What do we know about the sleep effects of caffeine used to treat apnoea of prematurity? A systematic review of the literature.

IF 2.4 Q1 PEDIATRICS Molecular and cellular pediatrics Pub Date : 2023-09-18 DOI:10.1186/s40348-023-00166-2
Ana Renata Pinto de Toledo, Higor Arruda Caetano, Jovito Adiel Skupien, Carina Rodrigues Boeck, Humberto Fiori, Rosane Souza da Silva
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Abstract

Objective: Scientific scrutiny has proved the safety and benefits of caffeine to treat apnoea of prematurity (AOP). However, there is no consensus on the effects of this treatment on sleep, especially considering the key role of adenosine and early brain development for sleep maturation. We systematically reviewed studies with sleep as a primary and/or secondary outcome or any mention of sleep parameters in the context of caffeine treatment for AOP.

Methods: We performed a systematic search of PubMed, Web of Science and the Virtual Health Library from inception to 7 September 2022 to identify studies investigating the short- and long-term effects of caffeine to treat AOP on sleep parameters. We used the PIC strategy considering preterm infants as the Population, caffeine for apnoea as the Intervention and no or other intervention other than caffeine as the Comparison. We registered the protocol on PROSPERO (CRD42021282536).

Results: Of 4019 studies, we deemed 20, including randomised controlled trials and follow-up and observational studies, to be eligible for our systematic review. The analysed sleep parameters, the evaluation phase and the instruments for sleep assessment varied considerably among the studies. The main findings can be summarised as follows: (i) most of the eligible studies in this systematic review indicate that caffeine used to treat AOP seems to have no effect on key sleep parameters and (ii) the effects on sleep when caffeine is administered earlier, at higher doses or for longer periods than the most common protocol have not been investigated. There is a possible correlation between the caffeine concentration and period of exposure and negative sleep quality, but the sleep assessment protocols used in the included studies did not have high-quality standards and could not provide good evidence.

Conclusions and implications: Sleep quality is an important determinant of health, and better investments in research with adequate sleep assessment tools are necessary to guarantee the ideal management of children who were born preterm.

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我们对用于治疗早产儿呼吸暂停的咖啡因对睡眠的影响了解多少?对文献的系统综述。
目的:科学研究已经证明咖啡因治疗早产儿呼吸暂停(AOP)的安全性和益处。然而,对于这种治疗对睡眠的影响,尤其是考虑到腺苷和早期大脑发育对睡眠成熟的关键作用,目前还没有达成共识。我们系统地回顾了将睡眠作为主要和/或次要结果的研究,或在咖啡因治疗AOP的背景下提及睡眠参数的研究,从成立到2022年9月7日,科学网和虚拟健康图书馆确定了研究咖啡因治疗AOP对睡眠参数的短期和长期影响的研究。我们使用PIC策略,将早产儿作为人群,将咖啡因治疗呼吸暂停作为干预措施,并将除咖啡因以外的无干预或其他干预措施作为比较。我们在PROSPERO(CRD42021282536)上注册了该方案。结果:在4019项研究中,我们认为20项,包括随机对照试验、随访和观察性研究,符合我们的系统审查条件。所分析的睡眠参数、评估阶段和睡眠评估工具在不同的研究中差异很大。主要发现可总结如下:(i)本系统综述中的大多数合格研究表明,用于治疗AOP的咖啡因似乎对关键睡眠参数没有影响;(ii)与最常见的方案相比,更早、更高剂量或更长时间服用咖啡因对睡眠的影响尚未得到研究。咖啡因浓度、暴露时间和负睡眠质量之间可能存在相关性,但纳入研究中使用的睡眠评估方案没有高质量的标准,也无法提供良好的证据。结论和意义:睡眠质量是健康的重要决定因素,有必要更好地投资于具有足够睡眠评估工具的研究,以确保对早产儿童进行理想的管理。
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