Effects of warm and cool thermal conditions on ventilatory responses to hyperoxic test in neonates

Body temperature interacts with respiratory control, but it is unclear what sites or mechanisms mediate those interactions. We hypothesized that warm and cool thermal conditions affect the decrease in ventilation (VE) seen during the hyperoxic test (HT), a breathing response believed to reflect the strength of the peripheral chemoreceptor drive. A breath-by-breath analysis during a 30 s HT was performed in eight premature neonates (postconceptional age: 36 +/- 1 weeks) under neutral, warm, and cool thermal conditions. Quiet sleep (QS) and active sleep (AS) were scored by neurophysiological criteria. The VE fall was higher in AS than in QS, and warm and cool conditions significantly enhanced the response only in AS (-24.2 +/- 6.0, -39.1 +/- 9.1, and -37.5 +/- 14.1% in neutral, warm, and cool conditions, respectively). Central control mechanisms of the respiratory chemoreflex may explain the increase in peripheral chemoreceptor drive during AS in response to thermal challenges, which may produce increased breathing instability leading to apnea in early life.     

Influence of thermal drive on central sleep apnea in the preterm neonate

BACKGROUND: The incidence of apnea in neonates depends on a number of factors, including sleep state and thermoregulation. OBJECTIVE: To assess the role of thermal drive (body heat loss [BHL]) in the mechanisms underlying short episodes of central apnea during active and quiet sleep in neonates. MATERIAL AND METHOD: Twenty-two neonates (postconceptional age: 36.3 +/- 0.9 weeks) were exposed at thermoneutral (incubator temperature: 32.5 degrees C), warm (34.2 degrees C), and cool (30.4 degrees C) conditions during 3 consecutive morning naps. Oxygen consumption (VO2), skin and rectal temperatures, and central apnea were scored during active sleep and quiet sleep. The thermal drive was expressed as BHL calculated using indirect partitional calorimetry. RESULTS: As expected, apnea occurred more frequently in active sleep than in quiet sleep (P < 0.001). The frequency of apnea in active sleep was higher in the warm condition (P < 0.05). In contrast, apnea episodes were less frequent (P < 0.05) and shorter (P < 0.05) for cool exposure, during which VO2 and rectal temperature increased. The frequency (P < 0.001, r2 = 0.31), mean (P < 0.05, r2 = 0.06), and maximum (P < 0.001, r2 = 0.19) durations of apnea were correlated with the BHL: the greater the BHL (body cooling), the less frequent and the shorter the apnea episodes. In contrast, no relationship between apnea and mean skin or rectal temperature was observed. CONCLUSION: Apneic events were more closely related to BHL than to body temperatures. In cool exposure, the decreases in the duration and frequency of apneic episodes suggest that these events depend on the metabolic drive (which is proportional to energy expenditure).     

Relationship between sleep and acid gastro-oesophageal reflux in neonates

The aim of the present study was to investigate the impact of gastro‐oesophageal acid reflux on sleep in neonates and, reciprocally, the influence of wakefulness (W) and sleep stages on the characteristics of the reflux (including the retrograde bolus migration of oesophageal acid contents). The pH and multichannel intraluminal impedance were measured during nocturnal polysomnography in 25 infants hospitalised for suspicion of gastro‐oesophageal reflux. Two groups were constituted according to whether or not the infants displayed gastro‐oesophageal reflux (i.e. a reflux group and a control group). There were no differences between the reflux and control groups in terms of sleep duration, sleep structure and sleep state change frequency. Vigilance states significantly influenced the gastro‐oesophageal reflux pattern: the occurrence of gastro‐oesophageal reflux episodes was greater during W (59 ± 32%) and active sleep (AS; 35 ± 30%) than during quiet sleep (QS; 6 ± 11%), whereas the mean duration of gastro‐oesophageal reflux episodes was higher in QS than in W and AS. The percentage of retrograde bolus migrations of distal oesophageal acid content was significantly higher in AS (62 ± 26%) than in W (42 ± 26%) and QS (4.5 ± 9%). In neonates, gastro‐oesophageal reflux occurred more frequently during W, whereas the physiological changes associated with sleep state increase the physiopathological impact of the gastro‐oesophageal reflux. The duration of oesophagus–acid contact was greater during sleep; AS facilitated the retrograde migration of oesophageal acid content, and QS was characterised by the risk of prolonged acid mucosal contact.     

