Sleep State Organization in Premature Infants of Less Than 35 Weeks' Gestational Age

Curzi‐Dascalova, Lilia; Figueroa, J Meneses; Eiselt, M.; Christova, Emilia; Virassamy, A; Am, D'Allest; Guimarães, Hercília; Gaultier, Claude; Dehan, M

doi:10.1203/00006450-199311000-00013

Cited by 114 publications

(61 citation statements)

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“…No studies have indicated the presence or absence of sleep state cyclicity in preterm infants who are Ͻ30 wk GA, although selected studies have suggested the coincidence among different physiologic behaviors during state transitions (15,16). Our findings suggest that preterm neonates with PCAs of …”

Section: Discussionsupporting

confidence: 47%

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Cyclicity of Neonatal Sleep Behaviors at 25 to 30 Weeks' Postconceptional Age

2005

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Previous sleep studies of preterm neonates describe the rudimentary expression of sleep state cyclicity after 30 wk postconceptional age (PCA), with stability over multiple cycles only after 36 wk PCA. The research objective for this study was to determine whether sleep state cyclicity was expressed in neonates of 25-30 wk PCA, using two criteria for state identification. Our neonatal sleep consortium includes a total cohort of 359 children who were healthy and medically ill neonates who were recruited from three obstetric-neonatal services and received multiple-hour EEG sleep studies. A subset of the 33 youngest preterm infants were selected to evaluate the first of serial 2-to 3-h EEG-sleep recordings to assess the presence of sleep state cyclicity. One neonatal neurophysiologist visually assigned EEG-sleep characteristics for each record. Rapid eye movement (REM) counts and EEG discontinuity were specifically chosen to assess whether sleep cyclicity was expressed. A combined measure of REM and EEG discontinuity were used in an autocovariance analysis to assess cycling and mean cycle duration. A mean cycle duration of 68 Ϯ 19 min with a range of 37-100 min was determined from the REM-EEG discontinuity state for 24 neonates. The remaining nine infants had absent or poor sleep cyclicity. Sleep state cyclicity is expressed for a majority of neonates between 25 and 30 wk PCA, reflecting an ultradian biologic rhythm during the early perinatal stage of brain development. (Pediatr Res 57: 879-882, 2005) Abbreviations GA, gestational age PCA, postconceptional age REM, rapid eye movement Functional brain organization can be assessed by applying analyses to EEG-sleep state architecture and continuity measures. The observation of sequentially recurring eye movement intervals alternating with no eye movement epochs was initially described in the newborn infant as early as the 1950s (1). Such a sequence suggests either the presence of a highly periodic process or, alternatively, the temporal coincidence, with variable predictability, among physiologic behaviors that sometimes define state transitions. Early investigators suggested the presence of periodicity in infant sleep measures (2,3). Sterman et al. (4) observed periodicity from early gestational ages (GAs), beginning with the basic rest-activity cycle in the fetus and the sleep cycle in infants. Globus (5) described cyclicity at all GAs, with predictable rhythmicity after 36 wk postconceptional age (PCA). Other authors stressed the clinical importance of sleep periodicity, as exemplified by reports of disturbed cyclic organization of sleep in infants with CNS disorders (6) as well as asymptomatic infants at risk for sudden infant death syndrome (7,8).Specific investigations questioned the definition of sleep state cyclicity when applying alternative methods, particularly when states were considered categorical events (5,9,10). On the basis of these specific methodologic approaches, sleep cyclicity did not appear until at least 6 wk of life (11), 4 -6 mo postnatally (...

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Section: Discussionsupporting

confidence: 47%

“…Studies of sleep state cyclicity for preterm infants who are Ͻ30 wk GA or PCA have not been widely reported, although some authors have suggested predictable sleep state transitions in this group of preterm infants by 27-30 wk GA, using rapid eye movements (REMs) and specific EEG patterns (15,16).…”

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confidence: 99%

Cyclicity of Neonatal Sleep Behaviors at 25 to 30 Weeks' Postconceptional Age

2005

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“…28,29 However, possibly because of improvements in neonatal intensive care in the last decades, more recent studies have described rudimentary sleep states in extremely premature infants. 5,30 Intact sleep organization is a prognostic factor in preterm infants. 31,32 Thus, the presence of cyclical variations of aEEG activity may be useful for prediction of outcome in preterm infants.…”

Section: E64mentioning

confidence: 99%

Reference Values for Amplitude-Integrated Electroencephalographic Activity in Preterm Infants Younger Than 30 Weeks’ Gestational Age

