Arterial oxygen saturation in infants at risk of sudden death: influence of sleeping position

Abstract

To study the possible influence of sleeping position on arterial oxygen saturation, measured by pulse oximetry (SpO2), 7-h overnight recordings of breathing movements and ECG were performed in 43 infants (median age 2.4 months, range 0.2-11 months) at increased risk of sudden infant death syndrome (SIDS). Infants were randomly allocated to start sleeping either in their usual sleeping position or in the opposite position. After 3.5 h, all infants were gently turned over. Thus, each infant served as their own control. Recordings were analysed for sleep time, baseline SpO2 (only during regular breathing), and the number and duration of desaturations (a decrease in SpO2 to < or = 80%). In the prone position, a significantly higher proportion of time was spent asleep (median 79% versus 70%; p < 0.05). Median baseline SpO2 was 98.8% (91.7-100%) in the prone and 99.0% (92.0-100%) in the supine position (ns). A total of 191 desaturations were found in 29 recordings; 96 in the prone and 95 in the supine position (ns). One infant subsequently died of SIDS while sleeping in the prone position. He had a relatively high number of desaturations (n = 12) which all occurred in the prone position. These results confirm earlier studies which could not find a significant influence of sleeping position on baseline oxygenation. The occurrence of desaturations in the prone position only in the infant who subsequently died requires further investigation.

Epidemiological features of sudden infant death after a German intervention campaign in 1992

“…Besides, causal factors include rebreathing of expired air when laying facedown [6,40], possibly in combination with cushions used before death [39], as can be seen from our data. It has been reported, however, that arterial oxygen saturation in the prone and supine position were similar [57]. Moreover, complete covering of the head is a predominant risk factor for cot death in our study, where 95.5% of all babies who were entirely covered by their blanket have been found facedown.…”

Pulse Oximetry Monitoring of Infants Who Require Prone Position For Sleep – Is There Evidence That This Practice Reduces SIDS?

“…30,31 The second search: 'infant AND prone AND pulse oximet* AND SIDS' resulted in three papers. 30,32,33 Removing infant from the search for 'prone AND pulse oximet* AND SIDS' yielded the same three results. 30,32,33 Expanding the search to the general PubMed database (not limited to the Clinical Queries section) with the limit of infant (age birth -23 months) and the search strategy: 'pulse oximetry AND prone AND SIDS' yielded five papers.…”

“…The Sahni et al 30 study examined low birth weight (LBW) and the Saiki et al 34 and Poets et al 32 studies examined premature babies, both of which are populations at increased risk of SIDS 8 and therefore not relevant to our population of interest. The Poets et al study from 1995 33 also included babies at increased risk of SIDS, either because they were premature, had a sibling who died of SIDS, or had a suspected airway obstruction. Furthermore, Poets et al found no significant differences in oxygen desaturations measured 32 while Saiki et al 34 found no significant differences in oxygen saturation levels between prone or supine position lying infants.…”

“…30,32,33 Expanding the search to the general PubMed database (not limited to the Clinical Queries section) with the limit of infant (age birth -23 months) and the search strategy: 'pulse oximetry AND prone AND SIDS' yielded five papers. 30,31,[33][34][35] In summary, a total of six unique papers were identified [30][31][32][33][34][35] from the literature search which could possibly address the question.…”

Birth Weight- and Gestational Age-Specific Sudden Infant Death Syndrome Mortality: United States, 1991 Versus 1995

“…Studies in preterm infants of Ͼ36 weeks of postconceptional age who are no longer experiencing respiratory distress, as well as in term infants, have not demonstrated improved oxygenation in the prone position. [22][23][24] Thus, there should be no particular advantage to prone sleeping for preterm infants who have resolved their respiratory distress at the time of discharge. In addition, the observations that prone sleeping is associated with deeper levels of sleep may put the somewhat weaker and less mobile preterm at greater risk of being trapped in a position from which it cannot extract itself.…”