Exploring frequencies of sleep and sleep-wake states in neonates admitted to the Neonatal Intensive Care Unit (NICU).

Abstract

Background: There is increasing evidence about the influence of sleep on neonatal brain development. Sleep deprivation in the neonatal period has short- and long-term negative impact on breathing patterns, brain development and behaviour. So far, no instrument for measuring sleep unobtrusive turned out to be valid and reliable in neonates. However, in the Neonatal Intensive Care Unit (NICU) it is possible to determine sleep states by observations. This can lead to valuable insights and direct performance of developmental care. Aims: To explore frequencies of sleep and sleep-wake states in neonates using clinical observations. Furthermore we aimed to explore disturbances in sleep and associations between sleeping time and patient characteristics. Methods: An observational longitudinal cohort design was used. An observational tool was developed to record sleep, characteristics and disturbances influencing sleep. Descriptive statistics were used to present these outcomes. A Pearson’s correlation determined associations between sleep, disturbances and patient characteristics. Results: A total of 43 neonates was included in this study. Mean sleeping time was 117.67 minutes, average percentage sleep was 65.68 (range 15-100). All infants were disturbed in their sleep. On average infants were disturbed 4.60 times in three hours. A significant correlation was found between sleep and number of disturbances (-0.39, p=0.01). Related to the number of disturbances, time in active sleep decreases (-0.47, p=0.001), while time awake increases (0.33, p=0.03). Furthermore, analysis showed significant correlations between age and states of active sleep (-0.44, p=0.003) and quiet sleep (0.33, p=0.03). Conclusion and implications of key findings: The main finding of this study is the fact that none of the infants was able to complete sleep cycles without being disturbed. This is affecting sleep and thereby negatively influences brain development. Important implications for practice are awareness of the importance of sleep, prevent unnecessary disturbances and focus on sleep promoting interventions.