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Horne RS, Harrewijn I, Hunt CE. Physiology during sleep in preterm infants: Implications for increased risk for the sudden infant death syndrome. Sleep Med Rev 2024; 78:101990. [PMID: 39116607 DOI: 10.1016/j.smrv.2024.101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 07/14/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024]
Abstract
Approximately 15 million babies are born preterm (<37 weeks of completed gestation) worldwide annually. Although neonatal and perinatal medicine have contributed to the increased survival rate of preterm newborn infants, premature infants are at increased risk of mortality in the first years of life. Infants born preterm are at four times the risk of Sudden Infant Death Syndrome (SIDS) compared to infants born at term. SIDS is believed to be multifactorial in origin. The Triple Risk hypothesis has been proposed to explain this. The model suggests that when a vulnerable infant, such as one born preterm, is at a critical but unstable developmental period in homeostatic control, death may occur if exposed to an exogenous stressor, such as being placed prone for sleep. The highest risk period is at ages 2-4 months, with 90 % of deaths occurring before 6 months. The final pathway to SIDS is widely believed to involve some combination of immature cardiorespiratory control and a failure of arousal from sleep. This review will focus on the physiological factors which increase the risk for SIDS in preterm infants and how these factors may be identified and potentially lead to effective preventative strategies.
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Affiliation(s)
| | | | - Carl E Hunt
- Uniformed Services University, Bethesda, MD, USA
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2
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Guyon A, Ravet F, Champavert A, Thieux M, Patural H, Plancoulaine S, Franco P. Maturation of Arousals during Day and Night in Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020223. [PMID: 35204943 PMCID: PMC8870058 DOI: 10.3390/children9020223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 11/19/2022]
Abstract
The objective of this study was to compare the maturation of spontaneous arousals during day and night sleep in preterm and term infants. From the Autonomic Baby Evaluation study, the sleep and arousal characteristics of 12 preterm (35.1 ± 2.1 weeks’ gestational age, GA) and 21 term (39.8 ± 0.8 weeks GA) newborns were compared between diurnal and nocturnal sleep periods at birth (M0) and 6 months (M6) of age. Models were adjusted for time (night/day), maturation (M0/M6), prematurity (yes/no). We found that preterm infants had less active sleep (AS)% than term infants with maturation during both day and night sleep, which may reflect accelerated brain maturation secondary to stress or environmental exposure after birth. Moreover, there was a difference in arousal maturation during day and night sleep in the preterm infants, as shown previously for term infants, which suggests the emergence of a circadian rhythm during the earliest postnatal period. We also showed that compared to term infants, these moderate preterm infants had fewer total arousals and, more specifically, fewer arousals in AS during day and night sleep, exposing them to a higher risk of sudden infant death syndrome.
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Affiliation(s)
- Aurore Guyon
- Unité de Sommeil, Service D’épilepsie, Sommeil et Explorations Fonctionnelles Neurologiques Pédiatriques—INSERM U1028—Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 59 bd Pinel Bron, 69500 Lyon, France; (A.G.); (A.C.); (M.T.)
| | - Francoise Ravet
- Unité de Sommeil Pédiatrique—Département Universitaire de Pédiatrie du CHU Liège—Site CHR, 1 bd du XIIème de Ligne, 4000 Liège, Belgium;
| | - Alex Champavert
- Unité de Sommeil, Service D’épilepsie, Sommeil et Explorations Fonctionnelles Neurologiques Pédiatriques—INSERM U1028—Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 59 bd Pinel Bron, 69500 Lyon, France; (A.G.); (A.C.); (M.T.)
| | - Marine Thieux
- Unité de Sommeil, Service D’épilepsie, Sommeil et Explorations Fonctionnelles Neurologiques Pédiatriques—INSERM U1028—Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 59 bd Pinel Bron, 69500 Lyon, France; (A.G.); (A.C.); (M.T.)
