Hurley Tim, Stewart Philip, McCarthy Robert, O'Dea Mary, Kelly Lynne, Daly Mandy, Butler John, McCarthy Rob, Miletin Jan, Sweetman Deirdre, Byrne Angela, Colleran Gabrielle, Bhroin Megan Ni, Bokde Arun L W, Molloy Eleanor J
Discipline of Paediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.
Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland.
Acta Paediatr. 2025 Feb;114(2):428-436. doi: 10.1111/apa.17457. Epub 2024 Nov 5.
Immune dysregulation and delayed onset of sleep wake cycling (SWC) are associated with worse outcome in neonatal encephalopathy (NE), however the association between sleep and immune dysfunction in NE remains unclear. Aimed to evaluate association of sleep and systemic inflammation with outcomes in NE.
Amplitude-integrated electroencephalography (aEEG) recordings were collected on infants undergoing therapeutic hypothermia (TH). Duration to onset of (SWC) and sleep quality (SQ) were examined. Blood samples collected during the first 2 days of life. Thirteen pro- and anti-inflammatory serum cytokines were quantified. Adverse outcome defined as death or abnormal MRI brain.
Earlier onset of SWC and better SQ had less adverse outcomes. SQ provided better prognostic value and showed better interobserver agreement compared to duration to SWC. Better SQ associated with lower cytokines EPO and interleukin (IL)-1β. In infants with unfavourable outcome, shorter duration to SWC was associated with higher EPO and better SQ was associated with lower TNF-α.
Earlier onset of SWC or better SQ showed less systemic inflammation and fewer adverse outcomes. SQ during TH provided better prognostic information than time of onset of SWC. Modulation of circadian rhythm in infants with NE may have an immunomodulatory role, leading to improved outcomes.
免疫失调和睡眠-觉醒周期（SWC）延迟发作与新生儿脑病（NE）的不良预后相关，然而NE中睡眠与免疫功能障碍之间的关联仍不清楚。旨在评估NE中睡眠和全身炎症与预后的关联。
对接受亚低温治疗（TH）的婴儿进行振幅整合脑电图（aEEG）记录。检查SWC发作的持续时间和睡眠质量（SQ）。在出生后的前两天采集血样。对13种促炎和抗炎血清细胞因子进行定量分析。不良预后定义为死亡或脑部MRI异常。
SWC发作越早且SQ越好，不良预后越少。与SWC持续时间相比，SQ具有更好的预后价值且观察者间一致性更好。更好的SQ与较低的细胞因子促红细胞生成素（EPO）和白细胞介素（IL）-1β相关。在预后不良的婴儿中，SWC持续时间较短与较高的EPO相关，而较好的SQ与较低的肿瘤坏死因子-α（TNF-α）相关。
SWC发作越早或SQ越好，全身炎症越少，不良预后也越少。TH期间的SQ比SWC发作时间提供了更好的预后信息。调节NE婴儿的昼夜节律可能具有免疫调节作用，从而改善预后。
