Time course of night sleep EEG in the first year of life: a description based on automatic analysis

The Architecture of Early Childhood Sleep Over the First Two Years

INTRODUCTION

The architecture and function of sleep during infancy and early childhood has not been fully described in the scientific literature. The impact of early sleep disruption on cognitive and physical development is also under-studied. The aim of this review was to investigate early childhood sleep development over the first two years and its association with neurodevelopment.

METHODS

This review was conducted according to the 2009 PRISMA guidelines. Four databases (OVID Medline, Pubmed, CINAHL, and Web of Science) were searched according to predefined search terms.

RESULTS

Ninety-three studies with approximately 90,000 subjects from demographically diverse backgrounds were included in this review. Sleep is the predominant state at birth. There is an increase in NREM and a decrease in REM sleep during the first two years. Changes in sleep architecture occur in tandem with development. There are more studies exploring sleep and early infancy compared to mid and late infancy and early childhood.

DISCUSSION

Sleep is critical for memory, learning, and socio-emotional development. Future longitudinal studies in infants and young children should focus on sleep architecture at each month of life to establish the emergence of key characteristics, especially from 7-24 months of age, during periods of rapid neurodevelopmental progress.

Ontogeny of EEG-sleep from neonatal through infancy periods

Serial neonatal and infant electroencephalographic (EEG)-polysomnographic studies document the ontogeny of cerebral and noncerebral physiologic behaviors based on visual inspection or computer analyses. EEG patterns and their relationship to other physiologic signals serve as templates for normal brain organization and maturation, subserving multiple interconnected neuronal networks. Interpretation of serial EEG-sleep patterns also helps track the continuity of brain functions from intrauterine to extrauterine time periods. Recognition of the ontogeny of behavioral and electrographic patterns provides insight into the developmental neurophysiological expression of neural plasticity. Sleep ontogenesis from neonatal and infancy periods documents expected patterns of postnatal brain maturation, which allows for alterations from genetically programmed neuronal processes under stressful and/or pathological conditions. Automated analyses of cerebral and noncerebral signals provide time- and frequency-dependent computational phenotypes of brain organization and maturation in healthy or diseased states. Research pertaining to the developmental origins of health and disease can use these computational phenotypes to design longitudinal studies for the assessment of gene-environment interactions. Computational strategies may ultimately improve our diagnostic skills to identify special-needs children and to track the neurorehabilitative care of the high-risk fetus, neonate, and infant.

Automated State Analyses: Proposed Applications to Neonatal Neurointensive Care

The two principal challenges of neonatal physiologic monitoring device are: (1) the development of computational strategies that consider the rudimentary forms of neonatal sleep state especially for preterm infants and (2) any physiologic monitoring device for clinical applications in a neonatal intensive care setting must be small, portable, and user-friendly. Our multicenter neonatal sleep consortium has acquired more than 1,100 multihour EEG-sleep recordings on over 370 neonates, ranging from 24 to 44 weeks gestation. Each recording was visually-scored for state, arousals, movements, and rapid eye movements, which were used as templates when applying spectral analyses. The authors have defined a brain dysmaturity index to represent functional brain reorganization as the prenate matures to a full-term age; delayed or accelerated physiologic behaviors have been described for the preterm cohort when compared to the full-term group at the same postmenstrual age. Seven EEG-sleep measures comprise this index: quiet sleep percentage, sleep cycle length, rapid eye movements, arousals, spectral beta EEG energies, spectral EEG correlations, and a spectral measure of respiratory regularity. Linear and nonlinear computational algorithms are being developed to automate the computation of the dysmaturity index and to identify new feature types that correlate with dysmaturity. Automated neonatal sleep monitoring system can potentially improve neonatal neurointensive care by facilitating analyses of pervasive neonatal brain disorders expressed primarily as altered sleep state organization, and help predict altered developmental trajectories of children at higher risk for neurologic sequelae.

Time course of EEG background activity level before spontaneous awakening in the second semester of human life

This research aimed at investigating the time course of the EEG background activity level before spontaneous awakening out of rapid eye movement (REM) sleep, and non-rapid eye movement sleep with and without slow wave sleep (NREMSWS+, NREMSWS-) in the second semester of life. Twelve infants from 25 to 54 weeks of life were continuously monitored by polygraphic recording and behavioural observation during the night, and the EEG activity was analyzed by a method of automatic analysis. The EEG activation level increased before the awakening out of NREMSWS+ sleep, and was always high both in REM sleep and in NREMSWS-.

