.jpg "Jamie Klapp, BS photo")
Jamie Klapp, BS
Oregon Health & Science University
Beaverton, Oregon
Disclosure information not submitted.
Trevor Hall, PsyD, ABPdN
Associate Professor of Pediatrics; Pediatric Neuropsychologist
Oregon Health and Science University, United States
Disclosure information not submitted.
Julie Randall, BA
Research Assistant
Oregon Health and Science University, United States
Disclosure information not submitted.
Cydni Williams, MD
Associate Professor of Pediatrics, Division of Pediatric Critical Care
Oregon Health and Sciences University, United States
Disclosure information not submitted.
Title: Sleep Disturbances in Infants and Young Children Following Critical Care for Acquired Brain Injury
Introduction/Hypothesis: Sleep disturbances following acquired brain injury (ABI) in children and teens are associated with worse outcomes and quality of life (QOL) after critical care, but are under-evaluated in infants and young children. Given the vital role of sleep in healthy development and impact on QOL, we hypothesized sleep disturbances would be associated with worse patient and family outcomes in this vulnerable population.
Methods: We performed a retrospective cohort study of 66 children aged 0-30 months receiving critical care for ABI. The Brief Infant Sleep Questionnaire (BISQ) assessed sleep disturbances. Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III) and Adaptive Behavior Assessment System, 3rd Edition (ABAS-3) assessed developmental and adaptive functioning outcomes. Pediatric Quality of Life Inventory core (QOL) and Family Impact Module (FIM) total scores assessed global patient and family outcomes. Spearman’s correlation (rs) assessed relationships between sleep disturbances and outcomes. Multiple linear regression assessed relationships controlling for covariates identified in bivariate analyses. Significance was defined as p< .05.
Results: Over 25% of children had ≥3 night awakenings and ≥60 minute duration of night awakenings. Increased night awakenings significantly correlated with worse scores for ABAS-3 General Adaptive Composite (GAC; rs=-.421), QOL (rs ==-.337), and FIM (rs=-.337). Increased duration of nighttime awakening significantly correlated with worse scores for QOL (rs=-.370) and Bayley-III Cognitive Index (rs=-.401). In separate models for each outcome controlling for age, primary diagnosis, chronic conditions, critical care interventions, and worsening from pre-admit Functional Status Scale, increased night awakenings was associated with significantly worse scores for ABAS-3 GAC (β=-3.7; 95% confidence interval (CI)=-6.1,-1.3), QOL (β=-4.9; 95% CI=-7.7,-2.1), and FIM (β=-6.4; 95% CI=-10.2,-2.6).
Conclusions: Sleep disturbances are associated with worse patient and family outcomes in infants and toddlers following ABI, aligning with research in older children. Sleep is vital to the recovery process and a potentially modifiable target to improve outcomes after critical care.