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Incomplete Arousal Processes in Infants Who Were Victims of Sudden Death

Department of Pediatrics, Nagoya City University Medical School, Nagoya, Japan; Pediatric Sleep Unit, Neuropediatrics, Erasmus Hospital; Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Brussels, Belgium; and St. Petersburg State Pediatric Medical Academy, St. Petersburg, Russia

Correspondence and requests for reprints should be addressed to Andre Kahn, Hôpital Universitaire des Enfants Reine Fabiola, Avenue J.J. Crocq 15, B-1020 Brussels, Belgium. E-mail: akahn{at}ulb.ac.be

Infants who became victims of sudden infant death syndrome (SIDS) aroused less from sleep than control infants. This study was conducted to determine the characteristics of arousal from sleep of infants who eventually died of SIDS. Sixteen infants were monitored some days or weeks before they died of SIDS. Their polygraphic sleep recordings were compared with those of matched control infants. Arousals were scored as subcortical activation (incomplete arousals) or cortical arousal (complete arousals). Cortical arousals were significantly less frequent in the victims who would succumb to SIDS in the future than in the control infants during both REM and non-REM sleep (p = 0.039). The frequency (p = 0.017) and duration (p = 0.005) of subcortical activation were significantly greater in the infants who died of SIDS than in the control infants during REM sleep. Compared with the control infants, the infants who later died of SIDS had more frequent subcortical activation in the first part of the night, between 9:00 P.M. and 12:00 A.M. (p = 0.038), and fewer cortical arousals during the latter part of the night, between 3:00 and 6:00 A.M. (p = 0.011). The present data are suggestive of incomplete arousal processes in infants who eventually died at a time they were presumed to have been asleep.

Key Words: sleep • arousal • death • sudden infant death syndrome • apnea

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