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A Novel EEG Scoring System to Assess Sleep in Critically Ill Children: A Proof of Concept Study
Neelima Marupudi1,2, Chiara Velez3, Lindsay Pagano4
1Division of Pediatric Critical Care, Department of Pediatrics, Banner Children's Hospital, University of Arizona, Mesa, Arizona, USA.
Insights
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.
Abstract:
Sleep disturbance may be a modifiable risk factor for neurocognitive decline in critically ill children. Polysomnography, the gold standard for sleep analysis, is time and cost-intensive and not commonly available in the paediatric intensive care unit (PICU). Electroencephalography (EEG) also provides measurements of sleep and is more commonly used. We devised a novel EEG-based scoring system to categorise electrographic sleep and assessed its feasibility. In this retrospective observational cohort study across two PICUs, EEGs performed in patients aged 6 months to 18 years were analysed for sleep using a four-category system: category 1-invariable background, no state cycling or reactivity; category 2-reactivity and variability present, no discernable sleep architecture; category 3-discernable sleep architecture, abnormal pattern of sleep cycle; and category 4-normal sleep architecture and pattern. We evaluated 51 subjects. Seven patients (14%) were classified as category 1, 11 patients (22%) as category 2, 24 patients (47%) as category 3, and 9 patients (18%) as category 4. For those patients in whom sleep was detected (categories 3 and 4), N2 sleep was detected in 33 (100%) of patients, N3 sleep was detected in 24 (73%), and REM sleep was identified in 13 (39%). In this small cohort study across two centres, paediatric neurologists were able to qualify sleep in critically ill children using a novel EEG-based scoring system. If clinically validated, this scoring system could facilitate exploration of modifiable risk factors leading to sleep disruption in the PICU.
