Children with a history of prematurity presenting with snoring and sleep-disordered breathing: a cross-sectional study. The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study The relationship between sleep disturbance in pregnancy and persistent common mental disorder in the perinatal period (sleep disturbance and persistent CMD) Neonatal Sleep Predicts Attention Orienting and Distractibility Perinatal Risk Factors Associated with the Obstructive Sleep Apnea Syndrome in School-Aged Children Born Preterm. The longitudinal course, risk factors, and impact of sleep disturbances in children with traumatic brain injury. Modulation of motor activity patterns and sleep states in low-risk prematurely born infants reaching normal term: a comparison with full-term newborns. Sleep problems predict comorbid externalizing behaviors and depression in young adolescents with attention-deficit/hyperactivity disorder Neurophysiologic Assessment of Neonatal Sleep Organization: Preliminary Results of a Randomized, Controlled Trial of Skin Contact With Preterm Infants Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Developmental care does not alter sleep and development of premature infants. Behavioral Observation Differentiates the Effects of an Intervention to Promote Sleep in Premature Infants: A Pilot Study Body position, sleep states, and cardiorespiratory activity in developing low birth weight infants. Sleep behaviors and sleep quality in children with autism spectrum disorders. Randomized clinical trial of an oscillating air mattress in preterm infants: effect on apnea, growth, and development. The relationship between longitudinal clinical course and sleep and cortisol changes in adolescent depression Sleep architecture and the risk of incident dementia in the community
OBJECTIVES /HYPOTHESIS To report on the prevalence of premature ( PM ) birth in a consecutive series of children treated for snoring and sleep-disordered breathing ( S/SDB ) , the parameters specific to their management and variables predictive of disease severity . STUDY DESIGN A retrospective study was undertaken at a tertiary pediatric hospital . METHODS Children with history of PM and presenting with S/SDB were identified from a prospect ively kept surgical data base . We set out to determine the prevalence of PM among the patients presenting with S/SDB who required airway evaluations and surgery .  Pulse oximetry is overnight recordable oxygen saturation and heart rate tracing that provides information about hypoxemia during sleep . This was performed on all children preoperatively . The pulse oximetry findings were used to plan for perioperative monitoring and care . A multivariable analysis was used to identify factors predictive of abnormal pulse oximetry studies . We evaluated the associated diagnoses , surgical procedures required , and response to treatment in these selected children . RESULTS Fifty-seven out of 1,038 patients were PM ( 33 males ; mean age , 62.09 ± 34.91 months ; range , 4 - 190 months ) . The mean gestational age was 30.3 ± 4.0 weeks . The prevalence rate of PM among patients treated surgically for SDB is 5.5 % ( 95 % CI 5.2 - 5.8 ) at our center . Comorbid pulmonary and gastrointestinal disorders were encountered on 23 ( 40 % ) and 17 ( 29.8 % ) occasions , respectively , and were the most commonly encountered comorbid diagnostic categories . Large airway abnormalities were encountered in 11 ( 19.3 % ) children , and the most common were subglottic stenosis ( four ) and laryngeal paralysis ( four ) . Comorbid respiratory disease was negatively predictive of abnormal pulse oximetry ( coefficient -0.35 , P<.05 ) . Postoperative respiratory outcomes correlated with abnormal pulse oximetry ( coefficient 0.3 ; P<.05 ) . CONCLUSIONS Our findings suggest children with PM presenting to pediatric otolaryngology require a comprehensive evaluation for S/SDB . A significant proportion of children with S/SDB and a history of PM frequently had pulmonary and gastrointestinal comorbidities in our cohort . One-half required admission postoperatively , and these were predictable based on preoperative pulse oximetry . Respiratory comorbidity was negatively predictive of severity of SDB . Inversely , children with untreated pulmonary comorbidities are more likely to have postoperative complications Background Sleep difficulties are prevalent in children with autism spectrum disorder ( ASD ) . The temporal nature of the association between sleep problems and ASD is unclear because longitudinal studies are lacking . Our aim is to clarify whether sleep problems precede and worsen autistic traits and ASD or occur as a consequence of the disorder . Methods Repeated sleep measures were available at 1.5 , 3 , 6 , and 9 years of age in 5151 children participating in the Generation R Study , a large prospect i ve birth cohort in the Netherl and s. Autistic traits were determined with the Pervasive Developmental Problems score ( PDP ) of the Child Behavior Checklist ( CBCL ) at 1.5 and 3 years and