Sleep Disturbances in Newborns

Daphna Yasova Barbeau, Michael D Weiss, Daphna Yasova Barbeau, Michael D Weiss

Abstract

The purpose of this review is to serve as an introduction to understanding sleep in the fetus, the preterm neonate and the term neonate. Sleep appears to have numerous important roles, particularly in the consolidation of new information. The sleep cycle changes over time, neonates spend the most time in active sleep and have a progressive shortening of active sleep and lengthening of quiet sleep. Additionally, the sleep cycle is disrupted by many things including disease state and environment, and the amplitude integrated EEG can be a useful tool in evaluating sleep, and sleep disturbances, in neonates. Finally, there are protective factors for infant sleep that are still being studied.

Keywords: aEEG; apnea; premature neonate; sleep; sleep disorder; sleep disturbances; sleep states; sleep wake cycling.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Active versus quiet sleep in neonates at 28 weeks, 36 weeks, term, and 1 month. The duration of quiet sleep increases as the neonate matures. The figure is adapted from [24].
Figure 2
Figure 2
Trace alternant in a term baby (A) and sleep-wake cycling in an amplitude integrated EEG (aEEG) (B). Note the alternating background in (A). (B) demonstrates expansion of the background pattern during quiet sleep and narrowing during awake/active sleep. Quiet sleep on the aEEG is the equivalent of trace alternant on the EEG. Figures are derived from [32,38].
Figure 2
Figure 2
Trace alternant in a term baby (A) and sleep-wake cycling in an amplitude integrated EEG (aEEG) (B). Note the alternating background in (A). (B) demonstrates expansion of the background pattern during quiet sleep and narrowing during awake/active sleep. Quiet sleep on the aEEG is the equivalent of trace alternant on the EEG. Figures are derived from [32,38].
Figure 3
Figure 3
The aEEG derives a tracing from the raw EEG. In step 1, six seconds of the raw EEG is extrapolated. In step 2, the signal is filtered. The filtering includes an asymmetric band pass filter that attenuates activity below 2 Hz and above 15 Hz. In step 3, the signal is rectified and smoothed. Note the negative inflections are converted to positive inflections. In steps 4, 5, and 6 the signal undergoes a series of time compressions. The time compressions steps then lead to a single line. Multiple lines then form a pattern for interpretation. The amplitude display on the bedside monitor is linear between 0 to 10 µV and logarithmic between 10 to 100 µV (Derived from [29]).

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