From the Department of Pediatrics and Communicable Diseases (R.A.S., J.D.E.B.) and the Michael S. Aldrich Sleep Disorders Center, Department of Neurology (R.D.C.), University of Michigan; and the Michigan Tech Research Institute (J.W.B.), Ann Arbor.
Neurology. 2014 Feb 4;82(5):390-5. doi: 10.1212/WNL.0000000000000085. Epub 2014 Jan 2.
To test the hypothesis that neonatal sleep physiology reflects cerebral dysfunction, we compared neurologic examination scores to the proportions of recorded sleep/wake states, sleep depth, and sleep fragmentation in critically ill neonates.
Newborn infants (≥35 weeks gestation) who required intensive care and were at risk for seizures were monitored with 8- to 12-hour polysomnograms (PSGs). For each infant, the distribution of sleep-wake states, entropy of the sequence of state transitions, and delta power from the EEG portion of the PSG were quantified. Standardized neurologic examination (Thompson) scores were calculated.
Twenty-eight infants participated (mean gestational age 39.0 ± 1.6 weeks). An increased fraction of quiet sleep correlated with worse neurologic examination scores (Spearman rho = 0.54, p = 0.003), but the proportion of active sleep did not (p > 0.1). Higher state entropy corresponded to better examination scores (rho = -0.43, p = 0.023). Decreased delta power during quiet sleep, but not the power at other frequencies, was also associated with worse examination scores (rho = -0.48, p = 0.009). These findings retained significance after adjustment for gestational age or postmenstrual age at the time of the PSG. Sleep stage transition probabilities were also related to examination scores.
Among critically ill neonates at risk for CNS dysfunction, several features of recorded sleep-including analyses of sleep stages, depth, and fragmentation-showed associations with neurologic examination scores. Quantitative PSG analyses may add useful objective information to the traditional neurologic assessment of critically ill neonates.
为了验证新生儿睡眠生理学反映大脑功能障碍的假说，我们将神经检查评分与记录的睡眠/觉醒状态、睡眠深度和睡眠片段化的比例进行了比较，以评估危重新生儿。
需要重症监护且有癫痫发作风险的新生儿进行 8-12 小时多导睡眠描记术（PSG）监测。对于每个婴儿，我们对睡眠-觉醒状态的分布、状态转换序列的熵和 PSG 脑电图部分的 delta 功率进行了量化。标准化神经检查（Thompson）评分也进行了计算。
28 名婴儿参与了研究（平均胎龄 39.0±1.6 周）。安静睡眠比例的增加与神经检查评分较差相关（Spearman rho=0.54，p=0.003），但活跃睡眠比例的增加则没有（p>0.1）。较高的状态熵与更好的检查评分相关（rho=-0.43，p=0.023）。安静睡眠时 delta 功率降低，但其他频率的功率没有降低，也与检查评分较差相关（rho=-0.48，p=0.009）。这些发现与 PSG 时的胎龄或校正后孕龄无关。睡眠阶段转换概率也与检查评分相关。
在有中枢神经系统功能障碍风险的危重新生儿中，记录的睡眠的几个特征，包括睡眠阶段、深度和片段化的分析，与神经检查评分相关。定量 PSG 分析可能为危重新生儿的传统神经评估提供有用的客观信息。
