Cardiorespiratory adaptation during sleep in infants and children
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1Laboratory of Physiology, Hospital Antoine Béclère, Faculty of Medicine Paris XI, Clamart, France.
Insights
Infant cardiorespiratory control matures after birth, with REM sleep posing risks for breathing and heart disturbances. Understanding these sleep changes is crucial for managing infant cardiorespiratory events.
Area of Science:
- Neonatal physiology
- Sleep medicine
- Cardiorespiratory control
Background:
- The cardiorespiratory control system matures postnatally, leaving infants vulnerable to disturbances, particularly during sleep.
- Rapid-eye movement (REM) sleep significantly influences cardiorespiratory control, with newborns spending over 50% of sleep time in this state.
- The predominance of REM sleep in early infancy may increase the risk of abnormal sleep-related events.
Purpose of the Study:
- To review the impact of sleep states on cardiorespiratory control mechanisms in infants.
- To highlight the significance of REM sleep in postnatal cardiorespiratory development and potential risks.
- To identify gaps in understanding cardiorespiratory control during late infancy and early childhood.
Main Methods:
- Review of existing literature on sleep and cardiorespiratory control in infants.
- Analysis of data on ventilatory mechanics, gas exchange, chemoreceptor function, and arousal responses during sleep.
- Examination of heart rate variability and bradycardia mechanisms during infant sleep states.
Main Results:
- REM sleep profoundly affects cardiorespiratory control, with specific risks during the neonatal period.
- Infant sleep patterns change significantly from term to six months, with a decrease in REM sleep proportion.
- Respiratory and cardiac disturbances are known to occur selectively during REM sleep.
Conclusions:
- Developmental changes in infant sleep patterns are critical for understanding and managing cardiorespiratory issues like ALTE and SIDS.
- Further research is needed on cardiorespiratory control during late infancy and early childhood.
- Clinicians must be aware of the interplay between sleep states and cardiorespiratory stability in infants.
Abstract:
The cardiorespiratory control system undergoes functional maturation after birth. Until this process is completed, the cardiorespiratory system is unstable, placing infants at risk for cardiorespiratory disturbances, especially during sleep. The profound influence of states of alertness on respiratory and cardiac control has been the focus of intense scrutiny during the last decade. The effects of rapid-eye movement (REM) sleep on various mechanisms involved in cardiorespiratory control are of particular significance during the postnatal period since newborns spend much of their time in this sleep state. In fullterm newborns, REM sleep occupies more than 50% of total sleep time, and this percentage is even greater in preterm newborns. From term to six months of age, the proportion of REM sleep decreases. Since respiratory and cardiac disturbances are known to occur selectively during REM sleep, the predominance of REM sleep may be a risk factor for abnormal sleep-related events during early infancy. Awareness of these developmental changes in sleep patterns is important for clinicians dealing with problems such as apparent life-threatening events (ALTE), sudden infant death syndrome (SIDS), and/or cardiorespiratory responses to respiratory disorders. Our current understanding of respiratory and cardiac control rests mainly on studies conducted during the first months of life. There is a paucity of data on late infancy and early childhood. The present paper will review available data on how sleep affects 1) ventilatory mechanics, in particular of the upper airways and the chest wall; ventilation and apnea; gas exchange; chemoreceptor function; and arousal responses; 2) changes in heart rate and heart rate variability, and the occurrence and mechanisms of bradycardia.