Waking and Ventilatory Responses During Sleep in Infants N ear-Miss for Sudden Infant Death Syndrome

Ariagno, Ronald L.; Nagel, Lynn; Guilleminault, Christian

doi:10.1093/sleep/3.3-4.351

Cited by 39 publications

(8 citation statements)

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“…Together, these studies demonstrate that the infant respiratory system is sensitive to very low concentrations of CO2 well within the range of values we measured, even without the enhancement caused by the blanket. At the other, high end of the CO2 spectrum, steady state breathing of concentrations of $4% is reported to often result in infant arousal (Katz-Salamon et al, 1991;Brady et al, 1985;Ariagno et al, 1980). We never observed such high levels during any measurements.…”

Section: Discussionmentioning

confidence: 47%

Maternal proximity and infant CO2 environment during bedsharing and possible implications for SIDS research

Mosko

Richard

McKenna

et al. 1997

Am. J. Phys. Anthropol.

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Sudden infant death syndrome (SIDS) is the leading cause of human infant mortality after the neonatal period in Western countries. Recently, child care practices have been shown to be important in determining infant vulnerability to SIDS. However, very little is known about the impact of parent-infant cosleeping on infant sleep physiology and behavior and SIDS risk. This reflects the failure of Western societal research paradigms to appreciate the human infant's evolutionary history of cosleeping, the recency of the emergence of solitary infant sleeping as a practice and the fact that parent-infant cosleeping is still the preferred sleeping arrangement for the majority of contemporary societies. Incorporating current hypotheses on the mechanisms of SIDS, we have hypothesized that the comparatively sensory-rich cosleeping environment might be protective against SIDS in some contexts. As a first step to characterize cosleeping environments, this investigation is aimed at assessing, in routinely bedsharing mothers and infants, their relative sleeping positions and the potential for sleeping in close face-to face proximity and for infant exposure to increased environmental CO2 produced by maternal respiration. The latter is important in that breathing elevated levels of CO2 can have diverse effects, ranging from respiratory stimulation at low levels to suffocation at very high levels. Two related laboratory studies were performed. In the first, all-night videotapes of 12 healthy, routinely bedsharing mother-infant pairs were analyzed for sleeping positions and time spent in face-to-face orientation and distances separating their faces. Infants were 11-15 wk old. Mothers predominantly positioned themselves on their sides facing their infants, with the infants placed either supine or on their sides. Mothers and infants slept oriented face-to-face for 64 +/- 27% (S.D.) of non-movement time, with distance less than 20 cm commonly separating their faces. In the second study, concentrations of CO2 in air were measured in six young women at distances of up to 21 cm from their nares. Peak expiratory CO2 concentrations remained above 1.0% at distances up to 9 cm and above 0.5% at 18 cm. Both baseline and peak CO2 levels were further increased at all distances when measured within a partial air pocket created to simulate a bedding environment sometimes seen during bedsharing. We conclude that during bedsharing there is potential for 1) a high degree of face-to-face orientation and close proximity and consequently 2) increased environmental CO2, as a result of maternal respiration, to non-lethal levels that might stimulate infant respiration. The close proximity would also maximize the sensory impact of the mother on the infant through other modalities. We also suggest that bedsharing may minimize prone infant positioning, a known risk factor for SIDS.

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Section: Discussionmentioning

confidence: 47%

Maternal proximity and infant CO2 environment during bedsharing and possible implications for SIDS research

Mosko

Richard

McKenna

et al. 1997

Am. J. Phys. Anthropol.

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“…But Ariagno rt a/. (2) failed to find significant differences in ventilatory response to hypercarbia in NM and control infants. Moreover, Shannon et ul.…”

Section: Discussionmentioning

confidence: 92%

Nocturnal Sleep Organization in Infants “at Risk” for Sudden Infant Death Syndrome

