Developmental care does not alter sleep and development of premature infants. Long-term effects of caffeine therapy for apnea of prematurity on sleep at school age. Effects of nesting and swaddling on the sleep duration of premature infants hospitalized in neonatal intensive care units Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. Influence of acoustic stimulation on the circadian and ultradian rhythm of premature infants Randomized controlled trial to compare sleep and wake in preterm infants less than 32weeks of gestation receiving two different modes of non-invasive respiratory support. Behavioral Observation Differentiates the Effects of an Intervention to Promote Sleep in Premature Infants: A Pilot Study Implementation of the American Academy of Pediatrics Recommendations to Reduce Sudden Infant Death Syndrome Risk in Neonatal Intensive Care Units: An Evaluation of Nursing Knowledge and Practice The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants Theophylline affects sleep-wake state development in premature infants. Predictors of shorter sleep in early childhood Sleep problems in early childhood and early onset of alcohol and other drug use in adolescence. Neurophysiologic Assessment of Neonatal Sleep Organization: Preliminary Results of a Randomized, Controlled Trial of Skin Contact With Preterm Infants Treating Complicated Grief: Effects on Sleep Quality The use of MElatonin in children with neurodevelopmental disorders and impaired sleep: a randomised, double-blind, placebo-controlled, parallel study (MENDS). Does an intervention that improves infant sleep also improve overweight at age 6? Follow-up of a randomised trial Effect of Prone and Supine Position on Sleep, Apneas, and Arousal in Preterm Infants Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women.
OBJECTIVE The Neonatal Individualized Developmental Care Program ( NIDCAP ) for very low birth weight ( VLBW ) preterm infants has been suggested by Als et al to improve several medical outcome variables such as time on ventilator , time to nipple feed , the duration of hospital stay , better behavioral performance on Assessment of Preterm Infants ' Behavior ( APIB ) , and improved neurodevelopmental outcomes . We have tested the hypothesis of whether the infants who had received NIDCAP would show advanced sleep-wake pattern , behavioral , and neurodevelopmental outcome . METHODS Thirty-five VLBW infants were r and omly assigned to receive NIDCAP  or routine infant care . The goals for NIDCAP intervention were to enhance comfort and stability and to reduce stress and agitation for the preterm infants by : a ) altering the environment by decreasing excess light and noise in the neonatal intensive care unit ( NICU ) and by using covers over the incubators and cribs ; b ) use of positioning aids such as boundary supports , nests , and buntings to promote a balance of flexion and extension postures ; c ) modification of direct h and s-on caregiving to maximize preparation of infants for , tolerance of , and facilitation of recovery from interventions ; d ) promotion of self-regulatory behaviors such as holding on , grasping , and sucking ; e ) attention to the readiness for and the ability to take oral feedings ; and f ) involving parents in the care of their infants as much as possible . The infants ' sleep was recorded at 36 weeks postconceptional age ( PCA ) and at 3 months corrected age ( CA ) using the Motility Monitoring System ( MMS ) , an automated , nonintrusive procedure for determining sleep state from movement and respiration patterns . Behavioral and developmental outcome was assessed by the Neurobehavioral Assessment of the Preterm Infant ( NAPI ) at 36 weeks PCA , the APIB at 42 weeks PCA , and by the Bayley Scales of Infant Development ( BSID ) at 4 , 12 , and 24 months CA . RESULTS Sleep developmental measures at 3 months CA showed a clear developmental change compared with 36 weeks PCA . These include : increased amount of quiet sleep , reduced active sleep and indeterminate sleep , decreased arousal , and transitions during sleep . Longest sleep period at night showed a clear developmental effect ( increased ) when comparing nighttime sleep pattern of infants at 3 months with those at 36 weeks of age . Day-night rhythm of sleep-wake increased significantly from 36 weeks PCA to 3 months CA . However , neither of these sleep developmental changes showed any significant effects of NIDCAP intervention . Although all APIB measures showed better organized behavior in NIDCAP patients , neither NAPI nor Bayley showed any developmental advantages for the intervention group . The neurodevelopmental outcome measured by the Bayley at 4 , 12 , and 24 months CA showed 64 % of the NIDCAP intervention group at the lowest possible score compared with 33 % of the control group . These findings could not be explained by the occurrence of intraventricular hemorrhage or the socioeconomic status of the parents , which showed no significant group effect . CONCLUSION The results of this study , including measures of sleep maturation and neurodevelopmental outcome up to 2 years of age did not demonstrate that the NIDCAP intervention results in increased maturity or development . Buehler et al ( Pediatrics . 