Sleep state organization in premature infants of less than 35 weeks' gestational age.

To assess sleep organization in premature infants of < 35 wk gestational age (w GA), we performed polygraphic recordings in 24 neurologically normal neonates (eight per group): artificially ventilated 27-30 and 31-34 w GA infants and nonventilated 31-34 w GA infants. Sleep states were defined by concordance of EEG and rapid eye movement criteria. Uninterrupted active sleep periods of > 13 min and quiet sleep periods of > 5 min were observed in all babies, except in one 33 w GA ventilated infant. Intervals from the beginning of recording to the 1st quiet sleep period varied from 0 to 63 min and intervals to the beginning of the longest sleep cycle varied from 5 to 84 min. Nonventilated 31-34 w GA infants had longer sleep cycles (p < 0.02), principally because of longer active sleep periods. However, percentages of different states in the cycles were similar in all groups. When body movements were required for state definition, amounts of active and quiet sleep diminished and the percentage of indeterminate sleep was augmented significantly. In conclusion, our study demonstrated that 1) sleep state differentiation is present as soon as 27 w GA; and 2) artificial ventilation, performed in a highly specialized neonatal intensive care unit, does not modify sleep organization of neurologically normal premature infants. We hypothesize that this "earlier" sleep state differentiation, compared with previous data, may be related to improvements in neonatal intensive care over recent years.