the Social Responsiveness Scale ( SRS ) at 6 years . This cohort included 81 children diagnosed with ASD . Results Sleep problems in early childhood were prospect ively associated with a higher SRS score , but not when correcting for baseline PDP score . By contrast , a higher SRS score and an ASD diagnosis were associated with more sleep problems at later ages , even when adjusting for baseline sleep problems . Likewise , a trajectory of increasing sleep problems was associated with ASD . Conclusions Sleep problems and ASD are not bidirectionally associated . Sleep problems do not precede and worsen autistic behavior but rather co-occur with autistic traits in early childhood . Over time , children with ASD have an increase in sleep problems , whereas typically developing children have a decrease in sleep problems . Our findings suggest that sleep problems are part of the construct ASD Abstract Background : Common mental disorder ( CMD ) and sleep disturbance are two common conditions among women in late pregnancy , affecting up to 20 % and 63 % of women , respectively , and may adversely affect their quality of life . Aim : The aim of this study is to examine the relationship between sleep disturbance in pregnancy and persistent CMD among low-income pregnant women living in Brazil . Methods : This was a prospect i ve cohort study conducted with pregnant women recruited from public primary care clinics in São Paulo , Brazil . We performed a longitudinal analysis of 219 women who had CMD from the Self-Report Question naire during the 20–30 weeks of pregnancy . Two groups were examined : ( 1 ) those who had CMD remission in the postpartum and ( 2 ) those who had persistent CMD in the postpartum ( measured once in the postpartum period ) . Poisson regression was used to estimate the degree of association between sleep disturbance in pregnancy and the risk for persistent CMD postpartum . Results : After adjusting for sociodemographic and clinical factors , sleep disturbance during pregnancy is associated with persistent CMD ( RR = 1.36 , 95 % confidence interval : 1.01–1.84 ) . Conclusion : In this sample of low-income pregnant women living in Brazil , the presence of sleep disturbance during pregnancy was associated with persistent common mental disorder in the postpartum period . Identification of sleep disturbance in pregnant women with CMD will be important in order to recognize those women at higher risk of persistent CMD in the postpartum period Objective : Children with sleep disorders tend to experience attention problems , yet little is known about the relationship between sleep and attention in early development . This prospect i ve follow-up study investigated the longitudinal relationships between neonatal sleep , attention , and distraction in infants born preterm . Method : We used actigraphy and sleep-wake diaries in the neonatal intensive care unit ( NICU , N = 65 ) , attention orienting in a visual-recognition-memory task ( VRM ) at age 4 months , and structured observation of attention and distractibility at age 18 months . Results : Infants with poorer neonatal sleep ( n = 31 ) exhibited longer first gaze duration s in the VRM at 4 months and longer distraction episodes at 18 months relative to neonatal controls who slept well ( p < .01 ) . Hierarchical regression models support relations between neonatal sleep and gaze behavior at 4 months and distractibility at 18 months ; moreover , alterations in orienting attention at 4 months predicted the likelihood of being distracted during the second year of life . Conclusion : Findings underscore the importance of early sleep-wake and attention regulation in the development of distraction in infants born preterm STUDY OBJECTIVES The obstructive sleep apnea syndrome ( OSAS ) is more prevalent in ex-preterm children compared to the general pediatric population . However , it is unknown whether OSAS in ex-preterm children is associated with specific perinatal risk factors . This multicenter cohort study aim ed to determine perinatal factors associated with OSAS at school age . METHODS 197 ex-preterm ( 500 - 1,250 g ) children aged 5 - 12 y who participated as neonates in a double-blind , r and omized clinical trial of caffeine versus placebo ( Caffeine for Apnea of Prematurity ) underwent comprehensive ambulatory polysomnography .  A negative binomial regression model was used to identify perinatal risk factors associated with OSAS . RESULTS 19 children had OSAS ( 9.6 % ) . Chorioamnionitis and multiple gestation were positively associated with OSAS with P values of 0.014 and 0.03 , respectively . Maternal white race ( P = 0.047 ) and maternal age ( P = 0.002 ) were negatively associated with OSAS . Other risk factors , such as birth weight , Apgar score at 5 min , antenatal corticosteroids , delivery route , and sex were not significant . CONCLUSIONS OSAS is very frequent , and is associated with chorioamnionitis and multiple gestation in ex-preterm children . Those born to older white mothers appear to be protected . We speculate that the former may be due to systemic inflammation and the latter to a higher socio-economic status . COMMENTARY A commentary on this article appears in this issue on page 721 This study aim ed to examine the prevalence and trajectory of sleep disturbances and their associated risk factors in children up to 24 months following a traumatic brain injury ( TBI ) . In addition , the longitudinal association between sleep disturbances and children 's functional outcomes was assessed . This was a prospect i ve study of a cohort of children with TBI and a comparison cohort of children with orthopedic injury ( OI ) . Parental reports of pre-injury sleep disturbances were compared to reports of post-injury changes at 3 , 12 , and 24 months . Risk factors for sleep disturbances were examined , including severity of TBI , presence of psychosocial problems , and pain . Sleep disturbances were also examined as a predictor of children 's functional outcomes in the areas of adaptive behavior skills and activity participation . Both cohorts ( children with TBI and OI ) displayed increased sleep disturbances after injury . However , children with TBI experienced higher severity and more prolonged duration of sleep disturbances compared to children with OI . Risk factors for disturbed sleep included mild TBI , psychosocial problems , and frequent pain . Sleep disturbances emerged as significant predictors of poorer functional outcomes in children with moderate or severe TBI . Children with TBI experienced persistent sleep disturbances over 24 months . Findings suggest a potential negative impact of disturbed sleep on children 's functional outcomes , highlighting the need for further research on sleep in children with TBI To evaluate the influence of prematurity and postnatal age on the relationship between motor activity ( MA ) and sleep states , forty clinical ly and neurologically normal infants were recorded polygraphically and grouped according to their gestational ( GA , prematures : < 36 weeks , full-term : 37 - 41 weeks ) and conceptional ( CA , 37 - 38 and 39 - 41 weeks ) ages . Sleep states ( active : AS , and quiet : QS ) were defined by the concordance of EEG and rapid eye movement criteria . Movements of both upper ( UL ) and lower ( LL ) limbs were independently recorded . In all groups the amount of MA in both UL and LL clearly predominated in AS compared with QS ( p < 0.02 ) . Contrariwise , both the longest period without movement and the no-movement 20-sec epochs were significantly higher in QS than in AS ( p < 0.005 ) . In AS , age-related modifications and modulation of MA amount throughout the state were similar for PRT and FT groups : a ) in both groups a significant decrease of MA with advancing CA was observed ( p < 0.05 ) ; b ) MA throughout the state was r and omly distributed regardless of CA . In QS , however , PRT were distinguishable from FT by the absence of : a ) a significant decrease of MA amount with advancing CA , together with a reduced increase of both the longest period without movements and the no-movement 20-sec epochs ; b ) prevalence of MA in LL compared with UL ; c ) modulation of the distribution of MA throughout the state Children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) experience high rates of sleep problems and are also at increased risk for experiencing comorbid mental health problems . This study provides an initial examination of the 1-year prospect i ve association between sleep problems and comorbid symptoms in youth diagnosed with ADHD . Participants were 81 young adolescents ( 75 % male ) carefully diagnosed with ADHD and their parents . Parents completed measures of their child ’s sleep problems and ADHD symptoms , oppositional defiant disorder ( ODD ) symptoms ,  and general externalizing behavior problems  at baseline ( Mage = 12.2 ) and  externalizing behaviors were assessed again 1 year later . Adolescents completed measures of anxiety and depression at both time-points . Medication use was not associated with sleep problems or comorbid psychopathology symptoms . Regression analyses indicated that , above and beyond demographic characteristics , ADHD symptom severity , and initial levels of comorbidity , sleep problems significantly predicted greater ODD symptoms , general externalizing behavior problems , and depressive symptoms 1 year later . Sleep problems were not concurrently or prospect ively associated with anxiety . Although this study precludes making causal inferences , it does nonetheless provide initial evidence of sleep problems predicting later comorbid externalizing behaviors and depression symptoms in youth with ADHD . Additional research is needed with larger sample s and multiple time-points to further examine the interrelations of sleep problems and comorbidity BACKGROUND . Sleep is important to brain organization , but few strategies to promote sleep among premature infants have been tested . Behaviorally based measures of sleep have shown increased quiet sleep ( QS ) and decreased active sleep ( AS ) during skin-to-skin contact ( SSC ) with the mother , but these results have not been confirmed with objective electroencephalographic/polysomnographic measures of sleep organization . Important differences exist between behavioral and electroencephalographic/polysomnographic definitions of sleep state . METHODS . Data for the first 28 relatively healthy , preterm subjects of an ongoing r and omized trial of one 2- to 3-hour session of SSC or incubator care between feedings are reported here . Infants were positioned prone , inclined , and nested in an incubator during the 2- to 3-hour pretest period , were fed , and then went into the test period of SSC or incubator care . Infants were left largely undisturbed throughout testing . A mixed-model regression analysis compared the test-pretest differences in outcome measures within and between groups . RESULTS . Results showed that arousals were significantly lower in the SSC group , compared with the control group , for the entire study period and for test-pretest matched segments of QS and AS . Rapid eye movement was significantly lower for the SSC group for the study period and AS segments . Indeterminate sleep was significantly lower for the SSC group when confounding environmental variables were included in the regression analysis . When 4 subjects who experienced excessive ambient light levels during SSC were removed from analysis , QS increased during SSC . CONCLUSIONS . The patterns demonstrated by the SSC group are analogous to more-mature sleep organization . SSC may be used as an intervention to improve sleep organization in this population of preterm infants OBJECTIVES This study examined the hypothesis that domains of neurobehavioral function would be selectively affected by sleep-disordered breathing ( SDB ) . Therefore , we assessed potential relationships between objective ly measured sleep disturbances and neurobehavioral function in children with reported symptoms of attention-deficit/hyperactivity disorder ( ADHD ) and also determined the incidence of snoring and other sleep problems in 5- to 7-year-old children in the local community and potential relationships to parental snoring and passive smoking . METHODS Parents of 5- to 7-year-old children in public schools were surveyed about their child 's sleeping habits using a vali date d question naire . The question naire also asked whether they believed their child to be hyperactive or have ADHD . Children with reported symptoms of ADHD and control children were r and omly selected and invited to the Sleep Medicine Center for an overnight polysomnographic assessment and a battery of neurocognitive tests . RESULTS The question naire response rate was 47.6 % ( n = 5728 ) . Frequent and loud snoring was reported for 673 children ( 11.7 % ) . Similarly , 418 ( 7.3 % ) children were reported to have hyperactivity/ADHD , 313 ( 76.5 % ) of which were boys . Eighty-three children with parentally reported symptoms of ADHD were invited for full evaluation at the Sleep Medicine Center together with 34 control children . After assessment with the Conners ' Parent Rating Scale , 44 children were design ated as having " significant " symptoms of ADHD , 27 as " mild , " and 39 design ated as " none " ( controls ) . Overnight polysomnography indicated that obstructive sleep apnea was present in 5 % of those with significant ADHD symptoms , 26 % of those with mild symptoms , and 5 % of those with no symptoms . In the cohort , no sleep variable accounted for more than a negligible proportion of the variance in domains of neurobehavioral function . CONCLUSIONS An unusually high prevalence of snoring was identified among a group of children design ated as showing mild symptoms of ADHD based on the Conners ' ADHD index identified from a community sample . However , whereas SDB is not more likely to occur among children with significant ADHD symptoms , it is significantly highly prevalent among children with mild hyperactive behaviors . Sleep studies further revealed that rapid eye movement disturbances are more likely to occur in children with significant symptoms , and they seem to impose significant but mild effects on daytime neurobehavioral functioning . We conclude that in children with significant symptoms of ADHD , the prevalence of SDB is not different from that of the general pediatric population and that rapid eye movement sleep in these children is disturbed and may contribute to the severity of their behavioral manifestations . Furthermore , SDB can lead to mild ADHD-like behaviors that can be readily misperceived and potentially delay the diagnosis and appropriate treatment OBJECTIVE The Neonatal Individualized Developmental Care Program ( NIDCAP ) for very low birth weight ( VLBW ) preterm infants has been suggested by Als et al to improve several medical outcome variables such as time on ventilator , time to nipple feed , the duration of hospital stay , better behavioral performance on Assessment of Preterm Infants ' Behavior ( APIB ) , and improved neurodevelopmental outcomes . We have tested the hypothesis of whether the infants who had received NIDCAP would show advanced sleep-wake pattern , behavioral , and neurodevelopmental outcome . METHODS Thirty-five VLBW infants were r and omly assigned to receive NIDCAP  or routine infant care . The goals for NIDCAP intervention were to enhance comfort and stability and to reduce stress and agitation for the preterm infants by : a ) altering the environment by decreasing excess light and noise in the neonatal intensive care unit ( NICU ) and by using covers over the incubators and cribs ; b ) use of positioning aids such as boundary supports , nests , and buntings to promote a balance of flexion and extension postures ; c ) modification of direct h and s-on caregiving to maximize preparation of infants for , tolerance of , and facilitation of recovery from interventions ; d ) promotion of self-regulatory behaviors such as holding on , grasping , and sucking ; e ) attention to the readiness for and the ability to take oral feedings ; and f ) involving parents in the care of their infants as much as possible . The infants ' sleep was recorded at 36 weeks postconceptional age ( PCA ) and at 3 months corrected age ( CA ) using the Motility Monitoring System ( MMS ) , an automated , nonintrusive procedure for determining sleep state from movement and respiration patterns . Behavioral and developmental outcome was assessed by the Neurobehavioral Assessment of the Preterm Infant ( NAPI ) at 36 weeks PCA , the APIB at 42 weeks PCA , and by the Bayley Scales of Infant Development ( BSID ) at 4 , 12 , and 24 months CA . RESULTS Sleep developmental measures at 3 months CA showed a clear developmental change compared with 36 weeks PCA . These include : increased amount of quiet sleep , reduced active sleep and indeterminate sleep , decreased arousal , and transitions during sleep . Longest sleep period at night showed a clear developmental effect ( increased ) when comparing nighttime sleep pattern of infants at 3 months with those at 36 weeks of age . Day-night rhythm of sleep-wake increased significantly from 36 weeks PCA to 3 months CA . However , neither of these sleep developmental changes showed any significant effects of NIDCAP intervention . Although all APIB measures showed better organized behavior in NIDCAP patients , neither NAPI nor Bayley showed any developmental advantages for the intervention group . The neurodevelopmental outcome measured by the Bayley at 4 , 12 , and 24 months CA showed 64 % of the NIDCAP intervention group at the lowest possible score compared with 33 % of the control group . These findings could not be explained by the occurrence of intraventricular hemorrhage or the socioeconomic status of the parents , which showed no significant group effect . CONCLUSION The results of this study , including measures of sleep maturation and neurodevelopmental outcome up to 2 years of age did not demonstrate that the NIDCAP intervention results in increased maturity or development . Buehler et al ( Pediatrics . 1995;96:923 - 932 ) have reported that premature infants ( N = 12 ; mean gestational age 32 weeks , mean birth weight 1700 g ) who received developmental care compared with a similar group of infants who received routine care showed better organized behavioral performance on an APIB assessment at 42 weeks PCA . None of the medical outcome measures were significantly different in this study . Although our APIB results are in agreement , the results of the NAPI , the Bayley and sleep measures do not show an increase in neurodevelopmental maturation . In the earlier report by Als et al ( Journal of the American Medical Purpose : Sleep and ongoing cycling of sleep states are required for neurosensory processing , learning , and brain plasticity . Many aspects of neonatal intensive care environments such as h and ling for routine and invasive procedures , bright lighting , and noise can create stress , disrupt behavior , and interfere with sleep in prematurely born infants . The study empirically investigated whether a 30-minute observation of infant sleep states and behavior could differentiate an intervention to promote sleep in premature infants with feeding difficulties relative to conventional care ( st and ard positioning , st and ard crib mattress [ SP ] ) . We included an intervention to determine the ability of the method to discriminate treatments and generate a benchmark for future improvements . The intervention , a conformational positioner ( CP ) , is contoured around the infant to provide customized containment and boundaries . To more fully verify the 30-minute observational sleep results , st and ard polysomnography was conducted simultaneously and sleep outcomes for the 2 modalities were compared . Subjects : In a r and omized crossover clinical trial , 25 infants , 31.5 ± 0.6 weeks ' gestational age and 38.4 ± 0.6 weeks at the study , with gastrointestinal conditions or general feeding difficulties used