Autoregulation of the cerebral circulation during sleep in newborn lambs

Autoregulation is a vital protective mechanism that maintains stable cerebral blood flow as cerebral perfusion pressure changes. We contrasted cerebral autoregulation across sleep–wake states, as little is known about its effectiveness during sleep. Newborn lambs ( n = 9) were instrumented to measure cerebral blood flow (flow probe on the superior sagittal sinus) and cerebral perfusion pressure, then studied during active sleep (AS), quiet sleep (QS) and quiet wakefulness (QW). We generated cerebral autoregulation curves by inflating an occluder cuff around the brachiocephalic artery thereby lowering cerebral perfusion pressure. Baseline cerebral blood flow was higher ( P < 0.05) and cerebral vascular resistance lower ( P < 0.05) in AS than in QW (76 ± 8% and 133 ± 15%, respectively, of the AS value, mean ± s.d. ) and in QS (66 ± 11% and 158 ± 30%). The autoregulation curve in AS differed from that in QS and QW in three key respects: firstly, the plateau was elevated relative to QS and QW ( P < 0.05); secondly, the lower limit of the curve (breakpoint) was higher ( P < 0.05) in AS (50 mmHg) than QS (45 mmHg); and thirdly, the slope of the descending limb below the breakpoint was greater ( P < 0.05) in AS than QS (56% of AS) or QW (56% of AS). Although autoregulation functions in AS, the higher breakpoint and greater slope of the descending limb may place the brain at risk for vascular compromise should hypotension occur.     

Arousal responses to somatosensory and mild hypoxic stimuli are depressed during quiet sleep in healthy term infants

STUDY OBJECTIVES: To compare arousal responses to somatosensory and hypoxic stimuli in sleeping human infants and to determine whether sleep state and postnatal age exerted similar changes in these arousal responses. DESIGN: We delivered somatosensory (nasal air-jet) stimulation and mild hypoxia (15% oxygen) to 10 healthy term infants aged 2 to 4 weeks, 2 to 3 months, and 5 to 6 months during identified sleep states. Hypoxic challenges were terminated at arousal, when the oxygen saturation fell below 85%, or at 5 minutes (failure to arouse). RESULTS: Infants failed to arouse to a greater percentage of hypoxia tests during quiet sleep (QS) than during active sleep (AS) at 2 to 3 months and 5 to 6 months of age (P < 0.01). Infants failed to arouse to a greater percentage of hypoxic challenges during QS at 2 to 3 months and 5 to 6 months than at 2 to 4 weeks of age. Arousal latency to hypoxia was significantly longer in QS than in AS at each study age; however, arousal latency was not affected by postnatal age. Arousal thresholds to somatosensory stimulation were significantly greater in QS than in AS, except at 2 to 4 weeks of age. In AS, arousability to the air-jet was greater at 2 to 3 months compared to 2 to 4 weeks of age (P < 0.05); in QS it was lower at 5 to 6 months compared to 2 to 4 weeks of age (P < 0.05). Arousal latency to hypoxia and arousal thresholds to air-jet stimulation were not correlated within infants. CONCLUSION: We conclude that arousal responses of infants to somatosensory and respiratory stimuli are similarly affected by sleep state and postnatal age. Infants are less arousable to both stimulus modalities in QS than in AS, and less arousable at 5 to 6 months of age than at 2 to 4 weeks in QS.     

