Objective Sleep Characteristics and Factors Associated With Sleep Duration and Waking During Pediatric Hospitalization
Authors: Robyn Stremler, Samantha Micsinszki, Sherri Adams, Christopher Parshuram, Eleanor Pullenayegum, Shelly K. Weiss
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Children’s sleep may be affected by hospitalization, yet few objective determinations of sleep patterns are reported for children in intensive care or general medicine units. There is limited research on relationships between sleep in hospital and child (eg, age, pain), treatment (eg, medications, nurse presence), or environmental (eg, noise, light, type of unit) factors. <h3>Objective</h3> To determine sleep quantity and patterns in hospitalized children and determine factors associated with sleep quantity and nighttime waking for children in hospital. <h3>Design, Setting, and Participants</h3> This was a prospective cross-sectional study of children admitted to a general pediatric unit or a pediatric intensive care unit at a pediatric quaternary teaching hospital in Toronto, Ontario, Canada, from October 2007 to July 2008. Participants included children aged 1 to 18 years who were expected to stay in hospital for at least 2 nights. Demographic data, information about the hospital stay and illness, and usual sleep habits were collected. Children wore an actigraph for 1 to 3 consecutive days and nights and completed a sleep diary. Sound and light meters were placed at the bedside. Data analyses took place in April 2009. <h3>Main Outcomes and Measures</h3> The primary outcome was the mean number of minutes of child nighttime sleep from 7:30pmto 7:29am. Sleep variables were averaged over days and nights recorded (mean [SD] days and nights of wear, 2.54 [0.71]) and examined for associations with sleep quantity and patterns, as well as hazard of waking in the night. <h3>Results</h3> Of 124 eligible children approached for inclusion, 69 children consented (35 [51%] female; 20 [29%] aged 1-3 years, 10 [14%] aged 4-7 years, 17 [24%] aged 8-12 years, and 22 [32%] aged 13-18 years; 58 [84%] in the general pediatric unit). Children aged 1 to 3, 4 to 7, 8 to 12, and 13 to 18 years obtained a mean (SD) of 444 (132), 475 (86), 436 (114), and 384 (83) minutes of nighttime sleep, respectively; mean (SD) number of night awakenings was 14 (3), 18 (3), 14 (8), and 12 (6), respectively. Children on general pediatric units slept 258 minutes more per night than children sleeping in the pediatric intensive care unit (95% CI, 165.16-350.56 minutes;<i>P</i> &lt; .001), children admitted for planned surgery slept 123 minutes more than children admitted for exacerbations of chronic illness (95% CI, 49.23-196.01 minutes;<i>P</i> &lt; .01), and children sleeping in rooms with other patients slept 141 minutes fewer than children in private rooms (95% CI, −253.51 to −28.35 minutes;<i>P</i> = .01). Sound events greater than 80 dB were significantly associated with increased risk of instantaneous waking (hazard ratio [HR], 1.35; 95% CI, 1.02-1.80;<i>P</i> = .04), as were light events greater than 150 lux (HR, 1.17; 95% CI, 1.01-1.36;<i>P</i> = .03), receiving a medication that promoted sleep (HR, 1.04; 95% CI, 1.00-1.08;<i>P</i> = .03), and having a nurse in the room for most or all of the night (HR, 1.08; 95% CI, 1.03-1.13;<i>P</i> = .003). Sleeping on the general pediatrics unit was significantly associated with decreased risk of instantaneous waking (HR, 0.81; 95% CI, 0.77-0.85;<i>P</i> &lt; .001), as was being admitted for planned surgery (HR, 0.95; 95% CI, 0.91-0.99;<i>P</i> = .04), receiving a medication that promoted wakefulness (HR, 0.96; 95% CI, 0.93-0.995;<i>P</i> = .02), and sharing a room with another patient (HR, 0.78; 95% CI, 0.72-0.84;<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> In this cross-sectional study of hospitalized children, children experienced considerable nighttime waking and sleep restriction to levels below national clinical recommendations at a time when they most needed the benefits of sleep. Given light and noise were the greatest contributors to nighttime waking in hospital, clinicians, administrators and hospital design experts should work together for solutions.