Childhood Cancer

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Testing a Hospital Sleep Hygiene Intervention

St. Jude Children’s Research Hospital
Belinda Mandrell, PhD, RN
Grant Type: 
Nurse Researcher Grants
Year Awarded: 
Type of Childhood Cancer: 
General Pediatric Cancer
Project Description: 

Project Goal

This pilot study examined sleep and fatigue in pediatric brain tumor patients hospitalized for high dose chemotherapy. The objective of the study was to assess if sleep quality (measured by actigraphy, fatigue, and daytime activity during the 5 day hospitalization) was more positive for patients randomized to the sleep environment intervention as compared to those who did not receive it. We also explored if change in sleep quality, fatigue, and daytime activity were related to gender, age, mood, and risk group, as well as biological markers of serum cytokines IL-6, TNFα and hypocretin cerebrospinal fluid levels.


Patients and parents were receptive to a sleep intervention and those on the intervention arm asked for sleep hygiene practices at subsequent admissions. However, we did not find a significant difference in the sleep quality between those randomized to intervention (n=19) when compared to standard of care (n=18). We did find that the standard of care patient and parent reported higher mood at the initiation of study. Sleep quality was better in females across the intervention and standard of care arms and sleep quality was better in those with average risk disease when compared to high risk disease. Serum cytokines IL-6 and TNF α were found to be associated with sleep quality after adjusting for potential confounders. The higher the serum cytokine IL-6, the longer the patients sleep latency (p<0.001) and daytime sleep minutes (p=0.0401). Higher serum cytokine levels of IL-6 (p=0.0145) and TNF α (p=0.0413) were associated with fatigue in adolescents. There were no differences in the serum cytokines IL-6 and TNF α between those on the standard of care, intervention arm or risk group (average vs. high). There was no difference in cerebrospinal fluid hypocretin between the intervention and standard of care arm. However, patients with high hypocretin levels had shorter sleep latency, higher sleep efficiency, and more total sleep minutes.

For hospitalized children and adolescents, we found that a sleep hygiene intervention is feasible, with patients and parents most receptive to measures in improving sleep. More specifically, we must consider the extent of tumor and prior therapy, with those treated for high risk disease having more difficulty in sleep regulation. Lastly, biological markers of serum cytokines and hypocretin were associated with sleep quality.

Next Steps

Mandrell B, Pritchard M, Browne E, Clifton S, Hammarback, T, Crabtree VM. A pilot study to examine sleep in pediatric brain tumor patients hospitalized for high dose chemotherapy. [Abstract]. 27th Annual Meeting of Associated professional Sleep Societies, LLC, Baltimore, MD, SLEEP, 36, Abstract Supplement, A362, 2013.

We are currently in the process of manuscript submission. Grant funding made staffing possible to implement the sleep intervention and processing of the biological specimens.

Updated July 2013