634 - Early Sleep in Infants with Prenatal Opioid Exposure Associated with Maternal Risk Factors and Neurobehavior

Publication Number: 4620.634

Sarah Maylott, Duke University School of Medicine, Durham, NC, United States; Lynne Dansereau, Women & Infants Hospital of Rhode Island, Providence, RI, United States; Amy L. Salisbury, Virginia Commonwealth University, Richmond, VA, United States; barry lester, The Warren Alpert Medical School of Brown University, east greenwich, RI, United States; Elisabeth Conradt, Duke University School of Medicine, Durham, NC, United States

Background: Opioid-exposed infants are at high risk for neurobehavioral problems and pharmacological treatment for neonatal opioid withdrawal syndrome (NOWS). Sleep architecture in the early postnatal period may provide a sensitive window into autonomic and state regulation. Altered perinatal environments may disrupt sleep through nervous system dysregulation and subsequent physiological and neurobehavioral disturbances. Understanding these pathways could help identify early indicators of neurodevelopmental vulnerability and elevated risk for NOWS.

Objective: Determine whether sleep states in infants with prenatal opioid exposure are associated with maternal prenatal risk factors—number of opioids used prenatally and maternal sleep disturbance—and infant neurobehavior.

Design/Methods: In a multi-site cohort of infants with prenatal opioid exposure, infant sleep was continuously monitored throughout the hospital stay using a noninvasive under-mattress sensor (Emfit QS) capturing proportions of transition, light, and deep sleep. Prenatal maternal sleep was assessed via the sleep item of the Patient Health Questionnaire–9 (“Trouble falling or staying asleep, or sleeping too much”), with higher scores representing more sleep problems. Infant neurobehavior was assessed shortly after birth with the NeoNatal Neurobehavioral Scale, a standardized comprehensive evaluation of infant neurologic integrity, motor and behavioral function, and signs of stress/abstinence. Using structural equation models, we examined how maternal sleep and number of prenatal opioids predicted infant sleep stages (N=222). We also examined associations between infant sleep and neurobehavior prior to the start of treatment for NOWS (n=41).

Results: Higher number of prenatal opioids predicted more infant light sleep (b=0.02, p=.017) and maternal sleep problems predicted less infant deep sleep (b=-0.03, p=.021; Table 1). More neurobehavioral signs of stress were associated with more infant light sleep prior to NOWS diagnosis (r(34)=0.38, p=.023).

Conclusion(s): These findings suggest that infant sleep architecture—marked by increased light and reduced deep sleep—could reflect physiological regulation problems in infants with prenatal opioid exposure, even before NOWS treatment is necessary. The use of a noninvasive sleep monitoring system provides an objective and scalable design, though data were occasionally limited by signal noise and device disconnection. These results raise the possibility that newborn sleep patterns may reflect early regulatory risk for NOWS and could inform later clinical outcomes.

Table 1.
Table 1.pdfAssociations Between Maternal Sleep, Prenatal Opioid Exposure, and Newborn Sleep Architecture