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. 2011 Jun 1;34(6):733-43.
doi: 10.5665/SLEEP.1038.

Fewer spontaneous arousals in infants with apparent life-threatening event

Patricia Franco  1 , Enza Montemitro, Sonia Scaillet, Jose Groswasser, Ineko Kato, Jian-Sheng Lin, Maria Pia Villa
Affiliations

Fewer spontaneous arousals in infants with apparent life-threatening event

Patricia Franco et al. Sleep. .

Abstract

Study objectives: 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.

Design: 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.

Results: 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.

Conclusions: 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.

Keywords: Apparent life-threatening event; arousal; infant; maturation; sudden infant death syndrome.

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Figures

Figure 1
Figure 1
Maturation of total arousals in NREM sleep in controls infants and ALTE infants with smoking and nonsmoking mothers. The frequency of arousals is given as an index (number of arousals/h of sleep). Wilcoxon non-matched tests were performed to compare control and ALTE groups with smoking and nonsmoking mothers. Statistically significant (★).
Figure 2
Figure 2
Maturation of cortical arousals in NREM sleep in controls infants and ALTE infants with smoking and nonsmoking mothers. The frequency of arousals is given as an index (number of arousals/h of sleep). Wilcoxon non-matched tests were performed to compare control and ALTE groups with smoking and nonsmoking mothers. Statistically significant (★).
Figure 3
Figure 3
Maturation of subcortical activations in NREM sleep in controls infants and ALTE infants with smoking and nonsmoking mothers. The frequency of arousals is given as an index (number of arousals/h of sleep). Wilcoxon non-matched tests were performed to compare control and ALTE groups with smoking and nonsmoking mothers. Statistically significant (★).
Figure 4
Figure 4
Cortical and subcortical arousals in 2-3 month-old control infants, ALTE infants with smoking and nonsmoking mothers, and in future SIDS infants (data previously published). The frequency of arousals is given as an index (number of arousals/h of sleep). Wilcoxon non-matched tests were performed to compare control and ALTE groups with smoking and nonsmoking mothers. Statistically significant (★).
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