title: Physical activity (PA) and sleep among children and adolescents with cancer.
abstract: BACKGROUND
  Although sleep and physical activity often are impaired among adult cancer patients, there is limited data among pediatric oncology populations. We conducted a prospective study to investigate the relationship between physical activity (PA) and sleep among children with cancer.
  
  
  METHODS
  Between 11/12/09 and 02/06/12, PA while awake and sleep variables were assessed by actigraphy collected over 7 days in 36 children (age range 8-18 years) with cancer (23 leukemia/lymphoma, 5 brain tumor, 8 solid tumor). Sleep diaries were used to determine sleep time, sleep quality, and morning mood. Fatigue was assessed at study initiation using fatigue instruments.
  
  
  RESULTS
  Participants had impaired sleep based upon normative data compiled from multiple studies of more than 1,700 healthy children from 1 to 18 years of age [1], including decreased total sleep time (mean 6.6 hours, standard deviation (SD) 1.3 hours), increased wake after sleep onset (WASO; mean 2 hours, SD 1.4 hours), increased awakenings during sleep (mean 28.3 wake bouts, SD 7.8 bouts), and decreased sleep efficiency (mean 74.2%, SD 13.3%). Fatigue correlated with self-reported sleep quality but not with disturbances in sleep as measured by actigraphy. In longitudinal models that controlled for age, diagnosis group, gender, race, and steroid use, higher average activity, as measured by actigraphy, was associated with improved sleep quantity (P = 0.005) and efficiency (P = 0.001).
  
  
  CONCLUSIONS
  Pediatric oncology patients demonstrate impaired sleep. Greater PA was significantly associated with improved sleep quantity and efficiency in pediatric oncology participants. As a potentially modifiable factor, PA may offer a mechanism to improve sleep in pediatric oncology patients.
authors.affiliation: Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, Hartford, Connecticut; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Orsey
authors.forename: Dorothy B
authors.initials: DB
authors.lastname: Wakefield
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Cloutier
mesh_terms: D056044:Actigraphy; D000293:Adolescent; D002648:Child; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D009369:Neoplasms / Q000150:complications*; D012890:Sleep
keywords: actigraphy; pediatric oncology; physical activity; sleep