(845) Assessing Sleep Quality and Its Association With Delirium in Pediatric ICU Patients

Monday, February 24, 2025

9:00am – 10:00am Eastern Time

Location: Connections Central - RST 05

First Author(s)

Emma Riordan, MD (she/her/hers)

Orlando Health - Arnold Palmer Hospital for Children, USA

Co-Author(s)

MW

Mark Weatherly, MD

Physician
Orlando Health Arnold Palmer Hospital for Children, United States
EV

Eric Vangerud, RRT

Respiratory Therapist
Orlando Health Arnold Palmer Hospital for Children, United States
NS

Nicole Slone, MD

Physician
Orlando Health - Arnold Palmer Hospital for Children, United States
MS

Mary Schreck, PhD

Biostatistician
Orlando Health Arnold Palmer Hospital for Children, United States
JC

J. Gene Chen, MD, MHS

Physician
Orlando Health Arnold Palmer Hospital for Children, United States

Introduction: Delirium in the pediatric intensive care unit (PICU) is associated with negative outcomes, but sleep disruption and the role it plays is not well understood. Actigraphy provides an objective physiological assessment of sleep quality via non-invasive motion accelerometers worn on the wrist to detect multiplanar gross motor activity. The aim of this study was to measure sleep quality via actigraphy and examine the relationship between sleep quality and delirium.

Methods: This prospective observational feasibility study was done in a tertiary care teaching children’s hospital with a 17-bed PICU. Data was collected between October 2023 and April 2024 on children ≥ 2 years who were admitted to the PICU for at least 24 hours. Exclusion criteria included patients with brain injury, encephalopathy, status epilepticus, developmental delay, or medically-induced paralysis. Delirium scores were calculated every 12 hours using the Cornell Assessment of Pediatric Delirium (CAPD). Actigraphy assessed the sleep metrics 1) number of awakenings (NA), and 2) wake after sleep onset (WASO), defined as the number of minutes awake after sleep time; higher numbers indicate worse sleep quality. Delirium scores and sleep metrics were collected over the first 7 hospital days (HD).

Results: In total, 23 patients were enrolled. Mean age was 12.4 years (SD 4.7); 74% were male. Six (26%) patients were intubated and on mechanical ventilation, and 8 (35%) received continuous intravenous sedation. Ten patients (43%) had a delirium score >=9 at some point during their stay. Median delirium scores ranged from 4.5 to 7; median NA ranged from 0 to 6; median WASO ranged from 0 to 15. As a group, intubated patients had less NA (p=0.02) and lower WASO (p=0.02); sedated patients had higher delirium scores (p=0.02). In repeated measures correlation analyses, delirium scores decreased across HD (r=-0.28, p = 0.02) and NA increased across HD (r=0.25, p = 0.03). In non-intubated patients, NA and WASO increased across HD (r=0.43, p=0.01; r=0.37, p=0.02 respectively). There was no association between sleep metrics and delirium scores.

Conclusions: In our sample, sleep quality deteriorated during the PICU stay, especially in non-intubated patients. However, there was no association between poor sleep quality and delirium.