Prospective Pilot Study Evaluating Sleep Disruption in Children and Young Adults Undergoing Stem Cell Transplantation

Background: Sleep disruption can adversely affect metabolism, psychological well being, performance, inflammatory cytokines, immune function, and cardiac function and is likely overlooked as a side effect of stem cell transplantation (SCT). There are no objective studies evaluating sleep in pediatric SCT patients. Actigraphic monitoring utilizes a small monitor that is worn like a wristwatch and when used in combination with self-reports of bedtime and rising time, has been found to be a reliable and valid measure of sleep patterns.

Purpose: To evaluate sleep patterns in SCT children and young adults through actigraphy, sleep diaries, and evaluation of environmental factors that influence sleep disruption.

Methods: Objective sleep parameters were measured with the Micro-Motionlogger SleepWatch® (Ambulatory Monitoring, Inc.) actigraph which was worn continuously. Sleep-wake patterns were reported in a sleep diary to allow for screening of artifacts (e.g., actigraph removal). The number of waking episodes per cycle of sleep, duration of sleep, minutes of sleep, and sleep efficiency (Abnormal is < 90%) were calculated using actigraphy data. Room entry checklists were utilized to record the frequency of nocturnal room entries in a separate cohort of patients on randomly-selected nights on the BMT unit.

Results: We obtained 71 nights of sleep for eight patients. Six patients (75%) were male with a median age of 12.4 years (IQR 10.6-14.1) at time of actigraphy.  Thirty-six nights (51%) were pretransplant, 35 nights (49%) were post-transplant.   The average sleep onset time was midnight with an average rise time of 9:00 am. The median duration from onset to offset was 9.1 hours (IQR 8.0-10.2) with a median duration of 7.1 hours (IQR 6.1-7.8). The median number of waking episodes per sleep cycle was 12 (IQR 9-17). Median sleep efficacy was 80.7% (IQR 70 to 89%); sleep efficiency was abnormally low 75% of the nights. During 189 nights of room monitoring, patient’s rooms were entered a median of 12 times per night (IQR 10-15). 

Conclusions: These preliminary data suggest that pediatric patients undergoing SCT often have poor sleep quality while hospitalized. Frequent room entries, amongst other causes, may contribute to sleep disruption.  Further research is needed to fully understand the impact of sleep disruption after HSCT, and evaluate potential interventions to improve sleep quality.