The development of sleep during the first months of life

doi:10.1053/smrv.2002.0198

Sleep Medicine Reviews

Volume 7, Issue 2, April 2003, Pages 179-191

https://doi.org/10.1053/smrv.2002.0198 Get rights and content

Abstract

The development of sleep during the first months of life is intriguing from a scientific point of view but is interesting to the clinician as well. This review aims at providing data on sleep in “low-risk” premature neonates, neonates born at term, and infants up to the age of 6 months. The various milestones in clinical and polygraphic features of sleep allow for week-to-week assessment of brain function in normal and sick children.

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Sleep consolidation into nighttime is considered the primary goal of sleep development in early infants. However, factors contributing to sleep consolidation into nighttime remain unclear.
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Sleep–wake time and light stimulation were measured in infants for 4 consecutive days using actigraphy. The infants’ mothers were asked to complete a sleep events diary and a questionnaire about childcare, including “co-sleeping”, defined as when the infant and mother slept on the same surface throughout the night.
The data were analyzed with a focus on daytime and nighttime sleep parameters.
Daytime light stimulation reduced daytime “active sleep”, tended to reduce daytime sleep, and increased daytime waking. Nighttime light stimulation reduced nighttime “quiet sleep” and nighttime sleep and increased nighttime waking. Co-sleeping reduced nighttime waking, and, as a result, nighttime sleep time and sleep efficiency increased. Co-sleeping reduced daytime sleep and tended to increase daytime waking. Consequently, co-sleeping tended to increase the ratio of nighttime sleep to daytime sleep.
The present findings suggest that an appropriate light environment promotes daytime waking and nighttime sleep in early infants, but it does not contribute to sleep consolidation into nighttime by itself. On the other hand, co-sleeping may promote sleep consolidation into nighttime. Therefore, further methods for safe co-sleeping need to be established while avoiding risk factors for sudden unexpected death in infancy/sudden infant death syndrome.
Possible contribution of better maternal psychological well-being to the acquisition of sleeping through the night in infants during the early postpartum period
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The objective of this study was to elucidate whether better maternal psychological well-being contributes to the acquisition of “sleeping through the night” (STN) in infants during the early postpartum period. Fifty-two primiparous mothers completed the General Health Questionnaire-28 (GHQ-28) in the third trimester (prenatal) and when the conceptional ages of their babies reached 8–9 weeks (hereafter, 2 months), 12–13 weeks (3 months), and 16–17 weeks (4 months). They also recorded babies’ nocturnal sleep patterns in a timetable for 5 consecutive days each month postpartum. “Regular STN” was defined when the mean of longest nocturnal sleep duration for 5 consecutive days was > 8 h or between 6 and 8 h with < 1.0 nocturnal awakenings. According to these criteria, a total of 14 infants (27 %) acquired regular STN at 4 months (referred to as “STN infants”), with STN infants showing a marked increase in longest nocturnal sleep duration and a decrease in nocturnal awakenings from 2 to 3 months of age. The mothers of STN infants demonstrated steady reductions in postnatal GHQ-28 scores and had significantly lower prenatal GHQ-28 scores compared with the mothers of non-STN infants (3.7 ± 3.0 vs. 6.4 ± 4.1, p = 0.027). In random forest models for binomial classification, both prenatal and postnatal (at 4 months) GHQ-28 scores were identified as significant covariates for distinguishing STN infants, and other important covariates, including weeks of delivery, stepfamily, birth weight of the infant, and maternal co-sleeping at bedtime, were selected. Among these covariates, maternal co-sleeping at bedtime had relatively stronger correlations with both STN infants (r = − 0.440) and prenatal maternal GHQ-28 scores (r = 0.377). In conclusion, because prenatal maternal psychological well-being was thought to predict the acquisition of STN in infants, infants born from mothers with better psychological well-being appear to have some advantages in acquiring STN. These cross-lagged correlations suggest that the pathway from mothers to infants may be mediated by certain parenting behaviors, such as maternal co-sleeping at bedtime.
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The infant's maturity and sleep state influence the central control of breathing, which is coordinated by complex interactions of the central nervous system with the respiratory muscles. Periodic breathing, apnea of prematurity and sudden infant death syndrome are thought to be caused by abnormalities of respiratory control in the infant. Sleep disordered breathing occurs in infancy, particularly in those with certain congenital anomalies. A common sleep disorder of infancy is behavioral insomnia, which can be managed effectively by a number of behavioral interventions.
Temperament and sleep behaviors in infants and toddlers living in low-income homes
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Temperament is a dynamic trait that can be shaped by maturity and environmental experiences. In this study, we sought to determine whether and the extent to which temperament was predicted by sleeping behaviors in an understudied sample of primarily Black and White infants and toddlers living in low-income homes (N = 150). Sleeping behaviors were assessed at 15–19 months of age with caregiver report of the Tayside Children’s Sleep Questionnaire. Temperament was examined as effortful control, negativity, and surgency with the Infant Behavior Questionnaire Very Short Form at 9–12 months of age and with the Early Childhood Behavior Questionnaire Short Form at 20–24 months of age. Covariates were maternal education, household income, and child sex and race. Continuous variables were standardized, then missing data from independent variables were multiply imputed in 20 datasets. Regression analyses showed that about 1 SD improvement in toddler sleep behaviors significantly predicted about 1/5 SD better toddler effortful control. However, sleep behaviors did not significantly predict toddler surgency or negative affect. This study shows that for a sample of infants and toddlers in low-income homes, how a child learns to regulate sleeping behaviors may influence the development of overall effortful control about six months later.
Effects of perinatal dioxin exposure on neonatal electroencephalography (EEG) activity of the quiet sleep stage in the most contaminated area from Agent Orange in Vietnam
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To investigate the effects of perinatal dioxin exposure indicated by dioxins in breast milk on neonatal electroencephalography (EEG) power in the quiet sleep stage, and associations with neurodevelopmental outcomes at 2 years of age.
Fifty-one mother-newborn pairs were enrolled for neonatal EEG analysis in the quiet sleep stage from a birth cohort recruited at a prefecture hospital in Bien Hoa city, Vietnam. Relative EEG power in intra-burst-intervals and high-voltage-bursts in the trace alternant pattern were computed from EEG data during the quiet sleep stage. Forty-three mother-child pairs participated in a 2-year follow-up survey to examine neurodevelopment using the Bayley-III scale and gaze behavior exhibited by fixation duration on the face of a child talking in videos. The general linear model and regression linear model were used for data analysis after adjusting for confounding factors.
Perinatal dioxin exposure, particularly 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure, influenced relative EEG power values mainly in the intra-burst-interval part of the trace alternant pattern in the quiet sleep stage. In intra-burst-intervals, decreased frontal delta power and increased frontal and parietal alpha power values in the left hemisphere and temporal beta power values in the right hemisphere were associated with increased TCDD exposure, with significant dose-response relationships. Almost none of the relative power values in these brain regions were associated with Bayley III scores, but relative delta power values were significantly associated with face fixation duration in left frontal and parietal regions at 2 years of age.
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Sleep is essential for human life. It has different characteristics in the early stages of life compared to later periods: during development, qualitative and quantitative changes in sleep features occur such as the onset of REM/NREM sleep at 3 months, the progressive increase of night sleep duration, and the reduction of total sleep time. Sleep seems to be essential in the cognitive functions' development, especially in the first period of life. Indeed, higher rates of night sleep at the age of 12 and 18 months are associated with higher executive functions' performance. Furthermore, memory consolidation occurs during sleep and sleep contributes to children's learning not only in retaining information but also in organizing memories most efficiently. Therefore, sleep problems could cause negative effects on some features of cognitive development like memory, executive functions, and learning process. There is also an intimate relationship between sleep and regulation of emotional brain functions, with a link between sleep disturbance and behavioral problems.

