Review of sleep-EEG in preterm and term neonates

Abstract

Neonatal sleep is a crucial state that involves endogenous driven brain activity, important for neuronal survival and guidance of brain networks. Sequential EEG-sleep analysis in preterm infants provides insights into functional brain integrity and can document deviations of the biologically pre-programmed process of sleep ontogenesis during the neonatal period. Visual assessment of neonatal sleep-EEG, with integration of both cerebral and non-cerebral measures to better define neonatal state, is still considered the gold standard. Electrographic patterns evolve over time and are gradually time locked with behavioural characteristics which allow classification of quiet sleep and active sleep periods during the last 10weeks of gestation. Near term age, the neonate expresses a short ultradian sleep cycle, with two distinct active and quiet sleep, as well as brief periods of transitional or indeterminate sleep. Qualitative assessment of neonatal sleep is however challenged by biological and environmental variables that influence the expression of EEG-sleep patterns and sleep organization. Developing normative EEG-sleep data with the aid of automated analytic methods, can further improve our understanding of extra-uterine brain development and state organization under stressful or pathological conditions. Based on those developmental biomarkers of normal and abnormal brain function, research can be conducted to support and optimise sleep in the NICU, with the ultimate goal to improve therapeutic interventions and neurodevelopmental outcome.

Sleep State Modulates Resting-State Functional Connectivity in Neonates

“…Monitoring arousal or sleep state in neonates is routinely performed with electroencephalography (EEG; Dereymaeker et al, 2017;Pillay et al, 2018). However, introducing additional neuro-monitoring equipment into a study of an already challenging population can be time consuming and problematic.…”

Music exposure and maturation of late preterm sleep–wake cycles: a randomised crossover trial

“…Recently, quantitative polysomnography analyses and visual assessment of neonatal sleep EEG have shown useful defining characterisation of sleep–wake states. PSG measures show association with neurologic examination scores . Future directions involve improving inter‐rater agreement and validity confirming among all three modalities, creating a gold standard.…”

Decomposition of a Multiscale Entropy Tensor for Sleep Stage Identification in Preterm Infants

“…The higher performance for higher ranks in noisy preterm EEG recordings confirms this reasoning. Secondly, the emergence of four distinct sleep states around 36 weeks PMA might also play a role in this phenomenon [4].…”

“…Generally, the EEG signal is relatively more discontinuous during quiet sleep compared to non-quiet sleep. Moreover, non-quiet sleep is characterized by a higher variability of the cardiorespiratory pattern and more body movements [4].…”

“…Near term age, both active sleep and quiet sleep constitute approximately half of the total sleep time [2,3]. Existing research recognises the importance of sleep in early brain development [1,3,4]. Sleep and established sleep cycling play a vital role in normal neurosensory development, learning processes, memory consolidation and in the protection of the infant's brain plasticity [1].…”