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Updated: Aug 16, 2026
Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
More awakenings and heart rate variability during supine sleep in preterm infants
K Goto1, M Mirmiran, M M Adams
1Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Insights
The supine sleeping position for preterm infants leads to more awakenings and less quiet sleep, supporting the "Back to Sleep" recommendation. This may help infants respond to dangerous events.
Area of Science:
- Neonatal physiology
- Sleep medicine
- Pediatric sleep disorders
Background:
- The American Academy of Pediatrics recommends nonprone sleeping for preterm infants to prevent sudden infant death syndrome (SIDS).
- The exact mechanism of SIDS reduction and the impact of sleeping position on preterm infant sleep and cardiorespiratory function are not fully understood.
Purpose of the Study:
- To investigate the effect of sleeping position (supine vs. prone) on sleep and cardiorespiratory characteristics in preterm infants nearing discharge.
- To provide evidence supporting safe sleep recommendations for vulnerable infant populations.
Main Methods:
- Videosomnography was used to study 16 preterm infants (36.5 +/- 0.6 weeks postconceptional age) in both supine and prone positions.
- Each infant served as their own control, with sleep, respiratory, and heart rate data compared between positions.
Main Results:
- The supine position was associated with more awakenings (>/=60 seconds) across all sleep states.
- Quiet sleep duration was shorter after feeding in the supine position, with increased heart rate variability and awakenings.
- No significant differences were found in brief arousals (<60 seconds), apnea, or periodic breathing; no clinically significant events like apnea, bradycardia, or oxygen desaturation occurred.
Conclusions:
- The supine sleeping position in 36-week-postconceptional age preterm infants results in less quiet sleep and more awakenings, with greater heart rate variability in the initial sleep cycle post-feeding.
- These findings support the
- Back to Sleep
- guideline, as increased awakenings may enhance an infant's response to life-threatening events.
- Further research is necessary to understand positional effects on physiological measures in preterm infants at later developmental stages.
Objective:
The Task Force of The American Academy of Pediatrics (1996) recommends the nonprone sleeping position for asymptomatic preterm infants to prevent sudden infant death syndrome. The mechanism by which the nonprone sleeping position reduces the rate of sudden infant death syndrome is unclear for full-term infants and the precise effect of sleeping position on sleep and cardiorespiratory characteristics has never been addressed in preterm infants. The purpose of the present study was to clarify the effect of sleeping position on sleep and cardiorespiratory characteristics in preterm infants at an age when they are ready for discharge.
Study Design:
Sixteen asymptomatic preterm infants were studied in both supine and prone sleeping positions at 36.5 +/- 0.6 weeks' postconceptional age using videosomnography. Sleep, respiratory, and heart rate characteristics were compared between the two positions using each infant as his/her own control.
Results:
More awakenings (ie, arousals >/=60 seconds) were seen during all sleep states in the supine sleeping position but overall the total sleep and percent sleep state were not affected by sleeping position. After each feeding, the first quiet sleep was significantly shorter, with more heart rate variability and awakenings in the supine position. There were no significant differences in the occurrence of arousals (<60 seconds) or the incidence or severity of apnea and periodic breathing. No clinically significant apnea (>/=15 seconds), bradycardia, or oxygen desaturations were seen.
Conclusion:
In 36-week-postconceptional age preterm infants, the supine sleeping position had less quiet sleep and was associated with greater heart rate variability during the first sleep cycle after the feeding. More awakenings were seen during all sleep states in the supine position. These data support the American Academy of Pediatrics recommendation for "Back to Sleep" for asymptomatic preterm infants because more awakenings and lower threshold for arousal may provide some benefit for the infant responding to a life-threatening event. However, further studies are needed to address positional effect on the physiologic measures in preterm infants at older ages (later stages of development). Precisely what constitutes the most healthy or advantageous sleep for newborn infants remains an important question.
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