Infants are prone to accidental asphyxiation. Therefore, we studied airway-defensive behaviors and their relationship to spontaneous arousal behavior in 41 healthy sleeping infants (2-26 wk old), using two protocols: 1) infant was rebreathing expired air, face covered by bedding material; and 2) infant was exposed to hypercarbia, face uncovered. Multiple measurements of respiratory and motor activities were recorded (video, polygraph). The infants' response to increasing hypercarbia consisted of four highly stereotyped behaviors: sighs (augmented breaths), startles, thrashing limb movements, and full arousal (eyes open, cry). These behaviors occurred abruptly in self-limited clusters of activity and always in the same sequence: first a sigh coupled with a startle, then thrashing, then full arousal. Incomplete sequences (initial behaviors only) occurred far more frequently than the complete sequence and were variably effective in removing the bedding covering the airway. In both protocols, as inspired CO2 increased, incomplete arousal sequences recurred periodically and with increasing frequency and complexity until the infant either succeeded in clearing his/her airway or was completely aroused. Spontaneous arousal sequences, identical to those occurring during hypercarbia, occurred periodically during sleep. This observation suggests that the infant's airway-defensive responses to hypercarbia consist of an increase in the frequency and complexity of an endogenously regulated, periodically occurring sequence of arousal behaviors.
The infant arousal response involves subcortical and cortical responses occurring as a sequence of stereotyped behaviour regardless of the eliciting stimulus. The spontaneous activity of these responses during sleep, however, is uncertain. We examined the spontaneous arousal pattern in normal infants to determine the sequence of responses, and to examine their periodicity and the effects of sleep state. We performed a nap polysomnographic study on 10 normal infants between 2 and 10 weeks of age. Electroencephalographic and electro‐oculographic activity, and respiratory airflow and movements were measured, and video recordings were made throughout each study. Different levels of arousal behaviour were examined. We found that spontaneous arousal activity occurred frequently and the majority of responses occurred as a sequence involving an augmented breath followed by a startle and then cortical arousal. Subcortical arousals as reflected by augmented breaths and startles were more common than cortical arousals. Additionally, augmented breaths followed by apnoea were recorded and were not usually associated with other arousal responses. All of the responses occurred periodically either as bursts of activity or as isolated responses. Each of the responses occurred more frequently during rapid eye movement (REM) sleep than during non‐rapid eye movement (NREM) sleep. We conclude that there is an endogenous rhythm of spontaneous activity in infants involving excitatory processes from the brainstem, which may or may not be closely followed by cortical excitation. The spontaneous arousal responses occur periodically but with a high level of irregularity and the level of activity is affected by sleep state.
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