human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: RATIONALE Apnea of prematurity is a common condition that is usually treated with caffeine , an adenosine receptor blocker that has powerful influences on the central nervous system . However , little is known about the long-term effects of caffeine on sleep in the developing brain . OBJECTIVES We hypothesized that neonatal caffeine use result ed in long-term abnormalities in sleep architecture and breathing during sleep . METHODS A total of 201 ex-preterm children aged 5 - 12 years who participated as neonates in a double-blind , r and omized , controlled clinical trial of caffeine versus placebo underwent actigraphy , polysomnography , and  parental sleep question naires . Co primary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography . MEASUREMENTS AND MAIN RESULTS There were no significant differences in primary outcomes between the caffeine group and the placebo ( adjusted mean difference of -6.7 [ 95 % confidence interval ( CI ) = -15.3 to 2.0 min ] ; P = 0.13 for actigraphic total sleep time ; and adjusted rate ratio [ caffeine/placebo ] for apnea-hypopnea index of 0.89 [ 95 % CI = 0.55 - 1.43 ] ; P = 0.63 ) . Polysomnographic total recording time and total sleep time were longer in the caffeine group , but there was no difference in sleep efficiency between groups . The percentage of children with obstructive sleep apnea ( 8.2 % of caffeine group versus 11.0 % of placebo ; P = 0.22 ) or elevated periodic limb movements of sleep ( 17.5 % in caffeine group versus 11 % in placebo group ) was high , but did not differ significantly between groups . CONCLUSIONS Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood . Ex-preterm infants , regardless of caffeine status , are at risk for obstructive sleep apnea and periodic limb movements in later childhood OBJECTIVE : To examine whether cycled lighting ( CL ) conditions during neonatal care in very preterm infants ( < 32 weeks ’ gestational age [ GA ] ) decrease crying and fussing behavior , improve the consolidation of sleep , and influence activity behavior at 5 and 11 weeks ’ postterm corrected age ( CA ) compared with preterm infants cared for in dim lighting ( DL ) conditions . METHODS : Thirty-seven preterm infants were r and omly assigned to  CL  ( 7 am–7 pm lights on , 7 pm–7 am lights off [ n = 17 ; mean GA : 30.6 ± 0.95 weeks ; 9 girls ] ) or DL ( lights off whenever the child is asleep [ n = 20 ; GA : 29.5 ± 2.1 weeks ; 8 girls ] ) conditions . Sleeping , crying , and activity behavior was recorded by using parental diaries and actigraphy at 5 and 11 weeks ’ CA . RESULTS : A significant reduction of fussing ( 59.4 minutes/24 hours [ ±25.8 minutes ] ) and crying ( 31.2 minutes/24 hours [ ±14.4 minutes ] ) behavior and a trend to higher motor activity during daytime was found in CL-exposed infants at 5 and 11 weeks ’ CA compared with infants cared for in DL conditions . No significant difference between groups was observed for sleep behavior at 5 and 11 weeks ’ CA . Infants in CL conditions showed a trend to improved daily weight gain ( average : 3.6 g/d ) during neonatal care compared with DL conditions . CONCLUSIONS : CL conditions in neonatal care have beneficial effects on infant ’s fussing and crying behavior and growth in the first weeks of life . This study supports the introduction of CL care in clinical neonatal practice OBJECTIVES To evaluate the extent to which sleep-disordered breathing ( SDB ) varies with putative demographic and medical risk factors and to estimate the prevalence of undiagnosed SDB . STUDY DESIGN Prospect i ve , cross-sectional study in a population -based cohort of 850 children ( 41 % black , 46 % preterm ) , 8 to 11 years of age . Participants ' caretakers completed question naires about health and sleep . Children underwent overnight in-home cardiorespiratory recordings of airflow , respiratory effort , oximetry , and electrocardiography . SDB was identified by respiratory disturbance indices commonly applied in clinical practice . Risk factors were estimated by logistic regression . Prevalence was derived from cohort-specific estimates with birth weights from US live births data . RESULTS Using the most inclusive definition , SDB was detected in 40 ( 4.7 % ) participants , with prevalence varying widely across population subsets . Depending on the definition used , SDB was 4 to 6 times more likely in black children compared with white children and almost 3 to 5 times more likely in former preterm compared with term children . The estimated population prevalence of SDB was 2.2 % ( 95 % CI , 1.2 % , 3.2 % ) . CONCLUSIONS SDB is a relatively common condition in 8- to 11-year-old children . Potentially vulnerable subgroups , black children , and former preterm infants , are at increased risk This prospect i ve observational study evaluated the behavioural responses of very preterm infants to spontaneous light variations 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 /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 : In neonatal intensive care unit ( NICU ) , neonatal sleep is disrupted due to different factors . Due to the critical role of sleep in premature infants′ brain development , this study aim ed to investigate the effect of nesting and swaddling on the sleep duration of premature infants hospitalized in NICUs . Material s and Methods : In a crossover clinical trial , 42 preterm infants who met the inclusion criteria were enrolled . They were r and omly assigned to two groups of nest-swaddle and swaddle-nest .  