et al. 1984

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SummaryNocturnal sleep organization was compared in normal infants and those "at risk" for sudden infant death syndrome (SIDS) (siblings and near-miss infants). Before 12 weeks of age, sleep modifications were observed in "at risk" infants. During their sleep they had a smaller percentage of intervening wakefulness with a higher amount of active sleep. Quiet and active sleep episodes had longer durations resulting in a longer sleep cycle. After 12 weeks, sleep organization tended to normalize. This fact is discussed as a possible factor for a SIDS event: a higher arousal threshold could play a critical role if homeostasy is disturbed during sleep, mainly at an age when the homeostatic control is not fully established. Abbreviations SIDS, sudden infant death syndrome W, wakefulness AS, active sleep QS, quiet sleep TS, transitional sleep C, control S, siblings NM, near-miss Polygraphic recordings in infants "at risk" for SIDS have been extensively carried out since the first Steinschneider paper (37). This author hypothesized a relationship between SIDS and apnea occurring during sleep. Therefore, most studies since then have been devoted to physiological functions during sleep such as respiratory, cardiovascular, and autonomic systems, gastrooesophageal reflux, etc. as reviewed by Hoppenbrouwers and Hodgman (19) and Kelly and Shannon (24).Sleep organization with relation to SIDS has only been taken into account in the past few years (4,12,15,31). The period between 6 and 12 weeks of age appears to be critical in the development of many physiological functions: circadian rhythm (25), body temperature [Jundell as cited by Minors and Waterhouse (29)], heart rate (14, 16), respiratory rhythm (7, 20), electrodermogram (6), as well as sleep organization (30).The aim of the present study is to compare the sleep organization of normal and "at risk" infants of about the same age corresponding to the maximum frequency of SIDS events. MATERIALS A N D METHODSNocturnal sleep organization was studied in 77 infants ages between 4 weeks and 12 months (35 boys, 42 girls). The population was distributed as follows (Table 1). There were 19 control infants (8 boys, 1 1 girls) having no pathological antecedents either personally or within the immediate family. Fifty-eight infants were "at risk" for SIDS divided into 24 siblings (9 boys, 15 girls) of an infant who died as a result of SIDS but who themselves had no personal pathology and 34 near-miss infants (18 boys, 16 girls) having suffered one or more episodes of unexplained apneawith or cyanosis necessitating vigorous stimulations or mouth to mouth resuscitation for survival.All these children were full-term babies with Apgar scores and birth weight in the normal range. Most of them had been hospitalized for at least 2 days prior to the recording session whereas only a few came directly from home in which case the mother was present in the laboratory during the entire recording night and was responsible for feedings.The 77 nocturnal polygraphic records analyzed in this study corre...

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“…lechniques for evaluation of the ventilatory response to C0 2 in infants during the first year of life are of great interest (1)(2)(3). However, both the steadystate and the rebreathing techniques are difficult to perform, as these infants strongly object to the mask or nosepiece required to obtain minute ventilation.…”

Section: Introductionmentioning

confidence: 99%

“…However, both the steadystate and the rebreathing techniques are difficult to perform, as these infants strongly object to the mask or nosepiece required to obtain minute ventilation. Investigators have, therefore, used either brief periods of inhalation of C0 2 (1,2), sedation with chloral hydrate (3,4), or techniques requiring plethysmography (5) or jackets (6) and electronic expertise. In 1980 we reported an indirect method of estimating the ventilatory response to C0 2 from the decrease in the inspired-alveolar Po 2 difference (7).…”

Section: Introductionmentioning

confidence: 99%

“…In 1980 we reported an indirect method of estimating the ventilatory response to C0 2 from the decrease in the inspired-alveolar Po 2 difference (7). This report is a comparison of 3 indirect methods: (7) changes in alveolar-inspired Pco 2 difference (AAIPco 2 ), (2) changes in inspired-alveolar Po 2 difference (AIAPo 2 ), and (5) changes in transcutaneous Po 2 (TcPo 2 ), with the standard steady-state method of measuring changes in minute ventilation in response to C0 2 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Simple Method for Estimating the Ventilatory Response to CO₂in Infants^1–³

Brady¹,

Durand²,

McCann³

1983

Am Rev Respir Dis

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We report a new noninvasive method for the estimation of CO2 response in uncooperative infants. By comparing the changes in inspired minus alveolar PO2 breathing air and 4% CO2, an indirect estimate of increase in alveolar ventilation can be obtained. This report is a comparison of 3 possible indirect methods: changes in inspired minus alveolar PCO2 (delta AIPCO2), changes in inspired minus alveolar PO2 (delta IAPO2), and changes in transcutaneous PO2 (TcPO2) with the standard steady-state method for ventilatory response to CO2. Twenty-one comparisons were made, 16 on 7 preterm infants, and 5 on an older child (at 2.5 and at 4 yr of age), with central hypoventilation syndrome. We found that changes in delta IAPO2 gave the best correlation with changes in minute ventilation (r = 0.83, p less than 0.001), that changes in delta AIPCO2 were less valid (r = 0.66, p less than 0.001), and that there was no correlation with changes in TcPO2. We conclude that changes in inspired PO2 minus alveolar PO2 can be used in uncooperative infants to estimate the ventilatory response to CO2.

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Waking and Ventilatory Responses During Sleep in Infants N ear-Miss for Sudden Infant Death Syndrome

Cited by 39 publications

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Maternal proximity and infant CO2 environment during bedsharing and possible implications for SIDS research

Maternal proximity and infant CO2 environment during bedsharing and possible implications for SIDS research

Nocturnal Sleep Organization in Infants “at Risk” for Sudden Infant Death Syndrome

A Simple Method for Estimating the Ventilatory Response to CO₂in Infants^1–³

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Waking and Ventilatory Responses During Sleep in Infants N ear-Miss for Sudden Infant Death Syndrome

Cited by 39 publications

References 0 publications

Maternal proximity and infant CO2 environment during bedsharing and possible implications for SIDS research

Maternal proximity and infant CO2 environment during bedsharing and possible implications for SIDS research

Nocturnal Sleep Organization in Infants “at Risk” for Sudden Infant Death Syndrome

A Simple Method for Estimating the Ventilatory Response to CO2in Infants1–3

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A Simple Method for Estimating the Ventilatory Response to CO₂in Infants^1–³