666: POST-PICU SLEEP EFFICIENCY AND QUALITY OF LIFE IN INFANTS AND TODDLERS WITH ACQUIRED BRAIN INJURY

Abstract

Introduction: Young children are high risk for long-term morbidity after critical care for acquired brain injury (ABI), including sleep disturbances. Poor sleep in children after ABI is associated with worse developmental outcomes. Sleep efficiency (SE) is a mainstay of the evaluation of sleep disorders and response to sleep interventions in adults, but is infrequently measured in pediatric populations, especially infants and toddlers. This study investigated SE after ABI in an at-risk cohort, and associations with quality of life and family impact outcomes. Based on prior work demonstrating the importance of sleep in healing after ABI, we hypothesized that there would be a positive correlation between SE and quality of life outcomes. Methods: This retrospective cohort study examined 98 children aged 0-3 years who survived critical care hospitalization for ABI and received outpatient follow-up care through the Pediatric Critical Care and Neurotrauma Recovery Program one to three months post-discharge. We derived SE from the Brief Infant Sleep Questionnaire as the ratio of nighttime sleep to total time in bed, which accounts for sleep latency and duration of nighttime awakenings. Poor SE defined as < 80%. Pediatric Quality of Life Inventory Core Total Score (QOL) and Family Impact Module Total Score (FIM) evaluated outcomes. Spearman’s correlation (rs) quantified associations between SE and outcomes. Multivariable linear regression evaluated association between SE and QOL controlling for significant covariates (age, comorbidities, worsening functional status scale score). Significance defined as p<.05. Results: Following ABI, we found a median SE of 91.4 (IQR= 83.1, 95.5). Nineteen (19.4%) children had poor SE. There was a significant positive correlation between SE and QOL (rs= .331) and FIM scores (rs= .321; both p<.01). When controlling for covariates, worse SE remained significantly associated with worse QOL (β-coefficient= -9.7; 95% Confidence Interval= -15.2, -4.1; p<.001). Conclusions: Young children with ABI are at an increased risk of poor SE and subsequent negative impacts on a variety of child and family health outcomes. Our study underscores the importance of identifying early sleep interventions following ABI in order to optimize recovery.