Sleeping position, infant apnea, and cyanosis: a population-based study

To examine the relationship between usual infant sleeping position and the parental report of infant cyanosis, pallor, breath-holding, and breathing difficulties; and to document hospital admission rates for apnea/cyanosis over time and to describe how admission rates vary by usual sleeping position.

A prospective cohort study was conducted. It involved the one fifth of Tasmanian live births that were assessed, using a perinatal score, as being at higher risk for sudden infant death syndrome (SIDS). From May 1, 1988 to April 30, 1993, 6213 infants participated in the hospital (4 days postnatal age) and home interview (5 weeks postnatal age) (89% of eligible infants). Data on usual sleep position and infant history of cyanosis were collected at home interview. Hospital admission records for apnea/cyanosis in the first year of life were linked to data on cohort infants in southern Tasmania.

Infants who slept supine were not more likely to have been reported to experience cyanosis, pallor, or breathing problems at 1 month of age, when compared with infants sleeping in other positions. In fact, the risk of cyanosis was higher in the prone, face-down sleeping position than in the supine sleeping position (adjusted odds ratio = 4.21, 95% confidence interval [1.33, 13.28]). Among cohort infants in southern Tasmania, hospital admission rates for apnea/cyanosis did not differ by usual sleeping position or year of birth.

Infants usually sleeping supine do not have increased rates of morbidity in relation to parental reports or hospital admissions for apnea/cyanosis. In a location where SIDS and total postneonatal mortality has fallen after intervention to reduce the prevalence of the prone position, rates of hospital admission for apnea/cyanosis have not changed.