Publications by authors named "Valerie McLaughlin Crabtree"

45 Publications

Impact of sleep, neuroendocrine, and executive function on health-related quality of life in young people with craniopharyngioma.

Dev Med Child Neurol 2021 Mar 22. Epub 2021 Mar 22.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.

Aim: To examine the impact of clinical factors, cognitive deficits, and sleepiness on health-related quality of life (HRQoL) among young people with craniopharyngioma.

Method: Seventy-eight patients (67% White; 41 males, 37 females; mean age 10y 8mo, SD 3y 11mo, range 6-20y) with craniopharyngioma were assessed for tumor extent and diabetes insipidus. All patients underwent overnight polysomnography and multiple sleep latency tests after surgical resection. Executive functioning was assessed using parent-reported measures. Patients and their parents completed measures of HRQoL. None had a history of previous radiation therapy.

Results: Path analysis was used to test hypothesized relations while controlling for demographic and disease characteristics. Analyses revealed poorer parent-reported HRQoL among young people with greater executive functioning symptoms (estimate -0.83; p<0.001). Direct and indirect effects were found among diabetes insipidus, executive functioning, and parent-reported HRQoL. Diabetes insipidus directly predicted greater global executive functioning impairment (estimate 5.15; p=0.04) and indirectly predicted lower HRQoL through executive functioning impairment (estimate -4.25; p=0.049). No significant effects were found between excessive daytime sleepiness, tumor hypothalamic involvement, diabetes insipidus, executive functioning, and patient-reported HRQoL.

Interpretation: These findings suggest that young people with craniopharyngioma presenting with diabetes insipidus may benefit from targeted neurocognitive and psychosocial screening to inform interventions.
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March 2021

Never Enough Time: Mixed Methods Study Identifies Drivers of Temporal Demand That Contribute to Burnout Among Physicians Who Care for Pediatric Hematology-Oncology Patients.

JCO Oncol Pract 2021 Mar 15:OP2000754. Epub 2021 Mar 15.

Office of Quality and Patient Care, St Jude Children's Research Hospital, Memphis, TN.

Purpose: Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment because of chronic occupational stress. Approximately one third of pediatric hematology-oncology physicians experience burnout. The goal of this mixed methods study was to determine the prevalence and drivers of burnout among physicians caring for pediatric hematology-oncology patients at our institution.

Materials And Methods: This mixed methods, cross-sectional study was conducted at a large academic cancer center. Validated survey instruments were used to measure burnout, job demands, experience with patient safety events, and workplace culture. Quantitative data informed development of a semistructured interview guide, and physicians were randomly selected to participate in individual interviews. Interviews were transcribed and analyzed via content analysis based on a priori codes.

Results: The survey was distributed to 132 physicians, and 53 complete responses were received (response rate 40%). Of the 53 respondents, 15 (28%) met criteria for burnout. Experiencing burnout was associated with increased temporal demand. Twenty-six interviews were conducted. Qualitative themes revealed that frequent meetings, insufficient support staff, and workflow interruptions were key drivers of temporal demand and that temporal demand contributed to burnout through emotional exhaustion and reduced personal accomplishment.

Conclusion: Nearly one-third of participating physicians met criteria for burnout, and burnout was associated with increased temporal demand. Qualitative interviews identified specific drivers of temporal demand and burnout, which can be targeted for intervention. This methodology can be easily adapted for broad use and may represent an effective strategy for identifying and mitigating institution-specific drivers of burnout.
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March 2021

Psychosocial collaboration fosters connection in times of isolation.

J Psychosoc Oncol 2021 Mar 9:1-4. Epub 2021 Mar 9.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

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March 2021

Do Anxiety and Mood Vary among Disparate Sleep Profiles in Youth with Craniopharyngioma? A Latent Profile Analysis.

Behav Sleep Med 2021 Mar 4:1-12. Epub 2021 Mar 4.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennesse.

Introduction: Craniopharyngioma is a histologically benign brain tumor that arises in the suprasellar region affecting critical neurovascular structures including the hypothalamic-pituitary-adrenal axis and optic pathways. Children with craniopharyngioma often experience excessive daytime sleepiness which may be compounded by anxiety and depression. The current study investigated disparate sleep profiles to better understand psychological adjustment among children diagnosed with craniopharyngioma. Method: Actigraphs recorded nightly sleep data, including measures of sleep onset latency and wake after sleep onset, in a cohort of 80 youth between the ages of 2 and 20 years (median age = 9). Parent reports of behavioral and emotional functioning were included in the analysis. A latent profile analysis examined disparate sleep profiles, and a multinomial logistic regression examined differences of anxiety and depression among the sleep profiles. Results: The latent profile analysis revealed three sleep profiles: "variable sleepers" (48.3%), "consistently poor sleepers" (45.4%), and "night wakers" (6.4%). Consistently poor sleepers had lower rates of anxiety ( = .76; = .009) and depression ( = .81; = .003) than variable sleepers and had significantly lower rates of anxiety than night wakers ( = .52; = .05); all other differences were nonsignificant (s > .05). Discussion: Youth with craniopharyngioma who have nightly variations in sleep may have worse psychological functioning than those with more consistent, albeit poor, sleep patterns. Patients with craniopharyngioma who report variable sleep should be assessed for anxiety and depression to prevent and intervene on emotional difficulties that may be reciprocally related to sleep.
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March 2021

Behavioral sleep intervention to reduce bedsharing prior to stem cell transplant.

J Clin Sleep Med 2021 Feb;17(2):333-335

Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.

