Parental Perspectives From the Survey of Sleep Quality in the PICU Validation Study on Environmental Factors Causing Sleep Disruption in Critically Ill Children

Abstract

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.