Polysomnographic studies and home monitoring of siblings of SIDS victims and of infants with no family history of sudden infant death

Abstract

We report preliminary results of a prospective study conducted to prevent sudden death in asymptomatic infants. From 1977-1984, 3658 infants were studied polygraphically. There were 923 siblings of SIDS victims and 2735 infants with no personal of family history of SIDS. The infants were studied at 8 weeks of age. Polygraphic "risk factors" were defined by central apnoeas longer than 15 s; periodic breathing above 5% sleep time; or obstructive apnoeas above 3 s. In 937 infants "risk factors" were seen and a second study was requested 4 weeks later. Out of 891 infants re-studied at 12 weeks, 153 still presented some "risk factors" and were selected for a home monitoring programme; 150 families agreed to monitor their infants at home with a cardiorespiratory monitor with the alarms set at 20 s apnoea, and 50 beats per min bradycardia. Repeated alarms were reported for 97/150 (65%) infants; 48/150 (32%) infants were stimulated and 8/150 (5.3%) were resuscitated on at least one occasion. No death occurred during monitoring, which could be interrupted before the end of the first year of life in all infants. In the group of 3459 infants with normal results and not monitored, three siblings (0.35%) and one infant without history (0.04%) died of SIDS. Of the infants with abnormal polygraphic results, one sibling not returned for the second recording, and two out of three infants for whom the parents refused monitoring, died of SIDS. It is concluded that the programme, may prevent the death of some infants, but that the outcome of a child with normal results cannot be foreseen.

Impact of home monitoring for sudden infant death syndrome on family life

“…We believed, however, that such an approach would be ethically unacceptable, as we had strong supportive evidence that home monitoring could prevent an untoward outcome in some children at risk. This favourable impression has recently been confirmed by Davidson et al [3], and by ourselves [7].…”

Can home monitoring reduce mortality in infants at increased risk of sudden infant death syndrome? A systematic review

“…Kahn et al. (25,29) reported four un‐monitored deaths in a background population of 3459 (1.2 per 1000) who were considered at low risk for SIDS after undergoing a polygraphic study and two deaths in three infants whose parents refused home monitoring. Finally, Ramanathan et al.…”

“…Nevertheless, cohort studies conducted by Kahn et al. (25,29) and Sivan et al. (26) suggest that home monitoring may help to reduce SIDS rates in at risk infants.…”

“…The anxiety faced by the parents of a child with a previous ALTE or of parents who have experienced a previous SIDS death is well known. Home monitoring can be stressful; some parents report that the use of such devices actually increases anxiety levels (25,26). However, many parents with a previous SIDS death may feel more anxious if a request for a home monitor is turned down.…”

Evaluation of periodic breathing in infants

“…So wurden bei SID-Geschwisterkindern [21,26] und ALTE-Kindern (ALTE = apparently life threatening event) [20,24,32] im frtihen S~iuglingsaiter erh6hte Werte ftir den Anteil periodischer Atmung beschrieben. Im Vergleich zu Reifgeborenen wurde bei mehr ehemaligen Frtihgeborenen (32,2-36,6 SSW) im Konzeptionsalter von 40 Wochen periodische Atmung nachgewiesen (75% vs. 42%).…”