Sleep and Cardiorespiratory Characteristics of Infant Victims of Sudden Death: A Prospective Case-Control Study

Kahn, André; Groswasser, José; Rebuffat, Elisabeth; Sottiaux, Martine; Blum, Denise; Foerster, Matthew; Franco, Patricia; Bochner, A.; Alexander, Marc; Bachy, A; Richard, Ph.; Verghote, Marc; Polain, D. Le; Wayenberg, Jean-Louis

doi:10.1093/sleep/15.4.287

Cited by 261 publications

(146 citation statements)

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“…This position did not increase SIDS risk in the present study. Sleeping in prone position, one of the main risk factor for SIDS, [8][9][10] was similar in both SIDS and non-SIDS cases studied.…”

Section: Discussionmentioning

confidence: 98%

Risk factors for sudden infant death syndrome in a developing country

2008

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OBJECTIVE:To analyze whether previously identifi ed risk factors for sudden death syndrome have a signifi cant impact in a developing country. METHODS:Retrospective longitudinal case-control study carried out in Porto Alegre, Southern Brazil. Cases (N=39) were infants born between 1996 and 2000 who died suddenly and unexpectedly at home during sleep and were diagnosed with sudden death syndrome. Controls (N=117) were infants matched by age and sex who died in hospitals due to other conditions. Data were collected from postmortem examination records and questionnaires answers. A conditional logistic model was used to identify factors associated with the outcome. RESULTS:Mean age at death of cases was 3.2 months. The frequencies of infants regarding gestational age, breastfeeding and regular medical visits were similar in both groups. Sleeping position for most cases and controls was the lateral one. Supine sleeping position was found for few infants in both groups. Maternal variables, age below 20 years (OR=2, 95% CI: 1.1; 5.1) and smoking of more than 10 cigarettes per day during pregnancy (OR=3, 95% CI: 1.3; 6.4), signifi cantly increased the risk for the syndrome. Socioeconomic characteristics were similar in both groups and did not affect risk. CONCLUSIONS:Infant-maternal and socioeconomic profi les of cases in a developing country closely resembled the profi le described in the literature, and risk factors were similar as well. However, individual characteristics were identifi ed as risks in the population studied, such as smoking during pregnancy and maternal age below 20 years. Sudden infant death syndrome (SIDS) is defi ned as "the sudden death of any infant under one year of age which remains unexplained after a thorough case investigation, including complete postmortem examination, review of clinical history and examination of death scene." 23 The pathology of SIDS has not been established, but many hypotheses have been raised in the last years. 19 Advances in the knowledge about SIDS are associated with the identifi cation of environmental risk factors, the so-called "triggers," that may favor this lethal outcome in an organically predisposed child. 7 Currently, many risk factors are associated with SIDS, some of which are definitely correlated with this syndrome. The implications of other factors, however, still need to be further explored. Prone sleeping position and maternal smoking are wellestablished risk factors for SIDS in developed countries. A 50% reduction in SIDS incidence in countries that have adopted the recommendation of supine sleeping position is well documented in the literature. 2,4 Pediatricians and health providers in developing countries, such as Brazil, have little knowledge on risk RESUMO OBJETIVO: Analisar se fatores de risco previamente identifi cados para a síndrome da morte súbita do lactente têm impacto signifi cativo em um país em desenvolvimento. DESCRIPTORS MÉTODOS:Estudo retrospectivo, longitudinal, de caso-controle pareado realizado em Porto Alegre, RS. Os cas...