The microstructure of active and quiet sleep as cortical delta activity emerges in infant rats

STUDY OBJECTIVES: Previous investigators have suggested that quiet sleep (QS) in rats develops rapidly upon the emergence of cortical delta activity around postnatal day (P)11 and that the presence of "half-activated" active sleep (AS) suggests that infant sleep is initially disorganized. To address these issues, we examined the temporal organization of sleep states during the second postnatal week in rats as delta activity emerges. DESIGN: Subjects were P9, P11, and P13 Sprague-Dawley rats. Electroencephalogram and nuchal electromyogram electrodes were implanted, and data were recorded at thermoneutrality for 2 hours. RESULTS: At all ages, using electromyogram and behavioral criteria, QS (defined as nuchal atonia and behavioral quiescence) dominated the first third of each sleep period, whereas AS (defined as nuchal atonia accompanied by myoclonic twitching) dominated the last third. When delta activity, which was first detected at P11, could be added to the definition of QS, gross assessments of sleep-state organization were not altered, although it was now possible to identify brief periods of QS interposed between periods of AS. No evidence of "half-activated" AS was found. Finally, "slow activity transients" were detected and were primarily associated with QS; their rate of occurrence declined as delta activity emerged. CONCLUSIONS: When delta activity emerges at P11, it integrates smoothly with periods of QS, as defined using electromyogram and behavioral criteria alone. Delta activity helps to refine estimates of QS duration but does not reflect a significant alteration of sleep-state organization. Rather, this organization is expressed much earlier in ontogeny as fluctuations in muscle tone and associated phasic motor activity.     

The characteristics of recovery sleep when recovery opportunity is restricted

STUDY OBJECTIVES: The aim of this study was to investigate the recovery of sleep and waking functions following one night of total sleep deprivation, when recovery opportunity was either augmented or restricted. DESIGN: The 9-day laboratory study involved a baseline night, a night of sleep loss (approximately 40 h) followed by 5 nighttime recovery sleep periods. Recovery consisted of either five 9-h sleep opportunities or five 6-h sleep opportunities. SETTING: All data collection took place in a controlled laboratory environment at the Centre for Sleep Research. PARTICIPANTS: A total of n = 20 healthy adults (18-35 yrs) participated in the study. RESULTS: Each sleep period was recorded using a standard polysomnographic EEG montage. Waking functions were assessed every 2 hours during all wake periods, using a 10 minute psychomotor vigilance task (PVT) and a subjective alertness visual analogue scale (VAS). Sleep analyses indicated that across the week TST, SOL, REM, and sleep efficiency varied significantly between the 2 conditions, but amounts of SWS did not. Waking functions in the 9-h condition recovered after one sleep period. In the 6-h condition however, mean response time on the PVT was 10% below baseline and subjective alertness 20% below baseline for the entire recovery period. CONCLUSIONS: The results suggest that TST is a key factor in determining recovery. When recovery opportunity is restricted, both sleep variables and measures of waking functions do not recover.     

Gender-related sleep differences in neonates in thermoneutral and cool environments

Although thermoregulation and sleep exhibit gender differences in adults, the question is still debated in neonates. The aim of this study was to examine the relationship between gender-related sleep differences and cool defence mechanisms in neonates. Sleep and thermoregulation were recorded in healthy preterm neonates (21 boys and 17 girls, 37 +/- 2 weeks post-conceptional age) exposed to thermoneutral and cool conditions. Sleep was analysed for continuity and structure. Although the cool exposure did not strongly impair body homeothermia, sleep was altered but without any significant gender difference. However, when data recorded under each of the thermal conditions were pooled, some gender differences emerged: boys slept less, with more wakefulness after sleep onset, more active sleep and less quiet sleep than girls. In contrast to sleep architecture, most of the sleep continuity parameters exhibited greater variability in boys than in girls. This variability may bias the statistical analyses and probably explains the varying conclusions reported in the literature regarding gender-specific sleep-related differences.     

