A scoping review of behavioral sleep stage classification methods for preterm infants
Anne Bik1, Chanel Sam1, Eline R de Groot1
1Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Insights
This review identified 36 behavioral sleep stage classification methods (BSSCs) for preterm infants. Most studies lacked consistent reporting on BSSC reliability and validity, hindering research comparability.
Area of Science:
- Neonatal neuroscience
- Developmental pediatrics
- Sleep medicine
Background:
- Sleep is crucial for neonatal brain development, especially in the neonatal intensive care unit.
- Preterm infants (<37 weeks gestational age) require specialized sleep assessment.
- Existing behavioral sleep stage classification methods (BSSCs) for preterm infants vary in criteria, impacting research comparability.
Purpose of the Study:
- To identify and describe neonatal BSSCs for preterm infants.
- To evaluate the reliability and validity of these BSSCs.
- To determine age-specific criteria used in BSSCs for infants aged 23-37 weeks postmenstrual age.
Main Methods:
- A systematic search of PubMed, EMBASE, and Cochrane databases was conducted.
- Studies utilizing BSSCs for sleep stage identification in preterm infants were included.
- Data on BSSC criteria, reliability, and validity were extracted.
Main Results:
- 36 distinct BSSCs were identified, commonly assessing eyes, body movements, facial movements, sounds, and respiratory patterns.
- Reliability and validity were assessed in less than half of the reviewed BSSCs.
- BSSCs were applied across various infant ages, irrespective of their original developmental age range.
Conclusions:
- While scoring items are relatively consistent, reporting of age ranges, reliability, and validity is inconsistent across BSSCs.
- There is a need for validation studies of existing BSSCs or development of new ones.
- Improved standardization is essential for enhancing the comparability and reproducibility of preterm infant sleep research.
Background:
Sleep is paramount for optimal brain development in infants admitted to the neonatal intensive care unit. Besides (minimally) invasive technical approaches to study sleep in infants, there is currently a large variety of behavioral sleep stage classification methods (BSSCs) that can be used to identify sleep stages in preterm infants born <37 weeks gestational age. However, they operate different criteria to define sleep stages, which limits the comparability and reproducibility of research on preterm sleep. This scoping review aims to: 1) identify and elaborate on existing neonatal BSSCs used for preterm infants, 2) examine the reliability and validity of these BSSCs, and 3) identify which criteria are most used for different ages, ranging from 23 to 37 weeks postmenstrual age at observation.
Methods:
To map the existing BSSCs, PubMed, EMBASE and Cochrane were searched for studies using a BSSC to identify sleep stages in preterm infants.
Results:
In total, 36 BSSCs were identified with on average five item categories assessed per BSSC, most frequently: eyes, body movements, facial movements, sounds, and respiratory pattern. Furthermore, validity and reliability of the BSSCs were tested in less than half of the included studies. Finally, BSSCs were used in infants of all ages, regardless the age for which the BSSC was originally developed.
Conclusions:
Items used for scoring in the different BSSCs were relatively consistent. The age ranges, reliability, and validity of the BSSCs were not consistently reported in most studies. Either validation studies of existing BSSCs or new BSSCs are necessary to improve the comparability and reproducibility of previous and future preterm behavioral sleep studies.
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