Sleep Measure Validation in a Pediatric Neurocritical Care Acquired Brain Injury Population
Lingering morbidities including physical, cognitive, emotional, and psychosocial sequelae, termed the Post-Intensive Care Syndrome, persist years after pediatric neurocritical care (PNCC) hospitalization. Sleep disturbances impact other Post-Intensive Care Syndrome domains and are under-evaluated to date due to a lack of appropriate measurement tools. The present study evaluated the validity of the Sleep Disturbance Scale for Children (SDSC) to address the growing need for assessing sleep problems after PNCC.
We conducted a prospective observational study of youth aged 3–17 years with acquired brain injury (N = 69) receiving care through longitudinal PNCC programs at two tertiary academic medical centers. Parents completed the SDSC and provided proxy reports of internalizing symptoms, health-related quality of life (HRQOL), fatigue, pain behavior, and cognitive function within 3 months of hospital discharge. Evidence for the validity of the SDSC was established by utilizing the full sample for psychosocial measure comparisons and by comparing SDSC outcomes by severity (Low Risk, Mild-Moderate Risk, and High Risk defined by reported standardized T-scores).
Internal consistency of the SDSC was good (α = .81). Within the full sample, increased sleep disturbances on the SDSC were significantly correlated with Post-Intensive Care Syndrome measures, including worse physical (r = .65), psychological (r = .62), and cognitive (r = − .74) sequelae. Youth in the High Risk group evidenced greater dysfunction in mental acuity, pain behavior, internalizing symptoms, and social engagement. Findings revealed both statistically and clinically significant impacts of sleep disturbances as measured by the SDSC on HRQOL.
The SDSC is a valid and reliable measure for assessing sleep disturbances in children after PNCC. Results support the use of the SDSC to measure sleep disturbances after PNCC. Targeted interventions for sleep disturbances may be key to overall patient recovery.
KeywordsCritical care Sleep Quality of life Hospitalization Pediatric Outcomes Brain injury
Williams is supported by the Agency for Healthcare Research and Quality, grant number K12HS022981. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Dr. Guilliams is supported by the National Institute of Neurologic Disorders and Stroke grant number K23NS099472. Dr. Piantino is supported by the National Heart, Lung and Blood Institute grant number K12HL133115.
Source of support
Dr. Cordts was involved in all aspects of manuscript preparation, including conceptualization, conducting statistical analyses, and writing of the manuscript. Drs. Hall and Wagner were involved in the study conceptualization, data collection, and writing of the manuscript. Dr. Williams supervises Ms. Madison Luther and Ms. Jalane Jara who assisted with data collection, entry, and writing of the manuscript. Dr. Williams was involved in all aspects of the research from conceptualization of the study to editing the manuscript. Drs. Piantino, Hartman, Guilliams, Guerriero assisted in data collection and editing the manuscript.
This study was approved by the Institutional Review Board and conducted with a waiver of informed consent.
Conflict of interest
The authors declare that they have no conflicts of interest.
- 2.Williams CN, Eriksson CO, Kirby A, Piantino J, Hall TA, Luther M, et al. Hospital mortality and functional outcomes in pediatric neurocritical care. Hospital Pediatrics Accepted 9/2019 (in press).Google Scholar
- 6.Williams CN, Hartman ME, McEvoy CT, Hall TA, Lim MM, Shea SA, et al. Sleep wake disturbances after acquired brain injury in children surviving critical care. Pediatr Neurol Accepted 8/2019 (in press).Google Scholar
- 10.Sandsmark DK, Elliott JE, Lim MM. Sleep-wake disturbances after traumatic brain injury: synthesis of human and animal studies. Sleep 2017;40(5).Google Scholar
- 14.Bruni O, Ottaviano S, Guidetti V, Romoli M, Innocenzi M, Cortesi F, et al. The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res. 1996;5(4):251–61.PubMedCrossRefPubMedCentralGoogle Scholar
- 18.Dodd JN, Hall TA, Guilliams K, Guerriero RM, Wagner A, Malone S, et al. Optimizing Neurocritical Care Follow-up through the Integration of Neuropsychology. Pediatr Neurol 2018.Google Scholar
- 21.Johns M. The assessment of sleepiness in children and adolescents. Sleep Biol Rhythms. 2015;13(Suppl 1):97.Google Scholar
- 31.Varni JW, Beaujean AA, Limbers CA. Factorial invariance of pediatric patient self-reported fatigue across age and gender: a multigroup confirmatory factor analysis approach utilizing the PedsQL Multidimensional Fatigue Scale. Qual Life Res. 2013;22(9):2581–94.PubMedCrossRefPubMedCentralGoogle Scholar
- 38.Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65–70.Google Scholar
- 47.Fayers P, Machin D. Clinical interpretation. Quality of life, the assessment, analysis and interpretation of patient-reported outcomes, 2007, pp 427–55.Google Scholar
- 54.Food and Drug Administration. Patient reported outcome measures: Use in medical product development to support labelling claims. Guidance for industry http://wwwfdagov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM193282pdf. Accessed 15 Aug 2013. [WebCite Cache ID 6ItVJsak1] 2009.Google Scholar