| | - Hugues Patural
- Neonatal and Pediatric Intensive Care Department, Inserm, U1059, University Hospital of Saint Etienne, 42270 Saint Etienne, France;
| | - Sabine Plancoulaine
- Centre of Research in Epidemiology and StatisticS (CRESS), Inserm, INRAE, Université de Paris Cité, F-75004 Paris, France;
| | - Patricia Franco
- Unité de Sommeil, Service D’épilepsie, Sommeil et Explorations Fonctionnelles Neurologiques Pédiatriques—INSERM U1028—Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 59 bd Pinel Bron, 69500 Lyon, France; (A.G.); (A.C.); (M.T.)
- Correspondence: ; Tel.: +33-4-27-85-60-52; Fax: +33-4-27-86-92-30
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Seppä-Moilanen M, Andersson S, Kirjavainen T. Spontaneous and apnea arousals from sleep in preterm infants. Pediatr Res 2021; 89:1261-1267. [PMID: 32682326 DOI: 10.1038/s41390-020-1068-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The significance of arousal in apnea termination in preterm infants is not known. METHODS We investigated the appearance of arousals from sleep with polysomnography for 21 preterm infants at a median age of 36 gestational weeks. RESULTS The polysomnographic appearance of sleep was fragmented by frequent arousals. The number of spontaneous arousals unrelated to apneas was 18 per hour in sleep; higher in rapid eye movement (REM) sleep than in non-REM sleep (p < 0.001). Eighty-two percent of arousals were regarded as spontaneous, and 18% were related to apneas. In turn, arousal followed 5% of all apneas; 30% of mixed, 2% of central, and 20% of long apneas defined as apnea of prematurity. Apneas without an arousal led to lower oxygen saturation levels than those followed by an arousal (p < 0.001). Mixed apneas with an arousal had stronger breathing effort and a higher number of breaths compared with apneas without an arousal (p < 0.05). CONCLUSIONS In preterm infants, frequent spontaneous arousals or arousal-type phenomena make the polysomnographic appearance of sleep fragmented. However, even long apneas or hypoxia commonly fail to elicit arousals or any sign of sleep interruption. Our findings suggest that arousal appears not to be the main mechanism for apnea termination in preterm infants. IMPACT Polysomnographic appearance of sleep in preterm infants is fragmented by arousals. Contrary to older children and adults, arousal to apnea is uncommon in preterm infants. Even long mixed apneas with desaturation mostly fail to elicit an arousal response. In preterm infants, apnea termination appears not to depend on an arousal. Low arousability is suggested to be caused by a low ventilation response to hypoxia.
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Affiliation(s)
- Maija Seppä-Moilanen
- Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Sture Andersson
- Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turkka Kirjavainen
- Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Cottengim C, Parks SE, Erck Lambert AB, Dykstra HK, Shaw E, Johnston E, Olson CK, Shapiro-Mendoza CK. U-Shaped Pillows and Sleep-Related Infant Deaths, United States, 2004-2015. Matern Child Health J 2020; 24:222-228. [PMID: 31828577 PMCID: PMC10961735 DOI: 10.1007/s10995-019-02847-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe infant deaths where a u-shaped pillow was under or around an infant and to describe cases classified as Explained Suffocation. METHODS We examined demographics and circumstances of 141 infant deaths during 2004-2015 in the US National Fatality Review Case Reporting System with u-shaped pillows in the sleep environment. RESULTS Most infants were < 6 months old (92%), male (58%), non-Hispanic White (53%), and of the nine explained suffocation deaths, four occurred when the u-shaped pillow obstructed the infant's airway; five occurred when the infant rolled off the pillow and their airway was obstructed by another object. CONCLUSIONS FOR PRACTICE Although infrequent, infant deaths with u-shaped pillows have occurred. Health care providers may include discussion of the importance of caregivers following infant product packaging precautions and warning labels for commonly used consumer products, such as u-shaped pillows in their advice to caregivers.