Study Objectives: Sleep disturbance is common in young children who are otherwise healthy and even more so in children with cancer. To address sleep disturbance in early childhood, caregivers may use bedsharing to reduce stress. Although bedsharing is not typically discouraged in children over the age of 1 year, it may present a safety and infection control concern for youth preparing for stem cell transplantation.

Methods: We highlight the successful application of evidence-based sleep interventions to eliminate bedsharing before admission to the stem cell transplantation unit through 3 case examples of patients who were 2 years of age or younger diagnosed with cancer and preparing for stem cell transplantation.

Results: The behavioral sleep interventions included sleep hygiene education, gradual fading, unmodified extinction, and graduated extinction.

Conclusions: When medically indicated and tailored to family preferences, behavioral interventions can effectively and efficiently eliminate bedsharing for young children preparing for stem cell transplantation.
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February 2021

Feasibility and Acceptability of Light Therapy to Reduce Fatigue in Adolescents and Young Adults Receiving Cancer-Directed Therapy.

Behav Sleep Med 2020 Aug 4:1-13. Epub 2020 Aug 4.

Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.

Objective/background: Fatigue is one of the most consistent and distressing symptoms reported by adolescent/young adult (AYA) oncology patients. Bright white light (BWL) is used to treat fatigue in adult oncology but has not been explored in AYA oncology patients. The purpose of the current study was to determine the feasibility and acceptability of BWL for AYA who were receiving cancer-directed therapy.

Participants: 51 AYA patients with newly diagnosed solid tumors, including lymphoma.

Methods: Participants were randomized to dim red light (DRL, n = 25) or BWL (n = 26) from devices retrofitted with adherence monitors for 30 minutes upon awakening daily for 8 weeks. Side effects were assessed via modified Systematic Assessment for Treatment-Emergent Effects (SAFTEE). Participants completed the PedsQL Multidimensional Fatigue Scale.

Results: Of patients approached, 73% consented and participated. Mean adherence was 57% of days on study with 30.68 average daily minutes of usage. BWL did not cause more extreme treatment-emergent effects over DRL. Patients in the BWL group demonstrated significant improvement on all fatigue outcomes by both self-report and parent proxy report, which was not observed in the DRL group.

Conclusions: This is the first study to evaluate the feasibility and acceptability of light therapy to reduce fatigue in AYA patients receiving cancer-directed therapy. These findings demonstrate the feasibility and acceptability of the intervention and provide preliminary evidence of the potential benefits of BWL, which warrants further study in a confirmatory efficacy Identifier Number: NCT02429063.
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August 2020

Predictors of narcolepsy and hypersomnia due to medical disorder in pediatric craniopharyngioma.

J Neurooncol 2020 Jun 28;148(2):307-316. Epub 2020 Apr 28.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.

Purpose: Several studies describe sleep-wake disturbances in pediatric craniopharyngioma, but none have determined the prevalence or associated predictors of excessive sleepiness in this group after diagnosis and prior to post-operative observation or adjuvant radiotherapy. In this study, we report sleep-wake disturbances in children and adolescents with craniopharyngioma and associated clinical and treatment variables.

Methods: After surgery and prior to radiotherapy or observation, pediatric patients (n = 110) with craniopharyngioma ≥ 3 years old completed a baseline sleep clinic evaluation by a pediatric sleep specialist, polysomnography (PSG) and next-day multiple sleep latency test (MSLT). MSLT was limited to those ≥ 6 years old. Logistic regression models were used to determine the relationship between patient characteristics and the presence and type of hypersomnia.

Results: Amongst patients completing PSG and MSLT, 80% had polygraphic evidence of excessive daytime sleepiness. Hypersomnia due to medical condition was diagnosed in 45% and narcolepsy in 35%. Overweight or obese patients were more likely to be diagnosed with hypersomnia (P = 0.012) or narcolepsy (P = 0.009). Grade 2 hypothalamic involvement (HI) at diagnosis was associated with the diagnosis of narcolepsy (P = 0.0008).

Conclusions: This study describes the prevalence and associated predictors of hypersomnia for patients with craniopharyngioma after surgical resection. HI was predictive of narcolepsy diagnosis, and a higher body mass index z-score was associated with hypersomnia due to medical condition and narcolepsy. We recommend that sleep assessment and intervention begin after surgical resection, especially in overweight or obese patients and those with extensive tumors.
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June 2020

A call to action for expanded sleep research in pediatric oncology: A position paper on behalf of the International Psycho-Oncology Society Pediatrics Special Interest Group.

Psychooncology 2020 03 3;29(3):465-474. Epub 2019 Nov 3.

St. Jude Children's Research Hospital, Department of Psychology, Memphis, Tennessee.

Sleep and circadian rhythms are closely related to physical and psychosocial well-being. However, sleep and circadian rhythm disruptions are often overlooked in children with cancer, as they are frequently considered temporary side effects of therapy that resolve when treatment ends. Yet, evidence from adult oncology suggests a bidirectional relationship wherein cancer and its treatment disrupt sleep and circadian rhythms, which are associated with negative health outcomes such as poor immune functioning and lower survival rates. A growing body of research demonstrates that sleep problems are prevalent among children with cancer and can persist into survivorship. However, medical and psychosocial outcomes of poor sleep and circadian rhythmicity have not been explored in this context. It is essential to increase our understanding because sleep and circadian rhythms are vital components of health and quality of life. In children without cancer, sleep and circadian disturbances respond well to intervention, suggesting that they may also be modifiable in children with cancer. We present this paper as a call to (a) incorporate sleep or circadian rhythm assessment into pediatric cancer clinical trials, (b) address gaps in understanding the bidirectional relationship between sleep or circadian rhythms and health throughout the cancer trajectory, and (c) integrate sleep and circadian science into oncologic treatment.
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March 2020

Sensitivity and Specificity of the Modified Epworth Sleepiness Scale in Children With Craniopharyngioma.

