title: Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia.
abstract: BACKGROUND
  Dexamethasone improves the cure rate of childhood acute lymphoblastic leukemia (ALL) but causes physical and behavioral adverse events. The objective of the current study was to determine the effect of dexamethasone exposure on sleep and fatigue in pediatric patients with ALL.
  
  
  METHODS
  One hundred pediatric patients with low-risk or standard-risk ALL were enrolled on 1 of 3 protocols (St. Jude Total XV, Children's Oncology Group [COG] 9904, or COG 9905) at 3 institutions. The mean age of the cohort was 9.24 +/- 3.23 years (range, 5.03-18.14 years). The majority of patients were white (79%) males (62%) with standard-risk ALL (63%). The cohort was divided into 4 subgroups: St. Jude low-risk, St. Jude standard-risk, COG low-risk, and COG standard-risk. Patients wore a wrist actigraph to monitor sleep activity during 2 consecutive 5-day periods: During the first period, they did not receive dexamethasone; and, during the second period, they did. Patients and their parents completed fatigue instruments on Days 2 and 5 of each period, and parents completed sleep diaries.
  
  
  RESULTS
  Actual sleep minutes, sleep duration, total daily nap minutes, and fatigue increased significantly during the dexamethasone treatment for 3 to 4 of the subgroups. Total daily nap minutes increased significantly for both standard-risk groups during the dexamethasone treatment. Parents reported significant increases in their child's nighttime awakenings, restless sleep, and nap time during dexamethasone treatment.
  
  
  CONCLUSIONS
  Dexamethasone treatment during continuation therapy for childhood ALL significantly and adversely altered sleep and fatigue, confirming that sleep and fatigue are behavioral responses to dexamethasone.
authors.affiliation: Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. pam.hinds@stjude.org
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Hinds
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Hockenberry
authors.forename: Jami S
authors.initials: JS
authors.lastname: Gattuso
authors.forename: Deo Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.forename: Xin
authors.initials: X
authors.lastname: Tong
authors.forename: Heather
authors.initials: H
authors.lastname: Jones
authors.forename: Nancy
authors.initials: N
authors.lastname: West
authors.forename: Kathy S
authors.initials: KS
authors.lastname: McCarthy
authors.forename: Avi
authors.initials: A
authors.lastname: Sadeh
authors.forename: Monica
authors.initials: M
authors.lastname: Ash
authors.forename: Cheryl
authors.initials: C
authors.lastname: Fernandez
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D005221:Fatigue / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000503:physiopathology; D012890:Sleep / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents; D003907:Dexamethasone