A Novel EEG Scoring System to Assess Sleep in Critically Ill Children: A Proof of Concept Study

Neelima Marupudi ^1,2, Chiara Velez ³, Lindsay Pagano ⁴

¹Division of Pediatric Critical Care, Department of Pediatrics, Banner Children's Hospital, University of Arizona, Mesa, Arizona, USA.
²Department of Child Health, University of Arizona, Mesa, Arizona, USA.
³99 MDG, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, Las Vegas, Nevada, USA.
⁴Division of Pediatric Neurology, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁵Division of Pediatric Neurology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
⁶Michael S. Aldrich Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan, USA.
⁷Division of Pediatric Critical Care, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁸Division of Pediatric Neurosurgery, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁹Division of Pediatric Neurology, Department of Pediatrics, C.S. Mott Children's Hospital and the University of Michigan, Ann Arbor, Michigan, USA.

⁰Division of Pediatric Critical Care, Department of Pediatrics, Banner Children's Hospital, University of Arizona, Mesa, Arizona, USA.

Journal of Sleep Research +

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November 24, 2025

View abstract on PubMed

Summary

A new electroencephalography (EEG) scoring system helps identify sleep patterns in critically ill children. This tool may aid research into sleep disruption as a factor in neurocognitive decline.

Area Of Science

Pediatric Intensive Care
Neuroscience
Sleep Medicine

Background

Sleep disturbance is a potential modifiable risk factor for neurocognitive decline in critically ill children.
Polysomnography is the gold standard for sleep analysis but is impractical in pediatric intensive care units (PICUs).
Electroencephalography (EEG) is more accessible and can measure sleep.

Purpose Of The Study

To develop and assess the feasibility of a novel EEG-based scoring system for categorizing electrographic sleep in critically ill children.
To evaluate the system's ability to identify different sleep stages when sleep is detected.

Main Methods

Retrospective observational cohort study in two PICUs.
Analysis of EEGs from 51 patients aged 6 months to 18 years using a four-category sleep scoring system.
Categorization based on background activity, reactivity, sleep architecture, and pattern.

Main Results

The novel EEG scoring system classified patients into four categories: Category 1 (14%), Category 2 (22%), Category 3 (47%), and Category 4 (18%).
In patients with detected sleep (Categories 3 & 4), N2 sleep was present in 100%, N3 sleep in 73%, and REM sleep in 39%.
Paediatric neurologists successfully used the scoring system to qualify sleep in critically ill children.

Conclusions

A novel EEG-based scoring system is feasible for categorizing sleep in critically ill children.
This system may facilitate further research into the impact of sleep disruption on neurocognitive outcomes in the PICU.
Clinical validation is needed to confirm its utility.

Keywords:

Circadian disruption Paediatrics critical care disordered sleep outcomes