J Clin Sleep Med 2019 10;15(10):1487-1493

Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee.

Study Objectives: Children with craniopharyngioma are at risk for excessive daytime sleepiness (EDS). Multiple Sleep Latency Testing (MSLT) is the gold standard for objective evaluation of EDS; however, it is time and resource intensive. We compared the reliability, sensitivity, and specificity of the modified Epworth Sleepiness Scale (M-ESS) and MSLT in monitoring EDS in children with craniopharyngioma.

Methods: Seventy patients (ages 6 to 20 years) with craniopharyngioma completed the M-ESS and were evaluated by polysomnography and MSLT. Evaluations were made after surgery, if performed, and before proton therapy.

Results: MSLT revealed that 66 participants (81.8%) had EDS, as defined by a mean sleep latency (MSL) < 10 minutes, with only 28.8% reporting EDS on the M-ESS by using a cutoff score of 10. The M-ESS demonstrated adequate internal consistency and specificity (91.7%) but poor sensitivity (33.3%) with the established cutoff score of 10. A cutoff score of 6 improved the sensitivity to 64.8% but decreased the specificity to 66.7%.

Conclusions: Patients with craniopharyngioma are at high risk for EDS, as documented objectively on the MSLT, but they frequently do not recognize or accurately report their sleepiness. Future sleep studies should investigate whether specific items or alternative self- and parent-reported measures of sleepiness may have greater clinical utility in monitoring sleepiness in this population.
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October 2019

Actigraphy versus Polysomnography to Measure Sleep in Youth Treated for Craniopharyngioma.

Behav Sleep Med 2020 Sep-Oct;18(5):589-597. Epub 2019 Jul 14.

Department of Psychology, St. Jude Children's Research Hospital , Memphis, TN.

Objective/background: Youth with craniopharyngioma are at increased risk for excessive daytime sleepiness and narcolepsy. Polysomnography (PSG) is the gold standard for diagnosing sleep disorders, but is time-intensive, costly, and does not offer an in vivo measure of typical sleep routine. We determined the sensitivity, specificity, and accuracy of actigraphy compared with PSG in measuring nocturnal sleep in pediatric craniopharyngioma.

Participants: Fifty youth with craniopharyngioma (age 3-20 years) were assessed by overnight PSG and concurrent actigraphy after surgical resection and before proton therapy.

Methods: PSG and actigraphy data were synchronized utilizing an epoch-by-epoch comparison method. Sensitivity, specificity, and accuracy were calculated using measures of true wake, true sleep, false wake, and false sleep. Bland-Altman plots were conducted to further assess level of agreement.

Results: Actigraphy was 93% sensitive (true sleep [TS]) and 87% accurate (ability to detect TS and true wake) in measuring sleep versus wakefulness and was a reliable measure of sleep efficiency (SE) and sleep latency (SL). Specificity (true wake) was poor (55%) and total sleep time (TST) was underestimated by an average of 15.1 min. Wake after sleep onset (WASO) was overestimated by an average of 14.7 min.

Conclusions: Actigraphy was highly sensitive and accurate and was a reliable measure of SE and SL. Although there were differences in TST and WASO measurements by actigraphy and PSG, our findings provide the basis for future studies on the use of actigraphy to monitor treatment response to wakefulness-promoting medications in youth with craniopharyngioma who demonstrate excessive daytime sleepiness.
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September 2020

Reducing Compassion Fatigue in Inpatient Pediatric Oncology Nurses.

Oncol Nurs Forum 2019 05;46(3):338-347

St. Jude Children's Research Hospital.

Objectives: To develop an evidence-based compassion fatigue program and evaluate its impact on nurse-reported burnout, secondary traumatic stress, and compassion satisfaction, as well as correlated factors of resilience and coping behaviors.

Sample & Setting: The quality improvement pilot program was conducted with 59 nurses on a 20-bed subspecialty pediatric oncology unit at the St. Jude Children's Research Hospital in Memphis, Tennessee.

Methods & Variables: Validated measures of compassion fatigue and satisfaction (Professional Quality of Life Scale V [ProQOLV]), coping (Brief COPE), and resilience (Connor-Davidson Resilience Scale-2) were evaluated preprogram and at two, four, and six months postprogram, with resilience and coping style measured at baseline and at six months postprogram.

Results: Secondary traumatic stress scores significantly improved from baseline to four months. Select coping characteristics were significantly correlated with ProQOLV subscale scores.

Implications For Nursing: Ongoing organizational support and intervention can reduce compassion fatigue and foster compassion satisfaction among pediatric oncology nurses.
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May 2019

Sleep and mood during hospitalization for high-dose chemotherapy and hematopoietic rescue in pediatric medulloblastoma.

Psychooncology 2018 07 16;27(7):1847-1853. Epub 2018 May 16.

Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA.

Objective: Disrupted sleep is common in pediatric cancer, which is associated with psychological distress and may impact neural recovery. Information regarding sleep during pediatric brain tumor treatment is limited. This study aimed to describe objective sleep-wake patterns and examine the sleep-mood relation in youth hospitalized for intensive chemotherapy and stem cell rescue.

