Sleep architecture correlates with neurological and neurobehavioral short- and mid-term outcome in a sample of very preterm infants

Newborns spend most of their time sleeping. This activity fosters neurodevelopment. Prematurity, defined by birth occurring prior the 37 th week of gestation, disrupts normal brain in-utero programming, with long-lasting consequences that carry a high social burden. Sleep alterations may contribute to these sequelae. In this pilot study we aimed to describe the 24-hours distribution of sleep states among very preterm infants (VPI), and to correlate it with neurobehavioral assessment up to 6 months of corrected age (CA). Secondly, we aimed to assess if the presence of a brain lesion detected at MRI could affect sleep duration, architecture, and quality. Ten VPI were assessed at 32 weeks PMA with a 24-hours video-polysomnography and received a neurobehavioral examination at the time of the recording, at term equivalent age (TEA), and at 6 months CA. Analysis of sleep stages distribution and transitions, and power spectra were conducted. Total sleep time and amount of quiet sleep positively correlated with neurological, and neurobehavioral assessment at 32 weeks PMA, at TEA, and at 6 months CA, while Sleep Onset Active Sleep (SOAS) had a negative association. Infants carrying brain lesions showed lower Total Sleep time accompanied by a higher prevalence of AS+SOAS and showed a gradient for higher power of posterior slow activity (slow δ and δ) during SOAS in the left hemisphere posterior regions. Understanding sleep dynamics among preterm infants might provide future therapeutic/management strategies, which need to encompass sleep care.