Avaliação do sono em prematuros submetidos ao suporte respiratório não-invasivo em UTI Neonatal

Abstract

Introduction: The organization of neonatal sleep has been extensively studied in recent years. It is known that premature infants spend more than 90% of their sleeping time This percentage decreases with increasing gestational age. The maturation of the sleep-wake cycle has an important relationship with cortical and sensorineural development in children, implying learning and behavior. Several studies have used the actigraphy and subjective scales to evaluate the macrostructure of sleep being less invasive and easier to use. However, few studies evaluate sleep in preterm infants and use of ventilatory support in neonatal intensive care units. Objective: to evaluate the influence of continuous positive airway pressure (CPAP) on the sleep of premature infants. Methods: A cross-over study in a neonatal intensive care unit. We selected preterm infants with gestational age between 28 and 37 weeks in incubators and nasal CPAP. Cerebral malformations, cerebral haemorrhage, use of sedative drugs and Apgar <7 at the fifth minute were exclusion criteria of the study. Study procedures were performed within the first week of life. The newborns in CPAP were monitored for 48 hours with an actigraph, placed for a period on the right leg and another period on the left leg. Total sleep time, total sleep period and sleep efficacy were evaluated. Taken together, in the subjective sleep evaluation the Brazelton scale was used in which the behavior was observed during a 2-hour period, accompanied by the sleep diary to exclude feeding and handling periods of the assistant team. After CPAP discontinuation, the neonates were re-monitored with an actigraph for 48 hours and reassessed using the same methodology. The data were analyzed in the program SPSS version 21.0.0 The calculation of the sample size was done in the program WinPEPI (Programs for Epidemiologists for Windows) version 11.43 and based on the study of Collins et al (2015). Results: We studied 18 preterm infants, 10 male and 8 female, with gestational age between 29-36 weeks (mean and standard deviation of 31.7 ± 2.1) and birth weight from 840g to 2340g mean 1,708g ± dp 416g. Considering the monitored parameters, we observed a reduction in sleep efficiency, total sleep time and total sleep time when compared to the CPAP-free period without CPAP, respectively 62% ± 13.2 x 76.2% ± 6.8 (p <0.001), 431.8 minutes ± 132.6 x 745.8 minutes ± 125.7 (p <0.001) and 691.2 minutes ± 186.6 minutes x 981.9 minutes ± 170.3 (p <0.001). The Brazelton scale demonstrated significantly greater time of deep sleep and light sleep in the period without CPAP (p 0.008, p 0.002) Conclusion: The results of this study suggest that the use of CPAP with pronga nasal during the first week of life in preterm neonates transiently changes the sleep pattern.