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In this cohort study, we objectively investigate the sleep behavior of infants with infantile hemangiomas on propranolol compared to a healthy, untreated control group. Sleep of propranolol-treated infants and controls was investigated using ankle actigraphy and a 24-h diary for 7\u201310 days at ages 3 and 6 months. The main outcome measures were the<jats:italic>Number of Nighttime Awakenings<\/jats:italic>and<jats:italic>Sleep Efficiency<\/jats:italic>. The main secondary outcome measures included<jats:italic>24-hour Total Sleep<\/jats:italic>, daytime sleep behavior, and parent-rated infant sleep quality and behavioral development based on the Brief Infant Sleep Questionnaire (BISQ) and the age-appropriate Ages-and-Stages Questionnaire (ASQ), respectively. Fifty-four term-born infants were included in each cohort. No group difference in any investigated parameter was seen at age 3 months. At age 6 months, the propranolol group exhibited a decrease in<jats:italic>Sleep Efficiency<\/jats:italic>and a trend towards an increased<jats:italic>Number of Nighttime Awakenings<\/jats:italic>compared to the control group. Treated infants at 6 months also had shorter daytime waking periods.<jats:italic>24-hour Total Sleep<\/jats:italic>was unaffected by propranolol. No negative impact of propranolol on subjective sleep quality and behavioral development was noted.<\/jats:p><jats:p><jats:italic>Conclusion<\/jats:italic>: Propranolol exerts a measurable yet mild impact on objectively assessed infants\u2019 sleep measures. Behavioral developmental scores were unaffected. Our results support propranolol as first-line therapy for complicated infantile hemangiomas.<jats:table-wrap><jats:table><jats:tbody><jats:tr><jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 Sleep disorders are frequently reported in infants with infantile hemangiomas treated with propranolol and often lead to treatment discontinuation.<\/jats:italic><jats:italic>\u2022 Investigations of the sleep pattern in this patient group using objective measures are lacking.<\/jats:italic><\/jats:td><\/jats:tr><jats:tr><jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 The sleep pattern of propranolol-treated infants is assessed using actigraphy and a 24-h sleep diary and compared to healthy, untreated controls.<\/jats:italic><jats:italic>\u2022 Propranolol leads to a decreased sleep efficiency at night and an increased demand of daytime sleep, yet effects are mild overall.<\/jats:italic><\/jats:td><\/jats:tr><\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-021-04147-3","type":"journal-article","created":{"date-parts":[[2021,6,18]],"date-time":"2021-06-18T08:03:03Z","timestamp":1624003383000},"page":"2655-2668","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Sleep behavior of infants with infantile hemangioma treated with propranolol\u2014a cohort study"],"prefix":"10.1007","volume":"180","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7160-3958","authenticated-orcid":false,"given":"Martin","family":"Theiler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6438-6550","authenticated-orcid":false,"given":"Nicole","family":"Kn\u00f6pfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"von der Heydt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7679-3981","authenticated-orcid":false,"given":"Agnes","family":"Schwieger-Briel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7725-8171","authenticated-orcid":false,"given":"Isabelle","family":"Luchsinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Kernland-Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5396-7675","authenticated-orcid":false,"given":"Regula","family":"Waelchli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2438-1779","authenticated-orcid":false,"given":"Kathrin","family":"Neuhaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1800-8003","authenticated-orcid":false,"given":"Malcolm","family":"Kohler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8120-6200","authenticated-orcid":false,"given":"Ralph","family":"Gnannt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3962-5804","authenticated-orcid":false,"given":"Sarah F.","family":"Schoch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8696-8164","authenticated-orcid":false,"given":"Lisa","family":"Weibel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1432-4367","authenticated-orcid":false,"given":"Salome","family":"Kurth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,18]]},"reference":[{"key":"4147_CR1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-3475","volume":"143","author":"DP Krowchuk","year":"2019","unstructured":"Krowchuk DP, Frieden IJ, Mancini AJ, Darrow DH, Blei F, Greene AK, Annam A, Baker CN, Frommelt PC, Hodak A, Pate BM, Pelletier JL, Sandrock D, Weinberg ST, Whelan MA, SUBCOMMITTEE ON THE MANAGEMENT OF INFANTILE HEMANGIOMAS (2019) Clinical practice guideline for the management of infantile hemangiomas. 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Lisa Weibel received honoraria from AbbVie, Pfizer, Eli Lilly, and Novartis for investigator services, and from Pierre Fabre, Sanofi-Aventis, Pfizer, Permamed, and Novartis for participation on advisory boards, as a speaker, and for consultancy. The other authors declared no conflicts of interest related to the content of this manuscript.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}