부산대학교 도서관

Introduction Sleep and wakefulness show a circadian rhythm, which is driven by the suprachiasmatic nuclei located in the anterior hypothalamus [1]. To align the circadian sleep-wake cycle to the environmental [...]
Study Objectives: To compare sleep-wake rhythms, melatonin, and cancer-related fatigue in pediatric patients with acute lymphoblastic leukemia (ALL) to healthy children and to assess the association between sleep-wake outcomes and cancer-related fatigue. Methods: A national cohort of ALL patients (2-18 years) was included. Sleep-wake rhythms were measured using actigraphy and generated the following variables: Interdaily stability (IS): higher IS reflects higher stability; intradaily variability (IV): lower IV indicates less fragmentation; L5 and M10 counts: activity counts during the five least and 10 most active hours, respectively; and relative amplitude (RA): the ratio of L5 and M10 counts (higher RA reflects a more robust rhythm). The melatonin metabolite, 6-sulfatoxymelatonin (aMT[beta]s), was assessed in urine. Cancer-related fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Using regression models sleep-wake rhythms, aMT[beta]s, and cancer-related fatigue were compared to healthy children and associations between sleep-wake outcomes and cancer-related fatigue were assessed in ALL patients. Results: In total, 126 patients participated (response rate: 67%). IS, RA, and M10 counts were lower in patients compared to healthy children (p < 0.001). aMT6s levels were comparable to healthy children (p = 0.425). Patients with ALL were more fatigued compared to healthy children (p < 0.001). Lower IS, RA and M10 counts and higher IV were significantly associated with more parent-reported cancer-related fatigue. Associations between sleep-wake rhythms and self-reported cancer-related fatigue were not statistically significant. Conclusions: Sleep-wake rhythm impairment is associated with more cancer-related fatigue in pediatric ALL patients. Interventions aimed to improve sleep hygiene and encourage physical activity may reduce cancer-related fatigue. Statement of Significance Sleep-wake cycle disruptions are associated with fatigue, amongst many other adverse health outcomes. Cancer-related fatigue is a common and distressing side-effect of anti-cancer treatments with few effective interventions available. The exact role of the sleep-wake rhythm in the pathophysiology of cancer-related fatigue in pediatric patients is unknown but could provide clues for improvement of cancer-related fatigue. Evidence on sleep-wake rhythms in pediatric cancer patients is limited. This study, therefore, aims to compare sleep-wake rhythms and cancer-related fatigue in pediatric patients with acute lymphoblastic leukemia (ALL) to healthy children and to evaluate the association between sleep-wake rhythm variables and cancer-related fatigue. The findings of this study suggest opportunities for interventions to improve cancer-related fatigue in pediatric patients with ALL. Key words: actigraphy; acute lymphoblastic leukemia; cancer-related fatigue; physical activity; children sleep-wake rhythms