Introduction: There is minimal existing literature regarding the role of sleep as a modulator of outcomes in critically ill children both within the PICU environment and after discharge. Studies of adults admitted to the ICU demonstrate a number of sleep difficulties including decreased sleep efficiency and an increase in arousal frequency. Furthermore poor sleep quality has been shown to persist even after discharge from ICU. Infants undergoing heart surgery for congenital heart disease undergo a significant period of sedation, mechanical ventilation and prolonged hospital admission. The aim of this study was to evaluate sleep in these infants at the point of hospital discharge.

Methods: The Cardiac Baby SPICE study is a blinded randomised controlled trial comparing 2 sedation protocols in infants undergoing cardiac surgery on bypass at <12 months of age. As a secondary outcome measures, sleep patterns were assessed in these infants at hospital discharge and at 6 and 12 months follow up. Infants underwent actigraphy and parents completed the Brief Infant Sleep Questionnaire (BISQ) each time.

Results: Baseline sleep data from the BISQ was available for 24 patients in this study who were an average age of 7 months at the time of hospital discharge (range 1‐23 months). Infants slept an average of 7.36hrs at night (5‐10 hrs) and 4.37hrs during the day (1.30‐9.30 hrs), giving an overall average sleep time of 12hrs. The average number of awakenings overnight was reported to be 2, with the average amount of time awake at night 74mins.11/24 infants fell asleep whilst being held and only 5 infants fell asleep in bed alone. Most infants slept supine (n=13) but there were 4 infants who slept prone. Only 8/24 parents felt their infant had a sleep problem and in all cases this was reported as a small problem only. Actigraphy data was also available for a subset of patients (n=9).

Discussion: Whilst parents did not feel sleep problems were prevalent in this group of infants, this study found the average sleep quantity to be at the lower end of recommended normal for this age group (12‐16hrs) and almost half the infants needed to be held by parents to fall asleep. It is possible that this is related to their prolonged hospital stay at birth and practices used for sleep during this time. Longitudinal data will be important to determine if circadian patterns are altered long‐term in this population of infants.