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\begin{document}

\title{Comprehensive assessment of sleep in newly diagnosed pediatric brain
tumor patients}



\author[1]{Eva Hooft van Huijsduijnen}%
\author[1]{Marita Partanen}%
\author[1]{MA Grootenhuis}%
\author[1]{Eelco Hoving}%
\author[2]{Myrthe Nuijts}%
\author[1]{Raphaële Van Litsenburg}%
\affil[1]{Prinses Maxima Centrum voor Kinderoncologie}%
\affil[2]{Universitair Medisch Centrum Utrecht}%


\vspace{-1em}



  
  \date{May 23, 2024}


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\selectlanguage{english}
\begin{abstract}
\emph{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. \emph{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.
\emph{Results.} Sixty-nine children (68\% male, mean age 11.6\selectlanguage{ngerman}±2.8 years,
53±28 days after diagnosis) participated. Parents reported more sleep
disturbances (mean T=53.7, \emph{P}\textless{}.01) compared to norms.
Rates of self- and parent-reported severe sleep disturbances were
elevated (11\% versus 5\% in norms, \emph{P}\textless{}.04). Parents
also reported higher rates of moderate sleep disturbance (31\%) and
sleep related impairment (42\%) than norms (25\%,
\emph{P}\textless{}.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).
\emph{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.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{Introduction}

Sleep problems are known to be highly prevalent in pediatric cancer
patients and can be caused by biological and/or psychosocial factors
such as treatment toxicity, pain, and anxiety\textsuperscript{1,2}. In
the short term, sleep problems can lead to distress, cognitive problems,
and lower quality of life in pediatric cancer
patients\textsuperscript{2-6}. In the long term, it is clear from
studies in the general population, that sleep problems are associated
with obesity, cardiovascular disease and lower life
expectancy\textsuperscript{2}. Sleep also plays a critical role in
neuroimmune function and neuronal recovery in pediatric cancer patients.
Moreover, fragmented sleep has increasingly been linked to tumor growth
in mice\textsuperscript{7-9}. Children with a brain tumor are especially
prone to develop sleep problems. Neurosurgery, hydrocephalus, cranial
radiation therapy and hypothalamic damage may further contribute to the
onset of disturbances in sleeping patterns\textsuperscript{1,10,11}.

Currently, little is known about the prevalence and extent of sleep
problems in children with a newly diagnosed brain tumor. Previous
studies have mainly focused on patients with all types of cancer
diagnoses, causing heterogeneity, or included only patients with
hematologic malignancies, the most common type of pediatric
cancer\textsuperscript{12}. In addition, most studies focus on sleep at
the end of treatment or further into survivorship. Multiple physical,
psychological, and therapeutic factors related to the period around
diagnosis may impact sleep, such as high levels of distress or the
requirement of one or multiple hospitalizations, which are characterized
by frequent nightly awakenings\textsuperscript{13,14}. Poor sleeping
habits and maladaptive strategies may emerge in this period and persist
over the course of the disease. Lastly, sleep is most often assessed by
questionnaires only, which provide information on sleep behaviors and
consequences of disrupted sleep. However, questionnaires do not measure
sleep duration and sleep efficiency, and do not correlate well with
polysomnography, the gold standard for measuring
sleep\textsuperscript{15}. Some questionnaire studies only assess
parent-reported sleep\textsuperscript{16,17}, and this inherently poses
some reporting bias. Using several modes of sleep assessment is
important as it provides complementary information and contributes to
our understanding of sleep\textsuperscript{15,17,18}.

Sleep in the early phases of treatment in pediatric brain tumor patients
has thus far not been studied comprehensively, even though this has been
strongly recommended by researchers and
clinicians\textsuperscript{6,7,19}. Identifying which children are at
risk to develop sleep problems is important, in order to provide
effective, targeted sleep interventions in a timely manner, with the aim
to improve long-term negative health outcomes associated with poor
sleep. In adult cancer patients, treatment of sleep problems by using
non-pharmacological interventions such as cognitive behavioural therapy
has shown favorable results\textsuperscript{20,21}. In contrast, in
children with central nervous system tumors, a multicomponent sleep
intervention consisting of cognitive and behavioral interventions
modestly improved sleep outcomes\textsuperscript{22}. Therefore, more
insight into disrupted sleep and contributing factors in the earliest
phase after brain tumor diagnosis is needed.

