Factors altering the sleep of burned children

Although few studies have been conducted on burn patients, they indicate th at sleep of burned children is altered. We suggest in this review, on the b asis of the limited data available that factors contributing to sleep disru ption in burned individuals may be broadly categorized as pathophysiologica l responses to the injury, the pain and discomfort experienced by the patie nt and medications used to treat these symptoms, and the physical environme nt in the Burns Intensive Care Unit. The responses to thermal injury includ e alterations in circulating neuropeptides, hormones, and immune-active sub stances. many of which are known to regulate/modulate sleep. Medications fo r the management of pain and for treating symptoms of various injury-induce d stress and anxiety disorders may also alter sleep. Finally, frequent disr uptions of the patient by medical staff is but one of the many environmenta l factors that may contribute to disrupted sleep. Severe burns induce a hyp ermetabolic response that may result in peripheral wasting, that depletes s ubstrates necessary for tissue repair, and is associated with reduced growt h hormone. Burn-induced growth hormone insufficiency is aggressively treate d to counteract peripheral wasting and to aid in wound healing of skin graf t donor sites. We speculate that improvement of sleep quality would result in a less severe reduction in growth hormone due to the well documented rel ationship between slow-wave sleep onset and growth hormone secretion. Such improvement in spontaneous growth hormone secretion patterns may aid in rec overy by supporting tissue repair and by minimizing the hypermetabolic resp onse to thermal injury. The experiments to test such hypotheses remain to b e conducted, yet the results of such experiments may provide the basis for beginning to answer the question of whether or not sleep aids in recovery f rom injury.