TY - JOUR
T1 - Creating an optimal observational sleep stage classification system for very and extremely preterm infants
AU - de Groot, E R
AU - Bik, A
AU - Sam, C
AU - Wang, X
AU - Shellhaas, R A
AU - Austin, T
AU - Tataranno, M L
AU - Benders, M J N L
AU - van den Hoogen, A
AU - Dudink, J
N1 - Funding Information:
Dr. Shellhaas receives research support from NIH and the Pediatric Epilepsy Research Foundation . She serves as an associate editor for Neurology, is a consultant for the Epilepsy Study Consortium, and receives royalties from UpToDate for authorship of topics related to neonatal seizures.
Funding Information:
The authors acknowledged the financial support of EU H2020 MSCA-ITN-2018 : INtegrating Functional Assessment measures for Neonatal Safeguard (INFANS) , funded by the European Commission under Grant Agreement # 813483 .
Funding Information:
The authors acknowledged the financial support of EU H2020 MSCA-ITN-2018: INtegrating Functional Assessment measures for Neonatal Safeguard (INFANS), funded by the European Commission under Grant Agreement #813483.Dr. Shellhaas receives research support from NIH and the Pediatric Epilepsy Research Foundation. She serves as an associate editor for Neurology, is a consultant for the Epilepsy Study Consortium, and receives royalties from UpToDate for authorship of topics related to neonatal seizures.
Publisher Copyright:
© 2022 The Author(s)
PY - 2022/2
Y1 - 2022/2
N2 - BACKGROUND: Sleep plays a major role in neuronal survival and guiding the fetal brain's development. Preterm infants in the neonatal intensive care unit are exposed to numerous external stimuli that can severely disrupt their sleep/wake patterns. Currently, almost no behavioral classification scales are validated for preterm infants. This study aims to develop a new, easy-to-use, validated visual sleep stage classification system for preterm infants with a gestational age between 25 and 37 weeks.METHODS: The Behavioral Sleep stage classification for Preterm Infants (BeSSPI) consists of four sleep-wake stages; active sleep (AS), quiet sleep (QS), intermediate sleep (IS) and wake (W), which are classified using seven items. Items include eye movements, body movements, facial movements, vocalizations, heart rate, respiratory pattern and activity level.RESULTS: 69 preterm infants were observed (24 + 6-36 + 0 weeks GA at birth; 25 + 2-36 + 6 weeks PMA at observation; 57.3% male). Across all 69 infants, the BeSSPI was based on 10,922 min of observed behavior, with 4264 min AS (38.83%), 2873 min QS (26.16%), 2887 min IS (26.29%), and 957 min W (8.72%). For the final BeSSPI, an interrater agreement of κ = 0.80 was reached. Additionally, construct, content, face validity, and expert validity were carefully assessed and deemed satisfactory.CONCLUSIONS: We developed a method to evaluate sleep-wake stages that is simple for all neonatal healthcare providers to learn and use. The BeSSPI is of high reliability and validity. Furthermore, it can be used in all preterm age-groups. Therefore, this novel instrument may improve rigor and reproducibility for future preterm sleep research.
AB - BACKGROUND: Sleep plays a major role in neuronal survival and guiding the fetal brain's development. Preterm infants in the neonatal intensive care unit are exposed to numerous external stimuli that can severely disrupt their sleep/wake patterns. Currently, almost no behavioral classification scales are validated for preterm infants. This study aims to develop a new, easy-to-use, validated visual sleep stage classification system for preterm infants with a gestational age between 25 and 37 weeks.METHODS: The Behavioral Sleep stage classification for Preterm Infants (BeSSPI) consists of four sleep-wake stages; active sleep (AS), quiet sleep (QS), intermediate sleep (IS) and wake (W), which are classified using seven items. Items include eye movements, body movements, facial movements, vocalizations, heart rate, respiratory pattern and activity level.RESULTS: 69 preterm infants were observed (24 + 6-36 + 0 weeks GA at birth; 25 + 2-36 + 6 weeks PMA at observation; 57.3% male). Across all 69 infants, the BeSSPI was based on 10,922 min of observed behavior, with 4264 min AS (38.83%), 2873 min QS (26.16%), 2887 min IS (26.29%), and 957 min W (8.72%). For the final BeSSPI, an interrater agreement of κ = 0.80 was reached. Additionally, construct, content, face validity, and expert validity were carefully assessed and deemed satisfactory.CONCLUSIONS: We developed a method to evaluate sleep-wake stages that is simple for all neonatal healthcare providers to learn and use. The BeSSPI is of high reliability and validity. Furthermore, it can be used in all preterm age-groups. Therefore, this novel instrument may improve rigor and reproducibility for future preterm sleep research.
KW - Behavioral observation
KW - Neonatal intensive care
KW - Preterm infants
KW - Sleep-wake stages
UR - http://www.scopus.com/inward/record.url?scp=85124593114&partnerID=8YFLogxK
U2 - 10.1016/j.sleep.2022.01.020
DO - 10.1016/j.sleep.2022.01.020
M3 - Article
C2 - 35182976
SN - 1389-9457
VL - 90
SP - 167
EP - 175
JO - Sleep Medicine
JF - Sleep Medicine
ER -