32 Chapter 2 Therefore, this systematic review aimed to summarize all available literature to identify potential risk factors for steroid treatment-induced APRs and sleep problems in children with ALL. APRs and sleep problems are closely linked and may influence each other, however since both phenomena are often described separately, we reviewed them individually as well. To address our aim, we formulated several research questions (with reference to patient population, interventions, comparisons, and outcomes [PICO]). Our patient population encompassed children (0 till 18 years old) with ALL receiving steroid treatment. The outcome parameters were either APRs or sleep problems (or both). Based on previous literature, we hypothesized that the following risk factors might contribute to APRs and/ or sleep problems (interventions and comparisons): sociodemographic factors (age and sex),5,24 treatment factors (type and dose of steroid),5,10,19,24,26 parental factors (coping strategies, stress),27-29 (medical) history,20,30 and genetic predisposition.24,31 However, we did not limit our search on these risk factors. See Supplemental Table 1 for an overview of the PICOs.
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