title: A Sleep Hygiene and Relaxation Intervention for Children With Acute Lymphoblastic Leukemia: A Pilot Randomized Controlled Trial.
abstract: BACKGROUND
  Sleep disturbance and fatigue are common and distressing pediatric cancer-related outcomes. Sleep hygiene education and relaxation techniques are recommended to improve sleep in healthy children and adult cancer survivors. No studies have tested these interventions to improve sleep and fatigue for children with acute lymphoblastic leukemia (ALL) in the home setting.
  
  
  OBJECTIVE
  The aim of this study is to establish the feasibility and acceptability of a sleep hygiene and relaxation intervention to improve sleep and fatigue for children receiving maintenance chemotherapy for ALL. The child's fatigue and sleep data were collected to inform sample size calculations for a future trial.
  
  
  METHODS
  In this pilot randomized controlled trial, 20 children were allocated randomly to the sleep intervention or control group. The sleep intervention group received a 60-minute educational session to discuss sleep and fatigue in children with cancer and strategies to improve sleep, including use of 2 storybooks to teach deep breathing and progressive muscle relaxation. Objective sleep data were collected using actigraphy and fatigue was measured using the Childhood Cancer Fatigue Scale.
  
  
  RESULTS
  The intervention was acceptable to families, and feasibility of the intervention and data collection was clearly established. Although not statistically significant, increases in mean nighttime sleep and decreases in mean wake time after sleep onset in the sleep intervention group represented clinically important improvements.
  
  
  CONCLUSIONS
  This pilot study demonstrated the feasibility and acceptability of a sleep hygiene and relaxation intervention for children undergoing maintenance chemotherapy for ALL.
  
  
  CONCLUSIONS
  Given the clinically important improvements in sleep observed, replication in a larger, adequately powered randomized controlled trial is merited.
authors.affiliation: Author Affiliations: Division of Haematology/Oncology (SickKids) (Mss Zupanec and Jones) and Division of Neurosurgery, Neurology, & Trauma (Ms McRae), The Hospital for Sick Children (SickKids); Faculty of Health Sciences, University of Ontario Institute of Technology (Dr Papaconstantinou), Oshawa; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada (Ms Weston and Dr Stremler).
authors.forename: Sue
authors.initials: S
authors.lastname: Zupanec
authors.forename: Heather
authors.initials: H
authors.lastname: Jones
authors.forename: Lyndsey
authors.initials: L
authors.lastname: McRae
authors.forename: Efrosini
authors.initials: E
authors.lastname: Papaconstantinou
authors.forename: Julie
authors.initials: J
authors.lastname: Weston
authors.forename: Robyn
authors.initials: R
authors.lastname: Stremler
mesh_terms: D002170:Canada; D002648:Child; D002675:Child, Preschool; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000523:psychology*; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D012064:Relaxation Therapy / Q000592:standards*; D000070263:Sleep Hygiene / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000209:etiology