Daniel Lauren C, Li Yimei, Kloss Jacqueline D, Reilly Anne F, Barakat Lamia P
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.
Support Care Cancer. 2016 Sep;24(9):3897-906. doi: 10.1007/s00520-016-3234-y. Epub 2016 Apr 23.
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.
皮质类固醇会影响睡眠模式、情绪和行为。急性淋巴细胞白血病（ALL）中最常用的两种皮质类固醇，地塞米松和泼尼松，对睡眠的影响可能不同，但尚无研究对儿童使用这两种药物进行比较。本研究检验了以下假设：地塞米松和泼尼松对ALL患儿的睡眠有不同影响，以了解这些药物如何影响健康相关生活质量（HRQL）。
81名接受ALL维持治疗的3至12岁儿童的父母完成了一项儿童睡眠的基线测量（地塞米松组n = 55，泼尼松组n = 26），61名父母从为期5天的类固醇疗程的第一天开始记录28天的儿童睡眠日记（地塞米松组n = 43，泼尼松组n = 18）。父母还在类固醇疗程的最后一天和当月的最后一天完成了HRQL和疲劳测量。
在基线时，父母报告服用地塞米松的儿童比服用泼尼松的儿童有更多睡眠障碍。在整个月中，与服用泼尼松的儿童相比，服用地塞米松的儿童睡眠质量较差。在皮质类固醇治疗期间，服用地塞米松的儿童夜间觉醒次数也比服用泼尼松的儿童多。睡眠变量在停用类固醇期间占HRQL差异的近一半，并且在皮质类固醇疗程期间和停用皮质类固醇期间对疲劳也有显著影响。
睡眠是服用皮质类固醇儿童HRQL的重要组成部分，与泼尼松相比，地塞米松对儿童睡眠的影响更明显。筛查睡眠障碍并提供简短干预措施以管理与类固醇相关的睡眠干扰可能会改善HRQL。
