Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Dr. Shelly Lane

Second Advisor

Dr. Henry Carretta

Third Advisor

Dr. Carole Ivey

Fourth Advisor

Dr. Helen Lynch



By Joanne Fallon MS, OT, PhD

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2015.

Major Director: Shelly J. Lane, PhD, Professor, Department of Occupational Therapy

Preterm infants represent the largest child patient group in the European Union (EU), accounting for 5.5-11.4% of all births (European Foundation for the Care of Newborn Infants, 2011b). Preterm birth is defined as birth prior to 37 weeks gestation. Infants born late preterm (34-36 weeks) are considered more similar to early preterm (> 34 weeks) than to full-term infants, despite previously regarded as near-term (Raju Higgins, Stark, & Leveno, 2006). For preterm infants, sleeping functions are critical as they demonstrate the ability to adjust to biological and social rhythms and support emotional regulation, learning, and memory. Many studies have focused on sleep patterns of full-term infants; however, few have investigated preterm infants and none have compared early and late preterm infants with a population from the Republic of Ireland. The purpose of this study was to identify infant and parent characteristics that promote optimal sleep in preterm infants and to establish whether the parent-infant relationship mediates this association. A secondary purpose was to test the transactional model of sleep. Parent report of infant sleep

was taken from a recent population-based dataset from the Republic of Ireland. A comparison of the day and nighttime sleep patterns of early and late preterm infants found no difference between groups. There was also no difference in infant temperament, breast-feeding, parental stress, depression, or sociodemographics. A difference was found between groups in infant development, weight at 9 months, and age infant began solid foods. This finding was not surprising as infants born early preterm are at greater at greater risk of developmental delay and disability. Results of this study suggest that the paternal-infant relationship has a mediating impact on the relationship between infant temperament and nighttime waking in the early preterm group only, while the maternal-infant relationship has a mediating role in both groups. These findings add to the body of knowledge on the transactional model of sleep, and are the first to identify infant temperament and the paternal-infant relationship as important factors. Implications of these results are discussed in the context of the transactional model of sleep and recommendations for future research are presented.


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