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Affiliation(s)
- Carri Cottengim
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, N.E. MS S107-2, Chamblee, GA, 30341, USA.
| | - Sharyn E Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Heather K Dykstra
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, MI, USA
| | - Esther Shaw
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, MI, USA
| | - Emily Johnston
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine K Olson
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ali K, Rosser T, Bhat R, Wolff K, Hannam S, Rafferty GF, Greenough A. Antenatal smoking and substance-misuse, infant and newborn response to hypoxia. Pediatr Pulmonol 2017; 52:650-655. [PMID: 27723956 DOI: 10.1002/ppul.23620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine at the peak age for sudden infant death syndrome (SIDS) the ventilatory response to hypoxia of infants whose mothers substance misused in pregnancy (SM infants), or smoked during pregnancy (S mothers) and controls whose mothers neither substance misused or smoked. In addition, we compared the ventilatory response to hypoxia during the neonatal period and peak age of SIDS. WORKING HYPOTHESIS Infants of S or SM mothers compared to control infants would have a poorer ventilatory response to hypoxia at the peak age of SIDS. STUDY DESIGN Prospective, observational study. PATIENT-SUBJECT SELECTION Twelve S; 12 SM and 11 control infants were assessed at 6-12 weeks of age and in the neonatal period. METHODOLOGY Changes in minute volume, oxygen saturation, heart rate, and end tidal carbon dioxide levels on switching from breathing room air to 15% oxygen were assessed. Maternal and infant urine samples were tested for cotinine, cannabinoids, opiates, amphetamines, methadone, cocaine, and benzodiazepines. RESULTS The S and SM infants had a greater decline in minute volume (P = 0.037, P = 0.016, respectively) and oxygen saturation (P = 0.031) compared to controls. In all groups, the magnitude of decline in minute volume in response to hypoxia was higher in the neonatal period compared to at 6-12 weeks (P < 0.001). CONCLUSIONS Both maternal substance misuse and smoking were associated with an impaired response to a hypoxic challenge at the peak age for SIDS. The hypoxic ventilatory decline was more marked in the neonatal period compared to the peak age for SIDS indicating a maturational effect. Pediatr Pulmonol. 2017;52:650-655. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kamal Ali
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Rosser
- Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom
| | - Ravindra Bhat
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Kim Wolff
- Addiction Sciences Unit, King's College London, London, United Kingdom
| | - Simon Hannam
- Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom
| | - Gerrard F Rafferty
- Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom
| | - Anne Greenough
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom.,Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
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Koos BJ, Rajaee A, Ibe B, Guerra C, Kruger L. Thalamic mediation of hypoxic respiratory depression in lambs. Am J Physiol Regul Integr Comp Physiol 2016; 310:R586-95. [PMID: 26818057 PMCID: PMC4867384 DOI: 10.1152/ajpregu.00412.2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/27/2016] [Indexed: 11/22/2022]
Abstract
Immaturity of respiratory controllers in preterm infants dispose to recurrent apnea and oxygen deprivation. Accompanying reductions in brain oxygen tensions evoke respiratory depression, potentially exacerbating hypoxemia. Central respiratory depression during moderate hypoxia is revealed in the ventilatory decline following initial augmentation. This study determined whether the thalamic parafascicular nuclear (Pf) complex involved in adult nociception and sensorimotor regulation (Bentivoglio M, Balerecia G, Kruger L. Prog Brain Res 87: 53-80, 1991) also becomes a postnatal controller of hypoxic ventilatory decline. Respiratory responses to moderate isocapnic hypoxia were studied in conscious lambs. Hypoxic ventilatory decline was compared with peak augmentation. Pf and/or adjacent thalamic structures were destroyed by the neuron-specific toxin ibotenic acid (IB). IB lesions involving the thalamic Pf abolished hypoxic ventilatory decline. Lesions of adjacent thalamic nuclei that spared Pf and control injections of vehicle failed to blunt hypoxic respiratory depression. Our findings reveal that the thalamic Pf region is a critical controller of hypoxic ventilatory depression and thus a key target for exploring molecular concomitants of forebrain pathways regulating hypoxic ventilatory depression in early development.
