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[Development of the sleep and autonomic nervous system control in premature and full-term newborn infants]
1INSERM, laboratoire de physiologie-EFR, hôpital Antoine-Béclère, Clamart, France.
Insights
Active sleep (AS) and quiet sleep (QS) are established early in development. Preterm infants show similar sleep structures but altered cardio-respiratory patterns compared to full-term newborns.
Area of Science:
- Neonatal physiology
- Developmental neuroscience
- Sleep medicine
Context:
- Sleep patterns, including active sleep (AS) and quiet sleep (QS), emerge early in fetal development.
- By 35 weeks gestational age (w GA), indeterminate sleep decreases, with AS dominating near term.
Purpose:
- To characterize the distinct physiological differences between active sleep (AS) and quiet sleep (QS) in developing infants.
- To compare the sleep structure and cardio-respiratory characteristics of preterm and intrauterine growth-restricted infants with full-term newborns.
Summary:
- Active sleep (AS) and quiet sleep (QS) are distinguishable by distinct cardio-respiratory patterns, including heart rate, respiratory rate, and heart rate variability.
- Infants born preterm or with intrauterine growth retardation exhibit similar sleep architecture to full-term infants but show accelerated cardio-respiratory rates and increased respiratory pauses.
Impact:
- Understanding sleep-state-specific cardio-respiratory regulation is crucial for neonatal care.
- Findings highlight potential physiological vulnerabilities in preterm and growth-restricted infants, even with similar sleep structures.
Abstract:
Well defined periods of active (AS) and quiet sleep (QS) are detected as early as 27 weeks gestational age (w GA). Beyond 35 w GA, the amount of indeterminate sleep is reduced to < 10% and, up to the normal term, sleep is marked by the prevalence of AS. AS differs from QS by faster respiratory and heart rates, more central respiratory pauses, lower amplitude of high frequency heart rate variability (parasympathetico-dependent) and higher amplitude of low frequency heart rate variability (sympathetico-dependent). In artificially ventilated infants, breathing is more dependent on the ventilator in QS than in AS. When they reach term, compared with normal full-term newborns, infants with intra-uterine growth retardation or prematurity do not show significant differences of sleep structure, but present in both AS and QS, faster heart and respiratory rates, more respiratory pauses and less heart rate variability; however, sleep-states-related cardio-respiratory modulations appear similar.