Sleep disturbances in children receiving short-term, high-dose glucocorticoid therapy for acute lymphoblastic leukemia

The purpose of this time series, case control study was to explore the existence of sleep disturbances in children receiving short-term, high-dose glucocorticoid therapy for treatment of acute lymphoblastic leukemia. The conceptual framework that guided the study was derived from Roy's Adaptation Model.

The sample consisted of 5 subjects, aged 7 to 11 years, who were being treated for acute lymphoblastic leukemia with chemotherapy including prednisone, on Pediatric Oncology Group Protocol 9605. The subjects were primarily female (60%) and hispanic (60%). Each subject served as his or her own control.

The instrument used to measure activity during sleep was the AMA-32 Motionlogger TM actigraph (Ambulatory Monitoring, Inc.), which was worn on the dominant wrist of the child for 14 consecutive days during data collection. The correlation codimension, C was calculated to measure the intermittency of activity during sleep. Paired t-tests were used to analyze the mean difference of time spent in sleep, and the mean intermittency of activity during sleep for the 7 days before prednisone therapy and the 7 days during prednisone therapy.

The findings revealed that the subjects demonstrated significantly less intermittency of activity during sleep during the 7 days prednisone therapy was given (t(4) = 2.79, p < .02). This finding suggested that sleep patterns were disturbed when compared to the previous 7 days when prednisone therapy was not being given. However, the amount of time spent sleeping was not significantly different between the 2 weeks (t(4) = 0.185, p < .85), both before and during prednisone therapy.

Implications from this study include the importance of educating pediatric oncology patients and their families. Parents and children need to know what to expect when taking prescribed medication as part of cancer treatment. Physiologic adaptation to prednisone pulse therapy does not occur, therefore the nurse may facilitate psychological adaptation in these patients by providing anticipatory guidance and education regarding methods of increasing total daily sleep.