A Systematic Review and Meta-analysis of Sleep Disturbances in Pediatric Burn Survivors

Purpose of Review: Sleep disorders post-burn injury are understudied. Particularly in the pediatric burn population, healthy sleep is essential for proper wound healing, social and behavioral development, and growth. We therefore decided to conduct a systematic review of the literature to identify the prevalence of sleep disorders in pediatric burn patients and to conduct a meta-analysis of pooled effects on all interventions to improve sleep. Recent Findings: Of 1,889 records, 22 studies were included. Questionnaires, polysomnography, and actigraphy were utilized to assess sleep. General sleep disturbances were reported in 57.6% of inpatients and 53.0% of outpatients. Overall prevalence for sleep disorders was 58.1%. Most common was non-specific sleep disturbances for 347 patients (23.1%) followed by nightmares (6.8%) and sleep interruptions (6.1%). Body mass index, pruritis, history of mature scarring from previous burn injury, and female gender were associated with worse sleep outcomes. Percentage of total body surface area burned was not associated with sleep disturbances. Meta-analysis of four studies found a significant improvement in TST in the intervention groups (mean difference [95% CI], 66.67 [58.05, 75.47] min, p < 0.00001), whereas meta-analysis of two studies did not show a significant improvement in sleep efficiency (mean difference [95% CI], 14.01 [9.90, 18.29]%, p < 0.001). Summary: Our systematic review presents evidence that pediatric burn patients are at a higher risk of sleep disorders when compared to their non-burned peers. The optimal environment for good sleep hygiene longitudinally includes treatment of physiologic, psychologic, and environmental factors.