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Parental Perspectives From the Survey of Sleep Quality in the PICU Validation Study on Environmental Factors Causing
Amanda B Hassinger1, Kalgi Mody2, Simon Li3
1Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, NY.
Insights
Pediatric ICU sleep is frequently disrupted by pain, alarms, and schedule changes, unlike adult ICUs. Future interventions should consider these factors for better child sleep quality.
Area of Science:
- Pediatric critical care medicine
- Sleep science
- Patient experience
Background:
- Pediatric intensive care unit (PICU) sleep promotion bundles often adapt adult protocols.
- Children's responses to ICU environments may differ from adults.
- Understanding parental perspectives on sleep disruption is crucial for effective interventions.
Purpose of the Study:
- To investigate parental reports of factors disrupting children's sleep in the PICU.
- To identify specific environmental and situational causes of sleep disturbance in pediatric critical care.
Main Methods:
- Secondary analysis of a multicenter validation study of the Survey of Sleep quality in the PICU.
- Anonymous survey administered to parents of children in four PICUs and a pediatric sleep laboratory.
- Survey assessed disruptions from hospital/ICU environment elements identified in validated questionnaires.
Main Results:
- 71% of children experienced significant sleep disruption in the PICU.
- Top disruptions included pain/discomfort (38%), not sleeping at home (30%), machine alarms (28%), and altered home schedules (26%).
- Nocturnal light disruption was minimal (5%); sleep disruption did not differ by sedation or across PICUs.
Conclusions:
- PICU environments present unique sleep challenges for children, differing from adults, notably schedule disruptions.
- Future sleep promotion bundles should encompass sedated children and be designed for multicenter application.
- Addressing pain, comfort, and home schedule adherence is key for improving pediatric ICU sleep.
Objectives:
Sleep promotion bundles being tested in PICUs use elements adapted from adult bundles. As children may react differently than adults in ICU environments, this study investigated what parents report disrupted the sleep of their child in a PICU.
Design:
Secondary analysis of a multicenter validation study of the Survey of Sleep quality in the PICU.
Setting:
Four Northeastern U.S. PICUs, one hospital-based pediatric sleep laboratory.
Patients:
Parents sleeping at the bedside of a child in the PICU or hospital-based sleep laboratory.
Interventions:
Anonymous one-time survey eliciting parts of hospital or ICU environments that have been described as disruptive to sleep in validated adult ICU and pediatric inpatient questionnaires.
Measurements And Main Results:
Level of sleep disruption was scored by Likert scale, with higher scores indicating more disruption. Age, demographics, baseline sleep, and PICU exposures were used to describe causes of sleep disruption in a PICU. Of 152 PICU parents, 71% of their children's sleep was disrupted significantly by at least one aspect of being in the PICU. The most prevalent were "being in pain or uncomfortable because they are sick" (38%), "not sleeping at home" (30%), "alarms on machines" (28%), and "not sleeping on their home schedule" (26%). Only 5% were disrupted by excessive nocturnal light exposure. Overall sleep disruption was not different across four PICUs or in those receiving sedation. The validation study control group, healthy children undergoing polysomnography, had less sleep disruption than those in a PICU despite sleeping in a hospital-based sleep laboratory.
Conclusions:
There are multiple aspects of critical care environments that affect the sleep of children, which are different from that of adults, such as disruption to home schedules. Future interventional sleep promotion bundles should include sedated children and could be applicable in multicenter settings.
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