1995;96:923 - 932 ) have reported that premature infants ( N = 12 ; mean gestational age 32 weeks , mean birth weight 1700 g ) who received developmental care compared with a similar group of infants who received routine care showed better organized behavioral performance on an APIB assessment at 42 weeks PCA . None of the medical outcome measures were significantly different in this study . Although our APIB results are in agreement , the results of the NAPI , the Bayley and sleep measures do not show an increase in neurodevelopmental maturation . In the earlier report by Als et al ( Journal of the American Medical RATIONALE Apnea of prematurity is a common condition that is usually treated with caffeine , an adenosine receptor blocker that has powerful influences on the central nervous system . However , little is known about the long-term effects of caffeine on sleep in the developing brain . OBJECTIVES We hypothesized that neonatal caffeine use result ed in long-term abnormalities in sleep architecture and breathing during sleep . METHODS A total of 201 ex-preterm children aged 5 - 12 years who participated as neonates in a double-blind , r and omized , controlled clinical trial of caffeine versus placebo underwent actigraphy , polysomnography , and  parental sleep question naires . Co primary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography . MEASUREMENTS AND MAIN RESULTS There were no significant differences in primary outcomes between the caffeine group and the placebo ( adjusted mean difference of -6.7 [ 95 % confidence interval ( CI ) = -15.3 to 2.0 min ] ; P = 0.13 for actigraphic total sleep time ; and adjusted rate ratio [ caffeine/placebo ] for apnea-hypopnea index of 0.89 [ 95 % CI = 0.55 - 1.43 ] ; P = 0.63 ) . Polysomnographic total recording time and total sleep time were longer in the caffeine group , but there was no difference in sleep efficiency between groups . The percentage of children with obstructive sleep apnea ( 8.2 % of caffeine group versus 11.0 % of placebo ; P = 0.22 ) or elevated periodic limb movements of sleep ( 17.5 % in caffeine group versus 11 % in placebo group ) was high , but did not differ significantly between groups . CONCLUSIONS Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood . Ex-preterm infants , regardless of caffeine status , are at risk for obstructive sleep apnea and periodic limb movements in later childhood Background : In neonatal intensive care unit ( NICU ) , neonatal sleep is disrupted due to different factors . Due to the critical role of sleep in premature infants′ brain development , this study aim ed to investigate the effect of nesting and swaddling on the sleep duration of premature infants hospitalized in NICUs . Material s and Methods : In a crossover clinical trial , 42 preterm infants who met the inclusion criteria were enrolled . They were r and omly assigned to two groups of nest-swaddle and swaddle-nest .  Sleep status was evaluated by observation and use of Prechtl′s criteria . Then , duration s of total sleep time ( TST ) and quiet sleep time ( QST ) were recorded . Data were analyzed using repeated measure analysis of variance ( ANOVA ) . Results : Mean values of TST and QST during nesting and also swaddling periods were significantly higher than in the control period in both groups ( P < 0.001 ) . Mean values of TST and QST in the swaddling period were higher than in the nesting period in both groups , However , these differences were not significant ( P = 0.245 ) . Conclusions : Both swaddling and nesting could significantly increase the duration of TST and QST , compared to the control . There were no significant differences between the effects of these interventions on TST and QST . Therefore , using any of these methods is suggested to improve infants′  quality of sleep in NICU , with respect to the ward policies OBJECTIVES To evaluate the extent to which sleep-disordered breathing ( SDB ) varies with putative demographic and medical risk factors and to estimate the prevalence of undiagnosed SDB . STUDY DESIGN Prospect i ve , cross-sectional study in a population -based cohort of 850 children ( 41 % black , 46 % preterm ) , 8 to 11 years of age . Participants ' caretakers completed question naires about health and sleep . Children underwent overnight in-home cardiorespiratory recordings of airflow , respiratory effort , oximetry , and electrocardiography . SDB was identified by respiratory disturbance indices commonly applied in clinical practice . Risk factors were estimated by logistic regression . Prevalence was derived from cohort-specific estimates with birth weights from US live births data . RESULTS Using the most inclusive definition , SDB was detected in 40 ( 4.7 % ) participants , with prevalence varying widely across population subsets . Depending on the definition used , SDB was 4 to 6 times more likely in black children compared with white children and almost 3 to 5 times more likely in former preterm compared with term children . The estimated population prevalence of SDB was 2.2 % ( 95 % CI , 1.2 % , 3.2 % ) . CONCLUSIONS SDB is a relatively common condition in 8- to 11-year-old children . Potentially vulnerable subgroups , black children , and former preterm infants , are at increased risk The aim of the present study was to evaluate the development of the circadian rhythm of the salivary cortisol in premature infants and