LAUSR

Introduction/Hypothesis: Historically, in critically ill children receiving mechanical ventilation (MV) and sedation with opiates and benzodiazepines, sleep was fragmented, with limited to no slow-wave and REM sleep. We hypothesized that children receiving MV and dexmedetomidine targeted to a lighter depth of sedation also experience disrupted sleep. Methods: We performed 24 hours (h) of modified polysomnogram (PSG) monitoring including electroencephalographic, electrooculographic and electromyographic leads on 18 intubated PICU patients (median age 2 years, IQR 1-11, 44% male) requiring sedation and MV for acute respiratory failure, excluding patients with acute neurologic injury or expected to extubate in <24h. We conducted analyses on 16 patients with complete data using chi-square test, Student t-test, and linear regression. Results: On the day of PSG monitoring, 15/16 patients received continuous dexmedetomidine; all received opiates; 7 received benzodiazepines, and 8 were awake or lightly sedated. Only 4 (25%) achieved any REM sleep (median total REM 23.5 minutes (m)/24 h). The patient with the most REM sleep received only prn opiate for sedation. Most (7/16) spent less time in slow-wave sleep than expected for age (median 260 m; range 26-1344 m). Sleep efficiency (% of sleep occurring at night) was poor, with 25% having ≥50% of sleep time during the day. Age; mode of ventilation; and opiate, dexmedetomidine, and benzodiazepine exposures were not associated with total sleep time, minutes in REM sleep, minutes in slow-wave sleep, arousals, or sleep efficiency. Higher dexmedetomidine dose was associated with trends to increased arousals (p=0.09) and fewer minutes in REM sleep (p=0.09). Of 15 patients receiving dexmedetomidine, only 3 (20%) achieved any REM sleep. Conclusions: Children receiving MV and dexmedetomidine targeted to a light level of sedation experience substantial sleep disruption. The implications of prolonged REM and slow wave sleep deprivation in critically ill children are unknown but are worrisome given the known physiologic derangements associated with sleep deprivation in healthy individuals.