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Impaired ventilation in infants sleeping facedown: potential significance for sudden infant death syndrome
1Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110.
Insights
Infants sleeping facedown may experience rebreathing and potential asphyxia. This sleep position could contribute to some sudden infant death syndrome cases.
Area of Science:
- Pediatrics
- Neonatology
- Sleep Medicine
Background:
- Sudden infant death syndrome (SIDS) is a leading cause of post-neonatal mortality.
- Accidental suffocation is a suspected cause of SIDS in infants found in a prone position.
- The breathing effects of the facedown sleep position in living infants are not well understood.
Purpose of the Study:
- To investigate if infants sleep facedown.
- To determine if infants can spontaneously change from the facedown position.
- To assess the influence of thermal stimuli and bedding softness on position changes.
- To evaluate the occurrence of rebreathing and airway obstruction.
Main Methods:
- Studied 11 healthy infants aged 0.2 to 6 months.
- Observed sleep position on soft and firm bedding.
- Monitored breathing, including carbon dioxide levels and oxygen saturation.
- Applied thermal stimuli (cold and warm).
Main Results:
- Most infants slept facedown spontaneously or when placed in this position.
- Infants could turn their heads but remained facedown for variable durations.
- Rebreathing occurred in all infants in the facedown position.
- Inspired carbon dioxide increased significantly on soft bedding.
- One infant experienced obstructive apnea, high carbon dioxide, and desaturation without arousal.
Conclusions:
- Infants sleeping facedown may experience significant asphyxia.
- The facedown sleep position can lead to increased carbon dioxide levels.
- This sleep position may play a role in some SIDS cases.
Abstract:
Although accidental suffocation has been suggested as a cause of sudden infant death syndrome in infants who are found prone with their faces straight down, the occurrence and effects on breathing of this position in living infants are unknown. We studied prone sleeping infants to see whether they will sleep with their faces straight down; whether they can spontaneously change from this position; the way that thermal stimuli or bedding softness influences this change; and whether rebreathing or airway obstruction occurs. We studied 11 healthy infants, aged 0.2 to 6 months, while they slept on soft and on firm bedding. Most infants slept facedown spontaneously or when turned to this position. All could turn their heads readily but slept facedown for variable periods. All infants put their faces straight down more often after cold than after warm stimuli. Obstructive apnea occurred only once, but rebreathing occurred in all subjects. When the infants were in the facedown position, inspired carbon dioxide was three times greater on soft than on hard bedding. End-tidal carbon dioxide partial pressure rose in all subjects while they were in the facedown position; in one infant, high end-tidal carbon dioxide partial pressure and desaturation occurred without signs of arousal. We conclude that infants sleeping facedown may occasionally have significant asphyxia; this sleep position may have a role in some infant deaths diagnosed as sudden infant death syndrome.