Thermal stress in sudden infant death: Is there an ambiguity with the rebreathing hypothesis?

To assess the role of thermal stress in the cause of sudden infant death syndrome (SIDS), and to compare risk factors with those of rebreathing.

Analysis of publications concerning the epidemiology and physiology of thermal stress in SIDS.

A strong association between thermal regulation and ventilatory control was found, specifically for prolonged apnea. Infections, excessive room heat and insulation, and prone sleeping produce significantly increased odds ratios for SIDS. Although some of the risk factors for rebreathing could be explained by the effects of thermal stress, several factors for thermal stress could not reasonably be explained by the rebreathing hypothesis.

Although the risk of thermal stress is widely accepted abroad, it has received relatively little attention in the United States. The incidence of SIDS in the United States can likely be further reduced by educating the public against the dangers of overheating, as an integral part of the back-to-sleep campaign.