Sleep in the pediatric ICU: an empirical investigation

BACKGROUND: Although sleep is important for physical and psychological health, no research has assessed the sleep of children in a pediatric ICU and the factors that affect sleep. OBJECTIVES: To observe the sleep of children in a pediatric ICU and to determine the relationship of noise, light, contact with caregivers, parental presence, and severity of illness to the sleep obtained by children in a pediatric ICU during a 10-hour night. METHODS: At 5-minute intervals from 8 PM until 6 AM, a convenience sample of nine patients was observed. Sleep state, noise and light levels, contact with caregivers, and parental presence were recorded. Severity of illness was measured on admission and within 26 hours of data collection. RESULTS: Subjects slept for a mean total of 4.7 hours (SD = 0.49) during the 10-hour night, interrupted by a mean of 9.8 awakenings (SD = 2.48). The mean length of a sleep episode was only 27.6 minutes (SD = 25.85). Mean noise level was 55.1 dB(A) (SD = 6.82), with sudden, sharp elevations of up to 90 dB(A). Probit analysis indicated that noise, light, and contact with caregivers were significant predictors of sleep. Parental presence and severity of illness were not. CONCLUSIONS: Patients in the pediatric ICU sleep significantly less than is normal for children of the same ages, and their patterns of sleep are seriously disturbed. Because noise, light, and contact with caregivers are significant predictors of sleep state, health professionals can use these findings to structure the environment and the care they give to promote the sleep of critically ill children.