Sleep disturbance has a significant impact on quality of life, including mental and physical health and academic, cognitive, and social functioning. It is one of the most common symptoms reported by pediatric patients with cancer and is significantly related to neurocognitive function for survivors.

Belinda Mandrell
ONS member Belinda N. Mandrell, PhD, RN, CPNP, FAAN, is director of the division of nursing research at St. Jude Children’s Research Hospital in Memphis, TN.

Sleep disturbance includes:

  • Circadian rhythm disruption
  • Excessive daytime sleepiness
  • Insomnia
  • Obstructive sleep apnea

Sleep disturbance is most common in patients and survivors of hematologic and lymphoma malignancies, central nervous system tumors, and sarcomas, as well as those treated with radiation and steroids. That understanding is changing the state of sleep science as we explore its biologic mechanisms and interventions.

As a nurse scientist, I have spent the past 14 years developing a research program focused on the biologic mechanisms and behavioral characteristics that contribute to symptoms of sleep disturbance throughout childhood cancer therapy and survivorship. I have found that collaboration with pediatric psychologists and neuropsychologists is essential to build the science of sleep research in pediatric patients with cancer.

The current gaps in pediatric cancer sleep research include:

  • A need to incorporate sleep and circadian rhythm assessment into clinical trials
  • Understanding the bidirectional relationship between sleep and circadian rhythm
  • Understanding the role of circadian timing and therapy

My collaborative research with Valerie McLaughlin Crabtree, PhD, pediatric psychologist at St. Jude Children’s Research Hospital, is addressing those gaps by incorporating patient-reported outcomes and objective sleep assessments, including assessing circadian rhythm, in ongoing clinical trials. Our work has shown the presence of significant sleep and circadian disturbance in patients with newly diagnosed central nervous system tumors.

Future research should address the implications of sleep disturbance and health-related outcomes of neurocognitive function, internalizing and externalizing behaviors, and physical function with feasible, low-resource, and advantageous interventions. An interprofessional team of sleep specialists, psychologists, physicians, and nurse scientists dedicated to advancing the understanding and treatment of sleep disturbance can accomplish that goal.

The author thanks Valerie McLaughlin Crabtree, PhD, for her assistance with the article.