its correlation with the onset of the sleep – activity behavior pattern during the first 3 weeks of life under controlled light : dark conditions . Furthermore , we investigated the influence of acoustic stimulation by audiotaped lullabies or the maternal voice on the cortisol values and long-term sleep – activity patterns . The study was a block-r and omized , prospect i ve clinical trial with a study population of 62 preterm neonates ( 30 < 37 gestational age ) . We compared two study groups who listened either to music or to the maternal voice ( music : N = 20 ; maternal voice : N = 20 ) with a matched control group ( N = 22 ) . The acoustic stimulation took place every evening between 20:00 and 21:00 h for 30 min over a period of 2 weeks . The cortisol values and activity – rest behavior of the neonates were determined during the first 3 weeks of life on the 1st , 7th and 14th day . Actigraphic monitoring was used to record the activity pattern continuously over 24 h and a vali date d algorithm for neonates was used to estimate sleep and wakefulness . The saliva sample s were obtained 10 min before and 10 min after the acoustic interventions for the study groups . Additionally , saliva sample s were obtained from the control group seven times over a 24-h period ( 20:00 , 21:00 , 01:00 , 05:00 , 08:00 , 13:00 and 17:00 h ) . The cortisol data were analyzed by fast Fourier transformation to assess periodic characteristics and frequencies . Hierarchical linear modeling was further performed for the statistical analysis . Results : The cortisol rhythm analysis indicated a circadian rhythm pattern for only one premature infant , all others of the neonates showed no circadian or ultradian rhythm in cortisol . Cortisol level of the premature neonates was significantly higher during the first day of the study period at night-time ( median : 17.1 nmol/L , IQR = 9.7–24.4 nmol/L ) than on days 7 ( median : 9.6 nmol/L , IQR = 4.7–14.6 nmol/L ; Tukey-HSD , z = 4.12 , p < 0.001 ) and 14 ( IQR = 5.8–13.7 nmol/L ; Tukey-HSD , z = 2.89 , p < 0.05 ) . No significant effect of acoustic stimulation was observed on the cortisol concentration and sleep – wake behavior . The activity – sleep rhythm of preterm neonates was dominated by ultradian rhythm patterns with a prominent period length of 4 h ( 30.5 % ) . Activity frequencies of neonates were also significantly higher overnight on the first study day ( mean : 329 ± 185.1 U ) than of night seven ( mean : 260.2 ± 132.4 U ; Tukey-HSD , z = 2.50 , p < 0.05 ) . Quiet-activity patterns increased , whereas high-activity patterns decreased during the observation period . Average sleep time increased significantly during the study time from day 1 to day 7 ( Tukey-HSD , z = 2.51 , p < 0.05 ) . In conclusion , premature infants showed higher cortisol levels – without a circadian rhythmicity – and higher activity frequencies in the first days after birth which may reflect an adaptation process of neonates after birth . Cortisol concentrations and the activity patterns were not influenced by music interventions AIM To determine whether respiratory support via heated humidified high flow nasal cannulae ( HHHFNC ) results in infants < 32weeks gestation spending a greater proportion of time in sleep compared to those receiving nasal continuous positive airway pressure ( NCPAP ) . METHODS A subgroup of infants enrolled in a r and omized controlled trial to compare HHHFNC or NCPAP post-extubation had sleep and wake activity measured by actigraphy for 72hours post-extubation . Activity diaries were completed contemporaneously to record episodes of infant h and ling . Actigraphy data were downloaded with known periods of h and ling excluded from the analysis . RESULTS 28 infants with mean gestation of 28.3weeks ( SD 2 ) and birth weight 1074 g ( SD 371 ) were studied . Infants receiving HHHFNC  spent a lesser proportion of time in sleep 59.8 % ( SD 18.5 ) than those on NCPAP 82.2 % ( SD 23.8 ) p=0.004 . Infants receiving HHHFNC had a lower sleep efficiency and higher mean activity score than those on NCPAP ( p=0.003 , p=0.002 , respectively ) . CONCLUSION Infants receiving HHHFNC  had a higher mean activity score and spent less time in sleep than those allocated NCPAP . Further study of sleep wake activity in preterm infants receiving respiratory support is required as this may impact on neurodevelopmental outcomes Purpose : Sleep and ongoing cycling of sleep states are required for neurosensory processing , learning , and brain plasticity . Many aspects of neonatal intensive care environments such as h and ling for routine and invasive procedures , bright lighting , and noise can create stress , disrupt behavior , and interfere with sleep in prematurely born infants . The study empirically investigated whether a 30-minute observation of infant sleep states and behavior could differentiate an intervention to promote sleep in premature infants with feeding difficulties relative to conventional care ( st and ard positioning , st and ard crib mattress [ SP ] ) . We included an intervention to determine the ability of the method to discriminate treatments and generate a benchmark for future improvements . The intervention , a conformational positioner ( CP ) , is contoured around the infant to provide customized containment and boundaries . To