Text: Sarah Schoch
Approximately 3 – 5% of all infants develop hemangiomas during the first year of life. The standard treatment is the administration of beta-blockers (propranolol). Previous studies suggested that infants with propranolol treatment had more sleep problems. Sleep problems are also the most common reason why treatment is discontinued. However, previous studies had relied only on parental reports and had not analyzed objective infant sleep data.
Therefore, the research group with Dr. Martin Theiler and colleagues at the Dermatology Department of the University Children’s Hospital Zurich collaborated with us to collect sleep data from 54 babies treated with propranolol. Baby sleep was measured using the same methods and protocol as we employ in the Baby Sleep Lab. This allowed us to compare the sleep development of the babies with treatment with babies without treatment. Fifty-four babies from our German-speaking cohort were selected as a comparison group, which were as similar as possible according to age and sex to the babies from the Children’s Hospital.
At 3 months of age, there was no difference between the two groups. At 6 months, sleep efficiency (how much time in bed is actually spent asleep) was slightly lower in the propranolol-treated babies (average 90% vs. 92%). However, this lack of sleep was made up during the day, so that total sleep time summed over 24 h was not significantly affected. The longest waking period (during the day) was significantly shorter in the babies with treatment (mean 3 h 13 min vs. 3 h 40 min). Most babies with treatment were within the spectrum of normal sleep development. Of the babies clearly outside the normal range, treatment was discontinued in three because of sleep problems. After switching to a different medication, their sleep improved.
Interestingly, parental assessment of baby sleep did not differ between groups. Nor did parental sleep quality and behavioral development vary significantly.
Propranolol, therefore, appears to be a safe treatment option for most babies with only limited impact on objectively measured sleep. However, it is worth keeping an eye on sleep with such treatments to notice any changes early.
SOURCE:
Theiler, M., Knöpfel, N., von der Heydt, S., Schwieger-Briel, A., Luchsinger, I., Smith, A., … & Kurth, S. (2021). Sleep behavior of infants with infantile hemangioma treated with propranolol-a cohort study. European Journal of Pediatrics, 1-14. https://doi.org/10.1007/s00431-021-04147-3