Methods: Participants included 37 patients (M age = 9.6 ± 4.2 years) enrolled on a medulloblastoma protocol (SJMB03) and their parents. Respondents completed a mood disturbance measure on 3 days, and patients wore an actigraph for 5 days as an objective estimate of sleep-wake patterns. General linear mixed models examined the relation between nocturnal sleep and next-day mood, as well as mood and that night's sleep.

Results: Sleep duration was deficient, sleep efficiency was poor, and daytime napping was common, with large between-subjects variability. There were minimal mood concerns across all days. The sleep and next-day mood relationship was nonsignificant (P > .05). Greater parent-reported child mood disturbance on day 2 was associated with decreased same-night sleep (P < .001) and greater patient-reported mood disturbance was associated with greater same-night sleep latency (P = .036).

Conclusions: Patients with medulloblastoma are vulnerable to disturbed sleep during hospitalization, and mood may be an important correlate to consider. Sleep and mood are modifiable factors that may be targeted to maximize daytime functioning.
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July 2018

In-home salivary melatonin collection: Methodology for children and adolescents.

Dev Psychobiol 2018 01 20;60(1):118-122. Epub 2017 Nov 20.

St. Jude Children's Research Hospital, Memphis, Tennessee.

In-home salivary collection quality and adherence to a prescribed collection methodology for evaluation of dim light melatonin onset (DLMO) is unknown in children. Primary aims of this study were to 1) describe a novel family centered methodology for in-home salivary collection; 2) determine the acceptance and feasibility of this methodology; 3) measure adherence to collection instructions; and 4) identify patterns between participants' age and quality of samples collected. After receiving instructional handouts from the study team, families utilized in-home salivary melatonin collection. Participants (N = 64) included 39 children (21 female, mean age 9.5 ± 1.61 years) and 25 adolescents (11 female, mean age 15.9 ± 2.12 years) with craniopharyngioma. Participants were 90% adherent to collection schedule, and 89% of the samples collected were of sufficient quantity and quality, with no differences found between age (child vs. adolescent) and melatonin sample quantity and quality. In-home saliva collection provides an acceptable and feasible method to collect salivary melatonin and biomarkers in children and adolescents.
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January 2018

Child Sleep Coaches: Current State and Future Directions.

Clin Pediatr (Phila) 2017 Jan 24;56(1):5-12. Epub 2016 Nov 24.

5 Children's Mercy Hospital, Kansas City, MO, USA.

Given the genuine gaps in the availability of clinical sleep services for children, sleep coaching as a field has emerged and appears to be significantly increasing. Sleep coaches are typically individuals who provide individualized services, often via the Internet or phone, to families of infants and young children (and increasingly to older children, adolescents, and adults as well) with sleep problems. At this time, there is no universally accepted definition of sleep coach, nor are there clear guidelines regarding educational background, training requirements, scope of practice, or credentialing. To start to address the needs of families seeking the services of a sleep coach, educational materials were developed for parents and health care providers regarding issues to consider. Furthermore, there is a need going forward that (1) the designation sleep coach or consultant be clear and well defined, with a clear standard of care and scope of practice; (2) there is a standard core body of knowledge included in all training programs; (3) a certification process is developed for sleep coaches that is reputable and has recognizable and clear standards; and (4) that care for sleep problems in infants and young children are available to diverse populations, irrespective of socioeconomic status.
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January 2017

Predictors of fatigue and poor sleep in adult survivors of childhood Hodgkin's lymphoma: a report from the Childhood Cancer Survivor Study.

J Cancer Surviv 2017 04 12;11(2):256-263. Epub 2016 Nov 12.

Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Ms 735, Room S6037, 262 Danny Thomas Place, Memphis, TN, 38105, USA.

Purpose: Survivors of pediatric Hodgkin's lymphoma (HL) are at risk for a number of debilitating late effects. Excessive fatigue and poor sleep quality are primary complaints of HL survivors. Understanding the emotional and physical factors that influence fatigue and sleep quality may provide opportunities for intervention to improve health-related quality of life for HL survivors.

Methods: Data from 751 adult survivors of childhood HL who participated in the Childhood Cancer Survivor Study (CCSS) from 2000-2002 were analyzed. Multivariable logistic regression analyses investigated the demographic, psychological, and physical variables that predicted clinically significant levels of poor sleep quality, fatigue, and excessive daytime sleepiness.

Results: Survivors' self-reported level of emotional distress, pain, and physical functioning limitations did not differ from population norms. Clinically elevated levels of emotional distress (OR 8.38, 95% CI 4.28-16.42) and pain (OR 3.73, 95% CI 2.09-6.67) increased the risk for endorsing elevated levels of fatigue. Survivors with elevated levels of emotional distress (OR 6.83, 95% CI 2.71-15.90) and pain (OR 5.27, 95% CI 1.78-15.61) were more likely to report poor sleep quality. Pain (OR 2.11, 95% CI 1.39-3.34) was related to excessive daytime sleepiness.

Conclusions: Emotional and physical factors are associated with elevated levels of fatigue, excessive daytime sleepiness, and poor sleep quality in survivors of pediatric HL. This is consistent with findings from research conducted with non-cancer survivors.

Implications For Cancer Survivors: These results suggest that interventions designed to target sleep and fatigue difficulties in the general population may be well suited for pediatric HL survivors as well.
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April 2017

Sleepiness, Fatigue, Behavioral Functioning, and Quality of Life in Survivors of Childhood Hematopoietic Stem Cell Transplant.