more fully verify the 30-minute observational sleep results , st and ard polysomnography was conducted simultaneously and sleep outcomes for the 2 modalities were compared . Subjects : In a r and omized crossover clinical trial , 25 infants , 31.5 ± 0.6 weeks ' gestational age and 38.4 ± 0.6 weeks at the study , with gastrointestinal conditions or general feeding difficulties used each intervention during an overnight neonatal intensive care unit sleep study . Methods : Infant sleep states and behaviors were observed during two 30-minute periods — that is , on the positioner and mattress — using the naturalistic observation of newborn behavior . Two certified developmental care nurses assessed sleep state , self-regulatory , and stress behaviors during 2-minute intervals and summed over 30 minutes . Sleep characteristics  from st and ard polysomnography  were measured at the time of behavior observations . Results : Infants on CP spent significantly less time in alert , active awake , or crying states by observation compared with SP . Surgical subjects spent more time awake , active awake , or crying and displayed a higher number of behavior state changes than the nonsurgical infants . The percentage of time in observed deep sleep and quiet sleep was correlated with both percentage sleep efficiency ( r = 0.78 ) and fewer state shifts per hour ( r = −0.65 ) from electroencephalogram ( EEG ) . Sleep efficiency by EEG was greater on CP versus SP . Conclusions : The CP enabled sleep compared with the st and ard mattress ( SP ) over 30-minute observation periods . Sleep status from behavioral observation was verified by st and ard EEG-based sleep techniques . Behavioral observation of sleep states may be a useful strategy for measuring the effectiveness of strategies to facilitate sleep in premature infants . Surgical subjects may benefit from additional interventions to promote sleep & NA ; There is a direct relationship between nonsupine sleeping and sudden infant death syndrome ( SIDS ) . Premature infants are at greater risk for SIDS and are often cared for in nonsupine positions during the course of hospitalization . Healthy premature infants should be placed supine for sleep before discharge from the neonatal intensive care unit ( NICU ) , and parents receive specific instruction about infant sleep position and other risk factors for SIDS . Most published literature addressing nursing practice s for SIDS reduction reflects practice s with the healthy newborn population . PURPOSE : To examine and describe NICU nurses ' knowledge of SIDS risk-reduction measures , modeling of safe infant sleep interventions prior to discharge , and inclusion of SIDS risk reduction in parent education . SUBJECTS : Convenience sample of nurses practicing in level II and III NICUs located in 2 Middle Atlantic States . DESIGN AND METHODS : A prospect i ve survey design was used for the study . The 14-item question naire was developed by a team of neonatal clinical experts and distributed via site coordinators to nurses in 19 NICUs . PRINCIPAL RESULTS : A total of 1080 surveys were distributed and 430 ( 40 % ) NICU nurses completed the survey . The majority of nurses ( 85 % ) identified the American Academy of Pediatrics SIDS risk-reduction strategies for safe sleep . The investigators found that age , years of nursing and neonatal nursing experience , and educational preparation did not significantly contribute to the practice of “ supine-only ” position for sleep for infants in NICUs . The study revealed that nurses frequently position healthy preterm infants supine for sleep when weaned to an open crib ( 50 % ) . Others wait one to a few days before discharge ( 15 % ) and some never position supine for sleep ( 6 % ) . Stuffed toys are removed from cribs 90.5 % of the time . For term infants without major medical complications , 45.5 % of surveyed nurses continued to use positioning aids/rolls in infants ' cribs . The most common reasons nurses cited to position preterm infants side-lying or prone in a crib were fear of aspiration ( 29 % ) , infant comfort ( 28 % ) , and infant safety ( 20 % ) . NICU nurses educated parents about SIDS and reduction strategies , using various media . At discharge , 73 % of the nurses verbally communicated with parents , 53 % provided printed literature , and 14 % used audiovisual aids with parents . CONCLUSIONS : NICU nurses are in influential positions to educate parents and model SIDS risk-reduction strategies . This study supports other published research that points to inconsistencies in nursing practice regarding implementation of methods to reduce the risk of SIDS Background Sleep difficulties are prevalent in children with autism spectrum disorder ( ASD ) . The temporal nature of the association between sleep problems and ASD is unclear because longitudinal studies are lacking . Our aim is to clarify whether sleep problems precede and worsen autistic traits and ASD or occur as a consequence of the disorder . Methods Repeated sleep measures were available at 1.5 , 3 , 6 , and 9 years of age in 5151 children participating in the Generation R Study , a large prospect i ve birth cohort in the Netherl and s. Autistic traits were determined with the Pervasive Developmental Problems score ( PDP ) of the Child Behavior Checklist ( CBCL ) at 1.5 