Sleep monitoring in children during neuromuscular blockade in the pediatric intensive care unit: a pilot study.
BACKGROUND
Sleep is an important physiologic process that is known to be disrupted in the intensive care unit. Nevertheless, there is little information on how intensive care unit admission affects sleep in children. Because laryngotracheoplasty is elective but entails 5-7 days of neuromuscular blockade following surgery, children undergoing this procedure present a unique opportunity to analyze sleep during neuromuscular blockade apart from confounding variables resulting from critical illness.


OBJECTIVE
To determine the feasibility of using polysomnography to assess sleep patterns in children during neuromuscular blockade.


METHODS
Polysomnography recordings were obtained continuously for 4 days (96 hrs) in two children following laryngotracheoplasty. Medication administration (neuromuscular blockades, sedatives) and time of suctioning were also recorded.


RESULTS
Both subjects had documented sleep. However, the proportion of time in each stage was markedly different from developmental norms, and a greater proportion of sleep occurred during the day. Furthermore, there was substantial day-night and day-to-day variability. Some rebound of consolidated sleep appeared by day 4. Sedative use varied considerably. However, neither bolus sedation administration nor endotracheal suctioning appeared to affect sleep. Few monitoring difficulties were encountered.


CONCLUSIONS
Sleep can be monitored with minimal difficulty in children undergoing neuromuscular blockade in the pediatric intensive care unit. Sleep occurred throughout the day, and there was considerable fragmentation. To fully assess sleep in the intensive care unit, monitoring needs to be continuous over several days, rather than only at night or for < or =24 hrs. Further research is needed in the area to determine typical sleep patterns in children undergoing neuromuscular blockade.
Carno
Margaret-Ann
MA
University of Rochester, School of Nursing, Rochester, NY, USA.
Hoffman
Leslie A
LA
Henker
Richard
R
Carcillo
Joseph
J
Sanders
Mark H
MH
D002675:Child, Preschool; D002940:Circadian Rhythm / Q000502:physiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007830:Larynx / Q000601:surgery; D019148:Neuromuscular Blockade; D010865:Pilot Projects; D017286:Polysomnography; D011184:Postoperative Period; D012894:Sleep Stages / Q000502:physiology*; D013997:Time Factors; D014132:Trachea / Q000601:surgery