A reproducible means of assessing the metabolic heat status of preterm neonates

The aim of the present study was to validate the measurement of metabolic heat production using partitional calorimetry (PC) in preterm neonates exposed to a near-thermoneutral environment in an incubator. In order to reduce experimental uncertainty (due to the different variables involved in the calculation of body heat exchanges between the infant and the environment), the mean radiant temperature and the heat transfer coefficients for convection, radiation and evaporation were measured using a multisegment, anthropometric thermal mannequin which represents a small-for-gestational-age neonate (body surface area: 0.150 m2; simulated birth weight: 1500 g). The metabolic heat production calculated by PC was compared with the results of indirect respiratory calorimetry, which is rarely done in clinical setting since this method interferes with the neonate's environment and requires a high degree of technical preparedness. The oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured in 20 preterm neonates exposed to thermoneutral (32.3 degrees C) and to slightly cool environments (30.2 degrees C). The mean skin temperature was measured by infrared thermography. The measurements were made during well-established periods of active and quiet sleep. Metabolic heat production was assessed by weighting each value of VO2 and VCO2 by the duration of the sleep stages. Our results showed that there was no significant difference between the two methods in terms of their estimation of metabolic activity at thermoneutrality (mean overall difference: 0.34 kJ h(-1) kg(-1)) and in the cool environment (0.26 kJ h(-1) kg(-1)). We observed significant interneonate variability. Partitional calorimetry enabled the prediction of body growth with a daily error of less than 5.3 g (2.38 kJ h(-1) kg(-1)) for all the neonates at thermoneutrality and for 85% of the subjects (3.03 kJ h(-1) kg(-1)) in the cool environment. Despite this limitation, we demonstrate here that PC provides reliable information for calculating the energy expenditure of individual preterm neonates on the basis of standard environmental input variables. We suggest that the technique can be advantageously used to assess the energy expenditure and normal growth of these infants.     

Polygraphic studies of kitten development: respiratory rate and variability during sleep-waking states.

The developmental course of respiration rate and variability during sleep states and waking was measured in chronically prepared kittens. Kittens had higher respiration rates during active sleep (AS) as compared to quiet sleep (QS) at all ages, with rates declining developmentally in both sleep states. Compared to waking, respiration rate and variability were decreased during sleep. The decrease was greatest in the youngest animals and during QS. Minute-to-minute respiratory variability declined from 10 to 40 days of age for each state, whereas breath-to-breath variability declined during the same period only during QS. Respiratory variability was higher in AS than QS in older kittens. Heart rate and variability were found to be correlated with respiratory parameters only during QS. These observations support the hypothesis that the control and development of respiration during sleep is achieved by different processes in QS and AS.     

Development of sinus arrhythmia during sleeping and waking states in normal infants.

The development of variability in heart rate (HR) due to respiration (sinus arrhythmia; SA) has been examined in normal infants from birth through the first 6 months of life. Two aspects of HR variation were examined: the absolute variation at the median respiratory frequency, or extent of sinus arrhythmia (XSA), and the degree to which HR follows respiration regardless of the absolute amount of variation, or coherence of sinus arrhythmia (CSA). Extent of sinus arrhythmia tended to be highest in quiet sleep (QS), lower in active or REM sleep (AS), and lowest in waking (AW), especially after 2 months of age. Extent declined at 1 month of age in QS, but rose over the first 6-month period in all states. During this same period, CSA was also highest in QS, lower in AS, and lowest in AW. Coherence in QS also declined at 1 month and rose between 1 and 6 months; however, no age effects were found in other states. Heart rate was negatively correlated with XSA, but less so with CSA. Sleep state appears to have a significant effect on cardiorespiratory coupling, and this coupling undergoes dramatic changes at 1 month in QS.     

Spectral analysis of heart rate variability and respiration during sleep in cocaine-exposed neonates.

