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Sleep, Sleepiness, and Fatigue Outcomes for Parents of Critically Ill Children

Stremler, Robyn RN, PhD1,2; Dhukai, Zahida RN, MN1; Pullenayegum, Eleanor PhD3; Weston, Julie RN, MSc1; Wong, Lily RN, BScN, BHSc1; Parshuram, Christopher MBChB, DPhil2

Pediatric Critical Care Medicine: February 2014 - Volume 15 - Issue 2 - p e56–e65
doi: 10.1097/01.pcc.0000436198.15337.15
Online Clinical Investigations
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Objectives: To describe sleep quantity, sleep patterns, fatigue, and sleepiness for parents of critically ill hospitalized children.

Design: Prospective observational study.

Setting: Quaternary academic PICU.

Participants: One hundred eighteen parents of 91 children recruited during their child’s PICU stay.

Interventions: None.

Measurements and Main Results: For 5 days and nights, parents wore an actigraph to determine objective sleep-wake times and reported sleep location, level of fatigue (Fatigue Visual Analogue Scale), and sleepiness (Stanford Sleepiness Scale). Mean amounts of nocturnal sleep were less than recommended for optimal health (398 min, fathers vs 422 min, mothers; p = 0.04). Parents woke frequently (7.8 wakes, fathers; 7.2 wakes, mothers) and spent over an hour awake at night (65 min, fathers; 60 min, mothers). On 130 nights (26%), parents slept less than 6 hours and 209 nights (44%) were evaluated as “worse” sleep than usual. Fifty-four parents (53%) experienced more than 30% difference in minutes of sleep between consecutive nights. Mean morning fatigue levels (41 mm, fathers vs 46 mm, mothers; p = 0.03) indicated clinically significant fatigue. Sleeping in a hotel, parent room, or residence was associated with 3.2 more wakes per night (95% CI, 0.61–5.78; p = 0.015) than sleeping in a hospital lounge or waiting room.

Conclusions: We performed a prospective observational study of 118 parents of critically ill children using objective measures of sleep and validated scales to assess fatigue and sleepiness. We found that more than a quarter of nights met criteria for acute sleep deprivation, there was considerable variability in the amount of nocturnal sleep that individual participants slept on different nights, and sleep was fragmented with a large portion of the night spent awake. Future research should focus on interventions that improve parents’ ability to return to sleep upon awakening and maintain regular sleep-wake schedules.

1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.

2The Hospital for Sick Children (SickKids), Toronto, ON, Canada.

3Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.

This study was done in Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada, and The Hospital for Sick Children (SickKids), Toronto, ON, Canada.

Dr. Stremler received grant support from the Canadian Institutes of Health Research (CIHR) (grants for projects other than the submitted work, funding from University of Toronto Connaught Fund) and received funding for this project through the Connaught Fund, University of Toronto, and the CIHR Randomized Controlled Trials Mentoring program. She is a recipient of a CIHR New Investigator Award and an Early Research Award from the Ontario Ministry of Research and innovation. Dr. Dhukai disclosed that payments were received for role as a Research Assistant while a Masters student and disclosed “Work for Hire”. Dr. Pullenayegum is employed by McMaster University and received grant support from CIHR & NSERC (research grants). Dr. Weston is employed by the University of Toronto. Dr. Wong is employed by the University of Toronto. Dr. Parshuram served as a board member for Bedside Clinical Systems (shares in company-unpaid); is employed by the Hospital for Sick Children; received grant support from the Canadian Institutes of Health Research; has patents with Bedside PEWS; and has stock options with Bedside Clinical Systems; he is a recipient of a Career Scientist Award from the Ontario Ministry of Health and Long-Term Care and an Early Research Award from the Ontario Ministry of Research and Innovation.

For information regarding this article, E-mail: robyn.stremler@utoronto.ca

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies