PRETERM SKIN CONTACT EFFECTS ON ELECTROPHYSIOLOGIC SLEEP

行为状态指数显示，肌肤接触（SSC）可以增加安静睡眠的频率和持续时间。然而，行为状态测量受到观察者偏差和记录误差的限制，而使用脑电图（EEG）、眼电图（EOG）、肌电图（EMG）和呼吸波形指示器进行睡眠电生理记录则不存在这种限制。然而，尚无关于SSC期间睡眠电生理学研究的报道。本研究的目的是确定SSC对电生理决定的睡眠的影响，并测试在SSC期间与培养期和实验组和对照组相比，安静睡眠的显著增加。将获得60例医学稳定的32周加4天胎龄的完整数据集，通过最小化技术将受试者随机分配到SSC组或对照组，进行一天的测试。所有婴儿将在带罩的恒温箱中进行3小时的监测（测试前），因为他们躺在巢中俯卧的位置，然后在测试期间进行3小时的监测。在测试期间，对照组婴儿在相同条件下保持在保温箱中；SSC婴儿将被抱在胸前，直立的位置，皮肤对皮肤在母亲的乳房之间，母亲斜靠在固定的椅子上，在新生儿重症监护病房的孵化器旁边。EEG、EOG、EMG和呼吸波形将实时记录在热敏纸上，以30毫米/秒的速度运行，使用配备了12型神经数据采集系统（Astromed-Grass）的Grass K2GR测波仪。当行为观察发生时，将在跟踪中记录。追踪将由一位神经学家阅读，他是多波脑电图/脑电图/肌电图/呼吸波形记录的专家。在马里兰州巴尔的摩马里兰大学医学中心的新生儿重症监护室，即使所有的测试都从上午9点开始，神经学家记录仪也将不知道组和周期。脑电图是通过Grass gold在O2和C4点上的7毫米电极获得的，肌电图是通过两个颏下电极获得的，脑电图是通过每只眼睛外角的电极获得的，呼吸波形是通过Grass提供的胸部偏移带获得的。光线、噪音和湿度每分钟都会被记录下来。所有电极将在测试前至少30分钟贴在婴儿身上，以便进行校准和预热。结果测量是安静睡眠、活跃睡眠、不确定睡眠和总睡眠时间的时间。delta刷和theta波的次数也将被计算。几乎所有的分析都将基于对每个主题的重复观察；各种类型的回归分析（线性，逻辑，或泊松作为适当的）制定纵向数据将被使用。在重复测量分析之前，将数据划分为15分钟的片段。

Skin-to-skin contact (SSC) has been shown to increase quiet sleep frequency and duration as measured by behavioral state indices. Yet, behavioral state measurements are subject to observer bias and recording error-limitations not present with electrophysiologic recording of sleep using electroencephalographic (EEG), electrooculographic (EOG), electromyographic (EMG), and respiratory waveform indicators. Yet, no electrophysiologic studies of sleep during SSC have been reported. The purpose of this study is to determine the effect of SSC on electrophysiologic- determined sleep and to test for a significant increase in Quiet Sleep during SSC as compared to incubator periods and between the treatment and control groups. Complete data sets from 60 medically stable 32 weeks plus 4 days conceptional age will be obtained and subjects will be randomly assigned by minimization technique to SSC or control group for one day of testing. All infants will be monitored in hooded incubators for 3 hours (pretest) as they lay in a nested prone position, followed by three hours of monitoring during the test period. In the test period control infants remain in the incubator in the same conditions; SSC infants will be held in chest-to-chest, upright position, skin-to-skin between maternal breasts as mother reclines in a stationary chair at the side of the incubator in the NICU. EEG, EOG, EMG, and respiratory waveform will be recorded in real time on thermal paper running at 30 mm/s using the Grass K2GR polygraph outfitted with Model 12 Neurodata Acquisition System (Astromed-Grass). Behavioral observations will be noted on the tracing as they occur. Tracings will be read by one neurologist who is a specialist in polygraphic EEG/EOG/EMG/Respiratory Waveform recording. The neurologist recorder will be blind to group and period, even though all testing commences with the 9 a.m. feeding in the neonatal intensive care unit of University of Maryland Medical Center, Baltimore, MD. EEG is obtained by Grass gold 7 mm electrodes over O2 and C4 points, EMG by two submental electrodes, EOG by electrodes at the outer canthus of each eye, Respiratory waveform by thoracic excursion belt provided by Grass. Light, noise and humidity will be recorded each minute. All electrodes will be attached to infants at least 30 minutes prior to testing to allow for calibration and warm-up. Outcome measures are number of epochs of Quiet Sleep, Active Sleep, Indeterminate Sleep, and Total Sleep Time. Number of delta brush and theta wave episodes will be calculated too. Nearly all analyses will be based on repeated observations on each subject; various types of regression analysis (linear, logistic, or Poisson as appropriate) formulated for longitudinal data will be used. Partitioning of data into fifteen minute segments will be performed prior to repeated measures analysis.