Arousals in Infants

Thach, Bradley T.; Lijowska, Anna S.

doi:10.1093/sleep/19.suppl_10.s271

Cited by 36 publications

(30 citation statements)

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“…The sighs could represent incomplete or partial arousal reactions, as has been observed previously (26,27). When combining the number of sighs and behavioral arousals, 91.5% of supine and 76% of prone infants would have either a partial or a complete arousal.…”

Section: Discussionsupporting

confidence: 56%

“…Factors known to increase the risks for SIDS, such as prone sleeping (9 -11, 29), prenatal exposure to cigarette smoke (30), high environmental temperature (31), or the use of sedative medications (32) were also associated with lower arousability. Arousal from sleep represents an autoresuscitative mechanism (26). A decreased propensity to arouse following obstructive sleep apneas could increase the risk to become victim of a life-threatening event, such as obstructive sleep apneas.…”

Section: Discussionmentioning

confidence: 99%

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Reduced Arousals Following Obstructive Apneas in Infants Sleeping Prone

et al. 2001

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A decreased arousability and an increased risk for sudden infant death syndrome (SIDS) have been shown in infants sleeping prone. Obstructive apnea, a known risk factor for SIDS, is less often terminated by an arousal reaction in infants than in adults. The effect of body position on the arousal reaction to spontaneous respiratory events had not been previously studied in infants. The aim of our study was to see if body position has an influence on the frequency and delay of the arousal reaction to obstructive apnea. All obstructive events recorded during two successive nights in 20 infants sleeping one night prone and one night supine were studied. During the supine recording 153 obstructive events were detected, and 217 were detected during the prone session. Prone sleep was not associated with an increased frequency of obstructive apneas. Total sleep time was 382 min (range, 283-456) supine and 423 min (range, 325-521) prone (p ϭ 0.003). Obstructive events duration was 6.5 s (range, 3-21.5) when sleeping supine and 8 s (range, 3.5-30.5) when prone (p ϭ 0.002). Behavioral arousal were found in 57.5% of obstructive events recorded supine and in 31.3% of those seen prone (p Ͻ 0.001). Arousal occurred after 8 s (range, 0 -21) from the start of the obstructions when supine and 10.5 s (range, 3.5-23.5) when prone (p ϭ 0.001). Sighs were found in 34% of supine obstructive events and in 44.7% of those prone (p ϭ 0.040). A reaction, i.e. arousal or sigh, was found in 91.5% of supine events and 76% of those prone (p Ͻ 0.001). We conclude that when sleeping supine, infants arouse to obstructive events more often and after shorter delay than when prone. An impaired arousability from sleep was postulated to contribute to the occurrence of SIDS (1). Prospective sleep studies showed that infants who eventually died of SIDS had less body movements and aroused less frequently from sleep than control subjects (2-4). Infants considered at risk for SIDS had higher arousal thresholds for respiratory, tactile, and visual stimuli than control infants (1, 5-8). Normal infants studied in risk conditions for SIDS, such as sleeping prone, aroused less frequently (9), had higher arousal thresholds (10), and less cardiac variability (11) than when sleeping supine.Future SIDS victims were also shown to have more frequent and longer obstructive sleep apneas than control subjects (2). In adults, obstructive apneas are often terminated by an arousal (12). Such apnea-induced arousals were reported to occur less frequently in infants (13,14), although most studies did not take in account the potential contributing effect of body position.The aim of the present study was to determine whether infants sleep position influences the cardiac and arousal responses following obstructive sleep apneas. METHODS Patients.Twenty-two successive infants with repeated obstructive sleep apnea were investigated (Table 1). The apneas had been identified during polygraphic sleep recordings, done during various sleep research studies on infants' cardiorespiratory ...

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Reduced Arousals Following Obstructive Apneas in Infants Sleeping Prone

et al. 2001

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“…It is generally thought that arousal from sleep, either spontaneously occurring, or in response to an external stimulus, is mediated by 1) ascending cholinergic, serotonergic, noradrenergic, and histaminergic pathways necessary for "cortical" arousal and 2) descending pathways that modulate breathing, spinal motor activity, and sympathetic activity that controls body temperature, heart rate and blood pressure, components of "subcortical" arousals. Thach and colleagues (54,55,68) described an "arousal sequence" in human infants in response to hypercapnia and tactile stimuli that consists of a spinal withdrawal, followed by an augmented breath, a startle (all subcortical events), and finally a change in the EEG and full awakening. We have described this same sequence in the newborn piglet (12).…”

Section: Discussionmentioning

confidence: 99%

Arousal from sleep in response to intermittent hypoxia in rat pups is modulated by medullary raphe GABAergic mechanisms

