title: Factors associated with sleep-wake disturbances in child and adult survivors of pediatric brain tumors: a review.
abstract: OBJECTIVE
  To identify factors associated with sleep-wake disturbances in pediatric and adult survivors (aged older than 18 years) of pediatric brain tumors.
  
  
  METHODS
  A computerized literature search was completed using MEDLINE, CINAHL, CancerLit, Dissertation Abstracts International, and PsycINFO. The search and a personal communication with one author discovered 25 English-language research articles and case reports describing sleep-wake patterns in brain tumor survivors from 1966-2008.
  
  
  RESULTS
  Disease- and treatment-related factors from direct injury to the hypothalamus results in irregular melatonin secretion and low hypocretin levels. This contributes to decreased daytime alertness, which remains the most reported sleep-wake disturbance in brain tumor survivors. Patients with craniopharyngiomas, radiation dose more than 3,500 cGy, and younger age at time of treatment experienced more severe sleep dysfunction.
  
  
  CONCLUSIONS
  Patients with brain tumors experience a disruption of sleep-wake patterns associated with major dysfunction in the hypothalamic-pituitary axis, affecting both Process S (homeostasis) and Process C (circadian) from the Two-Process Model of Sleep Regulation. Various demographic-, disease-, and treatment-related variables are involved in driving the onset of sleep disturbances. Interventions are needed to improve daytime function and decrease the effect of sleep disturbances on quality of life.
  
  
  CONCLUSIONS
  Current sleep literature has identified patterns of sleep disturbances in cross-sectional studies of brain tumor survivors. Rigorous longitudinal designs are needed for future studies to detect onset patterns and trajectory of sleep-wake disorders. Intervention studies are needed to impact excessive daytime sleepiness, irregular sleeping and waking patterns, and other identified sleep-wake disorders.
authors.affiliation: School of Nursing, University of Minnesota, Minneapolis, USA. rgapstur@emer-phys.com
authors.forename: Roxanna
authors.initials: R
authors.lastname: Gapstur
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Gross
authors.forename: Kirsten
authors.initials: K
authors.lastname: Ness
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000451:nursing*; D002648:Child; D006801:Humans; D009859:Oncology Nursing; D010371:Pediatric Nursing; D020178:Sleep Disorders, Circadian Rhythm / Q000209:etiology / Q000451:nursing*; D017741:Survivors