The prone sleeping position impairs arousability in term infants

Horne, Rosemary Sylvia Claire; Ferens, Dorta Maria; Watts, Anne-Maree; Vitkovic, Jessica; Lacey, Brendan; Andrew, Sarah; Cranage, Susan M; Chau, Bonnie; Adamson, T. M.

doi:10.1067/mpd.2001.114475

Cited by 135 publications

(90 citation statements)

References 25 publications

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“…[5][6][7][8][9] Prone sleep may inhibit arm movements associated with a full extensor startle response, which would lead to less frequent behavioral arousal by reducing proprioceptive stimuli in the same way that may occur during swaddling. Decreased arousability has been implicated as a cause for SIDS in prone sleeping infants.…”

Section: Ofmentioning

confidence: 99%

“…4 Studies confirm that the prone position decreases frequency of arousals. [5][6][7][8][9] Swaddled infants placed on their backs are said to "sleep better," presumably meaning that they sleep longer or with fewer arousals. Parents commonly report that infants who are back sleepers "startle themselves awake."…”

mentioning

confidence: 99%

“…Supine sleeping is associated with increased arousals from sleep compared with the prone sleep position. [5][6][7][8][9] The effect of swaddling on the frequency of brainstem arousals as well as full behavioral arousals is unknown. Likewise, the effect of swaddling on progression of brainstem arousals to full arousals is unknown.…”

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Spontaneous Arousals in Supine Infants While Swaddled and Unswaddled During Rapid Eye Movement and Quiet Sleep

2002

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ABSTRACT. Objective. Supine sleep is recommended for infants to decrease the risk of sudden infant death syndrome, but many parents report that their infants seem uncomfortable supine. Many cultures swaddle infants for sleep in the supine position. Swaddled infants are said to "sleep better"; presumably they sleep longer or with fewer arousals. However, there have been no studies of the effect of swaddling on spontaneous arousals during sleep. Arousal is initiated in brainstem centers and manifests as a sequence of reflexes: from sighs to startles and then to thrashing movements. Such "brainstem arousals" may progress to full arousal, but most do not.Methods. Twenty-six healthy infants, aged 80 ؎ 7 days, were studied during normal nap times. Swaddled (cotton spandex swaddle) and unswaddled trials were alternated for each infant. Sleep state (rapid eye move- ment [REM] or quiet sleep [QS]) was determined by behavioral criteria (breathing pattern, eye movements) and electroencephalogram/electrooculogram (10 infants).Respitrace, submental and biceps electromyogram, and video recording were used to detect startles and sighs (augmented breaths). Full arousals were classified by eye opening and/or crying. Frequencies of sighs, startles, and full arousals per hour were calculated. Progression of events was calculated as percentages in each sleep state, as was duration of sleep state.Results. Swaddling decreased startles in QS and REM, full arousal in QS, and progression of startle to arousal in QS. It resulted in shorter arousal duration during REM sleep and more REM sleep.Conclusions. Swaddling has a significant inhibitory effect on progression of arousals from brainstem to full arousals involving the cortex in QS. Swaddling decreases spontaneous arousals in QS and increases the duration of REM sleep, perhaps by helping infants return to sleep spontaneously, which may limit parental intervention. For these reasons, a safe form of swaddling that allows hip flexion/abduction and chest wall excursion may help parents keep their infants in the supine sleep position and thereby prevent the sudden infant death syndrome risks associated with the prone sleep position. Pediatrics 2002;110(6). URL: http://www.pediatrics.org/cgi/content/ full/110/6/e70; sudden infant death syndrome, sighs, startles.ABBREVIATIONS. SIDS, sudden infant death syndrome; REM, rapid eye movement; QS, quiet sleep; EMG, electromyogram; EEG, electroencephalogram; EOG, electrooculogram. S upine sleeping decreases the risk for sudden infant death syndrome (SIDS). 1 However, some parents place their infants in the prone sleep position despite these recommendations. [2][3][4] Many of these parents state that their infants seem more comfortable when prone and sleep better. 4 Studies confirm that the prone position decreases frequency of arousals. [5][6][7][8][9] Swaddled infants placed on their backs are said to "sleep better," presumably meaning that they sleep longer or with fewer arousals. Parents commonly report that infants who are back sleepers "startle ...

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Spontaneous Arousals in Supine Infants While Swaddled and Unswaddled During Rapid Eye Movement and Quiet Sleep

2002

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“…2,16 Term infants sleeping prone have alterations in cardiovascular control, [17][18][19][20][21] and we have previously demonstrated that this is reflected in the cerebral circulation, expressed as reduced cerebral oxygenation and altered cerebrovascular control. 22,23 It has been suggested that reduced cerebral oxygenation may contribute to impaired arousal, 22 which is seen in the prone position in both term 18,24 and preterm infants [25][26][27] and is likely to be significant in the pathophysiology of SIDS. 10,28 Preterm infants display immature cerebrovascular control before termequivalent age, [29][30][31][32] the severity of which is related to their GA at birth.…”

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Cerebral Oxygenation in Preterm Infants

et al. 2014

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BACKGROUND AND OBJECTIVE: Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS) and preterm infants are at significantly increased risk. In term infants, prone sleeping is associated with reduced mean arterial pressure (MAP) and cerebral tissue oxygenation index (TOI). However, little is known about the effects of sleeping position on TOI and MAP in preterm infants. We aimed to examine TOI and MAP in preterm infants after term-equivalent age, during the period of greatest SIDS risk. METHODS: Thirty-five preterm and 17 term infants underwent daytime polysomnography, including measurement of TOI (NIRO-200 spectrophotometer, Hamamatsu Photonics KK, Japan) and MAP (Finapress Medical Systems, Amsterdam, Netherlands) at 2 to 4 weeks, 2 to 3 months, and 5 to 6 months postterm age. Infants slept prone and supine in active and quiet sleep. The effects of sleep state and position were determined by using 2-way repeated measures analysis of variance and of preterm birth by using 2-way analysis of variance. RESULTS: In preterm infants, TOI was significantly lower when prone compared with supine in both sleep states at all ages (P < .05). Notably, TOI was significantly lower in preterm compared with term infants at 2 to 4 weeks, in both positions (P < .05), and at 2 to 3 months when prone (P < .001), in both sleep states. MAP was also lower in preterm infants in the prone position at 2 to 3 months (P < .01). CONCLUSIONS: Cerebral oxygenation is reduced in the prone position in preterm infants and is lower compared with age-matched term infants, predominantly in the prone position when MAP is also reduced. This may contribute to their increased SIDS risk.

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“…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.…”

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confidence: 99%

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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The prone sleeping position impairs arousability in term infants

Cited by 135 publications

References 25 publications

Spontaneous Arousals in Supine Infants While Swaddled and Unswaddled During Rapid Eye Movement and Quiet Sleep

Spontaneous Arousals in Supine Infants While Swaddled and Unswaddled During Rapid Eye Movement and Quiet Sleep

Cerebral Oxygenation in Preterm Infants

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

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