We performed a prospective, observational study into sleep shortly after
primary pediatric brain tumor diagnosis. Our primary goal was to
describe patient and parent reported sleep problems and daytime
consequences, and sleep estimates within three months after diagnosis.
Secondly, we defined biological and psychological risk factors of poor
sleep. This study is part of a larger longitudinal study into sleep,
post-traumatic stress, and neurocognitive functioning (SuSPeCT-study).

\textbf{Materials and Methods}

\emph{Participants and procedures}

The Princess M\selectlanguage{ngerman}áxima Center for Pediatric Oncology opened in 2018 and is
a Dutch nationwide center where specialized pediatric oncology care is
centralized. A small number of patients with a low grade brain tumor,
requiring neurosurgery only, are treated in former pediatric oncology
centers. All new patients with a primary brain tumor diagnosis between
January 2019 and October 2021 and treated at the Princess Máxima Center
were eligible if they were between the age of 6 and 16 years, had
sufficient understanding of the Dutch language, had no evident
pre-existing developmental delay and did not receive end-of-life care.
All participants and their parents/caregivers provided written informed
consent. Sleep assessments took place around four weeks after the child
entered the hospital, with a maximum of three months. This study was
reviewed and approved by the Clinical Research Committee of the Princess
Maxima Center and confirmed subsequently by the Medical Research Ethics
Committee of the University Medical Center Utrecht.

\emph{Demographic and medical information}

Children's demographic and medical information was abstracted from their
medical records. This included sex, age, body mass index (BMI), date of
diagnosis, tumor type and tumor location. Any treatment that had taken
place before the time of assessment was collected, including
neurosurgery, start of radiotherapy, and start of chemotherapy, as well
as complications of hydrocephalus and epilepsy. Patients and their
parents provided information on pre-existing sleep problems, use of
sleep medication during the seven day sleep assessment, daytime naps and
whether they slept at home or in the hospital during the assessment.
Lastly, through a general survey, parents provided sociodemographic
information.

\emph{Sleep questionnaires}

Subjective sleep was assessed with two questionnaires (both self-report
and proxy-report) from the Patient-Reported Outcomes Measurement
Information System (PROMIS)\textsuperscript{23}.

The PROMIS Pediatric Sleep Disturbance short form 8a consists of eight
questions and assesses satisfaction with sleep, including difficulties
and concerns with falling asleep and staying asleep. The PROMIS
Pediatric Sleep Related Impairment short form 8a is another eight-item
questionnaire, focusing on perceptions associated with sleep problems.
It measures impaired alertness, tiredness and sleepiness during usual
waking hours and impaired functioning. Parents complete similar
proxy-versions. The questionnaires assess sleep over the past seven
days, are generic rather than disease-specific and do not focus on
symptoms of specific sleep disorders. Both questionnaires demonstrated
strong internal consistency reliability and clinical
validiy\textsuperscript{24}. Raw scores are rescaled into T-scores with
a mean of 50 and a standard deviation (SD) of 10. Questionnaire-specific
cut-off points for moderate (75--94th percentile) and severe (\selectlanguage{english}[?] 95th
percentile) sleep problems were used\textsuperscript{25}.

\emph{Actigraphic measures}

Sleep estimates were assessed using a wrist-worn actigraph (type
wGT3XBT, Pensacola, FL). This device registers the occurrence and the
intensity of arm movements and distinguishes the wake state from sleep.
This low-cost measurement has been validated against polysomnography,
and is well-tolerated during this intense stage of cancer
therapy\textsuperscript{26}. Participants were instructed to wear the
actigraph for seven days and seven nights. Also, they were asked to keep
a sleep log, to facilitate correct interpretation of the data.

