Georgoulas, A;
Jones, L;
Laudiano-Dray, MP;
Meek, J;
Fabrizi, L;
Whitehead, K;
(2020)
Sleep-wake regulation in pre-term and term infants.
Sleep
10.1093/sleep/zsaa148.
(In press).
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Abstract
STUDY OBJECTIVES: In adults, wakefulness can be markedly prolonged at the expense of sleep, e.g. to stay vigilant in the presence of a stressor. These extra-long wake bouts result in a heavy-tailed distribution (highly right-skewed) of wake but not sleep durations. In infants, the relative importance of wakefulness and sleep are reversed, as sleep is necessary for brain maturation. Here we tested whether these developmental pressures are associated with unique regulation of sleep-wake states. METHODS: In 175 infants 28-40 weeks postmenstrual age (PMA), we monitored sleep-wake states using electroencephalography and behaviour. We constructed survival models of sleep-wake bout durations and the effect of PMA and other factors including stress (salivary cortisol), and examined whether sleep is resilient to nociceptive perturbations (a clinically necessary heel lance). RESULTS: Wake durations followed a heavy-tailed distribution as in adults, and lengthened with PMA and stress. However, differently from adults, active sleep durations also had a heavy-tailed distribution, and with PMA these shortened and became vulnerable to nociception-associated awakenings. CONCLUSIONS: Sleep bouts are differently regulated in infants, with especially long active sleep durations which could consolidate this state's maturational functions. Curtailment of sleep by stress and nociception may be disadvantageous, especially for pre-term infants given the limited value of wakefulness at this age. This could be addressed by environmental interventions in future.
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