Arousal responses in near-miss sudden infant death syndrome and in normal infants

McCulloch, Kristine M.; Brouillette, Robert T.; Guzzetta, Anthony J.; Hunt, Carl E.

doi:10.1016/s0022-3476(82)80009-7

Cited by 139 publications

(42 citation statements)

References 21 publications

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“…Data are accumulating that specific genotypes link to impaired brainstem regulation of breathing or other autonomic control as a risk factor for SIDS. Several reports have described near-miss SIDS infants as having a defect in hypercarbic and hypoxic ventilatory arousal responses similar to CCHS patients (Hunt et al 1981;McCulloch et al 1982). The receptor tyrosine kinase RET (rearranged during transfection) proto-oncogene (RET) and the glial cell line-derived neurotrophic factor (GDNF) signaling pathways play significant roles in the development of the respiratory center.…”

Section: Discussionmentioning

confidence: 99%

Sudden Infant Death Syndrome Is Not Associated with the Mutation of PHOX2B Gene, a Major Causative Gene of Congenital Central Hypoventilation Syndrome

Kijima

Sasaki

Niki

et al. 2004

Tohoku J. Exp. Med.

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Section: Discussionmentioning

confidence: 99%

Sudden Infant Death Syndrome Is Not Associated with the Mutation of PHOX2B Gene, a Major Causative Gene of Congenital Central Hypoventilation Syndrome

Kijima

Sasaki

Niki

et al. 2004

Tohoku J. Exp. Med.

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“…12 Furthermore, the arousal response to hypoxic or hypercarbic challenges during sleep may be impaired in both ALTE infants and subsequent siblings of SIDS victims. [13][14][15][16] The majority of SIDS cases occur between 1 and 6 months of age. If arousal deficiency is contributory, seemingly normal developmental changes in infant sleep architecture during this period might act in concert with an arousal deficit to increase an infant's risk.…”

mentioning

confidence: 99%

Infant Arousals During Mother-Infant Bed Sharing: Implications for Infant Sleep and Sudden Infant Death Syndrome Research

1997

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Routinely bed sharing infants also exhibited more frequent TAs in stage 3-4 than the routine solitary sleepers in both conditions. In both groups, the number of infant arousals (EWs ؉ TAs) that overlapped the mother's was doubled during bed sharing, with infant arousals leading most often.Conclusions. Mother-infant bed sharing promotes infant arousals. Together with a previous report that bed sharing reduces stage 3-4 sleep, this suggests that normative values for infant sleep must be interpreted within the context of the sleeping environment in which they were established. Given that arousability is diminished in stage 3-4, we speculate that, under otherwise safe conditions, the observed changes in stage 3-4 sleep and arousals associated with bed sharing might be protective to infants at risk for SIDS because of a hypothesized arousal deficit. The responsivity of the mother to infant arousals during bed sharing might also be protective. Pediatrics 1997;100:841-849; bed sharing, cosleeping, solitary sleeping, infant arousals, SIDS, infant sleep.

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“…25 Impaired alveolar ventilation and significantly higher arousal thresholds to high CO 2 have also been found in some infants with ALTE. 26 Ventilatory and arousal thresholds to hypercapnia and hypoxia are also increased during sleep and especially during REM sleep. 23,27 In adults, the common response to a single exposure of CO 2 seems to be an enhanced rather than a decreased sensitivity to CO 2 , 28 but this condition has not been studied in infants.…”

Section: Discussionmentioning

confidence: 99%

Consequences of Getting the Head Covered During Sleep in Infancy

Skadberg

Markestad

1997

Pediatrics

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ABSTRACT. Objective. To study the consequences of getting the head covered by bedding (fiber quilt) on carbon dioxide (CO 2 ) accumulation around the face, behavior, and physiologic responses during prone and supine sleep in infants to add understanding to why victims of sudden infant death syndrome are often found under the bedding.Methodology. Of 33 healthy term, usually nonprone sleeping infants, behavior and computerized polysomnography were successfully recorded for 30 during prone and supine sleep at 2 1 ⁄2 months and for 23 prone and 25 supine at 5 months.Results. For both ages and body positions, covering the head resulted in significant CO 2 accumulation around the face, fewer apneas (3 to 10 seconds), shorter duration of apneas after sighs, higher heart and respiratory rates, and peripheral skin temperature. Differences were generally greater at 2 1 ⁄2 than at 5 months. While covered, the prone position was associated with higher CO 2 levels close to the face, slightly higher transcutaneous PCO 2 , and higher heart rates and peripheral skin temperatures than the supine position. In the supine position 23% were able to remove the cover from the head at 2 1 ⁄2 and 60% at 5 months, whereas only 1 infant of 5 months managed to remove the cover when prone.Conclusions. The observed responses are consistent with a potential for distress when the head is covered, particularly when placed prone. Probably most important with respect to sudden infant death syndrome is the infants' inability to remove the bedding from the head upon awakening from prone sleep. Pediatrics 1997;100(2). URL: http://www.pediatrics.org/cgi/content/ full/100/2/e6; behavior, CO 2 rebreathing, hyperthermia, SIDS, sleeping position. 3 Although the concentration of carbon dioxide (CO 2 ) in the atmosphere is .03% to .04%, the exhaled air of infants contains 4% to 5% CO 2 , 4 and it has been speculated that under certain conditions, such as sleeping face down on soft bedding, extensive CO 2 accumulation around the infant's face may result in rebreathing, asphyxia, and suffocation. 3,5,6 The possibility of CO 2 rebreathing has mainly been studied in experimental in vitro and animal models, 3,5-10 whereas studies in infants are limited. 11-13We have previously shown that a significant number of SIDS victims are found with their head covered by bedding and usually in the prone position.14 The purpose of the present investigation was to study the effect of getting the head covered by bedding on CO 2 accumulation around the face, behavior, and physiologic responses in sleeping infants, and to compare outcome measures for the prone and supine sleeping positions. SUBJECTS AND METHODS SubjectsThirty-three infants (17 girls and 16 boys) were recruited for an overnight sleep study both at 2 1 ⁄2 (mean, 74 days; range, 71 to 79 days) and 5 (mean, 152 days; range, 147 to 158 days) months of age. The ages were chosen to correspond with the age of highest risk for SIDS (2 1 ⁄2 months) and a period of significantly lower risk (5 months) in Norway. 15 Only t...

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Arousal responses in near-miss sudden infant death syndrome and in normal infants

Cited by 139 publications

References 21 publications

Sudden Infant Death Syndrome Is Not Associated with the Mutation of PHOX2B Gene, a Major Causative Gene of Congenital Central Hypoventilation Syndrome

Sudden Infant Death Syndrome Is Not Associated with the Mutation of PHOX2B Gene, a Major Causative Gene of Congenital Central Hypoventilation Syndrome

Infant Arousals During Mother-Infant Bed Sharing: Implications for Infant Sleep and Sudden Infant Death Syndrome Research

Consequences of Getting the Head Covered During Sleep in Infancy

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