Sleep of 1- and 2-Year-old Children in Intensive Care

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Abstract
Physiologic and psychologic changes associated with sleep disturbance decrease the ability of a critically ill child to adapt to hospitalization and thus hamper recovery. Research demonstrates that intensive care settings interfere with sleep of adults, but little is known about the impact of these settings on children's sleep. An exploratory field study was conducted to describe the sleep-wake patterns of 1- and 2-year-old children in intensive care, identify intensive care environmental stimuli associated with sleep and waking states, compare the intensive care sleep-wake pattern to the pre-illness sleep-wake pattern, and determine the time required for children to return to their pre-illness sleep-wake pattern. Twelve children aged 13 to 35 months composed the sample for the study. Pre-illness and postdischarge sleep patterns, sleep patterns during a 12-hour night in the pediatric intensive care unit (PICU), and external and internal environmental stimuli were measured. Prior to hospitalization, subjects demonstrated sleep similar to that documented in healthy children. Children in the PICU experienced a significant loss of sleep, frequent awakenings, and a virtual rapid eye movement (REM) sleep deprivation. External environmental stimuli of light, noise, and caregiver activity were negatively correlated with sleep state. Pain and treatment with benzodiazepines were associated with sleep acquisition. Sleep changes persisted after discharge from the PICU and the hospital. Total sleep time recovered more rapidly than nighttime awakening. Parents perceived that their child's sleep remained different longer than total sleep time and night awakening values demonstrated. Children in the ICU experience sleep disturbance that can impede recovery. Nursing must take an active role in identifying and controlling environmental stimuli to improve sleep acquisition during this critical time. Only nurses well educated in sleep topics can provide comprehensive care that promotes sleep and rest. Development of nursing knowledge in the promotion of optimal sleep in children is in its infancy; continued study and research on the topic are needed.