title: Sleep of critically ill children in the pediatric intensive care unit: a systematic review.
abstract: Critically ill children in the pediatric intensive care unit (PICU) are exposed to multiple physical, environmental and pharmacologic factors which increase the propensity for sleep disruption and loss and may, in turn, play a role in short-term recovery from critical illness and long-term neurocognitive outcomes. Mechanically ventilated children receive sedative and analgesic medications, often at high doses and for long durations, to improve comfort and synchrony with mechanical ventilation. Sedatives and analgesics can decrease slow wave sleep and rapid eye movement sleep. Paradoxically, sedative medication doses are often increased in critically ill children to improve the subjective assessment of sedation and sleep, leading to further agitation and deterioration of sleep quality. The heterogeneity in age and critical illness encountered in the PICU pose several challenges to research on sleep in this setting. The present article reviews the available evidence on sleep in critically ill children admitted to the PICU, with an emphasis on subjective and objective methods of sleep assessment used and special populations studied, including mechanically ventilated children and children with severe burns.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Baltimore, USA. Electronic address: skudcha1@jhmi.edu.
authors.forename: Sapna R
authors.initials: SR
authors.lastname: Kudchadkar
authors.affiliation: Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Baltimore, USA.
authors.forename: Othman A
authors.initials: OA
authors.lastname: Aljohani
authors.affiliation: Johns Hopkins University School of Medicine, Departments of Medicine and Epidemiology, Division of Pulmonary and Critical Care Medicine, Baltimore, USA.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
mesh_terms: D000293:Adolescent; D002056:Burns / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D017286:Polysomnography; D012121:Respiration, Artificial / Q000009:adverse effects; D012890:Sleep; D012892:Sleep Deprivation / Q000453:epidemiology
keywords: Circadian rhythm; Delirium; Intensive care; Mechanical ventilation; Neonatal; Pediatric; Sleep