Onkolojik Hastalığı Olan Çocuk ve Ergenlerde Uyku Sorunları
Özet
Bu metin, onkolojik hastalığı olan çocuk ve ergenlerde görülen uyku sorunlarını, bu sorunların nedenlerini ve tedavi yaklaşımlarını kapsamlı bir şekilde ele almaktadır. Çocukluk çağı kanserlerinde sağkalım oranlarının artmasıyla birlikte, yaşam kalitesini doğrudan etkileyen uyku bozukluklarının yönetimi kritik bir önem kazanmıştır. Çalışmada; gündüz aşırı uykululuğu (EDS), uykusuzluk (insomnia), sirkadiyen ritim bozuklukları ve uyku ilişkili solunum bozuklukları temel başlıklar olarak incelenmektedir. Özellikle beyin tümörü olan çocuklarda hipotalamik hasar veya tedavi yan etkilerine bağlı olarak EDS ve sirkadiyen ritim bozukluklarının çok daha yaygın olduğu vurgulanmaktadır. Uykusuzluğun ise özellikle lösemi hastalarında ve kortikosteroid tedavisi alanlarda sık görüldüğü, davranışsal alışkanlıklar ve ağrının da bu durumu tetiklediği belirtilmektedir. Tedavi yaklaşımında öncelikle uyku hijyeni, bilişsel davranışçı terapiler ve çevresel düzenlemeler gibi farmakolojik olmayan yöntemler önerilmekte; bu yöntemlerin yetersiz kaldığı durumlarda ise melatonin veya uyarıcı ajanlar gibi ilaç tedavilerine başvurulabileceği ifade edilmektedir. Ayrıca, hastane ortamındaki gürültü ve ışık gibi faktörlerin çocukların uyku bütünlüğünü bozarak deliryum riskini artırabileceğine dikkat çekilmektedir. Sonuç olarak, onkolojik süreçteki çocuklarda uyku sorunlarının multidisipliner bir ekip tarafından erken dönemde taranması ve kişiye özel stratejilerle yönetilmesi, hem akademik başarı hem de genel ruh sağlığı açısından hayati bir gerekliliktir.
This text comprehensively examines sleep problems, their causes, and treatment approaches in children and adolescents with oncological diseases. As survival rates in childhood cancers have increased, managing sleep disorders that directly affect quality of life has become critical. The study investigates excessive daytime sleepiness (EDS), insomnia, circadian rhythm disorders, and sleep-related breathing disorders as primary headings. It is emphasized that EDS and circadian rhythm disorders are much more common, especially in children with brain tumors, due to hypothalamic damage or treatment side effects. Insomnia is reported to be frequent particularly in leukemia patients and those receiving corticosteroid therapy, with behavioral habits and pain also triggering this condition. In terms of treatment, non-pharmacological methods such as sleep hygiene, cognitive-behavioral therapies, and environmental adjustments are primarily recommended; if these are insufficient, pharmacological treatments like melatonin or stimulant agents can be utilized. Furthermore, it is highlighted that factors in the hospital environment, such as noise and light, can disrupt children's sleep integrity and increase the risk of delirium. In conclusion, screening for sleep problems in children during the oncological process by a multidisciplinary team and managing them with individualized strategies is vital for both academic success and general mental health.
Referanslar
Kaatsch P. Epidemiology of childhood cancer. Cancer Treat Rev. 2010;36(4):277-85.
Gatta G, Botta L, Rossi S, et al. Childhood cancer survival in Europe 1999-2007: results of EUROCARE-5--a population-based study. Lancet Oncol. 2014;15(1):35-47.
National Cancer Institute (2021). Surveillance, Epidemiology, and End Results Program (30/07/2021https://seer.cancer.gov/csr/1975_2017/results_merged/sect_29_childhood_cancer_iccc.pdf#search=pediatric%20cancer%20incidence adresinden ulaşılmıştır).
Steur LMH, Kolk RHE, Mooij F, et al. The prevalence and risk factors of sleep problems in pediatric oncology: its effect on quality of life during and after cancer treatment. Expert Review of Quality of Life in Cancer Care. 2016;1(2):153-71.
Rosen GM, Shor AC, Geller TJ. Sleep in children with cancer. Curr Opin Pediatr. 2008;20(6):676-81.
Merz EL, Tomfohr-Madsen L. Sleep Disruption in Pediatric Cancer Survivors: Conceptual Framework and Opportunities for Clinical Assessment and Behavioral Treatment. Am J Lifestyle Med. 2016;12(4):311-23.
Jacob E, Hesselgrave J, Sambuco G, et al. Variations in pain, sleep, and activity during hospitalization in children with cancer. J Pediatr Oncol Nurs. 2007;24(4):208-19.
Zupanec S, Jones H, Stremler R. Sleep habits and fatigue of children receiving maintenance chemotherapy for ALL and their parents. J Pediatr Oncol Nurs. 2010;27(4):217-28.
Wright M. Children receiving treatment for cancer and their caregivers: A mixed methods study of their sleep characteristics. Pediatr Blood Cancer. 2011;56(4):638-45.
