Maturation of Arousals during Day and Night in Preterm Infants.

Aurore Guyon,Alex Champavert,Patricia Franco,Francoise Ravet,Hugues Patural,Sabine Plancoulaine,Marine Thieux

doi:10.3390/children9020223

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.

Highlights

Arousal from sleep could play a central role in protection against the respiratory or cardiovascular challenges that may occur during sleep [1]
There was no significant difference between term and preterm infants regarding sex, maternal age during pregnancy, and WPPSI-III characteristics (verbal, performance, and total Intelligence Quotient (IQ) at 3 years; Table 1)
We found that the preterm infants displayed more QS% and lower active sleep (AS)% in day sleep and in night sleep than term infants at M6, even if they were younger in PGA, as an effect of the accelerated maturation in sleep stages

Summary

Introduction

Arousal from sleep could play a central role in protection against the respiratory or cardiovascular challenges that may occur during sleep [1]. Several studies suggested that a failure to arouse could be involved in the final steps of SIDS [2,3,4]. Filiano and Kinney proposed a triple risk model for SIDS combining three critical factors: prenatal vulnerability, an exogenous postnatal stressor, and a critical developmental period [5]. About 8 to 10% of births occur before 37 weeks of gestation [10], and these preterm infants represent 29 to 34% of SIDS victims [11,12,13]. Their sleep cycles last 50 to 60 min and are composed of

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