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QT interval prolongation in future SIDS victims: a polysomnographic study
Patricia Franco1, José Groswasser, Sonia Scaillet
1Pediatric Sleep Unit, Hôpital M&re-Enfant & INSERM-U628, University Lyon, Lyon, France. pfranco@univ-lyon1.fr
Insights
Infants who later died of sudden infant death syndrome (SIDS) had prolonged QTc intervals during sleep compared to healthy infants. This finding suggests a link between QTc prolongation, autonomic dysfunction, and SIDS risk.
Area of Science:
- Cardiology
- Pediatrics
- Autonomic Neuroscience
Background:
- Prolonged QTc interval in early life has been linked to sudden infant death syndrome (SIDS).
- Autonomic nervous system imbalance has been observed in infants who later succumb to SIDS.
Purpose of the Study:
- To investigate if future SIDS victims exhibit longer QTc intervals during sleep compared to controls.
- To determine if QTc interval differences correlate with autonomic imbalance in these infants.
Main Methods:
- QTc intervals and heart rate variability were analyzed during polysomnographic sleep recordings.
- 18 infants who died of SIDS were compared with 18 matched control infants.
- Analysis included power spectral analysis of heart rate during sleep.
Main Results:
- Future SIDS victims showed significantly longer QTc intervals during total, REM, and NREM sleep compared to controls.
- The difference in QTc intervals was most pronounced during the latter part of the night.
- A negative correlation was found between parasympathetic activity and QTc interval duration.
Conclusions:
- Infants who died of SIDS had increased QTc intervals compared to matched controls.
- This QTc interval prolongation may be associated with the autonomic dysfunction observed in SIDS cases.
Objective:
Previous data have suggested that a prolonged QTc interval during the first days of life can be associated with some cases of sudden infant death syndrome (SIDS). Analysis of heart rate variability during sleep in future SIDS victims has shown findings compatible with an imbalance in autonomic tone. We hypothesized that some future SIDS infants could have longer QTc intervals during sleep, compared with healthy control infants, and that this difference would correlate with the autonomic imbalance already found in these infants.
Methods:
QTc intervals and a heart rate autoregressive power spectral analysis were calculated during the same periods in the polysomnographic sleep recordings of 18 infants who eventually died of SIDS and of 18 control infants. The control infants were matched for sex, gestational age, postnatal age, birth weight, and sleep position. The median postnatal age was 8 weeks.
Results:
Compared with control infants, future SIDS victims were characterized by having longer QTc intervals during total sleep (P = 0.019), rapid eye movement sleep (P = 0.045) and non-rapid eye movement sleep (P = 0.029). When the night was divided into 3 equal parts, this difference was always present but was most marked during the last part of the night. There was, respectively, a negative and a positive correlation between parasympathetic activity and sympathovagal balance and median and maximum QTc interval values.
Conclusion:
Compared with QTc intervals in matched control infants, QTc intervals were increased in future SIDS victims. Such a prolongation could be related to the autonomic dysfunction already reported in these patients.
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