The actigraphy software ActiLife (version 6.13.4, Sadeh algorithm) and
the sleep- and wake times from the sleep log were used to process the
actigraph data and calculate sleep outcomes. Sleep outcomes were only
calculated if there were available recordings of at least five nights,
as this is advised to obtain reliable actigraphic
measures\textsuperscript{27}. The following outcomes were obtained:
sleep efficiency (SE; ratio between the time spent in bed and the total
sleep time), sleep onset latency (SOL; number of minutes between bedtime
and onset of sleep), wake after sleep onset (WASO; number of minutes
awake after the onset of sleep), total sleep time (TST), total time
spent in bed (TIB) and number of awakenings (NA). Norm data of 47
healthy Dutch children within the same age range were used to compare
actigraphic sleep outcomes\textsuperscript{28}.

\emph{Statistical analysis}

Baseline characteristics were descriptively reported. T-tests and
chi-square tests were used to examine potential differences in age, sex
and tumor location between participants and non-participants (active or
passive refusal), and between participants and patients who were not
approached (due to severe illness/palliative care or logistical issues).

To examine differences in reported sleep between participants and
healthy children, scores of the PROMIS questionnaires were compared to a
mean score of 50, using one-sided t-tests. Statistical significance was
considered as a \emph{P} -value of \textless{}.05. The percentage of
moderate and severe sleep problems was described by using the
questionnaire-specific cut-offs\textsuperscript{25} and compared to the
normal population by using non-parametric chi-square tests.

Linear regression models were used for comparing actigraphic sleep
estimates between the participants and healthy children. As sleep
estimates are age-dependent, regression models were adjusted for
age\textsuperscript{28}.

Risk factors for impaired sleep were explored by building linear
regression models. Demographic and medical variables relevant for sleep
outcomes were examined with univariate analyses. Variables with
a\emph{P} -value of \textless{}.10 were subsequently added to a
multivariable model. A \emph{P} -value of \textless{}.05 was considered
significant. All analyses were carried out with IBM SPSS Statistics
version 26.0.0.1.

\textbf{Results}

\emph{Demographic and medical information}

In total, 69 (75\%) children consented to the study; details of
participant enrollment are described in Figure 1. There were no
differences in age and sex between participants and nonparticipants,
however, nonparticipants more often had cerebral tumors compared to
participants (Table 1). There were no differences in age, sex, and tumor
location between participants and patients who were not approached.

The baseline characteristics of the participants are described in Table
1. Of the children with supratentorial midline tumors (N=26, 38\%),
fifteen children (22\%) had a tumor in the pituitary region, and no
child had a tumor in the hypothalamus. In the whole participant group,
pre-existing sleep problems were reported by the parents of seven (10\%)
participants, six (9\%) participants took daytime naps and two (3\%)
participants used melatonin during the assessment. No nights were spent
in the hospital during sleep examination.

\emph{Sleep questionnaires}

Results of the PROMIS Sleep Disturbance (N=53 self-report, N=65
proxy-report) and Sleep Related Impairment (N=53 self-report, N=65
proxy-report) questionnaires are presented in Table 2. Compared to norm
data, parents reported significantly more sleep problems on the Sleep
Disturbance questionnaire (mean T=53.7, \emph{P\textless{}} .01). This
was not reported by the children themselves (mean T=50.6, \emph{P}
=.64).

Severe sleep disturbance was experienced by 11\% of the children
compared to 5\% in the general population, according to both parent and
self-reports (\emph{P=} 0.03 and \emph{P} =.04, respectively). Moderate
sleep disturbance was also frequently reported by parents: 31\% compared
to 20\% in the general population (\emph{P} =.03). Rates of severe sleep
related impairment were not significantly elevated according to both
parents and children themselves. However, moderate sleep related
impairment was more prevalent according to parents (42\% vs
20\%\emph{P\textless{}} .01).

\emph{Actigraphic sleep estimates}

Actigraphic sleep outcomes were avialble from 53 participants. There
were no statistical differences between participants and controls (Table
3). Based on the sleeplog, participants' bedtime (mean 21:36) was 30
minutes later, compared to controls (\emph{P} =0.04). Also,
participants' wake time (mean 07:57) was 32 minutes later, compared to
controls (\emph{P} \textless{}0.001).