each intervention during an overnight neonatal intensive care unit sleep study . Methods : Infant sleep states and behaviors were observed during two 30-minute periods — that is , on the positioner and mattress — using the naturalistic observation of newborn behavior . Two certified developmental care nurses assessed sleep state , self-regulatory , and stress behaviors during 2-minute intervals and summed over 30 minutes . Sleep characteristics  from st and ard polysomnography  were measured at the time of behavior observations . Results : Infants on CP spent significantly less time in alert , active awake , or crying states by observation compared with SP . Surgical subjects spent more time awake , active awake , or crying and displayed a higher number of behavior state changes than the nonsurgical infants . The percentage of time in observed deep sleep and quiet sleep was correlated with both percentage sleep efficiency ( r = 0.78 ) and fewer state shifts per hour ( r = −0.65 ) from electroencephalogram ( EEG ) . Sleep efficiency by EEG was greater on CP versus SP . Conclusions : The CP enabled sleep compared with the st and ard mattress ( SP ) over 30-minute observation periods . Sleep status from behavioral observation was verified by st and ard EEG-based sleep techniques . Behavioral observation of sleep states may be a useful strategy for measuring the effectiveness of strategies to facilitate sleep in premature infants . Surgical subjects may benefit from additional interventions to promote sleep The objective of this study was to determine the effects of body position ( supine vs prone ) on cardiorespiratory activity during quiet and active sleep in growing low birth weight ( LBW ) infants . The effect of postconceptional age on cardiorespiratory activity in the two positions was also evaluated . Fifty-one healthy , growing , appropriate for gestational age LBW infants ( 795 - 1600 g ) , ranging from 26 - 37 weeks in gestational age , were evaluated . All subjects were enrolled in an ongoing study of the effects of quality of dietary energy on the rate and composition of weight gain . Infants were r and omly assigned to the supine or prone position for the first 3 h of the 6-h studies ; the position was reversed for the second 3 h. Continuous recordings of cardiorespiratory activity were performed along with simultaneous minute by minute assignment of behavioral sleep state . Measurements of heart rate ( HR ) , heart period variability ( RR-SD ) , respiratory rate ( f ) , and respiratory variability ( fSD ) were made each minute . Low birth weight infants had higher HR and f and lower RR-SD and fSD in the prone position compared to the supine position , during both quiet and active sleep . With increasing postconceptional age , positional differences in HR increased during quiet sleep and differences in RR-SD increased during both sleep states . These data demonstrate systematic differences in cardiorespiratory control related to body position during sleep . We speculate that such positional differences are due to variations in autonomic control , and may , in turn , contribute to variations in susceptibility to sudden infant death syndrome STUDY OBJECTIVES ( 1 ) Compare sleep behaviors of children with autism spectrum disorders ( ASD ) with sleep behaviors of typically developing ( TD ) children using the Children 's Sleep Habits Question naire ( CSHQ ) ; ( 2 ) compare sleep quality --defined as mean activity , sleep latency , number of awakenings , sleep efficiency and total sleep time -- of the cohort of children with ASD and TD , as measured by 10 nights of actigraphy ; and ( 3 ) estimate the prevalence of sleep disturbances in the ASD and TD cohorts . DESIGN Descriptive cross-sectional study . SETTING The Children 's Hospital of Philadelphia . PARTICIPANTS R and omly selected children from the Regional Autism Center . The ASD cohort of 59 children , aged 4 to 10 years , ( 26 with autism , 21 with pervasive developmental disorder-not otherwise specified [ PDD-NOS ] , and 12 with Asperger disorder ) were compared with 40 TD control subjects . MEASUREMENTS AND RESULTS The  CSHQ  ,  sleep diaries  , and 10 nights of actigraphy  using the Sadeh algorithm of children with ASD and TD control subjects were compared . CSHQ showed 66.1 % of parents of children with ASD ( 62.5 % autism , 76.2 % PDD-NOS , 58.3 % Asperger disorder ) and 45 % of parents of the control subjects reported that their children had sleep problems . Actigraphic data showed that 66.7 % of children with ASD ( 75 % autism , 52.4 % PDD-NOS , 75 % Asperger disorder ) and 45.9 % of the control subjects had disturbed sleep . CONCLUSIONS The prevalence estimate of 45 % for mild sleep disturbances in the TD cohort highlights pediatric sleep debt as a public health problem of concern . The prevalence estimate of 66 % for moderate sleep disturbances in the ASD cohort underscores the significant sleep problems that the families of these children face . The predominant sleep disorders in the ASD cohort