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Affiliation(s)
- Brian J Koos
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California;
| | - Arezoo Rajaee
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Basil Ibe
- Department of Pediatrics, C. W. Steers Biological Resource Center, Los Angeles Biomedical Research Institute, Harbor-University of California Los Angeles Medical Center, Torrance, California; and
| | - Catalina Guerra
- C. W. Steers Biological Resource Center, Los Angeles Biomedical Research Institute, Harbor-University of California Los Angeles Medical Center, Torrance, California
| | - Lawrence Kruger
- Department of Neurobiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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Richardson HL, Horne RSC. Arousal from sleep pathways are affected by the prone sleeping position and preterm birth: preterm birth, prone sleeping and arousal from sleep. Early Hum Dev 2013; 89:705-11. [PMID: 23725788 DOI: 10.1016/j.earlhumdev.2013.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 05/01/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Preterm infants exhibit depressed arousability from sleep when compared with term infants. As the final cortical element of the arousal process may be the most critical for survival, we hypothesized that the increased vulnerability of preterm infants to the Sudden Infant Death Syndrome (SIDS) could be explained by depressed cortical arousal (CA) responses. We evaluated the effects of preterm birth on stimulus-induced arousal processes in both the prone and supine sleeping positions. STUDY DESIGN 10 healthy preterm infants were studied with daytime polysomnography, in both supine and prone sleeping positions, at 36 weeks gestational age, 2-4 weeks, 2-3 months and 5-6 months post-term corrected age. Sub-cortical activations and cortical arousals (CA) were expressed as proportions of total arousal responses. Preterm data were compared with data from 13 healthy term infants studied at the same corrected ages. RESULTS In preterm infants increased CAs were observed in the prone position at all ages studied. Compared to term infants, preterm infants had significantly fewer CAs in QS when prone at 2-3 months of age and more CAs when prone at 2-4 weeks in AS. There were no differences in either sleep state when infants slept supine. CONCLUSIONS Prone sleeping promoted CA responses in healthy preterm infants throughout the first six months of post-term age. We have previously suggested that in term infants enhanced CA represents a critical protection against a potentially harmful situation; we speculate that for preterm-born infants the need for this protection is greater than in term infants.
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Affiliation(s)
- Heidi L Richardson
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
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8
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The physiological determinants of sudden infant death syndrome. Respir Physiol Neurobiol 2013; 189:288-300. [PMID: 23735486 DOI: 10.1016/j.resp.2013.05.032] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/19/2013] [Accepted: 05/27/2013] [Indexed: 01/08/2023]
Abstract
It is well-established that environmental and biological risk factors contribute to Sudden Infant Death Syndrome (SIDS). There is also growing consensus that SIDS requires the intersection of multiple risk factors that result in the failure of an infant to overcome cardio-respiratory challenges. Thus, the critical next steps in understanding SIDS are to unravel the physiological determinants that actually cause the sudden death, to synthesize how these determinants are affected by the known risk factors, and to develop novel ideas for SIDS prevention. In this review, we will examine current and emerging perspectives related to cardio-respiratory dysfunctions in SIDS. Specifically, we will review: (1) the role of the preBötzinger complex (preBötC) as a multi-functional network that is critically involved in the failure to adequately respond to hypoxic and hypercapnic challenges; (2) the potential involvement of the preBötC in the gender and age distributions that are characteristic for SIDS; (3) the link between SIDS and prematurity; and (4) the potential relationship between SIDS, auditory function, and central chemosensitivity. Each section underscores the importance of marrying the epidemiological and pathological data to experimental data in order to understand the physiological determinants of this syndrome. We hope that a better understanding will lead to novel ways to reduce the risk to succumb to SIDS.
