REVIEW article
Front. Sleep
Sec. Pediatric and Adolescent Sleep
Volume 4 - 2025 | doi: 10.3389/frsle.2025.1629408
This article is part of the Research TopicReviews in Sleep: 2024View all 6 articles
Sleep Fragmentation in Critically Ill Children: A Review of Contributing Factors in the Pediatric Intensive Care Unit and Neurodevelopmental Outcomes
Provisionally accepted
- 1Department of Medical Physiology, University of Toronto, Toronto, Canada
- 2Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
- 3Department of Pediatrics, University of Toronto, Toronto, Canada
- 4Department of Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Canada
- 5Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
- 6Departments of Medical Physiology and Pediatrics, University of Toronto, Toronto, Canada
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Sleep is a critical neurobiological process essential for brain maturation, emotional regulation, cognitive development, and overall organ system homeostasis. In the pediatric intensive care unit (PICU), sleep architecture is frequently disrupted by environmental stimuli, sedation, and clinical interventions, resulting in sleep fragmentation. Unlike sleep deprivation, sleep fragmentation preserves sleep duration but impairs its continuity and depth, disproportionately affecting slow-wave sleep, that is essential for growth, healing, in addition to immune function and REM sleep, that is fundamental for synaptic plasticity, neurogenesis, and memory consolidation. These disruptions are particularly concerning in children, who require more sleep than adults due to ongoing neurogenesis and rapid somatic growth, rendering them uniquely vulnerable to adverse effects. Emerging evidence links fragmented sleep in the PICU to altered neurodevelopmental trajectories and increased risk of Pediatric Post-Intensive Care Syndrome (PICS-p), with delirium serving as a key mediator. Despite promising adult studies on sleeppromoting interventions and EEG-based monitoring, pediatric research remains limited. Future research should prioritize objective sleep monitoring, developmental tailoring of care protocols, and longitudinal studies to clarify the impact of sleep fragmentation on recovery and neurodevelopment. This narrative review highlights the urgent need to recognize and preserve sleep as a modifiable determinant of neurocognitive outcomes in critically ill children.
Keywords: Sleep fragmentation; delirium, Neurodevelopmental Outcomes, Post-Intensive Care Syndrome (PICS), Intensive Care Units, pediatric
Received: 15 May 2025; Accepted: 04 Aug 2025.
Copyright: © 2025 Byeon, Weiss, Gilfoyle and McKinnon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Nicole K. McKinnon, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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