title: Randomized controlled trial to compare sleep and wake in preterm infants less than 32weeks of gestation receiving two different modes of non-invasive respiratory support.
abstract: OBJECTIVE
  To determine whether respiratory support via heated humidified high flow nasal cannulae (HHHFNC) results in infants <32weeks gestation spending a greater proportion of time in sleep compared to those receiving nasal continuous positive airway pressure (NCPAP).
  
  
  METHODS
  A subgroup of infants enrolled in a randomized controlled trial to compare HHHFNC or NCPAP post-extubation had sleep and wake activity measured by actigraphy for 72hours post-extubation. Activity diaries were completed contemporaneously to record episodes of infant handling. Actigraphy data were downloaded with known periods of handling excluded from the analysis.
  
  
  RESULTS
  28 infants with mean gestation of 28.3weeks (SD 2) and birth weight 1074g (SD 371) were studied. Infants receiving HHHFNC spent a lesser proportion of time in sleep 59.8% (SD 18.5) than those on NCPAP 82.2% (SD 23.8) p=0.004. Infants receiving HHHFNC had a lower sleep efficiency and higher mean activity score than those on NCPAP (p=0.003, p=0.002, respectively).
  
  
  CONCLUSIONS
  Infants receiving HHHFNC had a higher mean activity score and spent less time in sleep than those allocated NCPAP. Further study of sleep wake activity in preterm infants receiving respiratory support is required as this may impact on neurodevelopmental outcomes.
authors.affiliation: Mercy Hospital for Women, Melbourne, VIC, Australia. Electronic address: ccollins@mercy.com.au.
authors.forename: C L
authors.initials: CL
authors.lastname: Collins
authors.affiliation: Mercy Hospital for Women, Melbourne, VIC, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Barfield
authors.affiliation: Royal Womens' Hospital, Melbourne, VIC, Australia.
authors.forename: P G
authors.initials: PG
authors.lastname: Davis
authors.affiliation: The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, VIC, Australia.
authors.forename: R S C
authors.initials: RS
authors.lastname: Horne
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*; D012890:Sleep / Q000502:physiology*; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology*
keywords: High flow nasal cannulae; NCPAP; Preterm infant; Sleep; Wake