Effect of prone and supine position on sleep, apneas, and arousal in preterm infants
Effect of prone and supine position on sleep, apneas, and arousal in preterm infants
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DOI：
10.1542/peds.2005-1873
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发表时间：
2006-07-01
期刊：
影响因子：
8
通讯作者：
Greenough, Anne
中科院分区：
文献类型：
--
作者：
Bhat, Ravindra Y.;Hannam, Simon;Greenough, Anne
OBJECTIVE.早产儿与足月出生的婴儿相比，患婴儿猝死综合症的风险增加，特别是如果是俯卧睡觉。这项工作的目的是测试的假设，有或没有支气管肺发育不良的早产儿准备新生儿单位出院时，会睡得更长，有更少的觉醒和更多的中央呼吸暂停在俯卧位。这是一项在三级NICU中进行的前瞻性观察性研究。24名婴儿（14名患有支气管肺发育不良），中位胎龄为27周，中位孕龄为37周。在仰卧位和俯卧位进行视频多导睡眠图记录，包括双通道脑电图、双通道眼电图、鼻气流、胸和腹壁运动、肢体运动、心电图和血氧饱和度，每个位置保持3小时。记录睡眠持续时间、睡眠效率（总睡眠时间/总记录时间）以及呼吸暂停、觉醒和觉醒的次数和类型。总体而言，俯卧位婴儿睡眠时间更长，睡眠效率更高（89.5% vs 72.5%），中枢性呼吸暂停更多（中位数：5.6 vs 2.2），但阻塞性呼吸暂停更少（0.5 vs 0.9）。婴儿在仰卧时每小时有更多的觉醒（9.7 vs 3.5）和觉醒（13.6 vs 9.0）。在支气管肺发育不良的婴儿中也有类似的发现。在新生儿出院前研究的极早产儿睡眠更有效，觉醒更少，俯卧位的中枢性呼吸暂停更多，强调了建议早产儿在新生儿出院后仰卧睡眠的重要性。
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 prospective 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 electrooculogram, 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.