Background. Children with a brain tumor are at risk of developing sleep problems. It remains unclear whether these problems arise at an early or later stage, and insights can facilitate timely interventions. The aim of this study is to examine sleep problems and contributing factors shortly after diagnosis. Methods. Children 6-16 years with a newly diagnosed (≤3 months) primary brain tumor were recruited for a prospective study. Sleep was measured using actigraphy and questionnaires (PROMIS Sleep Disturbance and Sleep Related Impairment, self- and parent-reports). Prevalence of clinical sleep problems were established using PROMIS cut-off scores. Mean PROMIS scores, prevalence of sleep problems and actigraphic outcomes were compared to norms (t-test, chi-square, linear regression). Demographic and medical risk factors were explored with multivariable linear regression models. Results. Sixty-nine children (68% male, mean age 11.6±2.8 years, 53±28 days after diagnosis) participated. Parents reported more sleep disturbances (mean T=53.7, P<.01) compared to norms. Rates of self- and parent-reported severe sleep disturbances were elevated (11% versus 5% in norms, P<.04). Parents also reported higher rates of moderate sleep disturbance (31%) and sleep related impairment (42%) than norms (25%, P<.03). Actigraphic outcomes did not differ from norms. Only shorter time since diagnosis was identified as independent risk factor (self-reported sleep disturbances, B=-.11, 95%CI -0.19;-0.03). Conclusions. Sleep problems are more frequently reported by children and parents shortly after pediatric brain tumor diagnosis, compared to healthy controls. Attention for sleep around brain tumor diagnosis is important, as sleep is vital for recovery and health-related quality of life.

Objective: 7-50% of children with medulloblastoma (MB) develop postoperative cerebellar mutism syndrome (pCMS). pCMS has a short-term negative impact on intelligence, but results on long-term outcomes are contradictory. The aim of this study was to assess long-term effects of pCMS in MB patients on aspects of intelligence (IQ) and its perioperative risk factors. Methods: In this single centre retrospective cohort study, 31 children with MB were included of which 14 had pCMS. Peri-operative risk factors included brainstem invasion, vermis incision, pre-and post-operative hydrocephalus, tumor size, duration and severity of pCMS, neurological symptoms on day 10 after surgery, mean body temperature (BT) on days 1-4 post surgery, and age at resection. Age appropriate Wechsler Intelligence tests were assessed within a structured follow up programme. Results: No significant differences in IQ scores were found between pCMS and non pCMS groups. The pCMS group had a clinically relevant difference of 10 points when compared to age norms on verbal IQ (VIQ). Bilateral pyramidal and swallowing problems were risk factors for lower performance in this group. In the overall group, tumor size, younger age at surgery, and raised mean BT on days 1-4 post-surgery were negatively correlated with aspects of IQ. Conclusions: We found a clinically significant reduction of VIQ in the pCMS patient group. pCMS patients with a larger tumor size, younger age at surgery, a higher mean BT in the first days after surgery, bilateral pyramidal symptoms, and swallowing problems 10 days post-surgery are more at risk for VIQ deficits at long-term.