\emph{Risk factors}

Univariable risk factors for patient- and parent reported sleep outcomes
are presented in Supplementary Table 1. Higher sleep disturbances were
reported by children more shortly after diagnosis (B=-.12, 95\%CI
-.20;-.04, \emph{P} \textless{}.01), and by those with cerebral or
posterior fossa tumors, compared to children with supratentorial midline
tumors (B=-4.56, 95\%CI 10.01;-.88, \emph{P=} .10). Parents reported
higher child sleep disturbances more shortly after diagnosis (B=-.10,
95\%CI -.18;-.01, \emph{P=} .03\emph{)} and before radiotherapy
(B=-6.41, 95\%CI -12.46;-.35, \emph{P=} .04). However, in the
multivariable models (Table 4) shorter time after diagnosis (B=-.11,
95\%CI -.19;-.03,\emph{P} =\textless{}.01) remained the only independent
significant determinant for self-reported sleep disturbance. For sleep
related impairment, no significant risk factors were identified on both
the self- and proxy-reports.

For actigraphic outcomes, univariable analyses (Supplementary Table 2)
showed females had higher sleep efficiency (B=3.60, 95\%CI
-.60;-7.78,\emph{P} =.09). The history of an obstructive hydrocephalus
was associated with shorter sleep onset latency (B=-8.92, 95\%CI
-16.83;-1.01, \emph{P=} .03) and longer total sleeping time (B=32.86,
95CI 1.10;64.62, \emph{P} =.04). More nighttime awakenings were related
to neurosurgery (B=5.37, 95\% CI -.54;11.29, \emph{P=} .07) and
radiotherapy (proton or photon, B=4.27, 95\%CI -.74;9.28, \emph{P=}
.09). Younger children had higher sleep onset latency (B=-1.96, 95\%CI
-3.36;-.56, \emph{P} \textless{}.01), more total sleep time (B=-7.35,
95\%CI -12.98;-1.73, \emph{P=} .01) and spent more time in bed
(B=-10.59, 95\%CI 15.33;-5.85, \emph{P} \textless{}.01). Multivariable
analyses (Table 5) showed the history of an obstructive hydrocephalus
independently predicted longer sleeping times (B=41.04, 95\%CI
11.41;70.68, \emph{P\textless{}} .01). Finally, younger age remained
associated with longer sleep onset latency (B=-1.73, 95\%CI
-3.12;-.35,\emph{P=} .02) and more total sleeping time (B=-8.63, 95\%CI
-14.00;-3.26, \emph{P} \textless{}.01).

Body mass index, parental education level, start of chemotherapy,
hormone deficiency and epilepsy were not significantly associated with
any of the sleep outcomes.

\textbf{Discussion}

The results of this unique prospective nationwide cohort study of
children with a newly diagnosed brain tumor demonstrate a high
prevalence of sleep problems at brain tumor diagnosis, mostly reported
by parents of patients. Actigraphic sleep outcomes were not different
from those of healthy controls.

We found a high rate of parent reported child sleep disturbance and
sleep related impairment, with up to half of the parents reporting
moderate or severe problems. Children themselves frequently reported
severe sleep disturbances, especially more shortly after brain tumor
diagnosis. These findings are consistent with our expectations,
indicating sleep problems are experienced regularly and already at the
earliest phase of cancer treatment, possibly arising as a result of
factors such as distress and neurological damage. Interestingly, alhough
parents reported high rates of sleep related impairments, children did
not report this and on average these scores did not differ from the
general population.

Differences in self- and proxy-report are common in pediatric research
and may be explained by several factors\textsuperscript{29-31}. Firstly,
children may underreport symptoms. This can be the result of ``response
shift'', meaning symptoms are judged differently during cancer treatment
than how they would be judged before diagnosis\textsuperscript{32}. It
could also be that neurocognitive-, stress- and sleep disturbances
impact children's' capability of adequately recalling sleep
experiences\textsuperscript{33}. Second, parents may overreport symptoms
due to feelings of stress and concern. Earlier research suggests that
parental distress, parental sleep problems and parenting problems are
related to parent reported child sleep\textsuperscript{30}. Hence,
differences in self- and proxy-reports emphasize the importance of using
both types when measuring sleep, as they are both informative and may
provide complementary information in this phase of treatment.