J Pediatr Psychol 2016 Jul 16;41(6):600-9. Epub 2016 Mar 16.

Department of Psychology and

Objectives: To examine subjective fatigue and sleepiness as predictors of functional outcomes in long-term pediatric hematopoietic stem cell transplant (HSCT) survivors.

Methods: Participants included 76 survivors assessed 5-14 years post-HSCT. Self-report and parent-proxy (i.e., N = 38) measures of fatigue, excessive daytime sleepiness (EDS), emotional and behavioral functioning, executive functioning, and quality of life (QOL) were completed. Health-related correlates were obtained from medical records.

Results: Survivors exhibited significant fatigue for self (M = 69.21 ± 20.14) and parent-proxy (M = 72.15 ± 20.79) report. EDS was endorsed for 20-33% of survivors, depending on the respondent. EDS was not significant for parent-proxy outcomes, but was associated with poorer self-reported QOL and internalizing problems (p < .0016). Fatigue was associated with poorer functioning across all domains (p's < .0016).

Conclusions: A substantial number of pediatric HSCT survivors exhibit sleepiness and fatigue. Fatigue is associated with statistically and clinically greater functional difficulties, highlighting the importance of examining sleep and fatigue and considering interventions to improve alertness.
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July 2016

Sleep complaints in survivors of pediatric brain tumors.

Support Care Cancer 2016 Jan 21;24(1):23-31. Epub 2015 Apr 21.

Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, USA.

Purpose: Pediatric brain tumor survivors have increased risk of sleep problems, particularly excessive daytime sleepiness (EDS). Few studies have examined sleep disturbances in this population.

Methods: 153 children and adolescents ages 8-18 and their parents completed questionnaires (Modified Epworth Sleepiness Scale, Kosair Children's Hospital Sleep Questionnaire, Children's Report of Sleep Patterns, Children's Sleep Hygiene Scale) during clinic visits. Participants were at least 5 years from diagnosis and 2 years post-treatment. Group differences in age at diagnosis, body mass index, type of treatment received, and tumor location were examined.

Results: One-third of adolescents and one-fifth of children reported EDS. Children and parents had fair concordance (kappa coefficient = .64) in their report of EDS, while adolescents and parents had poor concordance (kappa coefficient = .37). Per parents, most children slept 8 to 9 h per night. Poor bedtime routines were reported for children, while adolescents endorsed poor sleep stability. Extended weekend sleep was reported across age groups. A BMI in the obese range was related to higher parent-reported EDS in children. Sleep-disordered breathing was associated with elevated BMI in adolescents.

Conclusions: While survivors reported achieving recommended amounts of sleep each night, 20 to 30% reported EDS. Poor concordance among parent and adolescent report highlights the importance of obtaining self-report when assessing sleep concerns. Obesity is a modifiable factor in reducing symptoms of EDS in this population. Finally, the lack of association between EDS and brain tumor location, BMI, or treatment received was unexpected and warrants further investigation.
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January 2016

The Children's Report of Sleep Patterns: validity and reliability of the Sleep Hygiene Index and Sleep Disturbance Scale in adolescents.

Sleep Med 2014 Dec 6;15(12):1500-7. Epub 2014 Sep 6.

St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 101, Memphis, TN 38105, USA.

Objective: Sleep is critical for adolescent health and well-being. However, there are a limited number of validated self-report measures of sleep for adolescents and no well-validated measures of sleep that can be used across middle childhood and adolescence. The Children's Report of Sleep Patterns (CRSP) has been validated in children aged 8-12 years. The purpose of this study was to examine the psychometric properties of the CRSP, a multidimensional, self-report sleep measure for adolescents.

Methods: The participants included 570 adolescents 13-18 years, 60% female, recruited from pediatricians' offices, sleep clinics, children's hospitals, schools, and the general population. A multi-method, multi-reporter approach was used to validate the CRSP. Along with the CRSP, a subset of the sample completed the Adolescent Sleep Hygiene Scale (ASHS), with a different subset of adolescents undergoing polysomnography.

Results: The CRSP demonstrated good reliability and validity. Group differences on the CRSP were found for adolescents presenting to a sleep or medical clinic (vs. a community sample), for older adolescents (vs. younger adolescents), for those who regularly napped (vs. infrequently napped), and for those with poor sleep quality (vs. good sleep quality). Self-reported sleep quality in adolescents was also associated with higher apnea-hypopnea index scores from polysomnography. Finally, the CRSP Sleep Hygiene Indices were significantly correlated with indices of the ASHS.

Conclusions: The CRSP is a valid and reliable measure of adolescent sleep hygiene and sleep disturbances. With a parallel version for middle childhood, the CRSP likely provides clinicians and researchers the ability to measure self-reported sleep across development.
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December 2014

Changes in sleep and fatigue in newly treated pediatric oncology patients.

Support Care Cancer 2015 Feb 13;23(2):393-401. Epub 2014 Aug 13.

Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, 38105, USA,

Background: Fatigue has been reported as one of the most distressing symptoms in oncology patients, yet few have investigated the longitudinal course of sleep and fatigue in newly diagnosed pediatric oncology patients.

Procedure: To longitudinally assess presence and changes of sleep complaints and fatigue, we administered questionnaires designed to measure sleep complaints, sleep habits, daytime sleepiness, and fatigue to parents of pediatric oncology patients ages 2-18 and to pediatric oncology patients, themselves, ages 8-18 within 30 days of diagnosis (n = 170) and again 8 weeks later (n = 153).

