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Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU)
Amanda B Hassinger1, Kalgi Mody2, Raquel Gomez3
1Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences and John R. Oishei Children's Hospital, Buffalo, New York.
Insights
This study validates a caregiver survey to accurately measure sleep disruption in critically ill children in the pediatric intensive care unit (PICU). The Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU) offers a practical tool for future research.
Area of Science:
- Pediatric critical care medicine
- Sleep medicine
- Psychometrics
Background:
- Pediatric intensive care unit-related sleep and circadian disruption (PICU-SCD) is prevalent in critically ill children.
- Measuring sleep in the PICU setting is challenging, hindering multicenter trials.
- A validated tool is needed to quantify sleep disruption in this population.
Purpose of the Study:
- To validate a caregiver-administered questionnaire for assessing sleep quality and disruption in children within the pediatric intensive care unit (PICU).
- To establish the reliability and accuracy of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU) compared to objective sleep measures.
Main Methods:
- A prospective, multicenter, case-control study involving caregivers of children in 4 PICUs and a sleep laboratory.
- Survey items were adapted from validated adult and pediatric sleep questionnaires.
- Caregiver responses were compared to polysomnography in controls to assess accuracy; a composite score was calculated.
Main Results:
- The SSqPICU demonstrated acceptable internal reliability (α = 0.75) and reproducibility (ICC > 0.600).
- Caregiver reports showed good agreement with polysomnography for sleep onset time (κ = 0.823) and latency (κ = 0.707).
- A strong correlation (r = .844) was found between SSqPICU scores and polysomnography, indicating high accuracy.
Conclusions:
- The SSqPICU is a reliable and accurate tool for describing inpatient sleep disruption in nonsedated children within the PICU.
- This validated survey provides a practical method for daily quantification of PICU-SCD in future research.
- The survey is generalizable across different PICU settings.
Study Objectives:
Observational data suggest pediatric intensive care unit-related sleep and circadian disruption (PICU-SCD) affects many critically ill children. Multicenter trials exploring PICU-SCD have been impractical because measuring sleep in this setting is challenging. This study validates a questionnaire for caregivers to describe children's sleep in the PICU.
Methods:
This prospective, multicenter, case-control study enrolled caregivers of children in 4 PICUs or in a hospital-based sleep laboratory (controls). Survey items were compiled from validated adult ICU and pediatric in- and outpatient sleep questionnaires. Control responses were compared to polysomnography to determine accuracy. A score was calculated by summing the level of disruption of sleep timing, duration, efficiency, quality, and daytime sleepiness and irritability.
Results:
In responses from 152 PICU and 61 sleep laboratory caregivers, sleep survey items had acceptable internal reliability (α = 0.75) and reproducibility on retest surveys (interclass correlation coefficient > 0.600). Caregivers could not assess sleep of sedated children. Factor analysis identified 3 subscales of PICU-SCD. Control parents had good agreement with polysomnography sleep onset time (κ = 0.823) and sleep onset latency (κ = 0.707). There was a strong correlation between sleep scores derived by parental reporting to those by polysomnography (r = .844, P < .001). Scores had a linear association with caregiver-reported child sleep quality. There were no site-specific differences in sleep quality. Nearly all respondents found the survey easy to understand and of appropriate length.
Conclusions:
The Survey of Sleep Quality in the Pediatric Intensive Care Unit provides a reliable, accurate description of inpatient sleep disruption in nonsedated children, generalizable across PICUs. It offers practical means to quantify PICU-SCD daily in future investigations.
Citation:
Hassinger AB, Mody K, Gomez R, et al. Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU). J Clin Sleep Med. 2024;20(8):1251-1258.
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