Effects of sleep disturbance on neuropsychological functioning in patients with pediatric brain tumor.

Jenna A Chiang,Paulina T Feghali,Ashley M Whitaker,Anita Saavedra

doi:10.1007/s11060-022-03954-4

Abstract

While the effects of sleep on cognition in typically developing children are well established, there is a paucity of research in patients with pediatric brain tumor (PBT), despite their increased risk for sleep-related disturbances. The aim of this retrospective study was to examine the impact of sleep factors on patient-reported outcome (PRO) measures, including adaptive and executive functioning within this population. 133 patients with PBT (52% male) ages 5-23 (x̄ = 12.8years;SD = 4.5years) underwent neuropsychological evaluation, including assessment of adaptive and executive functioning. Subjective sleep concerns, nocturnal sleep duration, and daytime sleep behavior were also collected and compared to age-based guidelines. Nearly 30% of patients endorsed subjective sleep concerns, while the sample as a whole reported reduced nocturnal sleep duration (approximately one hour below age-based recommendations). Despite the expectation for monophasic sleep by age five, nearly half of the sample reported consistent daytime napping. Inadequate sleep predicted decreased adaptive functioning, F(1, 56) = 4.23, p = .022 (R2 = .07), as well as increased symptoms of executive dysfunction, F(1, 108) = 3.51, p = .003 (R2 = .03). Patients with PBT demonstrate several aspects of abnormal sleep, which are associated with poorer long-term PROs. Further exploration of diagnostic, treatment-related, and demographic variables will be needed to better understand these relationships among patients with PBT in order to inform appropriate interventions.

Highlights

Sleep is an essential component to daily functioning and is necessary for multiple aspects of development, as well as energy conservation [1] and brain waste clearance [2]
Nearly 30% of patients reported subjective sleep concerns, while the sample as a whole presented with reduced nocturnal sleep duration
Patients with pediatric brain tumor (PBT) demonstrate several aspects of abnormal sleep, which are associated with poorer long-term patientreported outcome (PRO)

Summary

Introduction

Sleep is an essential component to daily functioning and is necessary for multiple aspects of development, as well as energy conservation [1] and brain waste clearance [2]. The consequences of insufficient sleep or reduced sleep duration in children have been associated with a wide range of adverse physical and mental health outcomes [5], as well as deficits in cognition [6,7,8,9,10], and executive functioning (EF; higher order thinking skills) in particular [9]. Increased risk and incidence of psychiatric disorders are observed [11, 12], as sleep and mental health appear to be bidirectional processes [13]. Sleep difficulties in children are associated with poorer quality of life and secondary familial effects (e.g., maternal stress) [14]. Sex and race/ethnicity are important factors to examine as well, considering prior studies reveal that girls consistently demonstrate greater sleep duration and shorter sleep latency (i.e., amount of time to fall asleep) than boys [15], while ethnic/racial minority [16] is identified as a risk factor for disrupted sleep

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