Results: Bedtimes, wake times, and sleep duration remained relatively stable across the first 8 weeks of treatment. Sleep duration and fatigue were not related for the entire sample, though children's self-reported sleep duration was positively correlated with fatigue only at the baseline time point. Parent reports of fatigue significantly decreased for leukemia patients but remained rather high for solid tumor and brain tumor patients.

Conclusions: Because fatigue remained high for solid tumor and brain tumor patients across the initial 8 weeks of treatment, this may highlight the need for intervention in this patient population.
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February 2015

The Children's Report of Sleep Patterns (CRSP): a self-report measure of sleep for school-aged children.

J Clin Sleep Med 2013 Mar 15;9(3):235-45. Epub 2013 Mar 15.

National Jewish Health, Denver, CO 80206, USA.

Study Objectives: (1) Present preliminary psychometrics for the Children's Report of Sleep Patterns (CRSP), a three-module measure of Sleep Patterns, Sleep Hygiene, and Sleep Disturbance; and (2) explore whether the CRSP provides information about a child's sleep above and beyond parental report.

Methods: A multi-method, multi-reporter approach was used to validate the CRSP with 456 children aged 8-12 years (inclusive). Participants were recruited from pediatricians' offices, sleep clinics/laboratories, children's hospitals, schools, and the general population. Participants completed measures of sleep habits, sleep hygiene, anxiety, and sleepiness, with actigraphy and polysomnography used to provide objective measures of child sleep.

Results: The CRSP demonstrated good reliability and validity. Differences in sleep hygiene and sleep disturbances were found for children presenting to a sleep clinic/laboratory (vs. community population); for younger children (vs. older children); and for children who slept less than 8 hours or had a sleep onset later than 22:00 on actigraphy. Further, significant associations were found between the CRSP and child-reported anxiety or sleepiness. Notably, approximately 40% of parents were not aware of child reported difficulties with sleep onset latency, night wakings, or poor sleep quality.

Conclusions: The three modules of the CRSP can be used together or independently, providing a reliable and valid self-report measure of sleep patterns, sleep hygiene, and sleep disturbances for children ages 8-12 years. Children not only provide valid information about their sleep, but may provide information that would not be otherwise captured in both clinical and research settings if relying solely on parental report.
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March 2013

Sleep hygiene and problem behaviors in snoring and non-snoring school-age children.

Sleep Med 2012 Aug 28;13(7):802-9. Epub 2012 May 28.

Missouri Department of Mental Health, Kansas City, MO 64108, USA.

Objectives: The effects of sleep-disordered breathing, sleep restriction, dyssomnias, and parasomnias on daytime behavior in children have been previously assessed. However, the potential relationship(s) between sleep hygiene and children's daytime behavior remain to be explored. The primary goal of this study was to investigate the relationship between sleep hygiene and problematic behaviors in non-snoring and habitually snoring children.

Methods: Parents of 100 5- to 8-year-old children who were reported to snore "frequently" to "almost always," and of 71 age-, gender-, and ethnicity-matched children who were reported to never snore participated in this study. As part of a larger, ongoing study, children underwent nocturnal polysomnography and parents were asked to complete the Children's Sleep Hygiene Scale (CSHS) and the Conners' Parent Rating Scales-Revised (CPRS-R:L).

Results: In the snoring group, strong negative correlations (r=-.39, p<.001) between the CSHS overall sleep hygiene score and the CPRS-R:L DSM-IV total scores emerged. Additionally, several subscales of the CSHS and CPRS-R:L were significantly correlated (p-values from <.000 to .004) in snoring children. No significant correlations were observed between the CSHS and the CPRS-R:L in the non-snoring children.

Conclusions: Parental reports of behavioral patterns in snoring children indicate that poorer sleep hygiene is more likely to be associated with behavior problems, including hyperactivity, impulsivity, and oppositional behavior. In contrast, no significant relationships between sleep hygiene and problem behaviors emerged among non-snoring children. These results indicate that children at risk for sleep disordered breathing are susceptible to daytime behavior impairments when concurrently coupled with poor sleep hygiene practices.
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August 2012

The Children's Report of Sleep Patterns--Sleepiness Scale: a self-report measure for school-aged children.

Sleep Med 2012 Apr 10;13(4):385-9. Epub 2012 Feb 10.

National Jewish Health, 1400 Jackson Street, G311 Denver, CO 80206, USA.

Objective: To establish the psychometric properties of a self-report measure of daytime sleepiness for school-aged children.

Methods: Three hundred eighty-eight children aged 8-12years (inclusive) from paediatrician's offices, sleep clinic/labs, children's hospitals, schools, and the general population were recruited. A multi-method approach was used to validate the Children's Report of Sleep Patterns--Sleepiness Scale (CRSP-S), including self-report measures (questions about typical sleep), parent-report measures (Children's Sleep Habits Questionnaire [CSHQ], proxy version of CRSP-S, Children's Sleep Hygiene Scale [CSHS], morningness-eveningness) and objective measures (actigraphy and polysomnography [PSG]).

Results: The CRSP-S was shown to be internally consistent (Cronbach's alpha = 0.77) and the scale's unidimensionality was supported by a one-factor confirmatory factor analysis. A Rasch-Masters Partial Credit model demonstrated that items cover a broad range of sleepiness experiences with minimal redundancy, gaps in coverage, or bias against age, gender, or clinical groups. Test-retest reliability was 0.82. Construct and convergent validity were demonstrated with actigraphy, parental reports of children's sleepiness, sleep disturbances, sleep hygiene, circadian preference, and comparison of groups of children (e.g., sleep clinic/lab vs. school children).

