Dexamethasone Alters Sleep and Fatigue in Pediatric Patient with ALL

Dr. Kumar Srivastava

Dexamethasone improves the cure rate of childhood ALL but causes physical and behavioral adverse events. The primary objective of this study was to determine the correlation between systemic exposure to Dexamethasone and sleep quality and fatigue levels in pediatric patients during continuation therapy for childhood ALL. The eligible patients were in the age range 5-18 years and were receiving continuation therapy at St. Jude Children’s Research Hospital (SJCRH), Texas Children’s Cancer Center (TCCC), or the Hospital for Sick Children in Toronto (HSCT). The patients in SJCRH were treated on TOTAL XV protocol and those in TCCC and HSCT were treated as per COG protocols 9904 or 9905. The 10 day study included two treatment periods: During the first 5 days patients did not receive dexamethasone (off-dex); and during the second consecutive 5 days they did (on-dex). Patients wore an actigraph on their dominant wrist 24 hours a day for 10 days. The key sleep measures including Sleep Efficiency, Total Sleep Duration, No. of Awakenings, and Daytime activity, were obtained from actigraph and analyzed in order to evaluate the effect of dexamethasone on sleep quality and fatigue. The results of the analyses supported the claim that dexamethasone treatment during continuation therapy for childhood ALL significantly and adversely altered sleep and fatigue, confirming that sleep and fatigue are behavioral responses to dexamethasone.

A report of this study appears in the Cancer 2007.  Others co-first authors include Pamela Hinds (St. Jude-Nursing Research), Marilyn Hockenberry (Texas Children’s Hospital), Jami Gattuso (St. Jude-Nursing Research), Xing Tong (St. Jude-Biostatistics), Heather Jones (Hospital for Sick Children, Toronto, Ontario, Canada), Nancy West (St. Jude-Nursing Research), Kathy McCarthy (Texas Children’s Hospital), Avi Sadeh (Tel Aviv University), Monica Ash (Our Lady of the Lake Regional Medical Center, Baton Rouge, LA), Cheryl Fernandez (Louisiana State University, Shreveport, LA) , and Ching-Hon Pui (St. Jude-Oncology).

This study was funded by National Institute of Nursing Research (RO1NR007610).

Full Citation

Hinds PS, Hockenberry MJ, Gattuso JS, Srivastava DK, Tong X, Jones H, West N, McCarthy KS, Sadeh A, Ash M, Fernandez C, Pui CH. Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia. Cancer 110(10):2321-30, 2007. PubMed Abstract
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