We hypothesized that actigraphic outcomes would show lower sleep
estimates compared to age-matched, healthy controls, due to the physical
and psychosocial stressors associated with the period following
pediatric brain tumor diagnosis. The absence of these findings is
largely consistent with earlier, similar research in patients with acute
lymphoblastic leukemia (ALL)\textsuperscript{30}. However, children with
ALL did show longer sleeping times than healthy peers, possibly because
these children require more sleep, as they are ill and physically
recovering. It could therefore be argued that although the number of
minutes children with recently diagnosed brain tumors sleep is similar
to healthy children, they might have a higher need for sleep to support
optimal recovery\textsuperscript{34,35}. Furthermore, this study sample
was almost entirely assessed during the Covid-19 pandemic, while data of
the control group was collected before. It is plausible that children
sleep better during the pandemic, as they were able to sleep longer due
to home schooling and were less exposed to stimuli during the
day\textsuperscript{36}. In the healthy population, it was found that
people with insomnia complaints experienced clinically meaningful
alleviations of symptoms during the pandemic\textsuperscript{37}.
Another factor that may influence sleep during the diagnostic period are
substantial efforts and strategies of parents, such as co-sleeping and
comforting activities, as illustrated in parents of children with
ALL\textsuperscript{38}. Possibly, as parents put in a great deal of
energy, they do report sleep problems, and yet these efforts seem
relatively effective in terms of sleep duration.

Generally, little research has been done with actigraphy and children
with cancer during treatment. However, sleep problems are well described
and measured amongst brain tumor survivors\textsuperscript{11,39}. Toxic
treatmens effects such as radiation therapy or endocrine disturbances
may lead to those sleep problems at a later stage. Longitudinal data
from this current study should provide more insight into this
matter\textsuperscript{11,40}.

This study has several limitations. Although the participant group is
relatively large for pediatric brain tumor research, there may not have
been enough power to demonstrate specific predictors for sleep problems.
In addition, not all parents and children participated in all sleep
measurements, due to for example treatment toxicity or study burden,
increasing the risk of participation bias. Subsequently, even though
participants were recruited from a national pediatric oncology hospital,
specific tumor groups were underrepresented which may have lead to
selection bias. Twenty-four children with low grade brain tumors who
required neurosurgery only and had a favorable prognosis were primarily
treated in affiliated hospitals and therefore not participating in this
study. Twelve children with high grade tumors were not invited, as they
were receiving palliative care with high morbidity, and the treating
physician requested not to burden the family.

Actigraphy measures movement and is well validated, but does not measure
sleep phases (light, deep and REM sleep). Also, children may have
shifted circadian rhythms or inconsistent bedtimes, which is not
reflected in the actual number of minutes asleep, but may still contribe
to fatigue\textsuperscript{3,7,41}. Future research should explore sleep
phases and rhythms to gain more insight into sleep quality. Lastly,
previous research suggests more knowledge of parents on sleep hygiene
benefits child sleep, suggesting education and support for parents may
be an efficient intervention\textsuperscript{42,43}. Future research
should therefore consider collecting more comprehensive data on parents
and parenting strategies as well.

In conclusion, sleep problems in children with a brain tumor are
frequently reported in the first three months after brain tumor
diagnosis. Clinicians should be attentive to sleep problems, as it may
induce serious, negative consequences in this already vulnerable group.
Increasing our understanding of sleep is of major importance because
sleep is vital for recovery and health-related quality of life.

\emph{Conflict of Interest.} The authors have no conflict of interest to
declare.

\emph{Acknowledgements.} The authors would like to thank the
psycho-oncology and neuro-oncology teams for their contribution and
support.

\emph{Funding.} This study was funded by The Princess Maxima Center for
Pediatric Oncology.

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28. Rensen N, Steur LMH, Wijnen N, van Someren EJW, Kaspers GJL, van
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children.\emph{Chronobiol Int.} 2020;37(5):660-672.