Conclusions: The CRSP-S is a reliable and valid self-report measure of sleepiness for school-aged children. As an adjunct to parental report measures and objective measures of sleep, the CRSP-S provides a brief and psychometrically robust measure of children's sleepiness. Children who endorse sleepiness should have a more detailed screening for underlying sleep disruptors or causes of insufficient sleep.
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April 2012

Excessive daytime sleepiness and sleep-disordered breathing disturbances in survivors of childhood central nervous system tumors.

Pediatr Blood Cancer 2012 May 18;58(5):746-51. Epub 2011 Oct 18.

Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.

Background: Improvements in treatment and management for pediatric central nervous system (CNS) tumors have increased survival rates, allowing clinicians to focus on long-term sequelae, including sleep disorders. The objective of this study was to describe a series of CNS tumor survivors who had sleep evaluations that included polysomnography (PSG) with attention to sleep disorder in relation to the tumor site.

Procedure: We report on 31 patients who had retrievable reports including an overnight PSG; 17 also underwent multiple sleep latency tests (MSLT) to characterize their sleepiness.

Results: Mean age at tumor diagnosis was 7.4 years, mean age at sleep referral 14.3 years, and a mean time between tumor diagnosis and sleep referral of 6.9 years. The most common tumor location was the suprasellar region, the most common reason for sleep referral was excessive daytime sleepiness (EDS), and the most common sleep diagnosis was obstructive sleep apnea (n = 14) followed by central sleep apnea (n = 4), hypersomnia due to medical condition (n = 4), and narcolepsy (n = 3). Twenty-six of the 31 subjects were obese/overweight, and among those with the concurrent complaint of EDS, the mean sleep latency on MSLT was 3.16 minutes, consistent with excessive sleepiness.

Conclusions: Suprasellar region tumor survivors who are obese or overweight are more likely to have complaints of EDS and are at greater risk of sleep-disordered breathing. Sleep-related symptoms may not be recognized and referral initiated until years after CNS diagnosis. A periodic and thorough sleep history should be taken when caring for CNS tumor survivors.
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May 2012

Disturbed sleep in pediatric patients with leukemia: the potential role of interleukin-6 (-174GC) and tumor necrosis factor (-308GA) polymorphism.

Oncol Nurs Forum 2011 Sep;38(5):E365-72

Department of Hematology/Oncology, Cook Children's Medical Center, Fort Worth, TX, USA.

Purpose/objectives: To explore an association between sleep quality in children and adolescents undergoing therapy for acute lymphoblastic leukemia (ALL) and polymorphisms in two proinflammatory cytokines, interleukin-6 (IL-6) and tumor necrosis factor (TNF).

Design: Retrospective exploratory analysis using data from a multi-institutional prospective study comparing objective sleep measures by actigraphy over 10 days with retrospective genotyping of IL-6 (-174GC) and TNF (-308GA).

Setting: Pediatric oncology centers in the southeastern and southwestern United States and in Canada.

Sample: 88 children or adolescents with ALL.

Methods: Secondary analysis of 88 patients (ages 5-18) with sleep quality measured by actigraphy over 10 days in their home environment and retrospective DNA genotyping.

Main Research Variables: Sleep variables and genotype.

Findings: IL-6 promoter (-174G>C) C allele was associated with fewer total daily sleep minutes (p = 0.028) and fewer daily nap minutes (p < 0.01). Patients with the TNF genotype AA had 28.2 more minutes of wake after sleep onset (p = 0.015), 3.4 more nocturnal wake episodes (p = 0.026), and a 5% lower sleep efficiency rate (p = 0.03) than their GA genotype counterparts.

Conclusions: Patients with the TNF (-308G>A) or IL-6 (-174G>C) polymorphisms demonstrated disturbed sleep. This study is the first to find a relationship between these two cytokines and disturbed sleep in children and adolescents with cancer.

Implications For Nursing: Disturbed sleep among pediatric patients with cancer is multifactoral and includes interactions among environment, medications, and genotype. Additional research should explore serum proinflammatory cytokine levels and the influence of mood and worry on sleep.
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September 2011

A transtheoretical, case management approach to the treatment of pediatric obesity.

J Prim Care Community Health 2010 Apr;1(1):4-7

Department of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.

Objective: The percentage of obese children in the United States has increased dramatically over the past three decades, particularly among ethnic/ racial minorities. This study sought to examine the impact of a clinical case-management intervention based upon the Transtheoretical Model (TTM) to reduce obesity and increase physical activity in children.

Methods: Nineteen obese African-American children ages 8-12 were recruited from two pediatric clinics and were randomized to either a 12-week intervention group or a control group. Dependent variables included body mass index (BMI) percentile, physical activity, and stage of change for the child and parent.

Results: In comparison to the control group, the intervention group demonstrated significant decreases in BMI and improvements in daily vigorous physical activity. The children in the intervention group demonstrated movement toward action/maintenance stages of change.

Conclusions: A 12-week TTM-based case management intervention can have a favorable impact on obesity and physical activity in African-American child.
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April 2010

Psychometric and clinical assessment of the 10-item reduced version of the Fatigue Scale-Child instrument.

J Pain Symptom Manage 2010 Mar;39(3):572-8

Department of Nursing Research, Children's National Medical Center, George Washington University, Washington, DC 20010, USA.

