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The effect of diphenhydramine on sleep in pediatric burn patients: a secondary analysis
Nyima Yangzom1, Michele M Gottschlich, Julie Ossege
1From the Departments of *Nursing, †Nutrition, and ‡Surgery, Shriners Hospitals for Children, Cincinnati, Ohio; §Department of Advanced Nursing, Northern Kentucky University, Newport; ‖Institute for Biomedical Ethics, University of Basel, Switzerland; and ¶Department of Surgery, University of Cincinnati College of Medicine, Ohio.
Insights
Diphenhydramine (DPH) increased total sleep time in pediatric intensive care unit burn patients. While not improving sleep quality, DPH enhanced sleep quantity, suggesting potential for further research in pediatric sleep interventions.
Area of Science:
- Pediatric critical care medicine
- Sleep science
- Burn injury research
Background:
- Sleep disruption is prevalent in pediatric intensive care units (PICUs), particularly for children with burn injuries.
- Adequate sleep is crucial for homeostasis and recovery from illness.
- Current sleep interventions for pediatric burn patients are limited.
Purpose of the Study:
- To evaluate the effect of diphenhydramine (DPH) on sleep patterns in pediatric ICU burn patients.
- To assess sleep onset latency, total sleep time, and sleep stage distribution.
- To utilize Myra Levine's Conservation Model as a framework for understanding sleep needs.
Main Methods:
- Secondary analysis of polysomnography data and retrospective chart review.
- Pair matching of 12 DPH-treated patients with 12 non-DPH-treated patients based on other sedatives.
- Statistical analysis using paired t-tests and chi-square analysis.
Main Results:
- DPH patients had significantly greater total sleep time (297.6 min) compared to non-DPH patients (209.2 min).
- Sleep onset latency was shorter in DPH patients (4.3 min) versus non-DPH patients (15.8 min), though not statistically significant (P = .06).
- The DPH group showed 50% more rapid eye movement (REM) sleep, but minimal differences in deep sleep stages (3 and 4).
Conclusions:
- Diphenhydramine (DPH) increased sleep quantity, specifically total sleep time and REM sleep, in pediatric burn patients.
- DPH did not lead to statistically significant improvements in overall sleep quality in this cohort.
- Further research is necessary to identify effective sleep interventions for pediatric burn patients in the ICU.
Abstract:
Adequate sleep is essential for maintaining homeostasis, especially when recovering from an illness; however, studies have shown that sleep disruption and sleep deprivation are common in intensive care unit patients, including children who have sustained burn injury. The purpose of this study was to evaluate the effect of diphenhydramine (DPH) on sleep in pediatric intensive care unit burn patients using Myra Levine's Conservation Model as the organizing framework. For this study, secondary analysis of polysomnography data and retrospective chart review were used. Twelve DPH patients were pair matched in terms of morphine, midazolam, and methadone with 12 non-DPH patients. The data were analyzed using paired t-tests for each dependent variable and χ analysis was used for frequency determinations. There was no difference in demographics between the two groups. DPH patients took 4.3 ± 1.6 minutes to fall asleep whereas non-DPH patients took 15.8 ± 1.6 minutes to achieve sleep onset (P = .06). Patients receiving DPH achieved 297.6 ± 29.9 minutes of total sleep time whereas those not receiving DPH achieved only 209.2 ± 29.9 minutes (P < .05). There was minimal difference in the mean percentage of sleep time in stages 3 and 4 between the two groups. The DPH group did have 50% more rapid eye movement sleep time compared with the non-DPH group. Even though DPH did not result in a statistical improvement in sleep quality, sleep quantity was increased in this study. More research is needed to find an effective sleep intervention in pediatric burn patients.
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