Incomplete Arousal Processes in Infants Who Were Victims of Sudden Death

Kato, Ineko; Franco, Patricia; Groswasser, José; Scaillet, Sonia; Kelmanson, Igor A.; Togari, Hajime; Kahn, André

doi:10.1164/rccm.200301-134oc

Cited by 155 publications

(117 citation statements)

References 45 publications

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“…Maternal smoking is a well‐known environmental factor that makes it more difficult for the vulnerable child to respond when oxygen saturation falls 25 and both the SIDS and explained deaths showed higher frequencies than comparable national Swedish figures (10%). The fact that maternal smoking is more common in SIDS than in SUDI has been reported before in two major case–control studies.…”

Section: Discussionmentioning

confidence: 95%

Bed sharing is more common in sudden infant death syndrome than in explained sudden unexpected deaths in infancy

et al. 2015

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AimDespite its declining incidence, sudden infant death syndrome (SIDS) is still an important cause of death in infancy. This study investigated the environmental circumstances associated with SIDS, by analysing data from all sudden unexpected deaths in infancy (SUDI) in Sweden from 2005 to 2011.MethodsAll Swedish infants forensically autopsied up to the age of 365 days from 2005 to 2011 were included. Medical records were obtained from the hospitals and supplementary data from the Swedish Medical Birth Register.ResultsOf the 261 infants, 136 were defined as SIDS and 125 as explained SUDI. The documentation in the medical records was poor when it came to issues such as bed sharing, sleep position, smoking, breastfeeding and pacifier use. The main findings were a significantly higher prevalence of bed sharing in SIDS than in explained deaths (odds ratio 7.77, 95% confidence interval 2.36–25.57) and that prone sleeping was still overrepresented. Bronchopneumonia, other infections and congenital anomalies were the most common causes of explained SUDI.ConclusionBed sharing and prone sleeping were more common in SIDS than in explained SUDI. Sparse data in medical records were a problem, and the authors are now working with the National Board of Health and Welfare on a project to establish new routines.

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Section: Discussionmentioning

confidence: 95%

Bed sharing is more common in sudden infant death syndrome than in explained sudden unexpected deaths in infancy

et al. 2015

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“…A feature of REM sleep is an almost complete absence of medullary 5-HT firing; this may be implicated in failure of autoresuscitation (4,61). Future SIDS victims showed significant alterations in sleep architecture compared to controls (Figure 1, "Prone Sleep, 5-HT defect"), with more REM in early life (62), and increased subcortical arousals during REM sleep and decreased cortical arousals (9,63). Sleep architecture itself may be subject to epigenetic adaptation in development: infants with previous ALTE had disturbances in "cyclic alternating pattern" of sleep (64).…”

Section: Hypothesized Mechanism For Sids Protection By Supine Sleepmentioning

confidence: 99%

Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

Bergman

2014

Pediatr Res

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Supine sleep decreases sudden infant death syndrome (SIDS) incidence, however the mechanisms for this are unclear. The triple risk model for SIDS requires that one or more underlying abnormalities of breathing or autonomic control are present; these are rare, but brainstem defects are found in most SIDS cases. Supine sleep increases sympathetic nervous system tone, and level of state organization, and may therefore act as a stressor. This is evidenced by physiological arousal, and by delayed neurodevelopment in supine compared to prone sleepers. It is argued here that prone sleep position is the biological normative standard in healthy infants, supporting autonomic regulation. During rapid eye movement (REM) sleep (and other circumstances), a parasympathetic-mediated adverse autonomic event (AAE) may be spontaneously triggered. In healthy infants, gasping initiates autoresuscitation and recovery. Hypothesis: the underlying vulnerability to SIDS is specific to autoresuscitation from an AAE, the initial serotonin-dependent gasp is commonly compromised. Serotonin metabolism defects also influence sleep architecture, increasing the likelihood of AAE. The mechanism whereby supine sleep decreases SIDS may therefore be a stressor effect, disturbing sleep architecture to decrease REM and AAEs, and increasing sympathetic tone, which may prevent and counteract the purely parasympathetic-mediated AAE, thereby decreasing the risk of SIDS.

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“…4 SIDS peaks in incidence at 2 to 4 months of age 5,6 and is believed to involve an uncompensated cardiovascular event presumed to occur during sleep, in conjunction with failure of the life-saving arousal response. [7][8][9][10][11] Preterm infants exhibit immature cardio-respiratory control, which persists past term-equivalent age, 12 is related to gestational age (GA) at birth, 13,14 and may contribute to their heightened risk for SIDS. 15 Prone sleeping is a major risk factor for SIDS, particularly among infants born preterm.…”

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confidence: 99%

“…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. 30 However, little is known about cerebral oxygenation in preterm infants during the period of greatest SIDS risk.…”

mentioning

confidence: 99%

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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Incomplete Arousal Processes in Infants Who Were Victims of Sudden Death

Cited by 155 publications

References 45 publications

Bed sharing is more common in sudden infant death syndrome than in explained sudden unexpected deaths in infancy

Bed sharing is more common in sudden infant death syndrome than in explained sudden unexpected deaths in infancy

Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

Cerebral Oxygenation in Preterm Infants

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