This study's objective was to examine the autonomic control of heart rate and respiration during the neonatal period in human infants with prenatal exposure to cocaine. Four-hour daytime recordings of the electrocardiogram (ECG) were obtained from 15 cocaine-exposed and 13 non-exposed full-term neonates at 2 weeks of age during quiet sleep (QS) and active sleep (AS). For each 1-min epoch of sleep, the power spectrum of the R-R intervals was computed from the ECG to obtain the total power (0-2 Hz), and spectral power in the high-frequency (HFP, 0.3-2 Hz), mid-frequency (MFP, 0.1-0.2 Hz), and low-frequency (LFP, 0.03-0.1 Hz) bands. Respiration was also monitored and processed using similar spectral analysis procedures. Cocaine-exposed neonates showed enhanced heart rate variability reflected by an increase in spectral power across all frequency bands. Spectral power in LFP and MFP was higher in cocaine-exposed neonates during both sleep states, but only in HFP during QS. There were no respiratory patterning differences between the groups to account for these findings. The index of sympathovagal balance (LFP + MFP)/HFP, showed no differences between the groups. We conclude that infants exposed to cocaine in utero show differences in the modulation of heart rate reflecting an increase in both vagal and sympathetic influences.     

Of sleep state and postnatal age on arousal responses induced by mild hypoxia in infants

STUDY OBJECTIVES: It has been suggested that mild hypoxia may not be a potent stimulus for arousal during sleep in infants because infants frequently fail to arouse from quiet sleep (QS). Our aim was to characterize arousal responses of sleeping infants in both active sleep (AS) and QS under normoxic and mildly hypoxic (15% O2) conditions over the first 6 months of life. PARTICIPANTS: Five healthy term and 6 healthy preterm infants were each studied at 2 to 5 weeks, 2 to 3 months, and 5 to 6 months postterm. All infants underwent daytime polysomnography during which nasal airflow was monitored using a purpose-built pneumotachograph. All infants were studied under both normoxic (21% O2) and hypoxic (15% O2, balance N2) conditions (presentation order randomized) in each sleep state at each study age. Tests were terminated at arousal, O2 saturation falling below 85%, or 5 minutes (failure to arouse). MEASUREMENTS: Probability of failure to arouse and mean arousal latency were compared between each experimental condition, with each infant serving as its own control. RESULTS: Infants aroused more frequently under hypoxic conditions than under normoxic conditions. Overall, arousal latencies were shorter during hypoxia compared to normoxia in both sleep states at each age. Arousal latencies were longer in QS compared to AS in both hypoxic and normoxic conditions. CONCLUSION: In sleeping infants, mild hypoxia serves as a stimulus for arousal in both AS and QS. Of particular significance is our finding that arousal from AS is readily elicited by mild hypoxia.     

新生儿睡眠期的脑电非线性分析方法

目的脑电（electroencephalogram,EEG）是新生儿脑功能监护中重要的生理信号,近年研究发现基于非线性动力学的复杂度分析能够客观反映大脑成熟度、睡眠周期和惊厥状态等。方法本文针对神经系统发育正常的早产新生儿组和足月新生儿组,采用近似熵（approximate entropy,ApEn）和样本熵（sample entropy,SampEn）两种非线性参数,对新生儿在安静睡眠期（quiet sleep,QS）和活动睡眠期（active sleep,AS）的脑电信号进行分析。结果神经系统发育正常的新生儿中,AS期的ApEn和SampEn均高于QS期,且具有显著性差异;随着受孕后年龄（postmenstrual age,PMA）的增大,新生儿QS期的ApEn和SampEn的值均随之增加,且波动逐渐减弱,而AS期的ApEn和SampEn的值并无显著变化;绝大多数新生儿在AS期与QS期的SampEn之差高于ApEn之差。结论AS期新生儿EEG的复杂度大于QS期的复杂度;随着PMA的增大,新生儿EEG的复杂度提高,脑功能发育趋于成熟;ApEn与SampEn在表现新生儿脑电信号复杂度上趋势一致,但SampEn在区分AS与QS方面更具优势。     