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Garcia AJ, Koschnitzky JE, Dashevskiy T, Ramirez JM. Cardiorespiratory coupling in health and disease. Auton Neurosci 2013; 175:26-37. [PMID: 23497744 DOI: 10.1016/j.autneu.2013.02.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 01/21/2013] [Accepted: 02/08/2013] [Indexed: 10/27/2022]
Abstract
Cardiac and respiratory activities are intricately linked both functionally as well as anatomically through highly overlapping brainstem networks controlling these autonomic physiologies that are essential for survival. Cardiorespiratory coupling (CRC) has many potential benefits creating synergies that promote healthy physiology. However, when such coupling deteriorates autonomic dysautonomia may ensue. Unfortunately there is still an incomplete mechanistic understanding of both normal and pathophysiological interactions that respectively give rise to CRC and cardiorespiratory dysautonomia. Moreover, there is also a need for better quantitative methods to assess CRC. This review addresses the current understanding of CRC by discussing: (1) the neurobiological basis of respiratory sinus arrhythmia (RSA); (2) various disease states involving cardiorespiratory dysautonomia; and (3) methodologies measuring heart rate variability and RSA.
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Affiliation(s)
- Alfredo J Garcia
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
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Darnall RA. The carotid body and arousal in the fetus and neonate. Respir Physiol Neurobiol 2012; 185:132-43. [PMID: 22684039 DOI: 10.1016/j.resp.2012.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/18/2012] [Accepted: 06/01/2012] [Indexed: 02/02/2023]
Abstract
Arousal from sleep is a major defense mechanism in infants against hypoxia and/or hypercapnia. Arousal failure may be an important contributor to SIDS. Areas of the brainstem that have been found to be abnormal in a majority of SIDS infants are involved in the arousal process. Arousal is sleep state dependent, being depressed during AS in most mammals, but depressed during QS in human infants. Repeated exposure to hypoxia causes a progressive blunting of arousal that may involve medullary raphe GABAergic mechanisms. Whereas CB chemoreceptors contribute heavily to arousal in response to hypoxia, serotonergic central chemoreceptors have been implicated in the arousal response to CO(2). Pulmonary or chest wall mechanoreceptors also contribute to arousal in proportion to the ventilatory response and decreases in their input may contribute to depressed arousal during AS. Little is known about specific arousal pathways beyond the NTS. Whether CB chemoreceptor stimulation directly stimulates arousal centers or whether this is done indirectly through respiratory networks remains unknown. This review will focus on arousal in response to hypoxia and CO(2) in the fetus and newborn and will outline what we know (and do not know) about the involvement of the carotid body in this process.
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Affiliation(s)
- Robert A Darnall
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, United States.
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Jadcherla SR, Parks VN, Peng J, Dzodzomenyo S, Fernandez S, Shaker R, Splaingard M. Esophageal sensation in premature human neonates: temporal relationships and implications of aerodigestive reflexes and electrocortical arousals. Am J Physiol Gastrointest Liver Physiol 2012; 302:G134-44. [PMID: 21852361 PMCID: PMC3345963 DOI: 10.1152/ajpgi.00067.2011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Electrocortical arousal (ECA) as an effect of visceral provocation or of its temporal relationships with aerodigestive reflexes in premature neonates is not known. We tested the hypothesis that esophageal provocation results in both esophageal reflex responses and ECAs during sleep and that ECAs are dependent on the frequency characteristics of esophageal neuromotor responses. We defined the spatiotemporal relationship of ECAs in relation to 1) spontaneous pharyngoesophageal swallow sequences and gastroesophageal reflux (GER) events and 2) sensory-motor characteristics of esophageal reflexes. Sixteen healthy premature neonates born at 27.9 ± 3.4 wk were tested at 36.8 ± 1.9 wk postmenstrual age. Ninety-five midesophageal and 31 sham stimuli were given in sleep during concurrent manometry and videopolysomnography. With stimulus onset as reference point, we scored the response latency, frequency occurrence and duration of