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Sleep behavior of infants with infantile hemangioma treated with propranolol—a cohort study

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Theiler Martin, Knöpfel Nicole, von der Heydt Susanne, Schwieger-Briel Agnes, Luchsinger Isabelle, Smith Alexandra, Kernland-Lang Kristin, Waelchli Regula, Neuhaus Kathrin, Kohler Malcolm, Gnannt Ralph, Schoch Sarah F., Weibel Lisa, Kurth Salome,
Project Development of sleep regulation - a window of opportunity for fostering healthy development
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Original article (peer-reviewed)

Journal European Journal of Pediatrics
Page(s) 0
Title of proceedings European Journal of Pediatrics
DOI 10.1007/s00431-021-04147-3

Open Access

Type of Open Access Publisher (Gold Open Access)


Sleep problems are frequently reported in infants treated with propranolol for infantile hemangiomas, possibly serving as a marker for a negative impact on central nervous system function. In this cohort study, we objectively investigate the sleep behavior of infants with infantile hemangiomas on propranolol compared to a healthy, untreated control group. Sleep of propranolol-treated infants and controls was investigated using ankle actigraphy and a 24-h diary for 7–10 days at ages 3 and 6 months. The main outcome measures were the Number of Nighttime Awakenings and Sleep Efficiency . The main secondary outcome measures included 24-hour Total Sleep , daytime sleep behavior, and parent-rated infant sleep quality and behavioral development based on the Brief Infant Sleep Questionnaire (BISQ) and the age-appropriate Ages-and-Stages Questionnaire (ASQ), respectively. Fifty-four term-born infants were included in each cohort. No group difference in any investigated parameter was seen at age 3 months. At age 6 months, the propranolol group exhibited a decrease in Sleep Efficiency and a trend towards an increased Number of Nighttime Awakenings compared to the control group. Treated infants at 6 months also had shorter daytime waking periods. 24-hour Total Sleep was unaffected by propranolol. No negative impact of propranolol on subjective sleep quality and behavioral development was noted. Conclusion : Propranolol exerts a measurable yet mild impact on objectively assessed infants’ sleep measures. Behavioral developmental scores were unaffected. Our results support propranolol as first-line therapy for complicated infantile hemangiomas. What is Known:• Sleep disorders are frequently reported in infants with infantile hemangiomas treated with propranolol and often lead to treatment discontinuation.• Investigations of the sleep pattern in this patient group using objective measures are lacking.What is New:• The sleep pattern of propranolol-treated infants is assessed using actigraphy and a 24-h sleep diary and compared to healthy, untreated controls.• Propranolol leads to a decreased sleep efficiency at night and an increased demand of daytime sleep, yet effects are mild overall.