A Pilot Review of the Long-Term Impact of Burn Injury on Sleep Architecture in Children

Abstract

Distorted sleep patterns exist in the acutely burned pediatric population. No prior study has used polysomnography to assess sleep proficiency in children years after discharge. The objective of this retrospective, pilot investigation was to examine sleep in children multiple years after burn injury to characterize the long-term impact of burns on sleep. Twenty-two subjects (mean age, 13.0 ± 0.9 years; 9.3 ± 0.7 years after burn; burn, 56.4 ± 6.1% TBSA; full-thickness burn, 52.0 ± 8.9%) whose parents reported disturbed sleep at home or in whom problematic sleep was exhibited during an inpatient stay, underwent overnight polysomnography. The amount of time children spent in various sleep stages, as well as sleep efficiency, were compared with norms. Sleep latency and number of arousals also were reviewed. Patients in the late burn recovery phase experienced significantly increased time in wake (P < .0001) and N1 stages (P < .0001) and nearly reached statistical significance in stage N2 (P = .07) in comparison with age-matched and sex-matched norms. Subjects exhibited decreased time in N3 (P = .07) and significantly less time in rapid eye movement sleep than normal controls (P < .0001). Sleep efficiency also was significantly decreased from the norm in the burn group (P < .0001). Marked reduction in the restorative phases of sleep persists for years after burn. Sleep efficiency also was significantly diminished in pediatric burn patients multiple years from injury. Evaluation of sleep adequacy should be a routine component of outpatient assessment in pediatric burns with consideration of referral to a sleep specialist as indicated.