Spontaneous awakenings from sleep in the first year of life

Spontaneous awakenings from nocturnal sleep were studied in a sample of 48 healthy infants (M = 26, F = 22), in four age groups (1 to 7 weeks, 8 to 15 weeks, 17 to 22 weeks, 25 to 54 weeks). Consistent with previous data, the number of awakenings is reported less frequently at later ages, owing to a lower frequency of awakenings out of REM sleep. Like young adults, infants in all age groups awake more often from REM than from quiet sleep (QS); this is particularly evident in the first 6 months of life, less so in the second. The duration of the bouts of wakefulness following awakenings remains stable with age. Awakenings out of QS are followed by longer periods of wakefulness than those out of REM sleep, although in older infants the duration is considerably reduced. Night sleep first shows a decrease in the number of awakenings out of REM sleep and then continues after the sixth month of life with the shortening of the wakefulness after awakenings out of QS. In the two younger groups, the distribution of the awakenings shows two main peaks and one main peak differently located during the night; a polymodal pattern appears in group 3, and is even more evident in group 4. It should be stressed that several changes as a function of age occur in the second 6 months of life, indicating this as a period of intense developmental change in sleep-wake rhythms.

Prior spontaneous nocturnal waking duration and EEG during quiet sleep in infants: an automatic analysis approach

To ascertain the role of spontaneous nocturnal waking duration on the EEG dynamics during quiet sleep (QS) periods, we analysed the nocturnal polygraphic recordings of 12 infants aged 9 47 weeks old. Their sleep was characterised by two sleep episodes, separated by spontaneous waking and containing at least two QS-paradoxical sleep (PS) cycles each. Automatic analysis of the EEG activity recorded by the centro-occipital lead and reflecting the degree of synchronisation allowed us to compute a parameter whose values ranged from 0 (maximum of EEG synchronisation) to 10 (maximum of EEG de-synchronisation). Three indicators of the time course of the parameter value were computed during the first QS period of the sleep episode subsequent to nocturnal waking: (i) the parameter range (difference between the EEG parameter value at the QS onset and that at the trough-maximum of EEG synchronisation); (ii) the trough latency (time interval between QS onset and trough); and (iii) rate of synchronisation (range/trough latency). These three indicators were the dependent variables in a multiple regression model, where the independent variables were age and the logarithm of the duration of prior waking. The parameter range was correlated with the duration of prior waking. Both the trough latency and the rate of synchronisation were correlated with age only, respectively, positively and negatively. The marked decline in the rate of synchronisation throughout the first year of life could account for the failure to find a significant correlation between prior waking and the above indicator of the EEG dynamics. The relationship between the duration of prior waking and the parameter range in following sleep in infants supports the hypothesis of the early emergence of the homeostatic regulation of sleep.

Dynamics of EEG background activity level during quiet sleep in multiple nocturnal sleep episodes in infants

The study reported in this paper investigated the dynamics of EEG background activity during quiet sleep (QS) in the first year of life. These dynamics have been previously shown to follow an intra-sleep trend within a single sleep episode, and the aim of this study was to show whether they were similar in two successive nocturnal sleep episodes interrupted by a waking episode, or whether they exhibited a progressive trend across the two episodes. The polygraphic recordings of two groups of 6 infants aged from 9 to 15 weeks old and from 25 to 47 weeks old, whose nocturnal sleep organisation was spontaneously interrupted, were selected. Three indicators of the time course of the parameter value, obtained from automatic analysis and reflecting the degree of synchronisation of the EEG activity recorded by the centro-occipital lead, were computed for the first two QS periods of two successive sleep episodes: the parameter range (difference between the EEG parameter value at the QS onset and that at the trough); the trough latency (time interval between QS onset and trough); and rate of synchronisation (range/trough latency). All 3 indicators differed between the first and the second QS period of both sleep episodes independently of age. The rate of synchronisation (but not the parameter range and the trough latency) was higher in the first sleep episode than in the second one, showing an over-night decreasing trend. Those results show that, when nocturnal sleep in infants is split into two episodes separated by an intervening waking, also the second sleep episode displays an internal organisation of its EEG dynamics. Moreover, an across-night trend in the rate of synchronisation can be observed from an early age, a finding which suggests, again, the early emergence of homeostatic regulation of sleep.

Delta (0.5-1.5 Hz) and sigma (11.5-15.5 Hz) EEG power dynamics throughout quiet sleep in infants

Twenty-eight healthy infants, split into 3 groups according to age (group 1: 2-6 weeks, n = 10; group 2: 7-14 weeks, n = 10; and group 3: 4-12 months, n = 8), were recorded during the whole night. For each infant, the longest quiet sleep (QS) phase occurring between 8 p.m. and midnight was selected for EEG power spectral analysis. The power in the frequency band related to low-frequency delta waves (0.5-1.5 Hz, "delta band") and the power in the frequency band related to sigma spindles (11.5-15.5 Hz, "sigma band") were analyzed. Group 1 infants showed no significant modification of the power in the sigma band in the course of the QS phase; the power in the delta band showed a significant increase between the second and the third 5 min segment and a decrease thereafter. Group 2 infants showed a progressive reduction of the power in the sigma band, whereas the power in the delta band increased during the first 15 min. In group 3 infants, the sigma band power significantly decreased between the third and the fifth 5 min segment without further changes. The power in the delta band, on the contrary, increased progressively for the first 20 min and showed a second progressive increase beyond 35 min. For both group 2 and group 3 infants, it appeared that the change in delta power preceded the change in sigma power. The above results provide quantitative evidence that a well-defined temporal inhomogeneity pattern in the EEG of the QS phase may appear between 7 and 14 weeks of age and continues from the fourth month on.