29. Mack JW, McFatrich M, Withycombe JS, et al. Agreement Between Child
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30. Steur LMH, Grootenhuis MA, Van Someren EJW, et al. High prevalence
of parent-reported sleep problems in pediatric patients with acute
lymphoblastic leukemia after induction therapy. \emph{Pediatr Blood
Cancer.} 2020;67(4):e28165.

31. Upton P, Lawford J, Eiser C. Parent-child agreement across child
health-related quality of life instruments: a review of the
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32. Visser MR, Smets EM, Sprangers MA, de Haes HJ. How response shift
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33. Lubas MM, Szklo-Coxe M, Mandrell BN, et al. Concordance between
self-reported sleep and actigraphy-assessed sleep in adult survivors of
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effects. \emph{Support Care Cancer.} 2021.

34. Hinds PS, Hockenberry M, Rai SN, et al. Nocturnal awakenings, sleep
environment interruptions, and fatigue in hospitalized children with
cancer. \emph{Oncol Nurs Forum.} 2007;34(2):393-402.

35. Hillman DR. Sleep Loss in the Hospitalized Patient and Its Influence
on Recovery From Illness and Operation. \emph{Anesth
Analg.}2021;132(5):1314-1320.

36. van Gorp M, Maurice-Stam H, Teunissen LC, et al. Psychosocial
function of Dutch children with cancer and their caregivers during
different phases of the COVID-19 pandemic. \emph{Pediatr Blood
Cancer.}2022;69(4):e29535.

37. Kocevska D, Blanken TF, Van Someren EJW, Rosler L. Sleep quality
during the COVID-19 pandemic: not one size fits all. \emph{Sleep
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38. McCarthy MC, Bastiani J, Williams LK. Are parenting behaviors
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39. Verberne LM, Maurice-Stam H, Grootenhuis MA, Van Santen HM,
Schouten-Van Meeteren AY. Sleep disorders in children after treatment
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40. Sato I, Higuchi A, Yanagisawa T, et al. Impact of late effects on
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43. McDowall PS, Elder DE, Campbell AJ. Relationship between parent
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Health.} 2017;53(8):788-793.

\textbf{Figure 1.} Flowchart of participant enrollment\selectlanguage{english}
\begin{longtable}[]{@{}llllllll@{}}
\toprule
\begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
TABLE 1 Baseline characteristics of participants\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
TABLE 1 Baseline characteristics of participants\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
TABLE 1 Baseline characteristics of participants\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
TABLE 1 Baseline characteristics of participants\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
TABLE 1 Baseline characteristics of participants\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Study participants (N=69)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Study participants (N=69)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Non-participants (N=23), \emph{P}-value\textsuperscript{3}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Not approached (N=14), \emph{P}-value\textsuperscript{3}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Child variables\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Child variables\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Child variables\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Child variables\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Male sex, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Male sex, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Male sex, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
47 (68\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
47 (68\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
14 (61\%), \emph{P=}.52\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
8 (57\%), \emph{P}=.44\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Age at assessment, mean years (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Age at assessment, mean years (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Age at assessment, mean years (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
11.6 (2.8)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
11.6 (2.8)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
11.1 (4.3), \emph{P}=.76\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
9.9 (2.3), \emph{P=}.08\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Time since diagnosis, mean days (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Time since diagnosis, mean days (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Time since diagnosis, mean days (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
53 (28)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
53 (28)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Body Mass Index, mean (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Body Mass Index, mean (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Body Mass Index, mean (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
18.7 (3.7)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
18.7 (3.7)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Parental education level\textsuperscript{1}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Parental education level\textsuperscript{1}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Parental education level\textsuperscript{1}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Low-Middle N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Low-Middle N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
33 (51\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
33 (51\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
High, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
High, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
32 (49\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
32 (49\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Medical variables\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Medical variables\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Medical variables\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Medical variables\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Tumor type\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Tumor type\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Tumor type\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Low grade glioma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Low grade glioma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
33 (48\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
33 (48\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Germ cell tumor, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Germ cell tumor, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
10 (15\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
10 (15\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Craniopharyngioma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Craniopharyngioma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
9 (13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
9 (13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
High grade glioma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
High grade glioma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6 (8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6 (8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Medulloblastoma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Medulloblastoma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6 (8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6 (8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Ependymoma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Ependymoma, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
2 (3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
2 (3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Other, N (\%)\textsuperscript{2}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Other, N (\%)\textsuperscript{2}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
3 (4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
3 (4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Tumor location\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Tumor location\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Tumor location\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Posterior fossa, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Posterior fossa, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
29 (42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
29 (42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
8 (35\%), \emph{P}=.54\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6 (43\%), \emph{P}=.95\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Supratentorial medial structures, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Supratentorial medial structures, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
26 (38\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
26 (38\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5 (22\%), \emph{P}=.16\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5 (36\%), \emph{P}=.89\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Cerebral lobes, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Cerebral lobes, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
14 (20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
14 (20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
10 (44\%), \emph{P}=.03*\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
3 (21\%), \emph{P}=.92\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Started treatment\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Started treatment\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Started treatment\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Neurosurgery, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Neurosurgery, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
63 (91\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
63 (91\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Started chemotherapy, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Started chemotherapy, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
12 (17\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
12 (17\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Started radiotherapy, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Started radiotherapy, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
13 (19\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
13 (19\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Proton therapy, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5 (7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5 (7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Photon therapy, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
8 (12\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
8 (12\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Obstructive hydrocephalus, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Obstructive hydrocephalus, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
33 (48\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
33 (48\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Hormone deficiency, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Hormone deficiency, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
18 (26\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
18 (26\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Epilepsy, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Epilepsy, N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
9 (13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
9 (13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textsuperscript{1} Low = no education, primary school, lower secondary
education; middle = upper secondary education, preuniversity education,
intermediate vocational education; high = higher vocational education,
university.