arousals, peristaltic reflex, and upper esophageal sphincter contractile reflex (UESCR). Changes in polysomnography-respiratory patterns and esophageal sensory-motor parameters were scored by blinded observers. Significantly (for each characteristic listed, P < 0.05), swallow sequences were associated with arousals and sleep state changes, and arousals were associated with incomplete peristalsis, response delays to lower esophageal sphincter relaxation, and prolonged esophageal clearance. GER events (73.5%) provoked arousals, and arousals were associated with response delays to peristaltic reflexes or clearance, sleep state modification, and prolonged respiratory arousal. Midesophageal stimuli (54%) provoked arousals and were associated with increased frequency, prolonged latency, prolonged response duration of peristaltic reflexes and UESCR, and increased frequency of sleep state changes and respiratory arousals. In human neonates, ECAs are provoked upon esophageal stimulation; the sensory-motor characteristics of esophageal reflexes are distinct when accompanied by arousals. Aerodigestive homeostasis is defended by multiple tiers of aerodigestive safety mechanisms, and when esophageal reflexes are delayed, cortical hypervigilance (ECAs) occurs.
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Affiliation(s)
- Sudarshan R. Jadcherla
- 1Sections of Neonatology, Pediatric Gastroenterology, and Nutrition, The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Department of Pediatrics, The Ohio State University College of Medicine, The Research Institute at Nationwide Children's Hospital, Columbus; ,2The Neonatal and Infant Feeding Disorders Program, The Research Institute at Nationwide Children's Hospital, Columbus;
| | - Vanessa N. Parks
- 2The Neonatal and Infant Feeding Disorders Program, The Research Institute at Nationwide Children's Hospital, Columbus;
| | - Juan Peng
- 2The Neonatal and Infant Feeding Disorders Program, The Research Institute at Nationwide Children's Hospital, Columbus;
| | - Samuel Dzodzomenyo
- 3Pediatric Sleep Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus;
| | - Soledad Fernandez
- 4Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio; and
| | - Reza Shaker
- 5Division of Gastroenterology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mark Splaingard
- 3Pediatric Sleep Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus;
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Apnea of prematurity: What can observational studies tell us about pathophysiology? Sleep Med 2010; 11:701-7. [DOI: 10.1016/j.sleep.2009.11.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 10/30/2009] [Accepted: 11/04/2009] [Indexed: 11/21/2022]
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Franco P, Kato I, Richardson HL, Yang JSC, Montemitro E, Horne RSC. Arousal from sleep mechanisms in infants. Sleep Med 2010; 11:603-14. [PMID: 20630799 DOI: 10.1016/j.sleep.2009.12.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/14/2009] [Accepted: 12/17/2009] [Indexed: 11/19/2022]
Abstract
Arousals from sleep allow sleep to continue in the face of stimuli that normally elicit responses during wakefulness and also permit awakening. Such an adaptive mechanism implies that any malfunction may have clinical importance. Inadequate control of arousal in infants and children is associated with a variety of sleep-related problems. An excessive propensity to arouse from sleep favors the development of repeated sleep disruptions and insomnia, with impairment of daytime alertness and performance. A lack of an adequate arousal response to a noxious nocturnal stimulus reduces an infant's chances of autoresuscitation, and thus survival, increasing the risk for Sudden Infant Death Syndrome (SIDS). The study of arousability is complicated by many factors including the definition of an arousal; the scoring methodology; the techniques used (spontaneous arousability versus arousal responses to endogenous or exogenous stimuli); and the confounding factors that complicate the determination of arousal thresholds by changing the sleeper's responses to a given stimulus such as prenatal drug, alcohol, or cigarette use. Infant age and previous sleep deprivation also modify thresholds. Other confounding factors include time of night, sleep stages, the sleeper's body position, and sleeping conditions. In this paper, we will review these different aspects for the study of arousals in infants and also report the importance of these studies for the understanding of the pathophysiology of some clinical conditions, particularly SIDS.