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^f1: Correspondence should be addressed to: A. W. de Weerd. E-mail: [email protected]

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Clinical ReviewThe development of sleep during the first months of life

Abstract

Developmental course of night-time sleep-wake patterns in full-term and premature infants during the first year of life

Sleep

Major problems in clinical pediatrics

Neurology of the New-born

Comparison of EEG sleep measures in healthy full-term and preterm infants at matched conceptional ages

Sleep

Polysomnographic quantification of bio-electrical maturation in preterm and fullterm newborns at matched conceptional ages

Electroenceph Clin Neurophysiol

Clinics in developmental medicine 28

A Neurological Study of New-born Infants

The behavioral states of the new-born infant (a review)

Brain Res

Ontogenesis of brain bioelectrical activity and sleep organisation in neonates and infants

Activité électroencéphalographique normale du nouveau né et du prematuré au cours des états de veille et de sommeil

Rev EEG Neurophysiol Clin

A manual of standardised technology, states of sleep and wakefulness in new-born infants

Atlas of Neonatal Electroencephalography

Atlas of EEG in the First Months of Life

EEG in premature and full-term new-born

Neurophysiol Clin

Computer classification of state in healthy preterm neonates

Sleep

J Clin Neurophysiol

Enregistrement ambulatoire de l'EEG pendant 24 h dans les spasmes infantiles épileptiques

Rev EEG Neurophysiol Clin

Continuous 4-channel EEG monitoring: a guide to interpretation, with normal values, in preterm infants

Neuropediatrics

Computer analyses of EEG-sleep in the neonate: methodological considerations

J Clin Neurophysiol

Cerebral function monitoring during the first week of life in extremely small low birthweight (ESLBW) infants

Neuropediatrics

A new system for cotside display and analysis of the preterm neonatal electroencephalogram

Dev Med Child Neurol

Recording sleep and wake

Infant polysomnography: reliability

Sleep

Development of EEG and daytime sleep in normal full-term infants during the first 3 months of life: longitudinal observations

Electroencephalogr Clin Neurophysiol

Neonatal polygraphy in full-term and premature infants: a review of normal and abnormal findings

J Clin Neurophysiol

The normal EEG of the human newborn

J Clin Neurophysiol

Prolonged inactive phases during the discontinuous pattern of prematurity in the electroencephalogram of very-low-birthweight infants

Electroencephalogr Clin Neurophysiol

Quantified electrographic scales on 10 pre-term healthy newborns followed up to 40–43 weeks of conceptional age by serial polygraphic recordings

Electroencephalogr Clin Neurophysiol

Periods of activity and quiescence in the premature EEG

Neuropediatrics

Sequential changes in electroencephalogram continuity in very premature infants

Electroencephalogr Clin Neurophysiol

The EEG of the early premature

Electroencephalogr Clin Neurophysiol

Interburst interval measurements in the EEGs of premature infants with normal neurological outcome

Electroencephalogr Clin Neurophysiol

Sleep disorders in infants and children

Development of EEG and daytime sleep patterns in low risk premature infants during the first year of life: longitudinal observations

Electroencephalogr Clin Neurophysiol

Organisation du sommeil des nouveau-nés prematures normaux. Etude polygraphique

Rev EEG Neurophysiol

Organisation temporelle dans les 24 heures des cycles de sommeil chez le nourrisson

Rev EEG Neurophysiol

Sleep onto-genesis revisited: a longitudinal 24-hour home polygraphic study on 15 normal infants during the first two years of life

Sleep

Sleep organisation in the first year of life: developmental trends in the quiet sleep cycle

J Sleep Res

Sleep spindles

J Clin Neurophysiol

Clinical Review
The development of sleep during the first months of life