重症监护后获得性脑损伤儿童睡眠障碍对健康相关生活质量的影响。
The Impact of Sleep Disturbances on Health-Related Quality of Life in Children With Acquired Brain Injury After Critical Care.
机构信息
Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon.
Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon; Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon.
出版信息
Pediatr Neurol. 2023 Apr;141:25-33. doi: 10.1016/j.pediatrneurol.2023.01.002. Epub 2023 Jan 11.
BACKGROUND
Over 60,000 children with acquired brain injury (ABI) in the United States require admission to pediatric intensive care units annually. Over 50% suffer sleep-wake disturbances (SWDs) months after discharge. Given the importance of sleep to brain repair, we hypothesized that SWD would be associated with poorer health-related quality of life (HRQOL).
METHODS
Cross-sectional analysis of prospectively collected data in children with ABI aged 3 to 18 years evaluated 1 to 3 months after critical care hospitalization (N = 151). SWD measured by Sleep Disturbances Scale for Children and defined as T-score ≥60 signifying moderate-severe risk of sleep disorders. HRQOL measured by Pediatric Quality of Life Inventory, which defines minimal clinically important difference as 4.5 points in total score. Secondary outcomes included scores for Physical, Emotional, Social, and School Function domains. SWD groups were compared with Mann-Whitney tests. Multiple linear regression evaluated association between SWD and HRQOL controlling for patient and ABI characteristics. Significance was defined as P < 0.05.
RESULTS
SWDs were present in 66% (n = 100). HRQOL total score was significantly lower in children with SWD (median = 70; interquartile range [IQR] = 54, 80) versus without (median = 85; IQR = 67, 94; P < 0.001). Median scores in emotional, social, and school domains were significantly lower in SWD group (all P < 0.01). When controlling for age, sex, critical care interventions, preadmission comorbidities, and decline from preadmission Functional Status Scale, presence of SWD significantly reduced HRQOL total score nearly three times minimal clinically important difference (β-coefficient = -12.1; 95% confidence Interval = -17.9, -6.2).
CONCLUSIONS
SWD following ABI significantly decreased HRQOL overall and across multiple health domains. Sleep is potentially modifiable. Our data support future studies targeting sleep to improve outcomes after ABI.
背景
每年，美国有超过 60000 名获得性脑损伤 (ABI) 的儿童需要入住儿科重症监护病房。 超过 50%的儿童在出院后数月出现睡眠-觉醒障碍 (SWD)。鉴于睡眠对大脑修复的重要性，我们假设 SWD 与较差的健康相关生活质量 (HRQOL) 有关。
方法
对入住重症监护病房后 1 至 3 个月的年龄在 3 至 18 岁的 ABI 儿童进行前瞻性数据的横断面分析 (N=151)。SWD 通过儿童睡眠障碍量表测量，定义为 T 评分≥60，表明存在睡眠障碍的中度至重度风险。HRQOL 通过儿科生活质量量表测量，定义为总分 4.5 分为最小临床重要差异。次要结局包括身体、情绪、社会和学校功能领域的评分。使用 Mann-Whitney 检验比较 SWD 组。使用多元线性回归，在控制患者和 ABI 特征的情况下，评估 SWD 与 HRQOL 之间的关联。定义显著性为 P < 0.05。
结果
存在 SWD 的比例为 66%（n=100）。有 SWD 的儿童 HRQOL 总分明显较低（中位数=70；四分位距 [IQR]=54，80），而无 SWD 的儿童（中位数=85；IQR=67，94；P < 0.001）。SWD 组的情绪、社会和学校领域的中位数评分均显著较低（均 P < 0.01）。在校正年龄、性别、重症监护干预、入院前合并症和入院前功能状态量表的下降后，SWD 的存在显著降低了 HRQOL 总分近三倍最小临床重要差异（β系数=-12.1；95%置信区间=-17.9，-6.2）。
结论
ABI 后 SWD 显著降低了总体和多个健康领域的 HRQOL。睡眠是潜在可改变的。我们的数据支持未来针对睡眠以改善 ABI 后结局的研究。
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