Auditory arousal thresholds are higher when infants sleep in the prone position

Franco, Patricia; Pardou, Anne; Hassid, Sergia; Lurquin, P; Groswasser, José; Kahn, André

doi:10.1016/s0022-3476(98)70438-x

Cited by 114 publications

(57 citation statements)

References 21 publications

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“…Our findings confirm the apparent differences in arousal between prone and supine sleep position, previously shown by Groswasser et al 27 which examined arousals after obstructive apnea events; and Franco et al 13 and Horne et al 11 in their study of arousal threshold after auditory and air-jet provoked arousals in term infants. In this study, we found a higher frequency of spontaneous arousals during supine sleep position which is consistent with previous reports for different evoked arousals.…”

Section: Discussionsupporting

confidence: 92%

“…In this study, we found a higher frequency of spontaneous arousals during supine sleep position which is consistent with previous reports for different evoked arousals. 11,13,22,[28][29][30][31] Horne et al, 10 found increased threshold of air jet applied alternately to the nares induced arousals during prone sleep in preterm infants at 2 to 3 months but not at 5 to 6 months of age. This finding may be important since it shows a decrease in arousal at 2 to 4 months, which is the period of greatest vulnerability for SIDS (2 to 4 months).…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Several recent papers have shown that the response to an external stimulus (provoked arousal) is greater during supine (i.e., infants were more responsive) compared with prone sleeping position for preterm and term infants. [10][11][12][13] In this paper, we have studied spontaneous arousal during both prone and supine sleep and have carried out a secondary analysis in a subgroup of preterm infants in whom we reported the effect of sleep position on sleep organization, duration and heart rate variability at 1 and 3 months of age. 8 We hypothesized that the intervals between arousals would be longer, and the duration of the arousals shorter in prone vs supine position as has been previously reported by others during provoked arousals.…”

Section: Introductionmentioning

confidence: 99%

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Fewer spontaneous arousals during prone sleep in preterm infants at 1 and 3 months corrected age

2006

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Objective: This study was performed to determine if there were fewer spontaneous arousals in prone sleep than in supine sleep.Study design: Home polysomnography/video recordings were done during daytime naps in 14 preterm infants: four at corrected age of 1 month, nine at both 1 and 3 months, and one only at 3 month. A body movement lasting 3 to 60 s during sleep was used as an indicator of spontaneous arousals.Results: Most arousals had a heart rate increase and change in respiration pattern. The mean duration of the intervals between successive arousals in active and quiet sleep was significantly longer in prone at 1 and 3 months of age. The duration of arousals was significantly shorter at 3 months corrected age compared with one month corrected age during active sleep. The duration of arousals was shorter during quiet sleep at one month compared with active sleep.Conclusion: There were fewer spontaneous arousals that is, longer interval between successive arousals in prone, which may, in part, explain the increase in risk of Sudden Infant Death Syndrome.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fewer spontaneous arousals during prone sleep in preterm infants at 1 and 3 months corrected age

2006

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“…The mechanism by which position affects neonatal state calls for continued investigation. Prior research indicates that autonomic 17,32 as well as cardiorespiratory and somatosensory 33,34 effects contribute to the quieting response. Future exploration may consider the functional integration of these systems and attempt to specify the neurochemical dimensions of pronate quieting.…”

mentioning

confidence: 99%

“…The positive consequences of prone position for sleep include: fewer awakenings and increased time in quiet sleep, 9,10 more sleep with higher arousal thresholds, [11][12][13] lower levels of activity, 14,15 enhanced respiratory control, 16 -18 and diminished heart rate variability. 11,17 Newborns laid prone cry much less than supine-lying infants 11 and have decreased energy requirements. 19 -21 Although the precise physiological mechanism constituting the pronate quieting response has not been elucidated, the phenomenon has been put to good purpose by investigators concerned with preserving the preterm or high-risk infant's often precarious metabolic margin.…”

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confidence: 99%

Use of Positioning to Reduce the Severity of Neonatal Narcotic Withdrawal Syndrome

1999

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OBJECTIVE:This study tested the hypothesis that highly fretful, narcotic-withdrawing neonates experience less distress in a prone-lying position than comparable, supine-lying neonates. STUDY DESIGN:Equivalent numbers of randomly assigned, narcotic-withdrawing newborns were assigned to prone-lying (n ϭ 25) or supine-lying (n ϭ 23) conditions. Subjects in the two groups were similar with regard to gestational age, birth weight, and clinical presentation. Peak and mean withdrawal severity, as measured by Neonatal Abstinence Scoring System (NASS) scores and daily caloric intake, were compared between supine and prone groups by Wilcoxon's two-sample test. RESULTS:The prone-lying neonates had lower peak NASS scores (p Ͻ 0.0001), lower mean NASS scores (p Ͻ 0.0001), and lower caloric intake (p Ͻ 0.001) than supine-lying, narcotic-withdrawing newborns. CONCLUSION:The fretfulness associated with neonatal withdrawal and other stressful conditions can be moderated by laying the affected infant prone. The pronate quieting response is a significant, endogenous source of neonatal pacification.Within the first days of life, most infants born to narcotic-dependent women experience a stressful withdrawal syndrome marked by tremor, sleeplessness, hypertonia, irritability, and autonomic and gastrointestinal symptoms. 1,2 Moderate to severe neonatal withdrawal is associated with increased mortality and morbidity 3,4 and is typically treated with low-dose opiates (paregoric, tincture of opium) or barbiturates (phenobarbital) and behavioral interventions such as swaddling, rocking, and increased feeding. 5,6 Even when treated aggressively, neonatal withdrawal can require lengthy intervention and persist for weeks in a subacute form. 7,8 Over the past 25 years, numerous studies have confirmed that infants laid prone enjoy a range of behavioral and physiological advantages. The positive consequences of prone position for sleep include: fewer awakenings and increased time in quiet sleep, 9,10 more sleep with higher arousal thresholds, 11-13 lower levels of activity, 14,15 enhanced respiratory control, 16 -18 and diminished heart rate variability. 11,17 Newborns laid prone cry much less than supine-lying infants 11 and have decreased energy requirements. 19 -21 Although the precise physiological mechanism constituting the pronate quieting response has not been elucidated, the phenomenon has been put to good purpose by investigators concerned with preserving the preterm or high-risk infant's often precarious metabolic margin. [22][23][24] Interestingly, the pronate quieting response has not been investigated with infants who are among the most consistently fretful, sleep-fractured of newborns -infants withdrawing from prenatal exposure to narcotics.We hypothesized that newborns undergoing neonatal withdrawal, an acutely stressful, protracted, excitability syndrome, would be positively affected by position; we predicted that withdrawing newborns laid prone (face down) for sleep would be less symptomatic than similar neonates laid supine...

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