Orsey AD, Wakefield DB, Cloutier MM. Physical activity (PA) and sleep among children and adolescents with cancer. Pediatr Blood Cancer. 2013;60(11):1908-13.
Allen JM, Graef DM, Ehrentraut JH, et al. Sleep and Pain in Pediatric Illness: A Conceptual Review. CNS Neurosci Ther. 2016;22(11):880-93.
Oeffinger KC, Mertens AC, Sklar CA, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572-82.
Kaleyias J, Manley P, Kothare SV. Sleep disorders in children with cancer. Semin Pediatr Neurol. 2012;19(1):25-34.
Daniel LC, van Litsenburg RRL, Rogers VE, et al. A call to action for expanded sleep research in pediatric oncology: A position paper on behalf of the International Psycho-Oncology Society Pediatrics Special Interest Group. Psychooncology. 2020;29(3):465-74.
Daniel LC, Wang M, Mulrooney DA, et al. Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Psychooncology. 2019;28(4):903-12.
Thorpy M. Current concepts in the etiology, diagnosis and treatment of narcolepsy. Sleep Med. 2001;2(1):5-17.
Rosen GM, Bendel AE, Neglia JP, et al. Sleep in children with neoplasms of the central nervous system: case review of 14 children. Pediatrics. 2003;112(1 Pt 1):e46-54.
Mandrell BN, Wise M, Schoumacher RA, et al. Excessive daytime sleepiness and sleep-disordered breathing disturbances in survivors of childhood central nervous system tumors. Pediatr Blood Cancer. 2012;58(5):746-51.
Erickson JM, Beck SL, Christian BR, et al. Fatigue, sleep-wake disturbances, and quality of life in adolescents receiving chemotherapy. J Pediatr Hematol Oncol. 2011;33(1):e17-25.
Müller HL, Handwerker G, Wollny B, et al. Melatonin secretion and increased daytime sleepiness in childhood craniopharyngioma patients. J Clin Endocrinol Metab. 2002;87(8):3993-6.
Kothare SV, Kaleyias J. The clinical and laboratory assessment of the sleepy child. Semin Pediatr Neurol. 2008;15(2):61-9.
Rosen G, Brand SR. Sleep in children with cancer: case review of 70 children evaluated in a comprehensive pediatric sleep center. Support Care Cancer. 2011;19(7):985-94.
Forsythe LP, Helzlsouer KJ, MacDonald R, et al. Daytime sleepiness and sleep duration in long-term cancer survivors and non-cancer controls: results from a registry-based survey study. Support Care Cancer. 2012;20(10):2425-32.
Laughton SJ, Merchant TE, Sklar CA, et al. Endocrine outcomes for children with embryonal brain tumors after risk-adapted craniospinal and conformal primary-site irradiation and high-dose chemotherapy with stem-cell rescue on the SJMB-96 trial. J Clin Oncol. 2008;26(7):1112-8.
Lecendreux M. Pharmacological management of narcolepsy and cataplexy in pediatric patients. Paediatr Drugs. 2014;16(5):363-72.
Marcus CL, Trescher WH, Halbower AC, et al. Secondary narcolepsy in children with brain tumors. Sleep. 2002;25(4):435-9.
Ismail D, O'Connell MA, Zacharin MR. Dexamphetamine use for management of obesity and hypersomnolence following hypothalamic injury. J Pediatr Endocrinol Metab. 2006;19(2):129-34.
Valerie McLaughlin Crabtree MSW (2021). Sleep disorders during and after cancer in children (04 /08/2021 tarihinde https://www.uptodate.com/contents/sleep-disorders-during-and-after-cancer-in-children/print#H1341595050 adresinden ulaşılmıştır).
Sateia MJ, Lang BJ. Sleep and cancer: recent developments. Curr Oncol Rep. 2008;10(4):309-18.
Davidson JR, MacLean AW, Brundage MD, et al. Sleep disturbance in cancer patients. Soc Sci Med. 2002;54(9):1309-21.
Stiefel FC, Kornblith AB, Holland JC. Changes in the prescription patterns of psychotropic drugs for cancer patients during a 10-year period. Cancer. 1990;65(4):1048-53.
Hinds PS, Hockenberry MJ, Gattuso JS, et al. Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia. Cancer. 2007;110(10):2321-30.
Zhou ES, Recklitis CJ. Internet-delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors. Pediatr Blood Cancer. 2020;67(9):e28506.
Zhou ES, Vrooman LM, Manley PE, et al. Adapted Delivery of Cognitive-Behavioral Treatment for Insomnia in Adolescent and Young Adult Cancer Survivors: A Pilot Study. Behav Sleep Med. 2017;15(4):288-301.
Owens JA, Moturi S. Pharmacologic treatment of pediatric insomnia. Child Adolesc Psychiatr Clin N Am. 2009;18(4):1001-16.
Pelayo R, Yuen K. Pediatric sleep pharmacology. Child Adolesc Psychiatr Clin N Am. 2012;21 4:861-83.
Ferracioli-Oda E, Qawasmi A, Bloch MH. Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One. 2013;8(5):e63773.
