Autonomic control during sleep and risk for sudden death in infancy

A variety of clinical pathology and experimental animal evidence suggests that cerebellar and vestibular structures mediate marked challenges to blood pressure and breathing, and are particularly involved in compensatory somatomotor and breathing efforts to overcome substantial losses in blood pressure. At least a subset of victims of the Sudden Infant Death Syndrome (SIDS), a sleep-related disorder, succumbs to a profound bradycardia and hypotension prior to respiratory cessation, suggesting a failure of autonomic control, or incompetent compensation of somatomotor and respiratory efforts, to overcome the cardiovascular collapse. The clinical and neurotransmitter evidence from SIDS victims implicates afferent and efferent components within vestibular/cerebellar blood pressure control systems in SIDS victims. Experimental evidence from animals suggests vestibular and cerebellar structures exercise critical roles in mediating autonomic responses to body position and extreme changes in blood pressure. The position-dependent risk for SIDS, together with the neuropathological evidence, suggests a significant role for vestibular/cerebellar structures in mediating the fatal outcome for the syndrome.