were behavioral insomnia sleep-onset type and insomnia due to PDD To investigate cl aims that oscillating mattresses reduce  apnea of prematurity  and improve growth and neurobehavioural development , we performed a r and omized clinical trial using a predetermined sample size . Preterm infants weighing from 750 to 1750 gm at birth were r and omly assigned , by 250 gm strata , to either a conventional mattress ( n = 63 ) or to an air mattress ( n = 59 ) oscillating at 14 to 16 regular pulses per minute . Infants remained on the oscillating air mattress for at least 7 days or until 34 weeks postmenstrual age . Apneic episodes occurred and required treatment equally in the two groups ; this lack of an effect was seen for both sexes and all weight groups . Both weight and energy intake were similar . Neurobehavioral development as shown by sleep state , habituation testing , and behavioral assessment at term , 3 , 6 , and 12 months was similar in the two groups . There was no difference in the incidence of neurologic abnormalities . We conclude that an oscillating air mattress has no prophylactic value in reducing apnea and does not enhance growth and development This study examined the relationship between longitudinal clinical course and sleep and cortisol findings in adolescent unipolar major depressive disorder ( MDD ) . Subjects were 28 adolescents ( 15.4 + /- 1.3 years ) systematic ally diagnosed with unipolar MDD and 35 group-matched normal controls who participated in EEG sleep and neuroendocrine studies .  Follow-up clinical assessment s were conducted 7.0 + /- 0.5 years later in 94 % of the original cohort . Although initial group comparisons failed to show significant differences in biologic measures , analyses incorporating clinical follow-up reveal that changes in sleep and cortisol measures are associated with differential longitudinal course . Normal controls who would develop depression after the biologic studies had shown significantly higher density of rapid eye movements ( REM ) and a trend for reduced REM latency compared to controls with no psychiatric disorder at follow-up . Depressed subjects with a recurrent unipolar course showed a trend towards elevated plasma cortisol near sleep onset compared to MDD subjects with no further episodes during the follow-up interval Objective : Sleep disturbance is common in dementia , although it is unclear whether differences in sleep architecture precede dementia onset . We examined the associations between sleep architecture and the prospect i ve risk of incident dementia in the community-based Framingham Heart Study ( FHS ) . Methods : Our sample comprised a subset of 321 FHS Offspring participants who participated in the Sleep Heart Health Study between 1995 and 1998 and who were aged over 60 years at the time of sleep assessment ( mean age 67 ± 5 years , 50 % male ) .  Stages of sleep were quantified using home-based polysomnography . Participants were followed for a maximum of 19 years for incident dementia ( mean follow-up 12 ± 5 years ) . Results : We observed 32 cases of incident dementia ; 24 were consistent with Alzheimer disease dementia . After adjustments for age and sex , lower REM sleep percentage and longer REM sleep latency were both associated with a higher risk of incident dementia . Each percentage reduction in REM sleep was associated with approximately a 9 % increase in the risk of incident dementia ( hazard ratio 0.91 ; 95 % confidence interval 0.86 , 0.97 ) . The magnitude of association between REM sleep percentage and dementia was similar following adjustments for multiple covariates including vascular risk factors , depressive symptoms , and medication use , following exclusions for persons with mild cognitive impairment at baseline and following exclusions for early converters to dementia . Stages of non-REM sleep were not associated with dementia risk . Conclusions : Despite contemporary interest in slow-wave sleep and dementia pathology , our findings implicate REM sleep mechanisms as predictors of clinical dementia
Compared to full term , premature infants exhibit significant differences in sleep structure , which mainly include differences in electroencephalographic spectral values , in total sleep time and in arousal threshold .
Furthermore , prematurity seems to be a risk factor of sleep breathing disorders in childhood and adolescence .
Conclusions The alterations in sleep patterns are an outcome of prematurity ( immaturity of nervous system ) as well as of postnatal factors and comorbidities .
Sleep problems in this population of infants seems to be a missing piece of the puzzle of impaired neurodevelopment .
Background Sleep undergoes changes from birth to adulthood , while sleep disorders are associated with various cognitive deficiencies in childhood .
In parallel , prematurity is known to predispose to poor neurodevelopmental outcomes .
Our aim is to provide literature data about factors influencing sleep in the premature infants and sleep outcomes in this population .