\textsuperscript{2} ATRT (N=1), plexus tumor (N=1), meningioma (N=1).

\textsuperscript{3} Compared to participant group.

* Statistically significant\selectlanguage{english}
\begin{longtable}[]{@{}llllllllllllllllll@{}}
\toprule
\begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
TABLE 2 Patient- and parent-reported child sleep and prevalence of sleep
problems\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
T-score\textsuperscript{1}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
T-score\textsuperscript{1}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
T-score\textsuperscript{1}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
T-score\textsuperscript{1}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
T-score\textsuperscript{1}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Moderate sleep problems\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Moderate sleep problems\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Moderate sleep problems\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Severe sleep problems\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Severe sleep problems\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Severe sleep problems\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Severe sleep problems\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Severe sleep problems\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Severe sleep problems\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Any sleep problem\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Any sleep problem\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Any sleep problem\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
Mean (SD) or median {[}IQR{]}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{2}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{2}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{2}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{3}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{3}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{4}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{4}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{4}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
N (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{5}\strut
\end{minipage} & \begin{minipage}[t]{0.05\columnwidth}\raggedright\strut
\emph{P}-value\textsuperscript{5}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
Self-report (n=53)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
Sleep Disturbance\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
50.6 (9.5)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
50.6 (9.5)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.64\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
8 (15\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
8 (15\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
8 (15\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
8 (15\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.37\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.37\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
6 (11\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
6 (11\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{.04}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{.04}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
14 (26\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
14 (26\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.81\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.81\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
Sleep Related Impairment\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
49.7 {[}40.1 -- 54.2{]}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
49.7 {[}40.1 -- 54.2{]}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
7 (13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
7 (13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
7 (13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
7 (13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.22\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.22\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
3 (6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
3 (6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.83\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.83\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
10 (19\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
10 (19\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.30\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.30\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
Proxy-report (n=65)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
Sleep Disturbance\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
53.7 (10.0)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
53.7 (10.0)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{\textless{}.01}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
20 (31\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
20 (31\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
20 (31\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
20 (31\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{.03}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{.03}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
7 (11\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
7 (11\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{.03}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{.03}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
27 (42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
27 (42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{\textless{}.01}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{\textless{}.01}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
Sleep Related Impairment\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
57.1 {[}37.9 -- 61.8{]}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
57.1 {[}37.9 -- 61.8{]}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
27 (42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
27 (42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
27 (42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
27 (42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{\textless{}.01}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{\textless{}.01}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
5 (8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
5 (8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.32\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
.32\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
32 (49\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
32 (49\%)\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{\textless{}.01}\strut
\end{minipage} & \begin{minipage}[t]{0.03\columnwidth}\raggedright\strut
\textbf{\textless{}.01}\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Abbreviations: SD = standard deviation, IQR = interquartile range.

