Shellhaas Renée A, Burns Joseph W, Hassan Fauziya, Carlson Martha D, Barks John D E, Chervin Ronald D
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.
Sleep Disorders Center, University of Michigan, Ann Arbor, MI.
Sleep. 2017 Nov 1;40(11). doi: 10.1093/sleep/zsx144.
The neurological examination of critically ill neonates is largely limited to reflexive behavior. The exam often ignores sleep-wake physiology that may reflect brain integrity and influence long-term outcomes. We assessed whether polysomnography and concurrent cerebral near-infrared spectroscopy (NIRS) might improve prediction of 18-month neurodevelopmental outcomes.
Term newborns with suspected seizures underwent standardized neurologic examinations to generate Thompson scores and had 12-hour bedside polysomnography with concurrent cerebral NIRS. For each infant, the distribution of sleep-wake stages and electroencephalogram delta power were computed. NIRS-derived fractional tissue oxygen extraction (FTOE) was calculated across sleep-wake stages. At age 18-22 months, surviving participants were evaluated with Bayley Scales of Infant Development (Bayley-III), 3rd edition.
Twenty-nine participants completed Bayley-III. Increased newborn time in quiet sleep predicted worse 18-month cognitive and motor scores (robust regression models, adjusted r2 = 0.22, p = .007, and 0.27, .004, respectively). Decreased 0.5-2 Hz electroencephalograph (EEG) power during quiet sleep predicted worse 18-month language and motor scores (adjusted r2 = 0.25, p = .0005, and 0.33, .001, respectively). Predictive values remained significant after adjustment for neonatal Thompson scores or exposure to phenobarbital. Similarly, an attenuated difference in FTOE, between neonatal wakefulness and quiet sleep, predicted worse 18-month cognitive, language, and motor scores in adjusted analyses (each p < .05).
These prospective, longitudinal data suggest that inefficient neonatal sleep-as quantified by increased time in quiet sleep, lower electroencephalogram delta power during that stage, and muted differences in FTOE between quiet sleep and wakefulness-may improve prediction of adverse long-term outcomes for newborns with neurological dysfunction.
对危重新生儿的神经学检查很大程度上局限于反射行为。该检查常常忽略了可能反映大脑完整性并影响长期预后的睡眠-觉醒生理学。我们评估了多导睡眠图和同步脑近红外光谱技术（NIRS）是否能改善对18个月时神经发育结局的预测。
疑似癫痫发作的足月儿接受标准化神经学检查以得出汤普森评分，并进行12小时床边多导睡眠图检查及同步脑NIRS检查。为每个婴儿计算睡眠-觉醒阶段分布和脑电图δ波功率。计算跨睡眠-觉醒阶段的NIRS衍生的组织氧提取分数（FTOE）。在18至22个月龄时，对存活的参与者使用贝利婴幼儿发育量表（第三版，贝利-III）进行评估。
29名参与者完成了贝利-III评估。新生儿安静睡眠时的时间增加预示着18个月时认知和运动评分较差（稳健回归模型，调整后的r2分别为0.22，p = 0.007，以及0.27，p = 0.004）。安静睡眠期间0.5 - 2赫兹脑电图（EEG）功率降低预示着18个月时语言和运动评分较差（调整后的r2分别为0.25，p = 0.0005，以及0.33，p = 0.001）。在对新生儿汤普森评分或苯巴比妥暴露进行校正后，预测值仍然显著。同样，在调整分析中，新生儿清醒和安静睡眠之间FTOE的差异减弱预示着18个月时认知、语言和运动评分较差（各p < 0.05）。
这些前瞻性纵向数据表明，新生儿睡眠效率低下——如通过安静睡眠时间增加、该阶段脑电图δ波功率降低以及安静睡眠和清醒之间FTOE差异不明显来量化——可能改善对神经功能障碍新生儿不良长期结局的预测。
