Project Summary More than 250,000 children survive pediatric intensive care unit (PICU) hospitalization each year in the United States, yet we have an incomplete understanding of recovery trajectory and modifiable factors to optimize survivorship. PICU survivors have multisystem diseases and suffer multisystem morbidities many years after hospital discharge in physical, cognitive, and psychosocial health domains. Our preliminary data indicate presence of clinically significant pain among 1 in 3 children and sleep disturbances in over 50% of children months to years after PICU hospitalization, placing them at risk for poorer long-term health outcomes. However, key knowledge gaps remain in understanding risk factors and mechanisms for persistent pain and sleep disturbances in PICU survivors, limiting potential interventions that could have broad implications for long-term recovery. For example, PICU survivors are known to suffer substantial cognitive impairments, particularly within the executive function construct, crucial to long-term academic achievement, quality of life, and psychosocial well-being. Chronic pain and sleep disturbances are potentially modifiable, and linked to worse executive function in other pediatric populations. However, we have an incomplete understanding of the impact of pain and sleep on executive function outcomes in PICU survivors. The central hypothesis of this proposal is that pain and sleep disturbances are important post-PICU morbidities that are key mediators between acute illness factors, psychosocial vulnerabilities and executive function outcomes in children after critical illness. We will conduct a longitudinal outcomes study of PICU survivors aged 8-18 years with the following objectives: 1) Identify pain trajectories and biopsychosocial risk factors for chronic pain in PICU survivors; 2) Elucidate longitudinal sleep disturbances in PICU survivors and sleep-pain associations over 12 months; 3) Test the impact of sleep and pain on EF outcomes in PICU survivors over 12-months. The study will utilize objective measures of acute illness severity, novel metrics of psychosocial vulnerabilities, and a mix of objective assessment and subjective report of pain, sleep, and executive function outcomes to comprehensively evaluate temporal and mediating relationships 3, 6, and 12-months after PICU hospitalization. This proposal is significant because it addresses the common and debilitating morbidities of chronic pain and sleep disturbances that affect thousands of PICU survivors annually. Our data will identify risk factors across a biopsychosocial framework to improve identification and treatment of pain and sleep disturbances, and aligns with the National Institutes of Health Sleep Disorders Research Plan and Federal Pain Research Strategy. This research will provide a greater understanding of sleep, pain, and executive function in PICU survivors key for designing and implementing interventions aimed at optimizing recov...