SPONTANEOUS AROUSALS IN INFANTS WITH LIFETHREATNING EVENT
Fewer Spontaneous Arousals in Infants with Apparent Life-Threatening Event
Patricia Franco, MD, PhD1; Enza Montemitro, MD, PhD2; Sonia Scaillet, MD3; Jose Groswasser, MD3; Ineko Kato, MD, PhD4; Jian-Sheng Lin, MD, PhD1; Maria Pia Villa, MD2
1Pediatric Sleep Unit, Hôpital Femme Mère Enfant & INSERM U628, Claude Bernard University Lyon 1, Lyon, France
; 2Department of Pediatrics, Sleep Disease Center, University of Rome “La Sapienza”-S Andrea Hospital, Rome, Italy
; 3Pediatric Sleep Unit, Free University of Brussels, Brussels, Belgium
; 4Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
A deficit in arousal process has been implicated as a mechanism of sudden infant death syndrome (SIDS). Compared with control infants, SIDS victims showed significantly more subcortical activations and fewer cortical arousals than matched control infants. Apparent life-threatening event (ALTE) is often considered as an aborted SIDS event. The aim of this study was to study the arousal characteristics of ALTE infants during the first months of life.
35 ALTE infants were studied with nighttime polysomnography at 2-3, 5-6, and 8-9 months of age. Eighteen of the infants had mothers who smoked. The infants were born full term and were usually supine sleepers. Sleep state and cardiorespiratory parameters were scored according to recommended criteria. Arousals were differentiated into subcortical activations or cortical arousals, according to the presence of autonomic and/or electroencephalographic changes. The results were compared with those of 19 healthy infants with nonsmoking mothers.
During NREM sleep, the ALTE infants had fewer total arousals, cortical arousals, and subcortical activations at 2-3 and 5-6 months (P < 0.001) than control infants. ALTE infants with smoking mothers had more obstructive apnea (P = 0.009) and more subcortical activations during REM sleep at 2-3 months of age (P < 0.001) than ALTE infants with nonsmoking mothers.
Spontaneous arousals were differently altered in ALTE infants than in SIDS infants, suggesting an entity different from SIDS. ALTE infants with smoking mothers had arousal and respiratory characteristics that were similar to future SIDS victims, suggesting some common abnormalities in brainstem dysfunction.
Franco P; Montemitro E; Scaillet S; Groswasser J; Kato I; Lin JS; Villa MP. Fewer spontaneous arousals in infants with apparent life-threatening event. SLEEP 2011;34(6):733-743.