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Effect of prone and supine position on sleep, apneas, and arousal in preterm infants
Ravindra Y Bhat1, Simon Hannam, Ronit Pressler
1Division of Asthma, Allergy, and Lung Biology, King's College London School of Medicine at Guy's King's College and St Thomas' Hospitals, London, United Kingdom.
Insights
Premature infants sleep longer and more efficiently in the prone position, but this position is associated with more central apneas. Supine sleeping is recommended after neonatal unit discharge for these infants.
Area of Science:
- Neonatal Medicine
- Pediatric Sleep Studies
- Respiratory Physiology
Background:
- Premature infants face higher risks of sudden infant death syndrome (SIDS), especially when sleeping prone.
- Bronchopulmonary dysplasia (BPD) is a common complication in premature infants, potentially affecting sleep patterns.
Purpose of the Study:
- To investigate sleep characteristics of preterm infants (with or without BPD) before hospital discharge.
- To test the hypothesis that prone sleeping increases sleep duration and efficiency while decreasing arousals and increasing central apneas.
Main Methods:
- Prospective observational study in a tertiary neonatal intensive care unit (NICU).
- Polysomnography was used to record sleep parameters in 24 preterm infants (median gestational age 27 weeks).
- Infants were recorded in both supine and prone positions for 3 hours each, assessing sleep duration, efficiency, apneas, and arousals.
Main Results:
- In the prone position, infants exhibited longer sleep duration and greater sleep efficiency (89.5% vs. 72.5%).
- Prone sleeping was associated with more central apneas (median 5.6 vs. 2.2) and fewer obstructive apneas.
- Infants had more awakenings and arousals per hour when in the supine position.
Conclusions:
- Very premature infants sleep more efficiently with fewer arousals in the prone position before discharge.
- Findings highlight the increased risk of central apneas in the prone position for preterm infants.
- The study emphasizes the importance of recommending supine sleeping for prematurely born infants post-discharge to mitigate SIDS risk.
Objective:
Prematurely born compared with term born infants are at increased risk of sudden infant death syndrome, particularly if slept prone. The purpose of this work was to test the hypothesis that preterm infants with or without bronchopulmonary dysplasia being prepared for neonatal unit discharge would sleep longer and have less arousals and more central apneas in the prone position.
Methods:
This was a prospective observational study in a tertiary NICU. Twenty-four infants (14 with bronchopulmonary dysplasia) with a median gestational age of 27 weeks were studied at a median postconceptional age of 37 weeks. Video polysomnographic recordings of 2-channel electroencephalogram, 2-channel electro-oculogram, nasal airflow, chest and abdominal wall movements, limb movements, electrocardiogram, and oxygen saturation were made in the supine and prone positions, each position maintained for 3 hours. The duration of sleep, sleep efficiency (total sleep time/total recording time), and number and type of apneas, arousals, and awakenings were recorded.
Results:
Overall, in the prone position, infants slept longer, had greater sleep efficiency (89.5% vs 72.5%), and had more central apneas (median: 5.6 vs 2.2), but fewer obstructive apneas (0.5 vs 0.9). The infants had more awakenings (9.7 vs 3.5) and arousals per hour (13.6 vs 9.0) when supine. There were similar findings in the bronchopulmonary dysplasia infants.
Conclusions:
Very prematurely born infants studied before neonatal unit discharge sleep more efficiently with fewer arousals and more central apneas in the prone position, emphasizing the importance of recommending supine sleeping after neonatal unit discharge for prematurely born infants.
