ABSTRACT. Retrospective analyses of patterns of breathing and heart rate variability obtained by visual inspection and spectral analysis of ECG and respiratory activity have provided markers associated with subsequent death in a referred population of infants at high risk for sudden infant death syndrome (SIDS). Such markers include breathing patterns characterized by excessive apneic pauses and periodic breathing, heart rate spectra characterized by increased low frequency oscillations, and respiratory activity spectra characterized by a widened "bandwidth" during regular breathing. To test whether such measurements could distinguish SIDS cases and randomly selected controls from a population study the data from 10 cases and 100 age-matched control subjects were analyzed blind. The code was disclosed after completion of the analysis. We found that none of the markers served to distinguish the SIDS cases from the controls in the population at large. This observation may indicate important physiological differences between infants destined to die in the referred high risk population and infants who die of SIDS at large. The possible reasons for our inability to identify the group of SIDS in the general population, as compared to the group of deaths in the referred high risk group are: (1) different disease processes in the two groups, (2) difference responses to the same disease process in the two groups, (3) a response reflecting the psychosocial setting of the referred high risk population, (4) methodological differences between this and previous studies. We conclude that these markers are not of value in screening the population at large. (Pediatr Res 20: 680-684, 1986) Abbreviations HR, heart rate SIDS, sudden infant death syndrome Received August 14, 195; accepted February 18, 1986. Correspondence Dr. D. Gordon, Pediatric Cardiology, University of Illinois at Chicago, University of Illinois Hospital Box 6998, Chicago, IL 60680.Supported by the Reynolds Foundation, the Healthdyne Company, MESCO, the McGraw Foundation, the National Foundation for Sudden Infant Death, PhysioParameters, Inc., the Scholl Foundation, NSF Grant ECS8 12 157 1, Office of Naval Research Grant N00014-80-C-0520, USAF School of Aerospace Medicine Award F33615-84-C-0601, and NASA Grant NAG2-327. JMR was supported by the U.K. Foundation for the Study of Infant Death and DPS was supported by the British Heart Foundation.Several patterns of breathing and heart rate variation have been identified in infants referred for evaluation for high risk of SIDS which appear to distinguish them from infants not at risk ( 1-3). High levels of periodic breathing and apneic pauses ( 1, 3, 4) have been identified by visual inspection of respiratory activity recordings in the high risk infant referred for evaluation. Power spectrum analysis demonstrated two spectral variables that were increased in referred high risk babies who subsequently died suddenly, unexpectedly, and without explanation (2): the power of oscillation in heart rate with a period of a...