Dynamics of EEG background activity level within quiet sleep in successive cycles in infants

We investigated in infants the emergence of the trends of the EEG synchronization throughout quiet sleep (QS) as a function of the QS rank. The night sleep of 3 groups with 6 subjects each (aged respectively 9-18 weeks, 21-47 weeks, and 16-45 years) was recorded. A parameter value reflecting the degree of synchronization of the EEG background activity for successive epochs was computed by automatic analysis. For each QS phase 3 indicators of the dynamics of the time course of the EEG parameter activity were determined: the range (difference between the EEG parameter value at the beginning of the QS episode and that at the trough), the trough latency (after QS onset), and the rate of synchronization (range/trough latency). The range and the trough latency increased with age, whereas the rate of synchronization decreased. The range and the rate of synchronization decreased in the successive cycles, whereas the trough latency increased. These results provide further support for the hypothesis of the early emergence of the process S mechanisms and suggest that the framework of the 2-process model could account also for the development of both the EEG background activity dynamics and the sleep-wake organization.

EEG spectral analysis in children with sociocultural handicaps

EEG recordings during spontaneous sleep were obtained in 50 children from 18-30 months of age (27 boys, 23 girls). Twenty five children were classified as high risk (HR) and twenty five as low risk (LR), taking into account social and cultural disadvantages. Absolute power (AP) and relative power (RP) for delta, theta, alpha and beta bands were computed. ANOVAS assessing the main effects of risk and sex as well as their interactions were performed. HR showed significantly more delta AP than LR, while LR had higher values of alpha AP than HR. Values of RP were significantly different in alpha and beta bands in Fp1, Fp2, O1 and O2. LR with more alpha and beta RP. Risk/sex interactions were only observed in delta AP in T5 and T6. Differences were more prominent in HR boys. These results suggest a maturational lag of the brain in high risk children.

[Automatic analysis of sleep-wake states during the first year of life]

Automatic analysis on infant sleep tracing was first considered as an aid to the rapid construction of hypnograms. It has long been thought more complicated than in adults, because of the significant changes in electrogenesis during the first year of life, resulting in difficulty to adapt to the criteria of Rechtschaffen and Kales (1968), even if modified, or to those of Anders et al (1971). In fact, these studies have shown that automatic analysis of sleep EEG tracings permit an easier analysis of the changes in electrogenesis according to subject age, sleep stage and time of night. Moreover, automatic analysis of parameters which change with the sleep-wake stages shows the continuity of these changes, and therefore the somewhat arbitrary nature of conventional hypnogram classification. The mathematical treatment of this information facilitates their visualisation, and permits a better analysis of circadian and ultradian variations that could scarcely be formalized by classical hypnogram analysis. In the study of maturation occurring during the first months of life, automatic signal processing will require adaptation that will lead to new forms of reasoning.

Post-natal development of sleep organization in man: speculations on the emergence of the 'S process'

We outline the development during the first year of life of both sleep-wake patterns and internal sleep organization (sleep states, quiet sleep-paradoxical sleep cycles, and slow-wave sleep), and raise the issue of the emergence of the 'S process'. The consolidation of sleep in episodes of longer duration takes place during the night; the ability to maintain sleep after sleep onset decreases during the day in infants older than 6 months. The main contribution to the increase of longest nocturnal sleep episode duration comes from the quiet sleep, the number of quiet sleep-paradoxical sleep cycles being of minor importance. The temporal analysis of infant sleep structure showed a difference between the first and the following cycles, not only for slow wave activity in infants older than five months, but also for younger infants and for other individual physiological activities (EEG activity, respiratory and cardiac rates): is the early development of these peculiar features a sketch of the 'S Process' described in the adult?

Ultradian, circahoral and circadian structures in endothermic vertebrates and humans

1. For more than 30 years many studies have been carried out concerning rhythms with periods approaching 24 hr (circadian rhythms). 2. The latter have been demonstrated as resulting from environmental 24 hr synchronizers (zeitgebers), but they usually persist in the absence of a 24 hr synchronization, which proves their endogenous nature. 3. Biological rhythms with periods less than 20 hr (ultradian rhythms) and particularly those approaching 1 hr (circahoral rhythms) have been determined: for motility, rest-activity, sleep phases, endocrine secretions and other physiological functions. 4. These ultradian and circahoral rhythms have been found in rodents, birds, monkeys and humans. 5. Existing at all stages of ontogeny, they have been proved to be endogenous and species and strain specific. 6. As these ultradian rhythms can be influenced by environmental factors and sometimes by circadian rhythms they are not truly periodic, so therefore cannot be computed by the usual processes of mathematical time analysis.