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Affiliation(s)
- Patricia Franco
- Pediatric Sleep Unit, HFME & INSERM U 628, University Lyon 1, Lyon, France.
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Richardson HL, Walker AM, Horne RSC. Stimulus type does not affect infant arousal response patterns. J Sleep Res 2009; 19:111-5. [PMID: 19691474 DOI: 10.1111/j.1365-2869.2009.00764.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous studies have examined infant arousal responses to various arousal stimuli; however it is unclear whether the patterns of responses to different stimuli are comparable within subjects across early development. The aim of the study was to compare the effects of both respiratory and somatosensory stimulation on arousal processes in the same infants throughout the first 6 months of life. Ten healthy term infants were studied with daytime polysomnography at 2-4 weeks, 2-3 and 5-6 months. Infants were challenged with both hypoxia (15% O(2), balanced N(2)) and a pulsatile air-jet to the nostrils. Stimulus-induced sub-cortical activations (SCA) and cortical arousals (CA) were expressed as percentages of total arousals. Heart rate (HR) changes and electroencephalogram (EEG) desynchronization were also contrasted for the two stimuli. During active sleep (AS), there was no significant effect of stimulus type on proportions of CA at any of the ages studied. During quiet sleep (QS), hypoxia elicited higher CA proportions than the air-jet at 2-3 and 5-6 months (P < 0.01). Overall, HR responses associated with SCA and CA and the duration of EEG desynchronization during CA were similar for both stimuli. Mild hypoxia and nasal air-jet stimulation produce qualitatively similar patterns of arousal responses during the first 6 months of life, supporting the concept of a final common neural pathway of cortical activation. Quantitatively, full CA from QS is more likely with hypoxia, in keeping with it being a life-threatening stimulus. This study supports the nasal air-jet as an appropriate stimulus for assessing developmental patterns of infant arousal process.
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Affiliation(s)
- Heidi L Richardson
- Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Melbourne, Australia
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Bollen B, Bouslama M, Matrot B, Rotrou Y, Vardon G, Lofaso F, Van den Bergh O, D'Hooge R, Gallego J. Cold stimulates the behavioral response to hypoxia in newborn mice. Am J Physiol Regul Integr Comp Physiol 2009; 296:R1503-11. [DOI: 10.1152/ajpregu.90582.2008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In newborns, hypoxia elicits increased ventilation, arousal followed by defensive movements, and cries. Cold is known to affect the ventilatory response to hypoxia, but whether it affects the arousal response remains unknown. The aim of the present study was to assess the effects of cold on the ventilatory and arousal responses to hypoxia in newborn mice. We designed an original platform measuring noninvasively and simultaneously the breathing pattern by whole body plethysmography, body temperature by infrared thermography, as well as motor and ultrasonic vocal (USV) responses. Six-day-old mice were exposed twice to 10% O2 for 3 min at either cold temperature (26°C) or thermoneutrality (33°C). At 33°C, hypoxia elicited a marked increase in ventilation followed by a small ventilatory decline, small motor response, and almost no USVs. Body temperature was not influenced by hypoxia, and oxygen consumption (V̇o2) displayed minimal changes. At 26°C, hypoxia elicited a slight increase in ventilation with a large ventilatory decline and a large drop of V̇o2. This response was accompanied by marked USV and motor responses. Hypoxia elicited a small decrease in temperature after the return to normoxia, thus precluding any causal influence on the motor and USV responses to hypoxia. In conclusion, cold stimulated arousal and stress responses to hypoxia, while depressing hypoxic hyperpnea. Arousal is an important defense mechanism against sleep-disordered breathing. The dissociation between ventilatory and behavioral responses to hypoxia suggests that deficits in the arousal response associated with sleep breathing disorders cannot be attributed to a depressed hypoxic response.
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