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Neonatal sleep physiology and early executive functioning in preterm children

Anneleen Dereymaeker1,2, Tim Hermans3, Bieke Bollen4

  • 1Department of Development and Regeneration, Woman and Child, KU Leuven, Leuven, Belgium. anneleen.dereymaeker@uzleuven.be.

Pediatric Research
|February 10, 2026
PubMed

Insights

Total sleep time in preterm infants is linked to better executive functioning at two years. Optimizing sleep in the NICU may support neurodevelopment in premature babies.

Area of Science:

  • Neonatal development
  • Neuroscience
  • Sleep medicine

Background:

  • Preterm infants often exhibit executive functioning (EF) deficits.
  • EF is associated with prefrontal cortex development and sleep regulation.
  • NICU sleep curtailment may negatively impact early brain maturation.

Purpose of the Study:

  • To investigate the association between neonatal sleep behavior and executive functioning at 2 years corrected age in preterm children.
  • To determine if objective sleep measurements in preterm infants predict later cognitive outcomes.

Main Methods:

  • 76 preterm infants underwent overnight polysomnography before NICU discharge.
  • Automated algorithms quantified sleep stages: Total Sleep Time, Active Sleep (AS), Quiet Sleep (QS), and Transitional Sleep.
  • Executive functioning (spatial working memory, cognitive flexibility, inhibitory control) was assessed at 2 years corrected age.

Main Results:

  • Greater Total Sleep Time correlated with higher overall EF scores and better spatial working memory.
  • Longer Active Sleep bouts were associated with increased Total Sleep Time.
  • Higher Transitional Sleep levels were linked to poorer EF performance.

Conclusions:

  • Neonatal sleep duration, specifically Total Sleep Time, is positively associated with improved executive functioning in preterm children at 2 years.
  • Protecting and enhancing sleep in the NICU may be a crucial modifiable factor for supporting neurodevelopment and executive function in preterm infants.
Abstract

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