and 3 years and the Social Responsiveness Scale ( SRS ) at 6 years . This cohort included 81 children diagnosed with ASD . Results Sleep problems in early childhood were prospect ively associated with a higher SRS score , but not when correcting for baseline PDP score . By contrast , a higher SRS score and an ASD diagnosis were associated with more sleep problems at later ages , even when adjusting for baseline sleep problems . Likewise , a trajectory of increasing sleep problems was associated with ASD . Conclusions Sleep problems and ASD are not bidirectionally associated . Sleep problems do not precede and worsen autistic behavior but rather co-occur with autistic traits in early childhood . Over time , children with ASD have an increase in sleep problems , whereas typically developing children have a decrease in sleep problems . Our findings suggest that sleep problems are part of the construct ASD OBJECTIVES : Recorded music risks overstimulation in NICUs . The live elements of music such as rhythm , breath , and parent-preferred lullabies may affect physiologic function ( eg , heart and respiratory rates , O2 saturation levels , and activity levels ) and developmental function ( eg , sleep , feeding behavior , and weight gain ) in premature infants . METHODS : A r and omized clinical multisite trial of 272 premature infants aged ≥32 weeks with respiratory distress syndrome , clinical sepsis , and /or SGA ( small for gestational age ) served as their own controls in 11 NICUs . Infants received 3 interventions per week within a 2-week period , when data of physiologic and developmental domains were collected before , during , and after the interventions or no interventions and daily during a 2-week period . RESULTS : Three live music interventions showed changes in heart rate interactive with time . Lower heart rates occurred during the lullaby ( P < .001 ) and rhythm intervention ( P = .04 ) . Sucking behavior showed differences with rhythm sound interventions ( P = .03 ) . Entrained breath sounds rendered lower heart rates after the intervention ( P = .04 ) and differences in sleep patterns ( P < .001 ) . Caloric intake ( P = .01 ) and sucking behavior ( P = .02 ) were higher with parent-preferred lullabies . Music decreased parental stress perception ( P < .001 ) . CONCLUSIONS : The informed , intentional therapeutic use of live sound and parent-preferred lullabies applied by a certified music therapist can influence cardiac and respiratory function . Entrained with a premature infant ’s observed vital signs , sound and lullaby may improve feeding behaviors and sucking patterns and may increase prolonged periods of quiet – alert states . Parent-preferred lullabies , sung live , can enhance bonding , thus decreasing the stress parents associate with premature infant care This study investigated the prolonged effects on state behavior of theophylline administered to infants for apnea of prematurity . There were three groups : Four premature infants who had received theophylline in the preterm period , five premature infants who had not received theophylline , and twenty-eight normal fullterm infants . The Theophylline infants had been off the drug for at least one month prior to the beginning of the study . Sleep-wake states were observed in the home for seven-hour periods when all infants were the same corrected ages : two , three , four and five weeks post-term . Data from the portion of the day that the infants were alone were analysed for this study . The state organization of the Theophylline group differed significantly from those of the other groups . They exhibited more non-alert waking activity , more alert , more drowse or transition , and less active sleep than did the Non-Theophylline and Fullterm infants . The state distributions of the latter two groups did not differ . On the basis of similarities between the results of this study and of a previous animal study , it was concluded that theophylline altered the normal development of state organization in premature infants . These effects persisted long after the drug had cleared the body Objective The aim of this study was to identify socio-demographic and home environmental predictors of  shorter sleep in early childhood , and to examine whether effects were mediated by the timing of bedtime or wake time . Methods Participants were from Gemini , a British birth cohort of twins , and included 1702 children ; one r and omly selected from each twin pair . Parents reported night-time sleep duration at an average age of 15.8 months ( range 14–27 months ) using a modified version of the Brief Infant Sleep Question naire . Multiple logistic regression models were used to identify predictors of shorter sleep for this study . Results Using a cut-off of < 11 h a night , shorter sleep was reported in 14.1 % of children . Lower maternal education , non-white ethnic background , being male , low birth weight , living in a home with > 1 older child and watching > 1 h of TV in the evening were independently associated with shorter sleep . Mediation analyses showed that associations between education , ethnicity , evening TV viewing and sleep were driven predominantly by later bedtimes , while sex differences were driven predominantly by earlier wake times in boys . Conclusion In this sample , multiple