Elsevier

Early Human Development

Volume 115, December 2017, Pages 46-50
Early Human Development

Maturation of arousals during day and night in infants with non-smoking and smoking mothers,☆☆

https://doi.org/10.1016/j.earlhumdev.2017.08.006Get rights and content

Highlights

  • Maturation of arousals is different during day and night sleep.

  • These differences must be taken in account in the interpretation of the studies on arousability in newborns and infants.

  • Tobacco exposure could induce a decrease in sleep time during night, exposing these infants to potential sleep deprivation.

Introduction

A number of studies have shown that the diurnal pattern of sleep and wakefulness becomes established sometime after 6 weeks of age with reports indicating a range from 6 weeks to 6 months [1]. However, some authors have reported evidence for day/night differences in sleep and wakefulness before 6 weeks of age [2]. Neonates were found to spend less time in Active Sleep (AS) and Quiet Sleep (QS) and more time in Wakefulness during the daytime [3], [4]. Parmelee et al. reported that in the postnatal period (days 1–3), 57% of the infants had their longest sleep period between 11 pm and 7 am [5]. Moreover, Sander et al. [6] found on postnatal day 2 that newborn infants with self-demand feeding routines had more daytime activity. Freudigman and Thoman observed 31 newborn infants continuously during the first 2 postnatal days and noted fewer sleep periods and more daytime wakefulness and sleep-wake transitions, suggesting newborns exhibit circadian behavioral diurnal rhythm in their sleep patterns beginning in the earliest postnatal period [4]. The biological clock appears during the course of prenatal development processes [7]. Several studies have reported that providing infants with responsive caretaking regimes or diurnal light/dark cues facilitates the development of diurnal rhythmicity in newborns. Sleep maturation could reflect the central nervous system maturation process. The early sleep change reflected by a marked decrease in AS occurs during the diurnal part of the nychthemere, underlying the importance of the circadian rhythm process on the maturation of sleep [8].

Moreover, impairment in arousability has been implicated in the final pathway of Sudden Infant Death Syndrome (SIDS) [9]. Indeed, arousal from sleep is a major survival response when an infant is exposed to a life-threatening event. Moreover, spontaneous and evoked arousability from sleep is altered when healthy infants were exposed to risk factors for SIDS such as prone sleeping position, maternal smoking, high ambient temperature or sleep deprivation [10]. For arousability, the persistent view is that no difference exists between day and night sleep in infants. In most studies, polygraphic data were obtained indifferently during day or night sleep in infants. However, Thiriez et al. already demonstrated a difference between day and night arousability in preterm infants reaching term [11]. Smoking has become the major risk factor for SIDS since the other modifiable risks for SIDS, such as prone sleep have decreased following numerous educational campaigns [12]. According to epidemiological studies, prenatal cigarette smoking is associated with 2.5-fold risk ratio for SIDS [13], [14]. In an epidemiological study, Williams et al. reported that maternal smoking was more strongly associated with SIDS at night [15]. However, Blair et al. found that only habitual paternal smoking carried a significant risk for night-time deaths but not maternal smoking [13].

The aims of this work were to study the maturation of spontaneous arousals during day and night sleep in a large prospective study on infant sleep maturation and to assess if there was a difference in maturation between infants with smoking and non-smoking mothers.

Section snippets

Study design and questionnaires

The Autonomic Baby Evaluation (AuBE) study was a prospective study to assess the relationship between autonomic and sleep maturation on psychometric development in a cohort of term and preterm newborns at 3 years. The study design has already been published [16]. The AuBE study was conducted at the University Hospital of Saint-Etienne (France), a level III university maternity ward with neonatal intensive care units and 3500 births annually. Infants were included in the study over a 24-month

General population (AuBe study)

Of the 283 mothers who completed the questionnaires, 81 mothers (28.6%) smoked before pregnancy (one mother of twins), 61 mothers (21.5%) smoked during the first trimester, and 51 (18.4%) kept smoking during their entire pregnancy. Before pregnancy, the mothers smoked 12.6 ± 6.5 (range: 1–40) cigarettes per day, 8.1 ± 5.2 cigarettes (range: 1–30) in the first trimester, 6.8 ± 5.2 cigarettes per day in the second trimester (range: 1–30), 6.2 ± 3.5 cigarettes per day in the third trimester (range: 1–20).

Discussion

In this study, we found that the maturation of spontaneous arousals from sleep differed between day and night sleep except for AQS. With age, arousals especially in AS/REM increased during night sleep but decreased during the day. Maturation of arousals during night was reported previously [23].

At birth, we found less sleep time and more arousals, especially arousals in AS during the day compared with night sleep. These results are in favor of the emergence of a circadian behavioral diurnal

Conclusion

Maturation of arousals was different during day and night sleep. This difference must be kept in mind in the interpretation of studies on arousals in infants. Only mild changes were found between infants with smoking and non-smoking mothers perhaps due to the mild tobacco exposure in this study.

Abbreviations

    AS

    Active Sleep

    AuBE

    Autonomic Baby Evaluation study

    BISQ

    Brief Infant Sleep Questionnaire

    HAD

    Hospital Anxiety Depression questionnaire

    IS

    Indeterminate Sleep

    M0

    term (usually 2 days of life)

    M6

    6 months

    M.I.N.I.

    Mental International Neuropsychiatric Interview

    NREM

    Non Rapid Eye Movement Sleep

    QS

    Quiet Sleep

    REM

    Rapid Eye Movement Sleep

    SE

    Sleep Efficiency

    T +

    infants with smoking

    T 

    infants with non-smoking mothers

    TST

    Total Sleep Time

    SIDS

    Sudden Infant Death Syndrome

    WPPSI-III

    Wechsler Preschool and Primary Scale of

Funding resources

The AuBE study is allowed through consecutive grants from the French Ministry of Health (protocole n° 0908020): Programmes Hospitaliers de Recherche Clinique – PHRC interregional, 2009 and AOL 2010.

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      Child gender, gestational age, birth weight, and duration of breastfeeding (never, ≤3 months, >3 months) were also collected. 24h-polysomnograms were performed following birth (usually the second day; M0) in the maternity unit and at six months (M6) at home and analyzed as previously described [14]. Briefly, the polysomnograph (Dream®, Medatec, Bruxelles, Belgium) simultaneously recorded frontal, central and occipital leads (FP2, C4, O2, A1), two electrooculograms, 1 chin electromyogram and 1 electrocardiogram, chest and abdominal respiratory movements by inductance plethysmography, as well as noninvasive arterial oxygen saturation using an oximetry probe placed on the foot.

    Disclosure statement: This was not an industry supported study. None of the authors have potential conflicts of interest to be disclosed. Each author listed on the manuscript has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.

    ☆☆

    Author contributions: Conception and study design: Barbara Gillioen, Patricia Franco, Hugues Patural; Data patients' collection: Sophie Flori, Aurore Guyon; Neuropsychological tests: Camille Stagnara; Polysomnographic Analysis: Barbara Gillioen, Enza Montemitro; Statistical analysis: Marie-Paule Gustin, Sabine Plancoulaine; Interpretation of results: Barbara Gillioen, Flora Bat-Pitault, Jian-Sheng Lin, Patricia Franco; Preparation of manuscript: Barbara Gillioen, Sabine Plancoulaine, Patricia Franco.

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