A Novel EEG Scoring System to Assess Sleep in Critically Ill Children: A Proof of Concept Study

ABSTRACT Sleep disturbance may be a modifiable risk factor for neurocognitive decline in critically ill children. Polysomnography, the gold standard for sleep analysis, is time and cost‐intensive and not commonly available in the paediatric intensive care unit (PICU). Electroencephalography (EEG) also provides measurements of sleep and is more commonly used. We devised a novel EEG‐based scoring system to categorise electrographic sleep and assessed its feasibility. In this retrospective observational cohort study across two PICUs, EEGs performed in patients aged 6 months to 18 years were analysed for sleep using a four‐category system: category 1—invariable background, no state cycling or reactivity; category 2—reactivity and variability present, no discernable sleep architecture; category 3—discernable sleep architecture, abnormal pattern of sleep cycle; and category 4—normal sleep architecture and pattern. We evaluated 51 subjects. Seven patients (14%) were classified as category 1, 11 patients (22%) as category 2, 24 patients (47%) as category 3, and 9 patients (18%) as category 4. For those patients in whom sleep was detected (categories 3 and 4), N2 sleep was detected in 33 (100%) of patients, N3 sleep was detected in 24 (73%), and REM sleep was identified in 13 (39%). In this small cohort study across two centres, paediatric neurologists were able to qualify sleep in critically ill children using a novel EEG‐based scoring system. If clinically validated, this scoring system could facilitate exploration of modifiable risk factors leading to sleep disruption in the PICU.