Significant \emph{P} -values are bold.

\textsuperscript{1} Higher scores indicate more sleep problems

\textsuperscript{2} Compared to norm population (mean=50, SD=10)

\textsuperscript{3} Compared to percentage of moderate sleep problems in
the norm population (20\%)

\textsuperscript{4} Compared to percentage of severe sleep problems in
the norm population (5\%)

\textsuperscript{5} Compared to percentage of sleep problems (moderate
or severe) in the norm population (25\%)

TABLE 3 Differences in actigraphic sleep estimates between participants
and healthy controls\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Participants (n=53) Mean (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Control group (n=47) Mean (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
B (95\% CI)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
\emph{P}-value\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
SE (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
79.0 (7.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
77.8 (7.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
-1.1 (-3.9 -- 1.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
.47\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
SOL (min)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
20.7 (14.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
25.9 (15.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4.2 (-1.6 -- 10.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
.15\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
WASO (min)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
107.3 (39.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
113.9 (45.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4.5 (-12.2 -- 21.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
.60\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
TST (min)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
480.9 (58.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
479.1 (48.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
-7.8 (-26.9 -- 11.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
.42\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
TIB (min)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
608.9 (55.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
618.6 (56.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
.8 (-15.3 -- 16.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
.92\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
NA (N)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
28.6 (6.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
28.6 (6.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
-.3 (-3.0 -- 2.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
.80\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Abbreviations: SE = sleep efficiency, SOL = sleep onset latency, WASO =
wake after sleep onset,

TST = total sleep time, TIB = total time spent in bed, NA = number of
awakenings, min = minutes.

Models were adjusted for age.

\textbf{TABLE 4} Multivariable regression models of risk factors for
patient- and parent reported sleep outcomes

Questionnaires, B (95\% CI)\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
PROMIS Sleep Disturbance Self-report\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
PROMIS Sleep Related Impairment Self-report\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
PROMIS Sleep Disturbance Proxy-report\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
PROMIS Sleep Related Impairment Proxy-report\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Time since diagnosis \emph{Continuous}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
\textbf{-.11*} \textbf{(-.19 -- -.03)}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-.07 (-.16 -- .02)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Tumor location \emph{Suprat. midline vs. others}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-3.56 (-8.74 -- 1.62)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Started radiotherapy\textsuperscript{1} \emph{Yes vs. no}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-4.60 (-10.96 -- 1.76)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
-\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textsuperscript{1} Proton and photon radiation therapy grouped together

* Statistically significant (\emph{P} \textless{}0.01)

\textbf{TABLE 5} Multivariable regression models of risk factors for
actigraphic sleep outcomes

Actigraphic outcomes, B (95\% CI)\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
SE\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
SOL\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
WASO\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
TST\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
TIB\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NA\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Age \emph{Continuous}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{-1.73*} \textbf{(-3.12 -- -.35)}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{-8.63**} \textbf{(-14.00 -- -3.26)}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{-10.59**} \textbf{(-15.33 -- -5.85)}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Neurosurgery \emph{Yes vs. no}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4.68 (-1.26 -- 10.61)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Started radiotherapy\textsuperscript{1} \emph{Yes vs. no}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3.63 (-1.37 -- 8.64)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Obstr. hydrocephalus \emph{Yes vs. no}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-7.28 (-14.93 - .37)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{41.04**} \textbf{(11.41 -- 70.68)}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
-\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Abbreviations: SE = sleep efficiency, SOL = sleep onset latency, TST =
total sleep time, TIB = total time in bed, NA = number of awakenings,
suprat. = supratentorial, obstr. = obstructive.

\textsuperscript{1} Proton and photon radiation therapy grouped together

* Statistically significant (\emph{P} \textless{}0.05)

** Statistically significant (\emph{P} \textless{}0.01)

\selectlanguage{english}
\FloatBarrier
\end{document}

