Sleep-Wake Disturbances After Acquired Brain Injury in Children Surviving Critical Care

Cydni N. Williams, Mary E. Hartman, Cindy T. McEvoy, Trevor A. Hall, Miranda M. Lim, Steven A. Shea, Madison Luther, Kristin P. Guilliams, Rejean M. Guerriero, Christopher C. Bosworth, Juan A. Piantino

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. Methods: We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes. Results: Sleep-wake disturbances were identified in 44 (56%) children and were classified as severe in 36 (46%). Sleep-wake disturbances affected ≥33% of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47%), although 68% had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43% vs 21%, P = 0.04) and in the traumatic brain injury subgroup (52% vs 5%, P = 0.001). Conclusions: Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.

Original languageEnglish (US)
JournalPediatric Neurology
DOIs
StateAccepted/In press - Jan 1 2019

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Critical Care
Brain Injuries
Sleep
Phenotype
Maintenance

Keywords

  • Brain injury
  • Critical care outcomes
  • Pediatric
  • Sleep
  • Sleep-wake disorders
  • Trauma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

Cite this

Sleep-Wake Disturbances After Acquired Brain Injury in Children Surviving Critical Care. / Williams, Cydni N.; Hartman, Mary E.; McEvoy, Cindy T.; Hall, Trevor A.; Lim, Miranda M.; Shea, Steven A.; Luther, Madison; Guilliams, Kristin P.; Guerriero, Rejean M.; Bosworth, Christopher C.; Piantino, Juan A.

In: Pediatric Neurology, 01.01.2019.

Research output: Contribution to journalArticle

Williams, Cydni N. ; Hartman, Mary E. ; McEvoy, Cindy T. ; Hall, Trevor A. ; Lim, Miranda M. ; Shea, Steven A. ; Luther, Madison ; Guilliams, Kristin P. ; Guerriero, Rejean M. ; Bosworth, Christopher C. ; Piantino, Juan A. / Sleep-Wake Disturbances After Acquired Brain Injury in Children Surviving Critical Care. In: Pediatric Neurology. 2019.
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abstract = "Background: Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. Methods: We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes. Results: Sleep-wake disturbances were identified in 44 (56{\%}) children and were classified as severe in 36 (46{\%}). Sleep-wake disturbances affected ≥33{\%} of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47{\%}), although 68{\%} had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43{\%} vs 21{\%}, P = 0.04) and in the traumatic brain injury subgroup (52{\%} vs 5{\%}, P = 0.001). Conclusions: Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.",
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author = "Williams, {Cydni N.} and Hartman, {Mary E.} and McEvoy, {Cindy T.} and Hall, {Trevor A.} and Lim, {Miranda M.} and Shea, {Steven A.} and Madison Luther and Guilliams, {Kristin P.} and Guerriero, {Rejean M.} and Bosworth, {Christopher C.} and Piantino, {Juan A.}",
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AU - Williams, Cydni N.

AU - Hartman, Mary E.

AU - McEvoy, Cindy T.

AU - Hall, Trevor A.

AU - Lim, Miranda M.

AU - Shea, Steven A.

AU - Luther, Madison

AU - Guilliams, Kristin P.

AU - Guerriero, Rejean M.

AU - Bosworth, Christopher C.

AU - Piantino, Juan A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. Methods: We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes. Results: Sleep-wake disturbances were identified in 44 (56%) children and were classified as severe in 36 (46%). Sleep-wake disturbances affected ≥33% of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47%), although 68% had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43% vs 21%, P = 0.04) and in the traumatic brain injury subgroup (52% vs 5%, P = 0.001). Conclusions: Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.

AB - Background: Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. Methods: We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes. Results: Sleep-wake disturbances were identified in 44 (56%) children and were classified as severe in 36 (46%). Sleep-wake disturbances affected ≥33% of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47%), although 68% had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43% vs 21%, P = 0.04) and in the traumatic brain injury subgroup (52% vs 5%, P = 0.001). Conclusions: Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.

KW - Brain injury

KW - Critical care outcomes

KW - Pediatric

KW - Sleep

KW - Sleep-wake disorders

KW - Trauma

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