environmental factors were associated with  shorter sleep in young children , with several operating predominantly through later bedtime . An emphasis on the importance of an early and consistent bedtime could help promote healthy sleep and reduce inequalities in child health BACKGROUND No prospect i ve studies exist on the relationship between sleep problems  early in life and subsequent alcohol use . Stimulated by the adult literature linking sleep problems to the subsequent onset of alcohol use disorders in some adults , we examined whether sleep problems in early childhood predicted the onset of alcohol and other drug use in adolescence and whether such a relationship was mediated by other known predictors of this relationship , namely , attention problems , anxiety/depression , and aggression in late childhood . METHODS This study is part of an ongoing longitudinal study of the development of risk for alcohol and other substance use disorders . Study participants were 257 boys from a community-recruited sample of high-risk families . RESULTS Mothers ' ratings of their children 's sleep problems  at ages 3 to 5 years significantly predicted an early onset of any use of alcohol , marijuana , and illicit drugs , as well as an early onset of occasional or regular use of cigarettes by age 12 to 14 . Additionally , although sleep problems in early childhood also predicted attention problems and anxiety/depression in later childhood , these problems did not mediate the relationship between sleep problems and onset of alcohol and other drug use . CONCLUSIONS This is , to our knowledge , the first study that prospect ively examines the relationship between sleep problems and early onset of alcohol use , a marker of increased risk for later alcohol problems and alcohol use disorders . Moreover , early childhood sleep problems seem to be a robust marker for use of drugs other than alcohol . Implication s for the prevention of early alcohol and other drug use are discussed BACKGROUND . Sleep is important to brain organization , but few strategies to promote sleep among premature infants have been tested . Behaviorally based measures of sleep have shown increased quiet sleep ( QS ) and decreased active sleep ( AS ) during skin-to-skin contact ( SSC ) with the mother , but these results have not been confirmed with objective electroencephalographic/polysomnographic measures of sleep organization . Important differences exist between behavioral and electroencephalographic/polysomnographic definitions of sleep state . METHODS . Data for the first 28 relatively healthy , preterm subjects of an ongoing r and omized trial of one 2- to 3-hour session of SSC or incubator care between feedings are reported here . Infants were positioned prone , inclined , and nested in an incubator during the 2- to 3-hour pretest period , were fed , and then went into the test period of SSC or incubator care . Infants were left largely undisturbed throughout testing . A mixed-model regression analysis compared the test-pretest differences in outcome measures within and between groups . RESULTS . Results showed that arousals were significantly lower in the SSC group , compared with the control group , for the entire study period and for test-pretest matched segments of QS and AS . Rapid eye movement was significantly lower for the SSC group for the study period and AS segments . Indeterminate sleep was significantly lower for the SSC group when confounding environmental variables were included in the regression analysis . When 4 subjects who experienced excessive ambient light levels during SSC were removed from analysis , QS increased during SSC . CONCLUSIONS . The patterns demonstrated by the SSC group are analogous to more-mature sleep organization . SSC may be used as an intervention to improve sleep organization in this population of preterm infants Complicated grief ( CG ) is characterized by recurrent distressing emotions and intrusive thoughts related to the loss of a loved one and avoidance of reminders of the deceased . Poor sleep quality characterizes CG . Cognitive – behavioral therapy and interpersonal psychotherapy reduce CG symptom severity . The effect of these treatments on sleep quality is not known , however . We investigated whether complicated grief treatments ( CGTs ) improve sleep quality , as assessed by the Pittsburgh Sleep Quality Index .  Data collected from 95 adults who participated in a r and omized controlled trial were review ed . Poor sleep quality persisted despite clinical ly significant improvements in CG severity posttreatment . Given that sleep disturbance is a risk factor for poor health outcomes , adjunctive sleep interventions may be necessary to enhance CGT outcomes BACKGROUND Difficulties in initiating and maintaining sleep are common in children with neurodevelopmental disorders .  Melatonin is unlicensed in children yet widely prescribed for sleep problems . OBJECTIVE To determine whether or not immediate-release melatonin is beneficial compared with placebo in improving total duration of night-time sleep in children with neurodevelopmental problems . DESIGN R and omised , double-blind , placebo-controlled , parallel study . SETTING Hospitals throughout Engl and and Wales recruited patients referred by community paediatricians and other clinical colleagues . PARTICIPANTS Children with neurodevelopmental problems aged from 3 years to 15 years 8 months who did not fall asleep within 1 hour of lights out or who had < 6 hours of continuous sleep . Before r and omisation , patients meeting eligibility criteria entered a 4- to 6-week behaviour therapy period in which a behaviour therapy advice booklet was provided .  