Fatigue is one of the most debilitating conditions associated with cancer and anticancer therapy. The lack of reliable and valid self-report instruments has prevented accurate assessment of fatigue in pediatric oncology patients. The purpose of this study was to identify the most sensitive and specific score, that is, the "cut score," on the Fatigue Scale-Child (FS-C) to identify those children with high cancer-related fatigue in need of clinical intervention. We first used Rasch methods to identify the items on the FS-C that distinguished children with high cancer-related fatigue from other children; our findings indicated that the FS-C needed to be reduced from 14 items to 10 items. We then assessed the 10-item FS-C for its psychometric properties and applied the receiver operating characteristics curve analysis to the FS-C responses from 221 children (aged 7-12 years) receiving anticancer treatment. The cut score identified with 75% sensitivity and 73.5% specificity was 12; 73 (33%) patients scored 12 or higher. Findings from this validated instrument provide a needed guide for clinicians to interpret fatigue scores and provide clinical interventions for this debilitating condition to their pediatric patients with cancer.
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March 2010

Normal sleep in children and adolescents.

Child Adolesc Psychiatr Clin N Am 2009 Oct;18(4):799-811

Department of Behavioral Medicine, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN 38105, USA.

This article reviews the normal development of sleep in infants, children, and adolescents, with specific focus on both the subjective and objective aspects of sleep. Notably, sleep duration decreases substantially from infancy through adolescence with increased consolidation of sleep to the nighttime period only. Sleep architecture exhibits developmental changes with decreases in slow-wave sleep and increases in stage 2 sleep from childhood through adolescence. Although the development of sleep is a dramatic and relatively rapid process during the first decades of life, changes in sleep continue across the life span.
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October 2009

Increased morning brain natriuretic peptide levels in children with nocturnal enuresis and sleep-disordered breathing: a community-based study.

Pediatrics 2008 May;121(5):e1208-14

Division of Pediatric Sleep Medicine and Kosair Children's Hospital Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky 40202, USA.

Introduction: Habitual snoring and obstructive sleep apnea have been associated with bed-wetting in children, and effective obstructive sleep apnea treatment may improve enuresis.

Objectives: The purpose of this work was to assess whether habitual snoring is associated with increased incidence of enuresis and whether severity of obstructive sleep apnea correlates with enuretic frequency and to evaluate brain natriuretic peptide levels.

Methods: Parental surveys of 5- to 7-year-old children were reviewed for habitual snoring and enuresis. Enuresis was also assessed in a cohort of 378 children with habitual snoring undergoing overnight polysomnographic evaluation, and brain natriuretic peptide plasma levels were determined in 20 children with obstructive sleep apnea, 20 with habitual snoring without obstructive sleep apnea, and 20 nonsnoring children, matched for enuresis.

Results: There were 17,646 surveys completed (50.6% boys; 18.3% black). A total of 1976 (11.2%) of these children were habitual snoring (53% boys; 25.2% black). A total of 531 habitual snoring children also had enuresis (26.9%), with a predominant representation of boys (472 boys [87.5%]). Among the 15670 nonsnoring children, enuresis was reported in 1821 children (11.6%), of whom 88.8% were boys. However, enuresis among 378 children with habitual snoring did not correlate with the magnitude of sleep respiratory disturbances. Indeed, enuresis was reported in 33 of 149 children with obstructive sleep apnea (obstructive apnea hypopnea index: >2 per hour of total sleep time; 53% boys) as compared with 36 habitual snoring children with enuresis (62% boys) and obstructive apnea hypopnea index <2 per hour of total sleep time. Brain natriuretic peptide levels were elevated among children with enuresis and were marginally increased among children with obstructive sleep apnea.

Conclusions: Habitual snoring is associated with increased prevalence of enuresis, and brain natriuretic peptide levels are increased in enuretic children with further increases with obstructive sleep apnea. However, the prevalence of enuresis is not modified by severity of sleep disturbance. Even mild increases in sleep pressure because of habitual snoring may raise the arousal threshold and promote enuresis, particularly among prone children, that is, those with elevated brain natriuretic peptide levels.
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May 2008

Plasma IGF-1 levels and cognitive dysfunction in children with obstructive sleep apnea.

Sleep Med 2009 Feb 7;10(2):167-73. Epub 2008 Mar 7.

Kosair Children's Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville School of Medicine, 570 S. Preston Street, Suite 204, Louisville, KY 40202, USA.

Background: Pediatric OSA is associated with substantial morbidity in cognitive function. However, for any given OSA severity level, altered cognitive performance may or may not be present. Since IGF-1 is neuroprotective, we hypothesized that higher systemic IGF-1 levels may identify children at lower susceptibility for cognitive morbidity.

Methods: Consecutive habitually snoring and non-snoring children ages 5-7 years were recruited from the community, and underwent overnight polysomnography, and neurocognitive testing and a blood draw the next morning. Snoring children were divided into OSA or no OSA, and OSA children were further subdivided into those with >=2 abnormal cognitive subtests and into those with normal cognitive scores. Plasma levels of IGF-1 were also measured using ELISA.

Results: Among snoring children without OSA, circulating IGF-1 was 910 +/- 110 pg/mL compared with 1070 +/- 240 pg/mL in those with OSA (p<0.01). However, IGF-1 was 540 +/- 70 pg/mL in children with OSA and cognitive deficits, compared to 1370 +/- 170 microg/L in children with OSA and normal cognitive scores (p<0.001).

Conclusions: IGF-1 levels are higher in children with OSA, particularly in those who do not manifest neurocognitive deficits, suggesting that the magnitude of the IGF-1 response elicited by OSA may play a significant protective role against the neurocognitive dysfunction associated with OSA.
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February 2009