Sympathetic nervous control of the cerebral circulation in sleep

Cerebral vessels are extensively innervated by sympathetic nerves arising from superior cervical ganglia, and these nerves might play a protective role during the large arterial pressure surges of active sleep (AS). We studied lambs (n=10) undergoing spontaneous sleep-wake cycles before and after bilateral removal of the superior cervical ganglia (SCGx, n=5) or sham ganglionectomy (n=5). Lambs were instrumented to record cerebral blood flow (CBF, flow probe on the superior sagittal sinus), carotid arterial pressure (P(ca)), intra-cranial pressure (P(ic)), cerebral perfusion pressure (Pcp=Pca-Pic) and cerebral vascular resistance (CVR). Prior to SCGx, CBF (mL min-1) was significantly higher in AS than in Quiet Sleep (QS) and Quiet Wakefulness (QW) (17+/-2, 13+/-3, and 14+/-3 respectively, mean+/-SD, P<0.05). Following SCGx, baseline CBF increased by 34, 31, and 29% respectively (P<0.05). CVR also decreased in all states by approximately 25% (P<0.05). During phasic AS, surges of Pca were associated with transient increases in Pcp, Pic and CBF. Following SCGx, peak CBF and Pic during surges became higher and more prolonged (P<0.05). Our study is the first to reveal that tonic sympathetic nerve activity (SNA) constricts the cerebral circulation and restrains baseline CBF in sleep. SNA is further incremented during arterial pressure surges of AS, limiting rises in CBF and Pic, possibly by opposing vascular distension as well as by constricting resistance vessels. Thus, SNA may protect cerebral microvessels from excessive distension during AS, when large arterial blood pressure surges are common.     

Polysomnographic sleep and waking states are similar in subsequent siblings of SIDS and control infants during the first six months of life

Twenty-five subsequent siblings of infants who died of Sudden Infant Death Syndrome (SIDS) underwent 12-h overnight polygraphic recordings during the first week of life and at 1, 2, 3, 4, and 6 months of age. The polygraphic tracings from these infants were compared with those from 25 infants without a family history of SIDS. One dozen sleep and waking parameters were examined including state transition probabilities, the ratio between quiet sleep (QS) and active sleep (AS), the incidence and duration of sustained states and the stability of an infant's sleep and waking during the first half year of life. Variability within and between infants was marked with a reduction of variability in measures of QS at 3 months and of AS at 4 months of age. The similarities between subsequent siblings of SIDS and control infants far outweighted the differences. However, subsequent siblings exhibited a tendency, once asleep, to remain asleep longer than controls. This finding was observed in a comparison of 20 infants in each group. When five infants were added to each group, infants in both groups tended to awaken equally from QS, but once in AS the subsequent siblings tended to proceed into QS instead of awaken as the controls did.     

Between-sleep states transitions in premature babies

To assess the manner in which between-sleep state transitions occur in infants, we examined polysomnography (PSG) studies in 25 clinically and neurologically normal, appropriate-for-gestational-age, 30-to-36-week-gestational age (GA) infants. Twenty infants underwent paper PSG and five infants digitised PSG. Sleep states were coded based on concordance of REMs and the electroencephalogram (EEG) pattern. Data were analysed using a multivariate linear model, with the subject factor as a cluster. Duration of active sleep (AS) to quiet sleep (QS) transitions (median 4.8 min) was significantly longer than duration of QS to AS transitions (1.7 min) and was independent from GA and from the recording method (paper vs. digitized PSG). The sequence of modifications in parameters (REM and EEG) was invariable: REM cessation was the first change in AS to QS transitions, and REM appearance was the last change in the QS to AS transitions. Our study demonstrates a stable, well-organized pattern of between-sleep-states transitions in healthy 30-to-36-week GA premature infants. These findings are similar to those described in full-term newborns and are in agreement with our previous observations of well-defined sleep states at the age investigated here.     

