![]() ![]() REM sleep is related to more fetal respiratory patterns such as susceptibility to apnea, suggesting that REM sleep is physiologically more immature than NREM sleep. 36.1).īy term, the sleep states have developed such that indeterminate sleep has disappeared and it has given space to NREM sleep, which comes ontogenically later than REM sleep. 15 A strong biologic basis can be assumed behind the maturation of sleep states, because fetuses and neonates have identical proportions of sleep states at corresponding gestational ages ( Fig. 4 In fetuses, because EEG is not available, REMs and body movements are used instead and similarly show the concordance from 28 weeks of gestation onward. From 28 weeks of gestation onward, the concordance between EEG and REMs begins to emerge, defining NREM and REM sleep in preterm infants. When polysomnography is available, electroencephalography (EEG) patterns together with REMs represent the established practice to classify sleep states in preterm infants. Fussing can be considered as a transition from active wakefulness to crying. ![]() Drowsiness can be seen as a transition between sleep and wakefulness, but it can be justified as a behavioral state in preterm infants who spend long time periods in drowsiness. Then sleep is classified as indeterminate, which can also occur as a transition between sleep states. In preterm infants with still immature sleep states, criteria for non–rapid eye movement (NREM) and rapid eye movement (REM) sleep are not always met. The behavioral states of a preterm infant are summarized in Table 36.1. The behavioral states of a newborn are commonly classified into six categories, from sleep to crying. Martin MBBS, FRACP, in Fanaroff and Martin's Neonatal-Perinatal Medicine, 2020 Behavioral/Sleep States and NICU Environment ![]()
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