Sleep status was evaluated by observation and use of Prechtl′s criteria . Then , duration s of total sleep time ( TST ) and quiet sleep time ( QST ) were recorded . Data were analyzed using repeated measure analysis of variance ( ANOVA ) . Results : Mean values of TST and QST during nesting and also swaddling periods were significantly higher than in the control period in both groups ( P < 0.001 ) . Mean values of TST and QST in the swaddling period were higher than in the nesting period in both groups , However , these differences were not significant ( P = 0.245 ) . Conclusions : Both swaddling and nesting could significantly increase the duration of TST and QST , compared to the control . There were no significant differences between the effects of these interventions on TST and QST . Therefore , using any of these methods is suggested to improve infants′  quality of sleep in NICU , with respect to the ward policies 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 OBJECTIVE . Prematurely born compared with term born infants are at increased risk of sudden infant death syndrome , particularly if slept prone . The purpose of this work was to test the hypothesis that preterm infants with or without bronchopulmonary dysplasia being prepared for neonatal unit discharge would sleep longer and have less arousals and more central apneas in the prone position . METHODS . This was a prospect i ve observational study in a tertiary NICU . Twenty-four infants ( 14 with bronchopulmonary dysplasia ) with a median gestational age of 27 weeks were studied at a median postconceptional age of 37 weeks .  Video polysomnographic recordings of 2-channel electroencephalogram , 2-channel electro-oculogram , nasal airflow , chest and abdominal wall movements , limb movements , electrocardiogram , and oxygen saturation  were made in the supine and prone positions , each position maintained for 3 hours . The duration of sleep , sleep efficiency ( total sleep time/total recording 
    Output:
    
agent
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 .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: RATIONALE Apnea of prematurity is a common condition that is usually treated with caffeine , an adenosine receptor blocker that has powerful influences on the central nervous system . However , little is known about the long-term effects of caffeine on sleep in the developing brain . OBJECTIVES We hypothesized that neonatal caffeine use result ed in long-term abnormalities in sleep architecture and breathing during sleep . METHODS A total of 201 ex-preterm children aged 5 - 12 years who participated as neonates in a double-blind , r and omized , controlled clinical trial of caffeine versus placebo underwent actigraphy , polysomnography , and  parental sleep question naires . Co primary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography . MEASUREMENTS AND MAIN RESULTS There were no significant differences in primary outcomes between the caffeine group and the placebo ( adjusted mean difference of -6.7 [ 95 % confidence interval ( CI ) = -15.3 to 2.0 min ] ; P = 0.13 for actigraphic total sleep time ; and adjusted rate ratio [ caffeine/placebo ] for apnea-hypopnea index of 0.89 [ 95 % CI = 0.55 - 1.43 ] ; P = 0.63 ) . Polysomnographic total recording time and total sleep time were longer in the caffeine group , but there was no difference in sleep efficiency between groups . The percentage of children with obstructive sleep apnea ( 8.2 % of caffeine group versus 11.0 % of placebo ; P = 0.22 ) or elevated periodic limb movements of sleep ( 17.5 % in caffeine group versus 11 % in placebo group ) was high , but did not differ significantly between groups . CONCLUSIONS Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood . Ex-preterm infants , regardless of caffeine status , are at risk for obstructive sleep apnea and periodic limb movements in later childhood OBJECTIVE : To examine whether cycled lighting ( CL ) conditions during neonatal care in very preterm infants ( < 32 weeks ’ gestational age [ GA ] ) decrease crying and fussing behavior , improve the consolidation of sleep , and influence activity behavior at 5 and 11 weeks ’ postterm corrected age ( CA ) compared with preterm infants cared for in dim lighting ( DL ) conditions . METHODS : Thirty-seven preterm infants were r and omly assigned to  CL  ( 7 am–7 pm lights on , 7 pm–7 am lights off [ n = 17 ; mean GA : 30.6 ± 0.95 weeks ; 9 girls ] ) or DL ( lights off whenever the child is asleep [ n = 20 ; GA : 29.5 ± 2.1 weeks ; 8 girls ] ) conditions . Sleeping , crying , and activity behavior was recorded by using parental diaries and actigraphy at 5 and 11 weeks ’ CA . RESULTS : A significant reduction of fussing ( 59.4 minutes/24 hours [ ±25.8 minutes ] ) and crying ( 31.2 minutes/24 hours [ ±14.4 minutes ] ) behavior and a trend to higher motor activity during daytime was found in CL-exposed infants at 5 and 11 weeks ’ CA compared with infants cared for in DL conditions . No significant difference between groups was observed for sleep behavior at 5 and 11 weeks ’ CA . Infants in CL conditions showed a trend to improved daily weight gain ( average : 3.6 g/d ) during neonatal care compared with DL conditions . CONCLUSIONS : CL conditions in neonatal care have beneficial effects on infant ’s fussing and crying behavior and growth in the first weeks of life . This study supports the introduction of CL care in clinical neonatal practice OBJECTIVES To evaluate the extent to which sleep-disordered breathing ( SDB ) varies with putative demographic and medical risk factors and to estimate the prevalence of undiagnosed SDB . STUDY DESIGN Prospect i ve , cross-sectional study in a population -based cohort of 850 children ( 41 % black , 46 % preterm ) , 8 to 11 years of age . Participants ' caretakers completed question naires about health and sleep . Children underwent overnight in-home cardiorespiratory recordings of airflow , respiratory effort , oximetry , and electrocardiography . SDB was identified by respiratory disturbance indices commonly applied in clinical practice . Risk factors were estimated by logistic regression . Prevalence was derived from cohort-specific estimates with birth weights from US live births data . RESULTS Using the most inclusive definition , SDB was detected in 40 ( 4.7 % ) participants , with prevalence varying widely across population subsets . Depending on the definition used , SDB was 4 to 6 times more likely in black children compared with white children and almost 3 to 5 times more likely in former preterm compared with term children . The estimated population prevalence of SDB was 2.2 % ( 95 % CI , 1.2 % , 3.2 % ) . CONCLUSIONS SDB is a relatively common condition in 8- to 11-year-old children . Potentially vulnerable subgroups , black children , and former preterm infants , are at increased risk This prospect i ve observational study evaluated the behavioural responses of very preterm infants to spontaneous light variations 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 /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 : In neonatal intensive care unit ( NICU ) , neonatal sleep is disrupted due to different factors . Due to the critical role of sleep in premature infants′ brain development , this study aim ed to investigate the effect of nesting and swaddling on the sleep duration of premature infants hospitalized in NICUs . Material s and Methods : In a crossover clinical trial , 42 preterm infants who met the inclusion criteria were enrolled . They were r and omly assigned to two groups of nest-swaddle and swaddle-nest .  Sleep status was evaluated by observation and use of Prechtl′s criteria . Then , duration s of total sleep time ( TST ) and quiet sleep time ( QST ) were recorded . Data were analyzed using repeated measure analysis of variance ( ANOVA ) . Results : Mean values of TST and QST during nesting and also swaddling periods were significantly higher than in the control period in both groups ( P < 0.001 ) . Mean values of TST and QST in the swaddling period were higher than in the nesting period in both groups , However , these differences were not significant ( P = 0.245 ) . Conclusions : Both swaddling and nesting could significantly increase the duration of TST and QST , compared to the control . There were no significant differences between the effects of these interventions on TST and QST . Therefore , using any of these methods is suggested to improve infants′  quality of sleep in NICU , with respect to the ward policies 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 OBJECTIVE . Prematurely born compared with term born infants are at increased risk of sudden infant death syndrome , particularly if slept prone . The purpose of this work was to test the hypothesis that preterm infants with or without bronchopulmonary dysplasia being prepared for neonatal unit discharge would sleep longer and have less arousals and more central apneas in the prone position . METHODS . This was a prospect i ve observational study in a tertiary NICU . Twenty-four infants ( 14 with bronchopulmonary dysplasia ) with a median gestational age of 27 weeks were studied at a median postconceptional age of 37 weeks .  Video polysomnographic recordings of 2-channel electroencephalogram , 2-channel electro-oculogram , nasal airflow , chest and abdominal wall movements , limb movements , electrocardiogram , and oxygen saturation  were made in the supine and prone positions , each position maintained for 3 hours . The duration of sleep , sleep efficiency ( total sleep time/total recording 
    Output:
    