Cerebral Oxygenation Is Depressed During Sleep in Healthy Term Infants When They Sleep Prone

Wong, Flora Yuen-Wait; Witcombe, Nicole B.; Yiallourou, Stephanie; Yorkston, Sophie; Dymowski, Alicia Rhian; Krishnan, Lalitha; Walker, Adrian M.; Horne, Rosemary Sylvia Claire

doi:10.1542/peds.2010-2724

Cited by 74 publications

(62 citation statements)

References 38 publications

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“…22 At 2 to 4 weeks CA cerebral TOI was lower in AS compared with QS, at 2 to 3 months no effect of sleep state was observed and at 5 to 6 months CA cerebral TOI was higher in AS compared with QS. We suggest that this agerelated progression is due to maturation of CBF-metabolism coupling during this period.…”

Section: Effects Of Sleep Statementioning

confidence: 80%

“…Term infants were all studied at 3 ages: 2 to 4 weeks, 2 to 3 months, and 5 to 6 months chronological age, and data from this study have previously been published. 22,23 …”

Section: Subjectsmentioning

confidence: 99%

“…22 Cerebral TOI reflects the ratio of oxygenated to deoxygenated hemoglobin (Hb) in the cerebral vasculature and is largely influenced by changes in the cerebral venous compartment because of its greater volume relative to the arterial compartment. Thus impaired cerebral venous drainage, resulting in venous congestion, may contribute to the reduction in cerebral TOI seen in the prone position.…”

Section: Effects Of Sleep Positionmentioning

confidence: 99%

“…50,51 In the mature brain, CBF usually overshoots the metabolic demands of AS resulting in an increase in oxygenated Hb relative to deoxygenated Hb and therefore increased cerebral TOI. 52 At 2 to 4 weeks CA, the CBF-metabolism coupling response appears to be relatively immature with inadequate increases in CBF 22 during AS resulting in increased oxygen extraction, increased deoxygenated Hb, and decreased cerebral TOI. The reversal of this observation at 5 to 6 months CA suggests that maturation of CBF-metabolism coupling is occurring during this period.…”

Section: Effects Of Sleep Statementioning

confidence: 99%

“…2,16 Term infants sleeping prone have alterations in cardiovascular control, [17][18][19][20][21] and we have previously demonstrated that this is reflected in the cerebral circulation, expressed as reduced cerebral oxygenation and altered cerebrovascular control. 22,23 It has been suggested that reduced cerebral oxygenation may contribute to impaired arousal, 22 which is seen in the prone position in both term 18,24 and preterm infants [25][26][27] and is likely to be significant in the pathophysiology of SIDS. 10,28 Preterm infants display immature cerebrovascular control before termequivalent age, [29][30][31][32] the severity of which is related to their GA at birth.…”

mentioning

confidence: 99%

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Cerebral Oxygenation in Preterm Infants

et al. 2014

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BACKGROUND AND OBJECTIVE: Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS) and preterm infants are at significantly increased risk. In term infants, prone sleeping is associated with reduced mean arterial pressure (MAP) and cerebral tissue oxygenation index (TOI). However, little is known about the effects of sleeping position on TOI and MAP in preterm infants. We aimed to examine TOI and MAP in preterm infants after term-equivalent age, during the period of greatest SIDS risk. METHODS: Thirty-five preterm and 17 term infants underwent daytime polysomnography, including measurement of TOI (NIRO-200 spectrophotometer, Hamamatsu Photonics KK, Japan) and MAP (Finapress Medical Systems, Amsterdam, Netherlands) at 2 to 4 weeks, 2 to 3 months, and 5 to 6 months postterm age. Infants slept prone and supine in active and quiet sleep. The effects of sleep state and position were determined by using 2-way repeated measures analysis of variance and of preterm birth by using 2-way analysis of variance. RESULTS: In preterm infants, TOI was significantly lower when prone compared with supine in both sleep states at all ages (P < .05). Notably, TOI was significantly lower in preterm compared with term infants at 2 to 4 weeks, in both positions (P < .05), and at 2 to 3 months when prone (P < .001), in both sleep states. MAP was also lower in preterm infants in the prone position at 2 to 3 months (P < .01). CONCLUSIONS: Cerebral oxygenation is reduced in the prone position in preterm infants and is lower compared with age-matched term infants, predominantly in the prone position when MAP is also reduced. This may contribute to their increased SIDS risk.

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Section: Effects Of Sleep Statementioning

confidence: 80%

“…Term infants were all studied at 3 ages: 2 to 4 weeks, 2 to 3 months, and 5 to 6 months chronological age, and data from this study have previously been published. 22,23 …”

Section: Subjectsmentioning

confidence: 99%

Section: Effects Of Sleep Positionmentioning

confidence: 99%