s11325-023-02886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/14/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To evaluate the associations of OSA severity, snoring symptoms, subjective sleep quality, and daytime sleepiness with executive functioning and behaviors in children with obesity. METHODS This was a cross-sectional study of children aged 8-18 years with obesity and symptoms suggestive of OSA. All participants underwent an overnight polysomnography and completed a set of questionnaires to assess their sleep-related breathing disordered (SRBD) symptoms [Pediatric Sleep Questionnaire (SRBD-PSQ)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], executive function [Behavior Rating Inventory of Executive Function (BRIEF)], and inattention and hyperactivity symptoms (Conners-3 Parent Short Form). RESULTS A total of 85 children (62% male, mean age: 13.9 ± 3.0 years) were included in this analysis, of whom 36, 16, and 33 were categorized into the non-OSA (obstructive apnea hypopnea index, OAHI < 1.5/h), mild OSA (OAHI 1.5-5/h), and moderate-severe OSA (OAHI ≥ 5/h) groups, respectively. Of 85 participants, 27 (32%) were classified with poor sleep quality (PSQI composite score ≥ 8). From multiple linear regression analyses, poor sleep quality and sleepiness were both independently associated with higher BRIEF behavioral regulation T-score, metacognition T-score, and global executive composite T-score in the fully adjusted model. In addition, poor sleep quality was also independently associated with higher Conners-3 inattention and executive functioning T-scores, while greater sleepiness was also associated with a higher learning problem T-score. The presence of OSA and snoring were not associated with any cognitive outcomes. CONCLUSIONS Subjective sleep quality and daytime sleepiness, but not OSA severity and snoring symptoms, were independently associated with executive functioning and behavioral problems in children with obesity.
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Affiliation(s)
- Chun Ting Au
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giorge Voutsas
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Sherri Lynne Katz
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Amy Chan
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Indra Narang
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
- University of Toronto, Toronto, Ontario, Canada.
- Division of Respiratory Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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Hardy KK, Kairalla JA, Gioia AR, Weisman HS, Gurung M, Noll RB, Hinds PS, Hibbitts E, Salzer WL, Burke MJ, Winick NJ, Embry L. Impaired neurocognitive functioning 3 months following diagnosis of high-risk acute lymphoblastic leukemia: A report from the Children's Oncology Group. Pediatr Blood Cancer 2023; 70:e30350. [PMID: 37129114 PMCID: PMC10205681 DOI: 10.1002/pbc.30350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer diagnosis. Cognitive late effects develop in 20%-40% of ALL survivors, but the course of declines is unclear. The aim of this paper is to characterize cognitive functioning, and its association with patient-reported outcomes, early in treatment. PATIENTS AND METHODS A total of 483 children with high-risk ALL, aged 6-12 years at diagnosis, consented to the neurocognitive study embedded in a prospective therapeutic trial, Children's Oncology Group (COG) AALL1131. A computerized neurocognitive battery (Cogstate) was administered 3 months post diagnosis assessing reaction time, visual attention, working memory, visual learning, and executive functioning. Parent-reported executive functioning and patient-reported physical symptoms were also collected. RESULTS Data from 390 participants (mean age at diagnosis = 9.2 years, 55.4% male) were obtained. Relatively few patients reported pain (16.0%) or nausea (22.6%), but a majority (68.5%) reported feeling at least some fatigue at testing. Mean Cogstate Z-scores were within normal limits across tasks; however, rates of impairment (Z-scores ≤ -1.5) for reaction time, working memory, visual learning, and visual attention were all higher than expected compared to the standardization sample. Patients reporting fatigue were significantly more likely to have impaired reaction time and visual attention compared to those reporting no fatigue. CONCLUSION Findings support feasibility of computerized cognitive assessments and suggest higher-than-expected rates of impaired cognitive performance early during treatment for pediatric ALL, notably within 3 months of diagnosis, suggesting intervention efforts may be indicated. These results also highlight acute factors that may impact reliability of "baseline" assessments conducted soon after diagnosis.
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Affiliation(s)
- Kristina K Hardy
- Children's National Hospital, Washington, District of Columbia, USA
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | | | | | | | - Meera Gurung
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Robert B Noll
- University of Pittsburgh Department of Pediatrics, Pittsburgh, Pennsylvania, USA
| | - Pamela S Hinds
- Children's National Hospital, Washington, District of Columbia, USA
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | | | - Wanda L Salzer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Naomi J Winick
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leanne Embry
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Chahin S, Morse M, Qaddoumi I, Phipps S, Crabtree VM, Brennan RC, Wilson MW, Rodriguez-Galindo C, Russell KM, Parris K, Goode K, Willard VW. An exploratory study of sleep habits in school-aged survivors of retinoblastoma. Sleep Med 2023; 103:123-130. [PMID: 36780752 PMCID: PMC10006349 DOI: 10.1016/j.sleep.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE/BACKGROUND Retinoblastoma is an ocular cancer diagnosed in early childhood. Previous research has indicated the impact of cancer treatment on sleep, but little is known about how sleep is impacted among survivors of retinoblastoma. The current study aimed to describe sleep habits of school-age survivors of retinoblastoma, to examine associations between sleep and quality of life, and to examine concordance between parent and child reports of sleep habits. PATIENTS/METHODS Sixty-nine survivors of retinoblastoma (Mage = 10.89, SD = 1.07, 50.7% female; 56.5% unilateral disease) and their caregivers participated, providing information on both self- and parent-reported sleep habits, quality of life, and demographic data. RESULTS Greater sleep concerns than national norms were reported by parents (bedtime resistance (t(58) = 2.69, p = .009), greater sleep onset delay (t(66) = 2.46, p = .017), shorter sleep duration (t(57) = 2.12, p = .038), increased daytime sleepiness (t(53) = 6.45, p= <.001)) and children (sleep location (t(61) = 2.39, p = .02), restless legs syndrome (t(62) = -2.21, p = .03), parasomnias (t(64) = 19.19, p=<.001)) . Both children and parents of children who received enucleation endorsed greater sleep concerns across several domains (e.g., electronic use before bed, sleep-disordered breathing). Child- and parent-reported sleep concerns were generally associated with decreased quality of life. Finally, child- and parent-report of sleep habits appeared generally consistent. CONCLUSIONS Survivors of retinoblastoma experience sleep difficulties. As such, assessment and targeted intervention is important to mitigate any effects on quality of life. Future research should examine sleep habits of survivors of retinoblastoma across cultures and developmental periods.