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Section: Discussionmentioning

confidence: 98%

Risk factors for sudden infant death syndrome in a developing country

2008

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“…Genetic factors and defects that contribute to the "underlying abnormality" are included as intrinsic factors. A common feature seen in rare instances where recordings are available during the death, is profound bradycardia with inadequate gasps (8,9), an adverse autonomic event from which there is a failure to autoresuscitate (10,11). The deficiency in serotonin and other related neurotransmitters and pathways are implicated in this failure (5), with effective gasping being "vulnerable to disruption by much smaller defects in multiple neurotransmitter systems" (page 533) (4).…”

Section: Aap Policy and Triple Risk Modelmentioning

confidence: 99%

“…Kohyama identifies the inhibitory phase of REM sleep as being the key period of risk in SIDS and ALTE (apparent life-threatening event) subjects (60); in polygraphic sleep recordings of future SIDS victims Kahn found that 78% of events with apnoeas and bradycardia occurred during REM sleep (9). A feature of REM sleep is an almost complete absence of medullary 5-HT firing; this may be implicated in failure of autoresuscitation (4,61).…”

Section: Hypothesized Mechanism For Sids Protection By Supine Sleepmentioning

confidence: 99%

“…A feature of REM sleep is an almost complete absence of medullary 5-HT firing; this may be implicated in failure of autoresuscitation (4,61). Future SIDS victims showed significant alterations in sleep architecture compared to controls (Figure 1, "Prone Sleep, 5-HT defect"), with more REM in early life (62), and increased subcortical arousals during REM sleep and decreased cortical arousals (9,63). Sleep architecture itself may be subject to epigenetic adaptation in development: infants with previous ALTE had disturbances in "cyclic alternating pattern" of sleep (64).…”

Section: Hypothesized Mechanism For Sids Protection By Supine Sleepmentioning

confidence: 99%

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Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

Bergman

2014

Pediatr Res

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Supine sleep decreases sudden infant death syndrome (SIDS) incidence, however the mechanisms for this are unclear. The triple risk model for SIDS requires that one or more underlying abnormalities of breathing or autonomic control are present; these are rare, but brainstem defects are found in most SIDS cases. Supine sleep increases sympathetic nervous system tone, and level of state organization, and may therefore act as a stressor. This is evidenced by physiological arousal, and by delayed neurodevelopment in supine compared to prone sleepers. It is argued here that prone sleep position is the biological normative standard in healthy infants, supporting autonomic regulation. During rapid eye movement (REM) sleep (and other circumstances), a parasympathetic-mediated adverse autonomic event (AAE) may be spontaneously triggered. In healthy infants, gasping initiates autoresuscitation and recovery. Hypothesis: the underlying vulnerability to SIDS is specific to autoresuscitation from an AAE, the initial serotonin-dependent gasp is commonly compromised. Serotonin metabolism defects also influence sleep architecture, increasing the likelihood of AAE. The mechanism whereby supine sleep decreases SIDS may therefore be a stressor effect, disturbing sleep architecture to decrease REM and AAEs, and increasing sympathetic tone, which may prevent and counteract the purely parasympathetic-mediated AAE, thereby decreasing the risk of SIDS.

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“…Thus, hypothetically the end result is an increasing and finally massive metabolic alkalosis which leads to a respiratory depression including systemic hypercapnea and tissue hypoxia despite a relatively good arterial oxygen saturation and thereby the absence of cyanosis. Due to the progressive acid-base disturbance and hypoxia, the infant's breathing center cannot function normally, and during sleep (51,52), not seldom after a period of wakefulness with relatively vigorous sensory stimulation possibly leading t o a relative hyperventilation, an additional compensatory hypoventilation arises acutely, resulting in an even more serious hypoxia, as a result of the fact that the hypoxic respiratory drive does not function in so small an infant, contributing to the "failure to arouse" which has been described in experimental animals (53). The final result is a bradycardia with secondary respiratory arrest (48,49,51) which leads to asystole and death which at the postmortem is given the diagnosis SIDS.…”

Section: Dysfunction In the System -Does It Exist?mentioning

confidence: 99%

Carbon Dioxide Formation and Elimination in Man

Wiklund

1996

Upsala Journal of Medical Sciences

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Sleep and Cardiorespiratory Characteristics of Infant Victims of Sudden Death: A Prospective Case-Control Study

Cited by 261 publications

References 0 publications

Risk factors for sudden infant death syndrome in a developing country

Risk factors for sudden infant death syndrome in a developing country

Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

Carbon Dioxide Formation and Elimination in Man

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