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Effects of age and sleeping position on arousal from sleep in preterm infants
Rosemary S C Horne1, Pratiti Bandopadhayay, Jessica Vitkovic
1Department of Paediatrics and Ritchie Centre for Baby Health Research, Monash University, Clayton, Victoria, Australia. rosemary.horne@med.monash.edu.au
Insights
The prone sleeping position impairs arousal in preterm infants, increasing their risk for sudden infant death syndrome (SIDS). This effect was observed during key developmental periods and was not linked to cardiorespiratory changes.
Area of Science:
- Neonatal Sleep Medicine
- Infant Development
- Sudden Infant Death Syndrome (SIDS) Research
Background:
- Preterm infants face a higher risk of SIDS.
- The prone sleeping position's impact on arousal in this population is not fully understood.
- Investigating arousal mechanisms is crucial for SIDS prevention strategies.
Purpose of the Study:
- To determine if the prone sleeping position impairs arousal in healthy preterm infants.
- To assess the relationship between impaired arousal, cardiorespiratory variables, temperature, and postnatal age.
- To elucidate the role of sleep position in SIDS risk for preterm infants.
Main Methods:
- Longitudinal polysomnography study of 14 healthy preterm infants.
- Arousal thresholds were measured using air-jet stimulation in prone and supine positions.
- Measurements were taken at multiple postconception and postterm ages.
Main Results:
- Prone sleeping significantly increased arousal thresholds at 36-38 weeks postconception and 2-3 months postterm.
- Impaired arousal in the prone position was independent of temperature, heart rate, or oxygen saturation.
- No significant arousal impairment was noted at 2-3 weeks or 5-6 months postterm.
Conclusions:
- The prone position impairs sleep arousal in preterm infants during periods of heightened SIDS risk.
- This reduced arousability occurs without significant cardiorespiratory or thermal changes.
- Impaired arousal in the prone position may contribute to the increased SIDS risk observed in these infants.
Study Objectives:
Preterm infants are at increased risk of sudden infant death syndrome (SIDS). We investigated whether the prone sleeping position impaired arousal from sleep in healthy preterm infants and whether this impairment was related to cardiorespiratory variables, temperature or postnatal age.
Design:
Longitudinal
Setting/Participants:
14 healthy preterm infants (mean 32 +/- 0.4 weeks) were studied using daytime polysomnography on 4 occasions: 36-38 weeks postconception age, 2 to 3 weeks postterm, 2 to 3 months postterm, and 5 to 6 months postterm.
Interventions:
N/A.
Measurements:
Multiple measurements of arousal threshold (cm H2O) in response to air-jet stimulation applied alternately to the nares were made in both active sleep and quiet sleep when infants slept both prone and supine.
Results:
Arousal thresholds were significantly higher in both AS and QS when infants slept prone at 36 to 38 weeks postconception age and 2 to 3 months postterm but not at 2 to 3 weeks or 5 to 6 months postterm. These increases were independent of any sleep position-related changes in either rectal or abdominal skin temperature, respiratory rate, oxygen saturation or heart rate.
Conclusions:
At the age when the risk of SIDS is highest, the prone position significantly impairs arousal from both active sleep and quiet sleep in healthy infants born prematurely. This impairment in arousability occurred with no clinically significant changes in cardiorespiratory parameters or body temperature. Decreased arousability from sleep in the prone position may explain its role as a risk factor for SIDS.