Electroencephalographic sleep macrostructure and sleep spindles in early infancy

Study Objectives: Sleep features in infancy are potential biomarkers for brain maturation but poorly characterized. We describe normative values for sleep macrostructure and sleep spindles at 4-5 months of age. Methods: Healthy term infants were recruited at birth and had daytime sleep electroencephalograms (EEGs) at 4-5 months. Sleep staging was performed and five features were analyzed. Sleep spindles were annotated and seven quantitative features were extracted. Features were analyzed across sex, recording time (am/pm), infant age, and from first to second sleep cycles. Results: We analyzed sleep recordings from 91 infants, 41% females. Median (interquartile range [IQR]) macrostructure results: Sleep duration 49.0 (37.8-72.0) min (n = 77); first sleep cycle duration 42.8 (37.0-51.4) min; rapid eye movement (REM) percentage 17.4 (9.5-27.7)% (n = 68); latency to REM 36.0 (30.5-41.1) min (n = 66). First cycle median (IQR) values for spindle features: number 241.0 (193.0-286.5), density 6.6 (5.7-8.0) spindles/min (n = 77); mean frequency 13.0 (12.8-13.3) Hz, mean duration 2.9 (2.6-3.6) s, spectral power 7.8 (4.7-11.4) μV2, brain symmetry index 0.20 (0.16-0.29), synchrony 59.5 (53.2-63.8)% (n = 91). In males, spindle spectral power (μV2) was 24.5% lower (p =. 032) and brain symmetry index 24.2% higher than females (p =. 011) when controlling for gestational and postnatal age and timing of the nap. We found no other significant associations between studied sleep features and sex, recording time (am/pm), or age. Spectral power decreased (p <. 001) on the second cycle. Conclusion: This normative data may be useful for comparison with future studies of sleep dysfunction and atypical neurodevelopment in infancy.