Neonatal Acoustically-Elicited Cardiac Response: Modulation by State and Antecedent Stimulation

This study investigated modulation of the acoustic cardiac reflex (ACR) in human neonates. Three groups of 16 human neonates born at term were presented an abrupt cardioacceleratory auditory stimulus during awake (AW), quiet sleep (QS), and active sleep (AS) states of wakefulness. On 3/4 of the trials this stimulus was preceded by a continuous pure tone at lead times of either 100, 250, or 4000 ms. Across state, prestimulation modified the amplitude and pattern of the neonatal ACR. Relative to trials without prestimulation, the 100-ms lead inhibited, whereas the 250-ms and the 4000-ms lead stimului enhanced the ACR. During AS, neonates exhibited a triphasic ACR that returned to baseline within 9 s in contrast to the sustained responses in AW and QS states. The results demonstrate central inhibitory and facilatatory control over the ACR early in postnatal life. The pattern of results is consistent with the adult pattern of acoustic startle modulation, as is the absence of significant state effects. Given data from 2-month-old infants suggesting an absence of inhibitory effects in acoustic modulation of cardiac startle, it appears that there are non-linear changes in this basic sensory processing mechanism during the first months after birth.     

Arousal and ventilatory responses to mild hypoxia in sleeping preterm infants

A failure to adequately respond to hypoxia has been implicated in the Sudden Infant Death Syndrome (SIDS). Preterm infants are at increased risk for SIDS, thus we compared ventilatory and arousal responses to mild hypoxia [15% oxygen (O₂)] in preterm and term infants. Eight preterm and 15 term infants were serially studied with daytime polysomnography during which nasal airflow was monitored by pneumotachograph at 2–5 weeks, 2–3 and 5–6 months. At each age, in both groups, hypoxia induced a significant decrease in oxygen saturation (SpO₂) during both active sleep (AS) and quiet sleep (QS). Infants invariably aroused in AS; and in QS either aroused or failed to arouse. In preterm infants arousal latency in AS was longer than in term infants ( P  < 0.05) at 2–5 weeks. Compared with term infants, preterm infants reached significantly lower SpO₂ levels at 2–5 weeks in both AS and QS non-arousing tests and at 2–3 months in QS. A biphasic hypoxic ventilatory response was observed in QS non-arousing tests in both groups of infants at all three ages. We conclude that the greater desaturation during a hypoxic challenge combined with the longer arousal latency in preterm infants could contribute to greater risk for SIDS.     

Sleeping Like a Baby—Does Gender Influence Infant Arousability?

Introduction:

Victims of the sudden infant death syndrome (SIDS) may have preexisting abnormalities in their arousal pathways, inhibiting the progression of subcortical activation (SCA) to full cortical arousal (CA). Approximately 60% of SIDS victims are male, and it has been suggested that male infants have delayed cortical maturation compared to females. We hypothesized that CA frequency would be lower and CA threshold would be higher in male infants during both active (AS) and quiet (QS) sleep.

Methods:

50 healthy term infants (21 male, 29 female) were studied with daytime polysomnography at 2–4 weeks and 2–3 months after birth. Arousal from sleep was induced using a pulsatile air-jet to the nostrils at increasing pressures.

Results:

At 2–4 weeks, arousability from AS was similar in males and females, however during QS, male infants required a lower stimulus to induce SCA and CA. This gender difference in arousal threshold was not observed at 2–3 months. CA frequencies were similar between genders during both sleep states at both ages, though overall, CA was more frequent in AS than in QS.

Conclusions:

This study demonstrated that at 2–4 weeks, male infants were easier to arouse than female infants during QS. There were no significant effects of gender on total arousability or SCA and CA frequencies at 2–3 months, the age of peak SIDS incidence. Thus, although male infants are at greater risk of SIDS than female infants, this difference is unlikely to be associated with gender differences in CA threshold or frequency.

Citation:

Richardson HL; Walker AM; Horne RSC. Sleeping like a baby—does gender influence infant arousability? SLEEP 2010;33(8):1055-1060.