The impact of dexamethasone and prednisone on sleep in children with acute lymphoblastic leukemia.
Corticosteroids can affect sleep patterns, mood, and behavior. Two of the most commonly prescribed corticosteroids in acute lymphoblastic leukemia (ALL), dexamethasone and prednisone, may impact sleep differently, but no research has compared these medications in children. The current study tested the hypothesis that dexamethasone and prednisone differentially affect sleep in children with ALL to understand how these medications contribute to health-related quality of life (HRQL).



Parents of 81 children 3-12 years old in maintenance therapy for ALL completed a baseline measure of child sleep (dexamethasone n = 55, prednisone n = 26), and 61 parents returned 28 days of child sleep diaries starting the first day of a 5-day steroid course (dexamethasone n = 43, prednisone n = 18). Parents also completed measures of HRQL and fatigue on the last day of steroids and the last day of the month.



At baseline, parents reported more sleep disturbances in children taking dexamethasone than prednisone. Across the month, children taking dexamethasone experienced poorer sleep quality compared to children taking prednisone. During corticosteroid treatment, children taking dexamethasone also experienced more night awakenings than children taking prednisone. Sleep variables accounted for almost half of the variance in HRQL during time off steroids and also significantly contributed to fatigue during the corticosteroids course and time off corticosteroids.



Sleep is an essential component of HRQL in children taking corticosteroids, and the impact on sleep is more pronounced in children taking dexamethasone compared to prednisone. Screening for sleep disturbances and offering brief interventions to manage steroid-related sleep disruptions may improve HRQL.
Division of Oncology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., CTRB 10-300, Philadelphia, PA, 19104, USA. daniell@email.chop.edu.
Lauren C
LC
Daniel
Division of Oncology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., CTRB 10-300, Philadelphia, PA, 19104, USA.|Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
Yimei
Y
Li
Department of Psychology, Drexel University, Philadelphia, PA, USA.
Jacqueline D
JD
Kloss
Division of Oncology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., CTRB 10-300, Philadelphia, PA, 19104, USA.|Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
Anne F
AF
Reilly
Division of Oncology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., CTRB 10-300, Philadelphia, PA, 19104, USA.|Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
Lamia P
LP
Barakat
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000473:pathology; D011241:Prednisone / Q000627:therapeutic use*; D011788:Quality of Life; D012890:Sleep / Q000187:drug effects*; D012893:Sleep Wake Disorders / Q000209:etiology*
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D011241:Prednisone
Acute lymphoblastic leukemia; Corticosteroid; Quality of life; Sleep