| BackgroundChildren in pediatric intensive care unit(PICU)are in a intensive stress environment,such as hypoxia,shock,infection,burning,trauma,surgery,frequent examination and invasive diagnosis and treatment procedures,the application of sedative and/or analgesic drugs,isolation from parents,a large number of unfamiliar faces and instruments,noise and lights disturbing diet and sleep as well as circadian clock;various intubations and long-term bed rest,worries about disease prognosis and fear of death,all of which lead to more pain,anxiety,fear,sleep deprivation and sleep disorders in children in PICU than in general wards,there are also differences in sleep quality between those with different gender,age,and sleep environment and home environment after discharge,whether there is poor sleep quality and the influencing factors leading to poor sleep are still unclear,and there are few studies at home and abroad.Part Ⅰ:Sleep disorder after discharge of children with severe pneumonia in PICU after dischargeObjectiveTo study the current status of sleep disorder and daytime sleepiness after discharge in children with severe pneumonia in the PICU.Methods267 Children with severe pneumonia admitted to the PICU of Shandong Provincial Hospital affiliated to Shandong University from December 2017 to June 2020 were selected as the study subjects in the PICU group.The follow-up time was more than 1 month and less than 6 months after discharge.Healthy children who had not been admitted to the PICU,had no history of major surgical trauma and chronic diseases were recruited by internet.523 healthy children matched for the age,gender,body mass index(BMI),and parental education of children with severe pneumonia in the PICU group were selected as the healthy control group according to the random sampling method.Survey tools include general data questionnaire for study subjects and their parents,the Sleep Disorder Scale for Children(SDSC),the modified Epworth Sleepiness Scale(ESS).Descriptive statistical analysis,x2 test,Fisher’s exact test,independent samples t-test,and non-parametric rank sum test were used to comparing the incidence of sleep disorders and daytime sleepiness and other informations between the two groups.Results1.There were no statistically significant differences in age,gender composition,BMI between the two groups of study subjects.The detection rate of sleep disorders in children with severe pneumonia in the PICU group(26.6%)was significantly higher than that in the healthy control group(9.7%),and the difference was statistically significant(P<0.001).Compared with children in the healthy control group,children with severe pneumonia in the PICU group had higher total crude and standard T-score scores for sleep disorders,and the differences were statistically significant(P=0.001),with higher scores for the sleep breathing disorder(SBD),disorder of excessive sleepiness(DEOS)and sleep hyperhidrosis(SH),and the differences were statistically significant(P<0.001).2.In the case of same gender,the scores of sleep breathing disorder(SBD),disorder of excessive sleepiness(DEOS),sleep hyperhidrosis/night sweating(SH),total crude score and standard T score in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05);in the male group,the scores of difficulty in initiating and maintaining sleep(DIMS)in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05).3.In the case of same age group,the scores of sleep breathing disorder(SBD),disorder of arousal(DA),disorder of excessive sleepiness(DEOS),sleep hyperhidrosis/night sweating(SH),total crude score and standard T score in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05);in the age group of 9-11 years,the scores of difficulty in initiating and maintaining sleep(DIMS)in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05).4.In the case of same sleep environment,the scores of sleep breathing disorder(SBD),disorder of excessive sleepiness(DEOS),sleep hyperhidrosis/night sweating(SH),total crude score and standard T score in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05);When they don’t sleep alone in a room,the scores of difficulty in initiating and maintaining sleep(DIMS)and sleep-wake transition disorder(SWTD)in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05).5.In the case of same routine,the scores of sleep breathing disorder(SBD),sleep hyperhidrosis/night sweating(SH),total crude score and standard T score in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05);the scores of disorder of excessive sleepiness(DEOS)in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05).6.In the case of whether exposure to electronic equipment 30 minutes before bedtime,the scores of sleep breathing disordered(SBD),disorder of excessive sleepiness(DEOS),sleep hyperhidrosis/night sweating(SH),total crude score and standard T score in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05).7.In the case of same family income,the scores of sleep breathing disorder(SBD),disorder of excessive sleepiness(DEOS),sleep hyperhidrosis/night sweating(SH),total crude score and standard T score in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05).The scores of sleep-wake transition disorder(SWTD)in children with severe pneumonia the PICU were significantly higher than those in healthy controls for family income under RMB 6000 yuan.8.In the case of whether parental snoring during sleep,the scores of sleep breathing disordered(SBD),sleep-wake transition disorder(SWTD),disorder of excessive sleepiness(DEOS),sleep hyperhidrosis/night sweating(SH),total crude score and standard T score in children with severe pneumonia in PICU were significantly higher than those in healthy controls(P<0.05).9.The daytime sleepiness score and detection rate of children with severe pneumonia in the PICU(26.2%)were significantly higher than those of healthy controls(10.3%),and the difference was statistically significant(P<0.001).10.The scores of daytime sleepiness in children with severe pneumonia in the PICU were significantly higher than those in healthy controls In the case of same gender,age,sleep environment,routines and family characteristics(P<0.05).ConclusionCompared with healthy children,the incidence of sleep disorders and daytime sleepiness after discharge is higher in children with severe pneumonia in PICU.Part Ⅱ:Risk factors for sleep disorder after discharge in children with severe pneumonia in PICUObjectiveTo study the risk factors associated with sleep disorder after discharge in children with severe pneumonia in PICU.Methods267 children with severe pneumonia in PICU in the first part of this study were selected as the study subjects and divided into sleep disorder group and non-sleep disorder group according to whether sleep disorder occurred during follow-up.The general demographic data,sleep profile,family characteristics and clinical data of the two groups were compared,and the related risk factors of sleep disorder in all children were elucidated.Descriptive statistical analysis,x2 test,Fisher’s exact test,independent samples t-test,non-parametric rank sum test were used to comparing general demographic data,sleep profile and clinical data.Multivariate logistic regression model was used to study the risk factors of sleep disorder.Results1.There were no statistically significant differences in age,gender composition,BMI between the two groups(P>0.05).Compared with children in the non-sleep disorder group,children in the sleep disorder group had significantly higher 24h-pSOFA scores(P<0.05),length of PICU stay as well as length of hospital stay(P<0.05);the proportion of midazolam,dexmedetomidine,opioid analgesic drug use and the proportion of mechanical ventilation were higher(P<0.05).2.Multivariate logistic regression analysis showed that poor routines(OR=1.121,95%CI:1.078-1.912,P=0.036),24h-higher blood lactate(OR=1.775,95%CI:1.176-2.680,P=0.006),length of stay in the PICU(OR=1.426,95%CI:1.050-2.928,P<0.001)and 24h-pSOFA score≥ 8(OR=8.584,95%CI:3.879-19.101,P=0.032)were all independent risk factors for the development of sleep disorders;however,the incidence of sleep disorders significant decreased with the duration of follow-up(OR=0.420,95%CI:0.287-0.639,P<0.001).Conclusion1.The risk factors of sleep disorder after discharge are poor sleep routines,longer the length of stay in PICU,24h-high blood lactate value and 24h-pSOFA score≥8.2.The sleep quality can be improved with following-up time. |
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