Darnall¹,

Schneider²,

Tobia³

et al. 2012

American Journal of Physiology-Regulatory, Integrative and Comp

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Darnall RA, Schneider RW, Tobia CM, Zemel BM. Arousal from sleep in response to intermittent hypoxia in rat pups is modulated by medullary raphe GABAergic mechanisms. Am J Physiol Regul Integr Comp Physiol 302: R551-R560, 2012. First published December 7, 2011; doi:10.1152/ajpregu.00506.2011Arousal is an important defense against hypoxia during sleep. Rat pups exhibit progressive arousal impairment (habituation) with multiple hypoxia exposures. The mechanisms are unknown. The medullary raphe (MR) is involved in autonomic functions, including sleep, and receives abundant GABAergic inputs. We hypothesized that inhibiting MR neurons with muscimol, a GABA A receptor agonist, or preventing GABA reuptake with nipecotic acid, would impair arousal and enhance arousal habituation and that blocking GABA A receptors with bicuculline would enhance arousal and attenuate habituation. Postnatal day 15 (P15) to P25 rat pups were briefly anesthetized, and microinjections with aCSF, muscimol, bicuculline, or nipecotic acid were made into the MR. After a ϳ30-min recovery, pups were exposed to four 3-min episodes of hypoxia separated by 6 min of normoxia. The time to arousal from the onset of hypoxia (latency) was determined for each trial. Latency progressively increased across trials (habituation) in all groups. The overall latency was greater after muscimol and nipecotic acid compared with aCSF, bicuculline, or noninjected controls. Arousal habituation was reduced after bicuculline compared with aCSF, muscimol, nipecotic acid, or noninjected pups. Increases in latency were mirrored by decreases in chamber [O2] and oxyhemoglobin saturation. Heart rate increased during hypoxia and was greatest in muscimol-injected pups. Our results indicate that the MR plays an important, not previously described, role in arousal and arousal habituation during hypoxia and that these phenomena are modulated by GABAergic mechanisms. Arousal habituation may contribute to sudden infant death syndrome, which is associated with MR serotonergic and GABAergic receptor dysfunction.␥-aminobutyric acid; sudden infant death syndrome; GABAA receptor; habituation IN HUMAN INFANTS, AROUSAL is an important protective mechanism against hypoxia during sleep. Spontaneous arousals and those in response to exogenous stimuli are affected by many factors: sleep position (3, 29, 37), sleep efficiency (30), prenatal exposure to cigarette smoking (28, 38), and stage of development (39). It has been hypothesized that arousal impairment may play an important role in the etiology of sudden infant death syndrome (SIDS) (32,40,43,46). Moreover, many SIDS infants have repeated episodes of apnea and hypoxia in the days or weeks prior to death (44,56). We propose that repeated exposure to hypoxia during sleep leads to progressive lengthening of the time to arousal in response to hypoxia that might contribute to sudden death.We and others have shown in newborn and infant rodents (17, 18, 21), lambs (25,41,42), and piglets (71) that repeated brief exposures to mild hypoxia result in...

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“…15 We used a different sequence of stimulus to other groups. 15 24 Although any stimulus produces a similar sequence of movement arousal regardless of type, 12 care must be taken to avoid additional stimuli during testing. We chose an auditory stimulus calibrated and delivered at a distance of 20 cm from the level of the infant's ears and operated from a computer distant to the infant to minimise such errors.…”

Section: Discussionmentioning

confidence: 99%

“…11 An alternative stimulus is an audiology stimulus, as the sequence of movement arousal is similar and reproducible, regardless of the stimulus type. 12 Using auditory stimuli during rapid eye movement (REM) sleep, Franco and colleagues had previously shown that decreased arousability is found in infants in the prone position, 13 who did not use pacifiers, 14 and with in utero tobacco smoke exposure. 15 To our knowledge there are no published data on arousibility to audiology in both REM and non-REM (NREM) sleep during the age when the incidence of SIDS is highest.…”

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confidence: 99%

Altered arousal response in infants exposed to cigarette smoke

Chang

2003

Archives of Disease in Childhood

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Aims: A failure of the arousal mechanism is a key feature in the apnoea theory for sudden infant death syndrome (SIDS). In infants studied at an age when the incidence of SIDS is highest, we evaluated whether in utero smoke exposed infants have altered arousal response to standardised auditory stimuli, and/or sleep pattern, as recorded on overnight complex sleep polysomnography. Methods: A standardised sequence of audiology stimuli was applied binaurally to 20 in utero smoke and non-smoke exposed infants aged 8-12 weeks during a rapid eye movement (REM) and NREM epoch, in a controlled (temperature, position, pacifier use, noise) sleep environment. Infants were monitored for 10-12 hours using complex sleep polysomnography. Results: Five infants exposed to in utero tobacco smoke did not have behavioural arousal response, whereas all non-smoke exposed infants aroused during NREM (p = 0.016). There was, however, no difference in REM sleep, and the groups did not differ in routine overnight complex sleep polysomnography parameters. Conclusion: At the age when the incidence of SIDS is at its peak, infants of smoking mothers are less rousable than those of non-smoking mothers in NREM sleep; this may partly explain why such infants are more at risk of SIDS.

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Arousals in Infants

Cited by 36 publications

References 0 publications

Reduced Arousals Following Obstructive Apneas in Infants Sleeping Prone

Reduced Arousals Following Obstructive Apneas in Infants Sleeping Prone

Arousal from sleep in response to intermittent hypoxia in rat pups is modulated by medullary raphe GABAergic mechanisms

Altered arousal response in infants exposed to cigarette smoke

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