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Affiliation(s)
- Summer Chahin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melanie Morse
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Global Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Rachel C Brennan
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew W Wilson
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Ophthalmology, University of Tennessee, Memphis, TN, USA
| | | | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kendra Parris
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kristin Goode
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Victoria W Willard
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Vyhlídal T, Dygrýn J, Chmelík F. Actigraphy-Based Characteristics of Sleep in Paediatric Cancer Patients in Remission and a Comparison with Their Healthy Peers in the Recovery Stay. Nat Sci Sleep 2022; 14:1449-1456. [PMID: 36045915 PMCID: PMC9423104 DOI: 10.2147/nss.s374234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous research has demonstrated that paediatric cancer survivors (PCS) have lower sleep quality than their healthy peers. However, the research to date has focused mainly on self-reported data. Therefore, the aim of this cross-sectional study was to characterise selected sleep parameters in PCS using objective monitoring techniques and to compare them with a control group (CG) of their healthy peers during a structured recovery stay. A specific objective was to characterise sleep with respect to gender, age, and cancer type. METHODS 26 PCS and 38 CG aged 7-15 years participated in the study. Selected sleep indicators (time in bed, total sleep time, sleep efficiency) were objectively assessed with an Actigraph wGT3X-BT accelerometer for 12 days during the recovery stay. RESULTS No significant differences were found between the PCS and CG groups in terms of the selected sleep parameters. The total time in bed was 543.1 min/day in the PCS and 537.2 min/day in the CG (p=0.91). The total sleep time was 455.3 min/day in the PCS and 457.5 min/day in the CG (p=0.57). Sleep efficiency was 85.3% in the PCS and 86.3% in the CG (p=0.36). Sleep efficiency >85% was achieved by 62% of the PCS (n=16) and 68% of the CG (n=26). There were no significant differences in sleep parameters in terms of variables such as gender, age, or cancer type. CONCLUSION The results of our study suggest that - under the same conditions - the PCS did not differ from their healthy peers in terms of the indicators of time in bed, total sleep time, and sleep efficiency. No significant differences according to age, gender, or cancer type were found.
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Affiliation(s)
- Tomáš Vyhlídal
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| | - Jan Dygrýn
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| | - František Chmelík
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
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Wrist actigraphic approach in primary, secondary and tertiary care based on the principles of predictive, preventive and personalised (3P) medicine. EPMA J 2021; 12:349-363. [PMID: 34377218 PMCID: PMC8342270 DOI: 10.1007/s13167-021-00250-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
Abstract Sleep quality and duration as well as activity-rest-cycles at individual level are crucial for maintaining physical and mental health. Although several methods do exist to monitor these parameters, optimal approaches are still under consideration and technological development. Wrist actigraphy is a non-invasive electro-physical method validated in the field of chronobiology to record movements and to allow for monitoring human activity-rest-cycles. Based on the continuous recording of motor activity and light exposure, actigraphy provides valuable information about the quality and quantity of the sleep–wake rhythm and about the amount of motor activity at day and night that is highly relevant for predicting a potential disease and its targeted prevention as well as personalisation of medical services provided to individuals in suboptimal health conditions and patients. Being generally used in the field of sleep medicine, actigraphy demonstrates a great potential to be successfully implemented in primary, secondary and tertiary care, psychiatry, oncology, and intensive care, military and sports medicines as well as epidemiological monitoring of behavioural habits as well as well-being medical support, amongst others. Prediction of disease development and individual outcomes Activity-rest-cycles have been demonstrated to be an important predictor for many diseases including but not restricted to the development of metabolic, psychiatric and malignant pathologies. Moreover, activity-rest-cycles directly impact individual outcomes in corresponding patient cohorts. Targeted prevention Data acquired by actigraphy are instrumental for the evidence-based targeted prevention by analysing individualised patient profiles including light exposure, sleep duration and quality, activity-rest-cycles, intensity and structure of motion pattern. Personalised therapy Wrist actigraphic approach is increasingly used in clinical care. Personalised measurements of sedation/agitation rhythms are useful for ICU patients, for evaluation of motor fatigue in oncologic patients, for an individual enhancement of performance in military and sport medicine. In the framework of personalised therapy intervention, patients can be encouraged to optimise their behavioural habits improving recovery and activity patterns. This opens excellent perspectives for the sleep-inducing medication and stimulants replacement as well as for increasing the role of participatory medicine by visualising and encouraging optimal behavioural patterns of the individual.
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