196 Chapter 6 Using the Sadeh algorithm, several sleep outcomes were generated: total sleep time (TST: number of minutes asleep during the time spent in bed); time in bed (TiB: total number of minutes spent in bed); sleep efficiency (SE: the ratio between TST and TiB), sleep onset latency (SOL: number of minutes between bedtime and first minute scored as sleep); and wake after sleep onset (WASO: number of minutes awake after onset of sleep). Parent reported questionnaires Parents were asked to fill in several questionnaires on different timepoints. All questionnaires were web based and data was collected through a secure website, www. hetklikt.nu, a safe internet environment which is widely used in pediatric (oncology) care in the Netherlands. Parents were instructed to provide information regarding the previous five days: that is, with or without dexamethasone and/or study medication. Strengths and difficulties questionnaire (SDQ) The parent-reported SDQ contains 25 items and is divided in 5 subscales: emotional symptoms, conduct problems, hyperactivity-inattention, peer problems and prosocial behavior. A Total difficulties score can be calculated by adding up the first four subscales (i.e. excluding prosocial behavior). Clinical cut-off scores are age dependent, and an increase of one SD above norm values is considered clinically significant and lies between 4 and 6 points.13 The primary caregiver was asked to complete the SDQ on all eleven testing moments. Sleep Disturbance Scale for Children (SDSC) The parent-reported SDSC contains 26 items and yields 6 subscales which cover the most common sleep problems in childhood and adolescence: disorders of initiating and maintaining sleep (DIMS), disorders of arousal (DA), sleep-wake transition disorders (SWTD), disorders of excessive somnolence (DES) and sleep hyperhidrosis (SHY). The total sleep score is the sum of the 26 items with a range of 26-130. The primary caregiver was asked to complete the SDSC before and after the dexamethasone course and before and after one hydrocortisone and placebo course. Eating Thermometer (ET) To measure a hunger score we used the ET questionnaire, which consisted of 4 different thermometers. Parents were asked to fill (together with their child when possible) in how much hunger their child experienced on average the past 24 hours, when waking up in the morning (fasting score) and to indicate the least and worst hunger feeling the past day on a visual analogue scale (range 0-10).
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