Study On Sleep Cycle Changes Of Different Sedation Levels In Children With Acute Severe Bronchopneumonia During Mechanical Ventilation

Objective: To observe the changes of sleep cycle in children with severe pneumonia with different degree of sedation and different stages of disease under mechanical ventilation.Methods: From January 2019 to January 2020,35 patients with severe pneumonia treated by invasive mechanical ventilation were selected for dynamic EEG monitoring.All children in the group were sedated with midazolam during mechanical ventilation,and the degree of sedation was assessed according to the Ramsay sedation score.According to the degree of sedation,the patients were divided into deep sedative group(Ramsay 5-6 points)and shallow sedative group(Ramsay 3-4 points).The sleep rhythm of the children was recorded by electroencephalogram(EEG)analysis of sleep rhythm in normal children in age group.Results:1.35 children were diagnosed with acute severe bronchopneumonia,5 with type I respiratory failure(14.3%),30 with type II respiratory failure(85.7%),11 with acute respiratory distress syndrome(31.4%),7 with sepsis(20.3%),and 3 with multiple organ failure(8.7%).During the first 24 hours of mechanical ventilation,29cases(82.9%)had abnormal sleep cycle and 31 cases(88.5%)had abnormal sleep structure(mainly slow wave sleep during sleep,and nrem-1 and or REM phase were absent).There were 21 cases(60%)of deep sedation group,21 cases(100%)of sleep cycle abnormality,14 cases(40%)of shallow sedation group,and 8 cases(57.1%)of sleep cycle abnormality.There was significant statistical difference between the two groups(2 = 10.862,P = 0.001).Under different sedation conditions,children’s sleep duration and awakening times were different.In deep sedation group,the total sleep time was(17.52 ± 1.58)h,the sleep efficiency was(74.17 ± 7.62)%,the awakening times were(14.10 ± 2.79)h,the total sleep time was(16.19 ± 2.31)h,the sleep efficiency was(67.46 ± 9.60)%,and the awakening times were(20.21 ± 4.93).The difference between the two groups was statistically significant(P < 0.05).The percentage of nrem-2 was(32.57 ± 18.68)%,nrem-3 was(61.07 ± 20.15)%,deep sedation was(16 ± 12.16)%,nrem-3 was(83.10 ± 12.55)%,the difference was statistically significant(P < 0.05).2.In the first 24 hours after discontinuation of mechanical ventilation and sedative drugs,27 children(77%)recovered to normal sleep cycle,and there was no NREM or REM sleep loss.Nrem-3 and REM sleep decreased in both groups.The percentage of REM sleep in shallow sedation group was(20.13 ± 7.25)%,while that in deep sedation group was(11.39 ± 2.12)%,the difference was statistically significant(P < 0.05).The percentage of nrem-2 sleep was55.58 ± 11.04% in the light sedation group and 62.06 ± 4.96% in the deep sedation group(P < 0.05).Conclusion: The EEG of children with acute severe bronchopneumonia treated by invasive mechanical ventilation was abnormal during sleep under sedation.The main manifestations are the slow down of EEG activity,the decrease or absence of sleep periodic and physiological sleep waves.During mechanical ventilation,the total sleep time of children with deep sedation is longer,the number of wakes is shorter,theproportion of deep sleep is increased,but the abnormal sleep structure is more serious.After stopping mechanical ventilation and sedative drugs,the sleep cycle of children with mild sedation recovered better.