Cydni N Williams1, Mary E Hartman2, Cindy T McEvoy3, Trevor A Hall4, Miranda M Lim5, Steven A Shea6, Madison Luther7, Kristin P Guilliams8, Rejean M Guerriero9, Christopher C Bosworth10, Juan A Piantino11. 1. Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, Portland, Oregon; Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon. Electronic address: willicyd@ohsu.edu. 2. Division of Critical Care Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri. 3. Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon. 4. Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, Portland, Oregon; Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon. 5. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon; Department of Neurology, Oregon Health and Science University, Portland, Oregon; Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon; Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon. 6. Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon. 7. Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, Portland, Oregon. 8. Division of Critical Care Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri; Division of Pediatric and Developmental Neurology, Department of Neurology, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri. 9. Division of Pediatric and Developmental Neurology, Department of Neurology, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri. 10. Department of Psychology, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri. 11. Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, Portland, Oregon; Division of Pediatric Neurology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.
Abstract
BACKGROUND: Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. METHODS: We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes. RESULTS: Sleep-wake disturbances were identified in 44 (56%) children and were classified as severe in 36 (46%). Sleep-wake disturbances affected ≥33% of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47%), although 68% had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43% vs 21%, P = 0.04) and in the traumatic brain injury subgroup (52% vs 5%, P = 0.001). CONCLUSIONS: Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.
BACKGROUND:Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. METHODS: We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes. RESULTS:Sleep-wake disturbances were identified in 44 (56%) children and were classified as severe in 36 (46%). Sleep-wake disturbances affected ≥33% of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47%), although 68% had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43% vs 21%, P = 0.04) and in the traumatic brain injury subgroup (52% vs 5%, P = 0.001). CONCLUSIONS: Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.
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