Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU).

Abstract

Observational data suggest pediatric intensive care unit-related sleep and circadian disruption (PICU-SCD) affects many critically ill children.Multi-center trials exploring PICU-SCD have been impractical as measuring sleep in this setting is challenging.This study validates a questionnaire for caregivers to describe children's sleep in the PICU. This prospective, multi-center, case-control study enrolled caregivers of children in four PICUs or in a hospital-based sleep lab (controls). Survey items were compiled from validated adult ICU and pediatric in- and outpatient sleep questionnaires.Control responses were compared to polysomnography to determine accuracy. A score was calculated by summing the level of disruption of sleep timing, duration, efficiency, quality, and daytime sleepiness and irritability. In 152 PICU and 61 sleep lab caregivers, sleep survey items had acceptable internal reliability (α=0.75) and reproducibility on re-test surveys (ICC>0.600). Caregivers could not assess sleep of sedated children. Factor analysis identified three sub-scales of PICU-SCD. Control parents had good agreement with polysomnography sleep onset time (κ=0.823) and sleep onset latency (κ=0.707).There was a strong correlation between sleep scores derived by parental reporting to those by polysomnography (r=0.844, p<0.001).Scores had a linear association with caregiver-reported child sleep quality.There were no site-specific differences in sleep quality.Nearly all respondents found the survey easy to understand and of appropriate length. The SSqPICU provides a reliable, accurate description of inpatient sleep disruption in non-sedated children, generalizable across PICUs. It offers practical means to quantify PICU-SCD daily in future investigations.