Sleep was measured using sleep diaries and actigraphy . After this period the sleep diaries were review ed to determine if the sleep problem fulfilled the eligibility criteria . Eligible participants were r and omised and followed for 12 weeks . INTERVENTIONS Melatonin or placebo capsules in doses of 0.5 mg , 2 mg , 6 mg and 12 mg for a period of 12 weeks . The starting dose was 0.5 mg and the dose could be escalated through 2 mg and 6 mg to 12 mg during the first 4 weeks , at the end of which the child was maintained on that dose . MAIN OUTCOME MEASURES The primary outcome was total night-time sleep time ( TST ) calculated using sleep diaries at 12 weeks compared with baseline . Secondary outcome measures included TST calculated using actigraphy data , sleep-onset latency ( SOL ) ( time taken to fall asleep ) , sleep efficiency , Composite Sleep Disturbance Index score , global measure of child 's sleep quality , Aberrant Behaviour Checklist , Family Impact Module of the Pediatric Quality of Life Inventory ( PedsQL ™ ) , the Epworth Sleepiness Scale , number and severity of seizures and adverse events . Salivary melatonin concentrations and association of genetic variants with abnormal melatonin production were also investigated . RESULTS A total of 275 children were screened to enter the trial ; 263 ( 96 % ) children were registered and completed the 4- to 6-week behaviour therapy period and 146 ( 56 % ) children were r and omised , of whom 110 ( 75 % ) contributed data for the primary outcome . The difference in TST time between the melatonin and placebo groups adjusted for baseline was 22.43 minutes [ 95 % confidence interval ( CI ) 0.52 to 44.34 minutes ; p = 0.04 ] measured using sleep diaries . A reduction in SOL , adjusted for baseline , was seen for melatonin compared with placebo when measured by sleep diaries ( -37.49 minutes , 95 % CI -55.27 to -19.71 minutes ; p < 0.0001 ) and actigraphy ( -45.34 minutes , 95 % CI -68.75 to -21.93 minutes ; p = 0.0003 ) . There were no significant differences between the two groups in terms of the reporting of adverse events . The results of other secondary outcomes favoured melatonin but were not statistically significant . CONCLUSIONS On average , the children treated with melatonin slept 23 minutes longer than those in the placebo group ; however , the upper limit of the confidence interval was less than 1 hour , the minimum clinical ly worthwhile difference specified at the outset of the trial . Melatonin is effective in reducing SOL in children with neurodevelopmental delay by a mean of 45 minutes ; a value of 30 minutes was specified a priori to be clinical ly important . Future studies should be conducted over longer periods and directly compare different formulations of melatonin with conventional hypnotic and sedative medications . It would also be important to study groups of children with specific neurological disorders . TRIAL REGISTRATION Current Controlled Trials IS RCT N05534585 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 16 , No. 40 . See the HTA programme website for further project information Objective Short sleep duration may contribute to childhood obesity . Amenable to intervention , sleep thus provides a potential path for prevention . The authors aim ed to determine the impact of a behavioural intervention that successfully reduced parent-reported infant sleep problems on adiposity at age 6 . Design 5-year follow-up of a previously reported population -based cluster r and omised trial . Participant allocation was concealed to research ers and data collection blinded . Setting Recruitment from well-child centres in Melbourne , Australia . Participants 328 children ( 174 intervention ) with parent-reported sleep problems at age 7–8 months drawn from 49 centres ( clusters ) . Intervention Behavioural sleep strategies delivered over one to three structured individual nurse consultations from 8 to 10 months , versus usual care . Main outcomes at age 6 years Body mass index ( BMI ) z-score , percentage overweight/obese and waist circumference . Analyses Intention-to-treat regression analyses adjusted for potential confounders . Results Anthropometric data were available for 193 children ( 59 % retention ) at age 6 . There was no evidence of a difference between intervention ( N=101 ) and control ( N=92 ) children for BMI z-score ( adjusted mean difference 0.2 , 95 % CI −0.1 to 0.4 ) , overweight/obese status ( 20 % vs 17 % ; adjusted OR 1.4 , 95 % CI 0.7 to 2.8 ) and waist circumference ( adjusted mean difference −0.3 , 95 % CI −1.6 to 1.1 ) . In posthoc analyses , neither infant nor childhood sleep duration were associated with anthropometric outcomes . Conclusions A brief infant sleep intervention did not reduce overweight/obesity at 6 years . Population -based primary care sleep services seem unlikely to reduce the early childhood obesity epidemic . Trial registration IS RCT OBJECTIVE . Prematurely born compared with term born infants are at increased risk of sudden infant death syndrome , particularly if slept prone . The purpose of this work was to test the hypothesis that preterm infants with or without bronchopulmonary dysplasia being prepared for neonatal unit discharge would sleep longer and have less arousals and more central apneas in the prone position . METHODS . This was a prospect i ve observational study in a tertiary NICU . Twenty-four infants ( 14 with bronchopulmonary dysplasia ) with a median gestational age of 27 weeks were studied at a median postconceptional age of 37 weeks .  