Owens JA.(2021) Pharmacotherapy for insomnia in children and adolescents: A rational approach (05/08/2021 tarihinde https://www.uptodate.com/contents/pharmacotherapy-for-insomnia-in-children-and-adolescents-a-rational-approach?topicRef=97876&source=see_link#H447980782 adresinden ulaşılmıştır).
Hofstra WA, de Weerd AW. How to assess circadian rhythm in humans: a review of literature. Epilepsy Behav. 2008;13(3):438-44.
Scheer FA, Pirovano C, Van Someren EJ, et al. Environmental light and suprachiasmatic nucleus interact in the regulation of body temperature. Neuroscience. 2005;132(2):465-77.
Baron KG, Reid KJ. Circadian misalignment and health. International review of psychiatry (Abingdon, England). 2014;26(2):139-54.
Eismann EA, Lush E, Sephton SE. Circadian effects in cancer-relevant psychoneuroendocrine and immune pathways. Psychoneuroendocrinology. 2010;35(7):963-76.
Sephton S, Spiegel D. Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to disease? Brain Behav Immun. 2003;17(5):321-8.
Gapstur R, Gross CR, Ness K. Factors associated with sleep-wake disturbances in child and adult survivors of pediatric brain tumors: a review. Oncol Nurs Forum. 2009;36(6):723-31.
Xia HC, Niu ZF, Ma H, et al. Deregulated expression of the Per1 and Per2 in human gliomas. Can J Neurol Sci. 2010;37(3):365-70.
Liu L, Marler MR, Parker BA, et al. The relationship between fatigue and light exposure during chemotherapy. Support Care Cancer. 2005;13(12):1010-7.
Rogers VE, Zhu S, Mandrell BN, et al. Relationship between circadian activity rhythms and fatigue in hospitalized children with CNS cancers receiving high-dose chemotherapy. Support Care Cancer. 2020;28(3):1459-67.
Liu L, Rissling M, Neikrug A, et al. Fatigue and Circadian Activity Rhythms in Breast Cancer Patients Before and After Chemotherapy: A Controlled Study. Fatigue. 2013;1(1-2):12-26.
Steur LMH, Kaspers GJL, van Someren EJW, et al. The impact of maintenance therapy on sleep-wake rhythms and cancer-related fatigue in pediatric acute lymphoblastic leukemia. Support Care Cancer. 2020;28(12):5983-93.
Rogers VE, Zhu S, Ancoli-Israel S, et al. Impairment in circadian activity rhythms occurs during dexamethasone therapy in children with leukemia. Pediatr Blood Cancer. 2014;61(11):1986-91.
Steur LMH, Kaspers GJL, Van Someren EJW, et al. Sleep–wake rhythm disruption is associated with cancer-related fatigue in pediatric acute lymphoblastic leukemia. Sleep. 2019;43(6).
Müller HL, Handwerker G, Gebhardt U, et al. Melatonin treatment in obese patients with childhood craniopharyngioma and increased daytime sleepiness. Cancer Causes Control. 2006;17(4):583-9.
Etzioni A, Luboshitzky R, Tiosano D, et al. Melatonin replacement corrects sleep disturbances in a child with pineal tumor. Neurology. 1996;46(1):261-3.
Witmans M, Young R. Update on pediatric sleep-disordered breathing. Pediatr Clin North Am. 2011;58(3):571-89.
Erler T, Paditz E. Obstructive Sleep Apnea Syndrome in Children. Treat Respir Med. 2004;3(2):107-22.
Chervin RD, Dillon JE, Bassetti C, et al. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep. 1997;20(12):1185-92.
Peng B, Li SW, Kang H, et al. Cognitive and emotional impairment in obstructive sleep apnea syndrome. Chin Med Sci J. 2004;19(4):262-5.
Brimeyer C, Adams L, Zhu L, et al. Sleep complaints in survivors of pediatric brain tumors. Support Care Cancer. 2016;24(1):23-31.
O'Gorman CS, Simoneau-Roy J, Pencharz P, et al. Sleep-disordered breathing is increased in obese adolescents with craniopharyngioma compared with obese controls. J Clin Endocrinol Metab. 2010;95(5):2211-8.
Corser NC. Sleep of 1- and 2-year-old children in intensive care. Issues Compr Pediatr Nurs. 1996;19(1):17-31.
Hinds PS, Hockenberry M, Rai SN, et al. Nocturnal awakenings, sleep environment interruptions, and fatigue in hospitalized children with cancer. Oncol Nurs Forum. 2007;34(2):393-402.
Linder LA, Christian BJ. Nighttime sleep disruptions, the hospital care environment, and symptoms in elementary school-age children with cancer. Oncol Nurs Forum. 2012;39(6):553-61.
Hinds PS, Hockenberry M, Rai SN, et al. Clinical field testing of an enhanced-activity intervention in hospitalized children with cancer. J Pain Symptom Manage. 2007;33(6):686-97.
Traube C, Ariagno S, Thau F, et al. Delirium in Hospitalized Children with Cancer: Incidence and Associated Risk Factors. The Journal of Pediatrics. 2017;191:212-7.
Dechnik A, Traube C. Delirium in hospitalised children. The Lancet Child & Adolescent Health. 2020;4(4):312-21.
