Apnoea of prematurity and arousal from sleep

The incidence of sudden infant death syndrome (SIDS) has been found to be consistently higher in preterm and low birth weight infants than in infants born at term and this increase is inversely related to gestational age. The incidence and severity of apnoea of prematurity, are also inversely related to gestational age. The aim of this study was to investigate whether a neonatal history of apnoea/bradycardia affected the maturation of arousal responses. Twenty-five premature infants were studied. A perinatal risk score was determined for each infant and infants were divided into those with a neonatal history of apnoea/bradycardia (n=16) and those without (n=9). All infants were studied using daytime polysomnography on three occasions: (a) a preterm study around 36 weeks gestation, (b) within 3 weeks of term, and (c) 2-3 months post-term. Multiple measurements of arousal threshold (cm H2O) in response to air-jet stimulation applied alternately to the nares were made in both active sleep (AS) and quiet sleep (QS). Arousal thresholds were elevated in apnoeic infants compared to control infants in both AS (P<0.05) and QS (P<0.001) at the term study and in QS at 2-3 months post-term (P<0.01). In addition, arousal thresholds were positively correlated with perinatal risk score in both sleep states, in all studies, with the exception of AS at 2-3 months when all infants were readily arouseable. We conclude that a history of prematurity with neonatal apnoea has a persisting effect on decreasing arousabilty from sleep and these infants may be at increased risk for SIDS.