Biobehavioral and Environmental Influences on Sleep in Children with Cancer

描述（由申请人提供）：癌症症状管理是国家癌症研究所和国家护理研究所提高生活质量的优先事项。很少有研究涉及癌症儿童的睡眠问题，住院癌症儿童睡眠障碍的来源也没有得到很好的了解。对急性患儿的研究表明，医院环境刺激会损害睡眠的数量和质量。其他癌症症状也会影响睡眠。气质特征会影响儿童对医院刺激的反应，影响睡眠。与气质变异相关的常见遗传多态性可能影响对生理和环境刺激的反应，并影响症状负担。设计：本研究将采用多病例研究设计来描述生物行为和环境对接受住院化疗的癌症儿童睡眠-觉醒模式的影响。具体目标是：1.；描述接受住院化疗的癌症儿童夜间睡眠-觉醒模式。2. 描述夜间环境因素（房间声音、光线和温度水平）的变化模式，以及与临床变量（疼痛、恶心/呕吐和药物管理）的关系。3. 描述癌症儿童夜间睡眠-觉醒模式、环境变量、生物行为变量（气质和行为基因型）和疲劳之间的关系。方法：15名5 - 12岁的癌症患儿接受住院化疗。活动记录仪将测量睡眠变量。数据记录器将测量环境变量。凯里气质量表和使用聚合酶链反应的行为基因分型将测量生物行为变量。疲劳将使用7- 12岁儿童和家长疲劳量表进行测量。分析：（目标1）对个体和群体数据生成睡眠变量的描述性时间序列图。重复测量方差分析将评估睡眠的变化。（目标2）将生成环境变量的图形图，并与临床变量叠加。自相关函数将评估环境变量的趋势。（目标3）单独的时间序列图将比较睡眠、环境和疲劳数据。相关系数将评估气质、睡眠和疲劳之间的关联。Kruskall-Wallis统计将根据行为基因型评估睡眠和疲劳的差异。公共卫生：该研究将通过确定导致医院睡眠紊乱的因素和开发改善睡眠的干预措施来提高癌症儿童的生活质量。

DESCRIPTION (provided by applicant): Cancer symptom management is a National Cancer Institute and National Institute of Nursing Research priority for improving quality of life. Few studies have addressed sleep in children with cancer, and sources of sleep disturbances in children with cancer in inpatient settings are not well understood. Studies of acutely ill children indicate that hospital environmental stimuli impair sleep quantity and quality. Other cancer symptoms also can contribute to disturbed sleep. Temperament characteristics can impact children's response to hospital stimuli and impair sleep. Common genetic polymorphisms associated with variations in temperament may influence response to physiologic and environmental stimuli and impact symptom burden. Design: The proposed study will utilize a multiple-case study design to describe biobehavioral and environ- mental influences on sleep-wake patterns among children with cancer receiving inpatient chemotherapy. Specific aims are: 1. Describe nighttime sleep-wake patterns among children with cancer receiving inpatient chemotherapy. 2. Describe nighttime patterns of variation in environmental factors (room sound, light, and temperature levels), and relationships with clinical variables (pain, nausea/vomiting, and medication administration). 3. Describe relationships between nighttime sleep-wake patterns in children with cancer, environmental variables, biobehavioral variables (temperament and behavioral genotype), and fatigue. Methods: Fifteen children with cancer ages 5 to 12 years receiving inpatient chemotherapy will be included. Actigraphs will measure sleep variables. Data loggers will measure environmental variables. Carey Temperament Scales and behavioral genotyping using polymerase chain reaction will measure biobehavioral variables. Fatigue will be measured using the Fatigue Scales for 7- to 12-Year Olds and for Parents. Analysis: (Aim 1) Descriptive time series plots of sleep variables will be generated for individual and group data. Repeated measures ANOVA will evaluate change in sleep. (Aim 2) Graphical plots will be generated for environmental variables and superimposed with clinical variables. Autocorrelation functions will evaluate environmental variable trends. (Aim 3) Individual time-series plots will compare sleep, environment, and fatigue data. Correlation coefficients will evaluate associations between temperament, sleep, and fatigue. Kruskall-Wallis statistics will evaluate differences in sleep and fatigue based on behavioral genotype. Public Health: The study will promote quality of life for children with cancer through identification of factors contributing to disturbed sleep in the hospital and the development of interventions to improve sleep.