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Sleep position may influence preterm infants’ risk for SIDS
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Cerebral oxygenation among preterm infants is reduced in the prone position and is lower compared with age-matched term infants, according to study findings in Pediatrics.
Karinna L. Fyfe, BMedSc, of Monash University in Melbourne, Australia, and colleagues used daytime polysomnography to assess the effects of sleep state and position among 35 preterm infants and 17 term infants. Researchers measured tissue oxygenation index (TOI) and mean arterial pressure (MAP) at post-term age 2 to 4 weeks, 2 to 3 months and 5 to 6 months. Preterm study participants were born at 26 to 36 weeks gestation. Term study participants were born at 38 to 42 weeks gestation.
Gestational age at birth was not significantly associated with cerebral TOI or MAP at any age in either sleep state or positon.
Among preterm infants, cerebral TOI was lower in prone position compared with supine position in both active and quiet sleep states at age 2 to 4 weeks, 2 to 3 months and 5 to 6 months. MAP was not significantly affected by sleep position at any age, but there was a trend toward lower MAP in the prone position at 2 to 3 months corrected age in both sleep states.
Cerebral TOI was higher among preterm infants in quiet sleep vs. active sleep in supine and prone positions at age 2 to 4 weeks. At age 2 to 3 months, cerebral TOI was not affected by sleep state in either sleep position. When preterm infants were aged 5 to 6 months, cerebral TOI was lower in quiet sleep vs. active sleep in both positons.
During quiet sleep in supine position, TOI was higher at age 2 to 4 weeks than at 2 to 3 months and 5 to 6 months. During active sleep in supine position, TOI was lower at age 2 to 3 months compared with 5 to 6 months.
When in prone position, TOI was higher at age 2 to 4 weeks and 5 to 6 months compared with 2 to 3 months during quiet and active sleep.
There was no difference in TOI between age 2 to 4 weeks and 5 to 6 months when in supine position during active sleep and prone position during both sleep states.
At age 2 to 4 weeks, preterm infants had lower cerebral TOI in both sleep states in both positions compared with term infants. There was no difference in cerebral TOI between term and preterm infants in supine position at age 2 to 3 months. However, cerebral TOI was lower among preterm infants in prone position during quiet and active sleep. Preterm birth had no effect on TOI at age 5 to 6 months.
Preterm birth did not affect MAP in supine position at all three ages and in prone position at age 5 to 6 months. Preterm birth had an overall effect on MAP in prone position at age 2 to 4 weeks, with MAP being lower among preterm infants.
These study findings have significant implications for sudden infant death syndrome (SIDS), according to the researchers.
“We suggest preterm infants may be particularly vulnerable to critically impaired cerebral oxygenation in the prone position, particularly in the presence of cardiovascular instability, contributing to their heightened risk of SIDS,” the researchers wrote.
However, Avihu Z. Gazit, MD, and James S. Kemp, MD, of Washington University School of Medicine in St. Louis, question whether a single TOI value is sufficient to support the researchers’ conclusions.
“A figure in an earlier publication from this group shows that there variability in cerebral TOI over longer periods of recording in a single infant may be on the order of 10% to 12%, a magnitude that is significant statistically when between-group and between-positions comparisons were made by Fyfe et al. If the authors had provided coefficients of variation for their time-weighted TOI averages to support the lack of variability in TOI measurement from infant to infant, that would have been reassuring,” Gazit and Kemp said in an accompanying editorial.
Disclosure: The researchers report no relevant financial disclosures.
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