Postoperative sleep disturbance in pediatric patients using patient-controlled devices (PCA).
BACKGROUND
Sleep disturbance has not been well quantified in pediatric postoperative management, yet has broad implications in pain management as well as upon the physical and psychological well-being of the young patient admitted for surgery. We aimed to describe sleep disturbance in this population using patient-controlled analgesia (PCA) and then identify the predictors of disturbed sleep.


METHODS
A retrospective audit and analysis of sleep disturbance in postoperative pediatric patients using PCA devices were performed in a postoperative surgical ward population of a major tertiary referral center. PCA presses were used as a proxy measure of sleep. The description of the sleep disturbance included an unadjusted and adjusted analysis of the proposed predictors of sleep disturbance: age, sex, nature of presentation, operation type, PCA opioid type, presence of background infusion, postoperative night number, and adjuvant medication. All data were entered into an access database developed for the audit and analyzed using stata 8.0.


RESULTS
The first 126 children prescribed PCA devices in the year 2004 were audited. One-third of patients in the population prescribed PCA experienced sleep disturbance. Observed predictors of sleep disturbance include older children (OR: 0.86, P=0.001) and those receiving a background infusion (OR: 0.19, P=0.002). Other predictors were not significant.


CONCLUSIONS
Sleep disruption is common in children-prescribed PCA opioid analgesia. Older children and those receiving a background infusion were observed to experience less sleep. Other proposed predictors were not found to be reliable. Further investigation into the predictors of disturbed sleep in the postoperative patient is warranted.
Kelly
J J
JJ
Department of General Medicine, Royal Children's Hospital, Parkville, Vic., Australia. julian.kelly@rch.org.au
Donath
Susan
S
Jamsen
Kris
K
Chalkiadis
G A
GA
D000293:Adolescent; D000367:Age Factors; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects* / Q000295:instrumentation*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology*; D013514:Surgical Procedures, Operative
D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl