Acute Sleep Organization Following Unanesthetized Circumcision of Neonates

Abstract

Sleep changes in response to environmental pressures and the needs of individuals. The adaptability of sleep is noticeable following largely stressful or adverse events, and is understood to facilitate recovery. Rapid changes in sleep occur in-utero, during the days following birth, and across the first few postnatal years. These rapid changes are considered adaptive and indicative of normal and healthy development. Elective surgical intervention, such as circumcision, may influence the organization and quality of sleep during this developmentally sensitive period. Neonates undergoing circumcision, a prevalent procedure in the U.S. (American Academy of Pediatrics Circumcision Policy Statement [AAP], 1999, 2005, 2012), also are at risk for operative stress or postoperative pain. Changes in the sleep organization of neonates have been observed following circumcision, but are not consistent. In these analyses, I specifically evaluated changes in infant sleep cycles surrounding circumcision from pre-existing data. These data present a unique opportunity to characterize sleep in relation to circumcision because they were collected prior to routine use of anesthetic or analgesic. Infants were compared on sleep state organization, determined using Motility Monitoring recordings of infant movement and respiration. Quiet sleep of circumcised infants decreased and transitional sleep marginally increased from before circumcision to after circumcision. Respiratory rate during quiet sleep increased among both circumcision and control groups. The lapse from active sleep to quiet sleep decreased for uncircumcised males and did not change for the circumcised group. Male neonates appear to demonstrate Quiet and Transitional sleep trends from pre-to post-circumcision, but ultimately neither of their changes differed in comparison to a group of combined females and uncircumcised males. It is plausible that test outcomes did not reach statistical significance because of differences in the distribution of infant sex across groups, or because of small sample size. Although no causal relation between circumcision and sleep measures can be inferred from these data, the changes in sleep organization that were demonstrated by circumcised males in this study should be investigated among infants receiving procedural anesthesia, but who do not typically receive analgesic intervention to mediate postoperative pain's effect on sleep during recovery after circumcision. Table of Contents Introduction…………………………………………………………………………………………………1 Infant Sleep Architecture and Behavioral Assessment…………………………………………….2 Circumcision……………………………………………………………………………………….4 Changes in Infant Sleep Organization Following Physical Trauma or Stress……………………..6