Video polysomnographic recordings of 2-channel electroencephalogram , 2-channel electro-oculogram , nasal airflow , chest and abdominal wall movements , limb movements , electrocardiogram , and oxygen saturation  were made in the supine and prone positions , each position maintained for 3 hours . The duration of sleep , sleep efficiency ( total sleep time/total recording time ) , and number and type of apneas , arousals , and awakenings were recorded . RESULTS . Overall , in the prone position , infants slept longer , had greater sleep efficiency ( 89.5 % vs 72.5 % ) , and had more central apneas ( median : 5.6 vs 2.2 ) , but fewer obstructive apneas ( 0.5 vs 0.9 ) . The infants had more awakenings ( 9.7 vs 3.5 ) and arousals per hour ( 13.6 vs 9.0 ) when supine . There were similar findings in the bronchopulmonary dysplasia infants . CONCLUSIONS . Very prematurely born infants studied before neonatal unit discharge sleep more efficiently with fewer arousals and more central apneas in the prone position , emphasizing the importance of recommending supine sleeping after neonatal unit discharge for prematurely born infants CONTEXT Sleep-disordered breathing ( characterized by recurrent arousals from sleep and intermittent hypoxemia ) is common among older adults . Cross-sectional studies have linked sleep-disordered breathing to poor cognition ; however , it remains unclear whether sleep-disordered breathing precedes cognitive impairment in older adults . OBJECTIVES To determine the prospect i ve relationship between sleep-disordered breathing and cognitive impairment and to investigate potential mechanisms of this association . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve sleep and cognition study of 298 women without dementia ( mean [ SD ] age : 82.3 [ 3.2 ] years ) who had overnight polysomnography measured between January 2002 and April 2004 in a sub study of the Study of Osteoporotic Fractures . Sleep-disordered breathing was defined as an apnea-hypopnea index of 15 or more events per hour of sleep . Multivariate logistic regression was used to determine the independent association of sleep-disordered breathing with risk of mild cognitive impairment or dementia , adjusting for age , race , body mass index , education level , smoking status , presence of diabetes , presence of hypertension , medication use ( antidepressants , benzodiazepines , or nonbenzodiazepine anxiolytics ) , and baseline cognitive scores . Measures of hypoxia , sleep fragmentation , and sleep duration were investigated as underlying mechanisms for this relationship . MAIN OUTCOME MEASURES Adjudicated cognitive status ( normal , dementia , or mild cognitive impairment ) based on data collected between November 2006 and September 2008 . RESULTS Compared with the 193 women without sleep-disordered breathing , the 105 women ( 35.2 % ) with sleep-disordered breathing were more likely to develop mild cognitive impairment or dementia ( 31.1 % [ n = 60 ] vs 44.8 % [ n = 47 ] ; adjusted odds ratio [ AOR ] , 1.85 ; 95 % confidence interval [ CI ] , 1.11 - 3.08 ) . Elevated oxygen desaturation index ( ≥15 events/hour ) and high percentage of sleep time ( > 7 % ) in apnea or hypopnea ( both measures of disordered breathing ) were associated with risk of developing mild cognitive impairment or dementia ( AOR , 1.71 [ 95 % CI , 1.04 - 2.83 ] and AOR , 2.04 [ 95 % CI , 1.10 - 3.78 ] , respectively ) . Measures of sleep fragmentation ( arousal index and wake after sleep onset ) or sleep duration ( total sleep time ) were not associated with risk of cognitive impairment . CONCLUSION Among older women , those with sleep-disordered breathing compared with those without sleep-disordered breathing had an increased risk of developing cognitive impairment
Compared to full term , premature infants exhibit significant differences in sleep structure , which mainly include differences in electroencephalographic spectral values , in total sleep time and in arousal threshold .
Furthermore , prematurity seems to be a risk factor of sleep breathing disorders in childhood and adolescence .
Conclusions The alterations in sleep patterns are an outcome of prematurity ( immaturity of nervous system ) as well as of postnatal factors and comorbidities .
Sleep problems in this population of infants seems to be a missing piece of the puzzle of impaired neurodevelopment .
Background Sleep undergoes changes from birth to adulthood , while sleep disorders are associated with various cognitive deficiencies in childhood .
In parallel , prematurity is known to predispose to poor neurodevelopmental outcomes .
Our aim is to provide literature data about factors influencing sleep in the premature infants and sleep outcomes in this population .