Maturation of Arousals during Day and Night in Preterm Infants

Abstract

The objective of this study was to compare the maturation of spontaneous arousals during day and night sleep in preterm and term infants. From the Autonomic Baby Evaluation study, the sleep and arousal characteristics of 12 preterm (35.1 ± 2.1 weeks’ gestational age, GA) and 21 term (39.8 ± 0.8 weeks GA) newborns were compared between diurnal and nocturnal sleep periods at birth (M0) and 6 months (M6) of age. Models were adjusted for time (night/day), maturation (M0/M6), prematurity (yes/no). We found that preterm infants had less active sleep (AS)% than term infants with maturation during both day and night sleep, which may reflect accelerated brain maturation secondary to stress or environmental exposure after birth. Moreover, there was a difference in arousal maturation during day and night sleep in the preterm infants, as shown previously for term infants, which suggests the emergence of a circadian rhythm during the earliest postnatal period. We also showed that compared to term infants, these moderate preterm infants had fewer total arousals and, more specifically, fewer arousals in AS during day and night sleep, exposing them to a higher risk of sudden infant death syndrome.

Sleep Studies for Clinical Indications during the First Year of Life: Infants Are Not Small Children

“…In a previous issue of Children, Guyon et al, presented longitudinal data on the sleep structure and maturation of spontaneous arousals in a limited number of preterm and term infants from the Autonomic Baby evaluation study [1]. Participants were evaluated after birth in the maternity unit and at 6 months of age at home, using 24 h polysomnography (PSG).…”

Precision caffeine therapy for apnea of prematurity and circadian rhythms: New possibilities open up

“…The results varied due to the different GA of the enrolled cases, but most studies revealed that preterm infants experienced more total sleep time and AS, while less QS than term ones ( Anders and Keener, 1985 ; Ardura et al, 1995 ; Sahni et al, 1995 ; Hoppenbrouwers et al, 2005 ; Guyer et al, 2015 ; Georgoulas et al, 2021 ), which might reflect the accelerated neurological maturation of preterm infants ( Mirmiran et al, 2003a ; Bennet et al, 2018 ). Besides, preterm infants had fewer total arousals and, more specifically, fewer arousals in the AS ( Guyon et al, 2022 ), which seemed to cause a higher risk of sudden infant death syndrome ( Mirmiran et al, 2003a ; Bennet et al, 2018 ).…”

“…With developmental maturity, preterm infants have more sleep during nighttime but less during daytime ( Antonini et al, 2000 ; Korte et al, 2001 ; Guyer et al, 2015 ; Lan et al, 2019 ; Guyon et al, 2022 ). Meanwhile, as the PMA increased, the AS proportion comes out of a decreasing trend, but it is not true for the QS, IS, wakefulness, and activity, which all experience an increasing trend ( Anders and Keener, 1985 ; Curzi-Dascalova et al, 1988 ; Curzi-Dascalova et al, 1993 ; Borghese et al, 1995 ; Sahni et al, 1995 ; Ingersoll and Thoman, 1999 ; Mirmiran et al, 2003b ; Holditch-Davis et al, 2004 ; Hoppenbrouwers et al, 2005 ; Foreman et al, 2008 ; Dorn et al, 2014 ; Guyer et al, 2015 ; Lan et al, 2019 ; Cailleau et al, 2020 ; Park et al, 2020 ; Georgoulas et al, 2021 ; Guyon et al, 2022 ).…”

“…With developmental maturity, preterm infants have more sleep during nighttime but less during daytime ( Antonini et al, 2000 ; Korte et al, 2001 ; Guyer et al, 2015 ; Lan et al, 2019 ; Guyon et al, 2022 ). Meanwhile, as the PMA increased, the AS proportion comes out of a decreasing trend, but it is not true for the QS, IS, wakefulness, and activity, which all experience an increasing trend ( Anders and Keener, 1985 ; Curzi-Dascalova et al, 1988 ; Curzi-Dascalova et al, 1993 ; Borghese et al, 1995 ; Sahni et al, 1995 ; Ingersoll and Thoman, 1999 ; Mirmiran et al, 2003b ; Holditch-Davis et al, 2004 ; Hoppenbrouwers et al, 2005 ; Foreman et al, 2008 ; Dorn et al, 2014 ; Guyer et al, 2015 ; Lan et al, 2019 ; Cailleau et al, 2020 ; Park et al, 2020 ; Georgoulas et al, 2021 ; Guyon et al, 2022 ). In addition, other factors like sex, illness severity, body weight, ventilatory support, maternal smoking, and ambient temperature also affect the sleep-wake patterns ( Bach et al, 2000 ; Hoppenbrouwers et al, 2005 ; Foreman et al, 2008 ; Lan et al, 2019 ).…”

Cerebrospinal Fluid Histamine Levels in Healthy Children and Potential Implication for SIDS: Observational Study in a French Tertiary Care Hospital

“…Compared to a group of age-matched control infants, these SIDS victims had significantly more subcortical activations during the first part of the night between 9:00 p.m. and midnight, and fewer cortical arousals during the latter part of the night, suggesting an incomplete arousal process ( 8 ). On the other hand, all known major risk factors for SIDS such as prone sleep position, in utero tobacco exposure, preterm births,… have been consistently associated with decrease in both spontaneous and induced arousals from sleep ( 9 – 11 ).…”