Simple instructions for partial sleep deprivation prior to pediatric EEG reduces the need for sedation

Abstract

Objective: To study the effects of providing simple instructions for partial sleep deprivation on the necessity for sedation in children and adolescents undergoing electroencephalography (EEG).

Methods: Children and adolescents below 18 years undergoing non-urgent routine EEG were studied for the need for sedation during the EEG test. Two consecutive 3-year periods were reviewed. During the first 3 years no instructions for sleep deprivation were given, and during the second 3-year period, simple instructions were given to the patient or parents of young children to have less sleep prior to the EEG test. This was achieved by using the same sleep deprivation schedule irrespective of the age of the patient.

Results: In the first 3-year period between January 1996 and December 1998, 785 non-urgent routine EEG recordings were performed in which only 146 (19%) pediatric patients managed to fall asleep without the need for any sedation within 30 min of being ready for the sleep recording. When partial sleep deprivation was implemented in the 3-year period between January 2000 and December 2002, 449 (55%) out of 821patients undergoing the test fell asleep in the laboratory without sedation, an overall increase of 36%. Analyzing the different age-specific groups, the maximal increase in the success for natural sleep following partial sleep deprivation was 44% for pediatric patients aged above 10 years.

Conclusions: Simple instructions for partial sleep deprivation prior to the EEG reduced the need for sedation in children and adolescents undergoing the test.

Introduction

Electroencephalography (EEG) is a non-invasive and integral tool in the diagnostic evaluation of pediatric patients with suspected seizures. During the EEG procedure, sleep is required in order to obtain both the drowsy and sleep states, which are necessary to provide the most complete data. For example, benign focal epileptiform discharges of childhood may only appear in drowsiness and sleep. For young children, sleep is also necessary, as it allows the application of the recording electrodes to the scalp without causing excessive anxiety. Sleep can be achieved either naturally or by administering sedatives.

To reduce the necessity for sedatives, most EEG laboratories suggest sleep deprivation as an important precursor to obtain natural sleep. In most cases, sleep deprivation is carried out for the entire night prior to the EEG. The EEG laboratories in the Kaweah Delta District Hospital and the Advocate-Christ Hospital had implemented age-specific sleep deprivation guidelines for pediatric patients (Sweeney et al., 1997, Brown et al., 1997) (Table 1). Their guidelines required different sleep deprivation schedules for different age groups. Children above 12 years were to be kept awake all night and these presented difficulties to the patients and family members. To use these guidelines, the ages of the patients needed to be verified and there could be problems in relaying the correct age-specific instructions for each patent. Kubicki had tried an alternative method, doing short-term sleep recording in the early afternoon following only partial sleep deprivation the preceding night (Kubicki et al., 1991). His method was well received and successful in achieving natural sleep for most patients. However, the EEG tests were only conducted in the afternoon and the majority of the patients in his study were adults. All the above methods and schedules for sleep deprivation proved successful but each had its own limitations and inconveniences.

In our laboratory, routine EEG studies are performed both in the morning and afternoon. From the beginning of the year 2000, we implemented a simplified partial sleep deprivation schedule for pediatric patients aged less than 18 years. This required only a fixed number of hours of sleep deprivation irrespective of the age of the patient (Table 2). The total hours of partial sleep deprivation required using our schedule was generally shorter than that implemented by Sweeney at al. or Brown et al. Thus, we avoided the difficulty of patients having to go through an entire night without sleep. In the typical clinical setting, there was a clear advantage in the ease of relaying the instructions by doctors and nurses at the time of scheduling the EEG appointment as there was only one standard set of instructions.