et al. 2004

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ABSTRACT. Objective. To prospectively investigate the development of amplitude-integrated electroencephalographic (aEEG) activity during the first 2 weeks of life in neurologically normal and clinically stable preterm infants <30 weeks' gestational age (GA).Patients and Methods. Infants with a GA of <30 weeks admitted to the neonatal intensive care unit of the Vienna University Children's Hospital (Vienna, Austria) were studied prospectively by using aEEG and cranial ultrasound. Clinically stable infants without clinical or sonographic evidence of neurologic abnormalities were eligible for inclusion in the reference group. The distribution of 3 background aEEG activity patterns (discontinuous low-voltage, discontinuous high-voltage, and continuous), presence of sleep-wake cycles, and number of bursts per hour in the reference group were determined by visual analysis.Results. Seventy-five infants (median GA: 27 weeks; range: 23-29 weeks) were eligible for inclusion in the reference group and had aEEG recordings during the first 2 weeks of life available. Analysis of aEEG background activity showed that with higher GA the relative amount of continuous activity increased while discontinuous patterns decreased. The number of bursts per hour decreased with increasing GA. Cyclical changes in aEEG background activity resembling early sleep-wake cycles were observed in all infants.Conclusions. Normal values for aEEG background activity were determined in preterm infants <30 weeks' GA. Clinically stable and neurologically normal preterm infants exhibit at least 2 different patterns of aEEG activity. There is a correlation between the GA and the relative duration of continuous aEEG activity. A dvances in neonatal intensive care during the last decades have led to an increased survival rate of extremely low birth weight infants. However, neurologic and developmental disability is still common among survivors. 1 Prevention of brain injury in these patients has become one of the main goals of modern neonatology. Continuous monitoring of neonatal brain function may aid in the identification of risk factors and patients at increased risk for neurologic morbidity. Early recognition and modification of potentially harmful environmental factors may prevent secondary brain injury.Conventional electroencephalography (EEG) is one of the most useful tools for intermittent and continuous assessment of brain function and prediction of neurologic outcome in term infants and children. 2-4 However, conventional EEG has limitations in its application for extremely low birth weight infants. Registration and interpretation of conventional EEG in this age group are difficult because of the electrical interferences on the neonatal intensive care unit, the large volume of data generated during a longer recording, and the need for 24-hour availability of a skilled examiner experienced in EEG of preterm infants. Further, data on normal EEG patterns in extremely premature infants are still limited. 5,6 Recently, amplitude-integrated EEG (aEEG) pro...

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“…У недоношенных детей, родивших-ся на сроке гестации до 35 нед, продолжительность цикла сна составляет 45-50 мин, на более поздних сроках гестации она достигает тех же значений, что у доношенных новорожденных. Структура сна у детей, родившихся недоношенными и достигших срока до-ношенности, а также у детей, родившихся доношен-ными с признаками задержки внутриутробного раз-вития, существенно не отличается от структуры сна доношенных новорожденных детей [14].…”

Section: персонализированная педиатрияunclassified

Child Sleep Ontogeny and Application of the Standardized Questionnaire for the Evaluation of Child Behaviour During Sleep

Kelmanson¹

2017

Ross. vestn. perinatol. pediatr.

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Формирование сна ребенка начинается в периоде внутриутробного развития. В целом отчетли-вую цикличность изменений состояний плода мож-но зафиксировать с 28-31-й недели гестации, когда наблюдается чередование периодов относительной активности и покоя, отражающее наличие элемен-тарных ультрадианных ритмов (т.е. с периодом ме-нее 24 ч), регулируемых ЦНС плода и подверженных влиянию внешних стимулов. По мере увеличения сроков гестации периоды относительного покоя уве-личиваются по своей продолжительности. Так, если на сроке гестации 26-29 нед средняя продолжитель-ность подобных эпизодов составляет 15-17 мин, то к 34 нед и вплоть до рождения ребенка их продолжи-тельность составляет уже 28-41 мин. У плода наблю-дается формирование и циркадианных (т.е. суточных) ритмов. Супрахиазматическое ядро гипоталамуса, ответственное за регуляцию этих ритмов, формиру-ется у плода к середине гестации, его дальнейшее со-зревание продолжается на протяжении всего периода гестации и после рождения ребенка. На сроках геста-ции 20-22 нед можно выявить циркадианные ритмы функции сердечно-сосудистой системы, дыхательных движений, общей двигательной активности, уров-ня гормонов в крови плода, и эти колебания син-хронизированы с чередованием темного и светлого времени суток. Как полагают, такая синхронизация обеспечивается колебаниями уровня мелатонина, вы-рабатываемого эпифизом беременной, уровня глюко-Адрес для корреспонденции: Кельмансон Игорь Александрович -д.м.н., проф. кафедры клинической психологии Института специальной пе-дагогики и психологии Международного университета семьи и ребенка им. Рауля Валленберга, проф. кафедры общей, возрастной и дифферен-циальной психологии Санкт-Петербургского государственного института психологии и социальной работы 194356 Санкт-Петербург, ул. Большая Озерная, д. 92. iakelmanson@hotmail.com Сон ребенка в онтогенезе и использование стандартизованного опросника для оценки поведения детей во время сна И.А. КельмансонИнститут специальной педагогики и психологии международного университета семьи и ребенка им. Рауля Вал-ленберга, Санкт-Петербург; Санкт-Петербургский государственный институт психологии и социальной работы, Санкт-Петербург, РоссияChild sleep ontogeny and application of the standardized questionnaire for the evaluation of child behaviour during sleep. 37-52. DOI: 10.21508/102737-52. DOI: 10.21508/ -4065-2017 The questions I.A. Kelmanson

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Sleep State Organization in Premature Infants of Less Than 35 Weeks' Gestational Age

Cited by 114 publications

References 0 publications

Cyclicity of Neonatal Sleep Behaviors at 25 to 30 Weeks' Postconceptional Age

Cyclicity of Neonatal Sleep Behaviors at 25 to 30 Weeks' Postconceptional Age

Reference Values for Amplitude-Integrated Electroencephalographic Activity in Preterm Infants Younger Than 30 Weeks’ Gestational Age

Child Sleep Ontogeny and Application of the Standardized Questionnaire for the Evaluation of Child Behaviour During Sleep

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