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The value of cardiorespiratory parameters for sleep state classification in preterm infants: A systematic review
Eline R de Groot1, Marit S Knoop1, Agnes van den Hoogen1
1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
Insights
Cardiorespiratory parameters like heart rate and respiration are linked to sleep states in preterm infants. Maturation influences these cardiorespiratory patterns, impacting sleep classification accuracy.
Area of Science:
- Neonatal research
- Sleep science
- Cardiorespiratory physiology
Background:
- Infant sleep quality and duration are closely tied to cardiorespiratory activity.
- Understanding sleep states in preterm infants is crucial for their development and care.
- Cardiorespiratory parameters offer potential for objective sleep state assessment.
Purpose of the Study:
- To systematically review the literature on using cardiorespiratory parameters for sleep state classification in preterm infants.
- To investigate how infant maturation influences the relationship between cardiorespiratory signals and sleep states.
- To identify reliable cardiorespiratory markers for distinguishing active and quiet sleep in preterm neonates.
Main Methods:
- Systematic literature search of PubMed and EMBASE databases.
- Inclusion criteria focused on preterm infants (<37 weeks postmenstrual age) with measured sleep states and cardiorespiratory parameters.
- Methodological quality assessment by two independent researchers.
Main Results:
- Heart rate and respiration frequency strongly correlate with active and quiet sleep states.
- Quiet sleep exhibits more stable respiration and lower, less variable heart rate compared to active sleep.
- The cardiorespiratory-sleep state association varies with gestational age and postnatal age, indicating maturation effects.
Conclusions:
- Cardiorespiratory patterns reliably differentiate sleep states in preterm infants.
- Infant maturation significantly modulates cardiorespiratory signatures of sleep.
- Findings can enhance behavioral and automated sleep classification algorithms for preterm neonates.
Abstract:
Cardiorespiratory activity is highly associated with infants' sleep duration and quality. We performed a systematic literature search of PubMed and EMBASE databases to investigate if and how cardiorespiratory parameters can be used for sleep state classification in preterm infants and in what way maturation influences this relation. All retrieved citations were screened against predetermined inclusion and exclusion criteria. Only studies of preterm infants (<37 wk postmenstrual age during sleep state classification) admitted to a neonatal ward and of whom at least one sleep state and one cardiorespiratory parameter was measured, were included. Two researchers independently reviewed the included studies on methodological quality. Of the 1097 initially retrieved studies, 23 were included for analysis. Heart rate and respiration frequency are strongly correlated with active sleep and quiet sleep. In quiet sleep, as compared to active sleep, respiratory frequency is more stable, and the heart rate is lower and less variable. This association, however, differed across preterm birth subtypes (i.e., extremely, very or late preterm), indicating that maturation - in the form of both gestational and postnatal age - influences the cardiorespiratory characteristics of preterm sleep states. The knowledge gained from this review can help improve behavioral sleep classification and automated sleep classification algorithms for preterm infants.
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