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Creating an optimal observational sleep stage classification system for very and extremely preterm infants

E R de Groot1, A Bik1, C Sam1

  • 1Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands.

Sleep Medicine
|February 19, 2022
PubMed

Insights

A new visual tool, the Behavioral Sleep stage classification for Preterm Infants (BeSSPI), accurately classifies sleep stages in preterm infants. This reliable system enhances sleep research for vulnerable newborns.

Area of Science:

  • Neonatal neuroscience
  • Developmental pediatrics
  • Sleep medicine

Background:

  • Sleep is crucial for neuronal survival and fetal brain development.
  • Neonatal intensive care unit (NICU) environments disrupt preterm infants' sleep-wake patterns.
  • Validated behavioral sleep classification scales for preterm infants are lacking.

Purpose of the Study:

  • To develop and validate a user-friendly visual system for classifying sleep stages in preterm infants.
  • To establish a reliable tool for assessing sleep in preterm infants aged 25-37 weeks gestational age.

Main Methods:

  • The Behavioral Sleep stage classification for Preterm Infants (BeSSPI) system was developed.
  • BeSSPI utilizes seven observable items: eye movements, body movements, facial movements, vocalizations, heart rate, respiratory pattern, and activity level.
  • Four sleep-wake stages were defined: active sleep (AS), quiet sleep (QS), intermediate sleep (IS), and wake (W).

Main Results:

  • The study observed 69 preterm infants, totaling 10,922 minutes of behavioral data.
  • Sleep stage distribution included 38.83% AS, 26.16% QS, 26.29% IS, and 8.72% W.
  • The BeSSPI achieved a high interrater agreement (κ = 0.80) and satisfactory construct, content, face, and expert validity.

Conclusions:

  • A simple, reliable, and valid visual method for assessing preterm infant sleep-wake stages was developed (BeSSPI).
  • This novel instrument is applicable across all preterm age groups.
  • BeSSPI is expected to enhance the rigor and reproducibility of future preterm infant sleep research.
Abstract

Keywords:
Behavioral observationNeonatal intensive carePreterm infantsSleep-wake stages

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