Neonatal Sleep Disruption and Brain Development in Preterm Infants: A Narrative Review of Neurodevelopmental Outcomes

Abstract

Sleep plays a fundamental role in early brain maturation, synaptic plasticity, neuronal differentiation, cortical network formation, white matter maturation, and neuroendocrine regulation during the neonatal period. Preterm infants admitted to neonatal intensive care units (NICUs) are frequently exposed to environmental stressors including noise, continuous lighting, repeated caregiving interventions, and painful procedures that may disrupt normal sleep architecture. These environmental stressors may fragment sleep, alter normal sleep cycling, activate physiological stress pathways, and interfere with ongoing brain maturation. Increasing human evidence suggests that disturbances in neonatal sleep organization may influence long-term neurodevelopmental outcomes.

This narrative review summarizes current research examining the relationship between neonatal sleep disruption and later cognitive, behavioral, neuroimaging, and physiological outcomes. Cohort studies and meta-analyses have shown that very-preterm and very-low birth weight children have problematic attachments and an increased risk for attention-deficit/hyperactivity disorder. Neuroimaging studies have additionally demonstrated altered white matter maturation and impaired structural connectivity among children born very preterm. In addition, neonatal stress and sleep disturbance may influence hypothalamic–pituitary–adrenal axis regulation and stress responsiveness.

Although causal relationships remain difficult to establish because of the confounding factors associated with prematurity, illness severity, environmental exposures, and neonatal comorbidities, available evidence highlights sleep as a potentially modifiable determinant of neurodevelopment. Implementation of sleep-protective strategies in NICUs—including environmental modification, clustered caregiving, and kangaroo mother care—may help mitigate long-term neurodevelopmental risk. Developmental care interventions aimed at preserving sleep integrity may, therefore, represent an important and potentially modifiable strategy for improving neurodevelopmental outcomes. Further prospective research is required to clarify mechanisms and guide clinical practice. Future studies integrating neurophysiological monitoring, neuroimaging, endocrine biomarkers, and long-term developmental follow-up are required to better define causal pathways and guide evidence-based neonatal practice.