This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goto, K.
Right arrow Articles by Ariagno, R. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Goto, K.
Right arrow Articles by Ariagno, R. L.
Related Collections
Right arrow Premature & Newborn

PEDIATRICS Vol. 103 No. 3 March 1999, pp. 603-609

More Awakenings and Heart Rate Variability During Supine Sleep in Preterm Infants

Received Mar 20, 1998; accepted Aug 11, 1998.

Kazuya Goto*, Dagger , Majid Mirmiran*, §, Marian M. Adams*, Robyn V. Longford*, Roger B. Baldwin*, Margaret A. Boeddiker*, and Ronald L. Ariagno*

From the * Department of Pediatrics, Stanford University School of Medicine, Stanford, California; the Dagger  Department of Pediatrics, Oita Medical University, Oita, Japan; and the § Netherlands Institute of Brain Research, Amsterdam, The Netherlands.

Objective.  The Task Force of The American Academy of Pediatrics (1996) recommends the nonprone sleeping position for asymptomatic preterm infants to prevent sudden infant death syndrome. The mechanism by which the nonprone sleeping position reduces the rate of sudden infant death syndrome is unclear for full-term infants and the precise effect of sleeping position on sleep and cardiorespiratory characteristics has never been addressed in preterm infants. The purpose of the present study was to clarify the effect of sleeping position on sleep and cardiorespiratory characteristics in preterm infants at an age when they are ready for discharge.

Study Design.  Sixteen asymptomatic preterm infants were studied in both supine and prone sleeping positions at 36.5 ± 0.6 weeks' postconceptional age using videosomnography. Sleep, respiratory, and heart rate characteristics were compared between the two positions using each infant as his/her own control.

Results.  More awakenings (ie, arousals >= 60 seconds) were seen during all sleep states in the supine sleeping position but overall the total sleep and percent sleep state were not affected by sleeping position. After each feeding, the first quiet sleep was significantly shorter, with more heart rate variability and awakenings in the supine position. There were no significant differences in the occurrence of arousals (<60 seconds) or the incidence or severity of apnea and periodic breathing. No clinically significant apnea (>= 15 seconds), bradycardia, or oxygen desaturations were seen.

Conclusion.  In 36-week-postconceptional age preterm infants, the supine sleeping position had less quiet sleep and was associated with greater heart rate variability during the first sleep cycle after the feeding. More awakenings were seen during all sleep states in the supine position. These data support the American Academy of Pediatrics recommendation for "Back to Sleep" for asymptomatic preterm infants because more awakenings and lower threshold for arousal may provide some benefit for the infant responding to a life-threatening event. However, further studies are needed to address positional effect on the physiologic measures in preterm infants at older ages (later stages of development). Precisely what constitutes the most healthy or advantageous sleep for newborn infants remains an important question.  Key words:  sleep, preterm infant, sleeping position, apnea, heart rate variability, sudden infant death syndrome, prone, supine.




This article has been cited by other articles:


Home page
 J. Appl. Physiol.Home page
M. St-Hilaire, N. Samson, E. Nsegbe, C. Duvareille, F. Moreau-Bussiere, P. Micheau, J. Lebon, and J.-P. Praud
Postnatal maturation of laryngeal chemoreflexes in the preterm lamb
J Appl Physiol, April 1, 2007; 102(4): 1429 - 1438.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. Y. Bhat, S. Hannam, R. Pressler, G. F. Rafferty, J. L. Peacock, and A. Greenough
Effect of Prone and Supine Position on Sleep, Apneas, and Arousal in Preterm Infants
Pediatrics, July 1, 2006; 118(1): 101 - 107.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
R Sahni, K F Schulze, S Kashyap, K Ohira-Kist, W P Fifer, and M M Myers
Sleeping position and electrocortical activity in low birthweight infants
Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2005; 90(4): F311 - f315.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
M. St-Hilaire, E. Nsegbe, K. Gagnon-Gervais, N. Samson, F. Moreau-Bussiere, P.-H. Fortier, and J.-P. Praud
Laryngeal chemoreflexes induced by acid, water, and saline in nonsedated newborn lambs during quiet sleep
J Appl Physiol, June 1, 2005; 98(6): 2197 - 2203.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
S. L. Tonkin, C. G. McIntosh, W. Hadden, C. Dakin, S. Rowley, and A. J. Gunn
Simple Car Seat Insert to Prevent Upper Airway Narrowing in Preterm Infants: A Pilot Study
Pediatrics, October 1, 2003; 112(4): 907 - 913.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. L. Ariagno, M. Mirmiran, M. M. Adams, A. G. Saporito, A. M. Dubin, and R. B. Baldwin
Effect of Position on Sleep, Heart Rate Variability, and QT Interval in Preterm Infants at 1 and 3 Months' Corrected Age
Pediatrics, March 1, 2003; 111(3): 622 - 625.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
L. Vernacchio, M. J. Corwin, S. M. Lesko, R. M. Vezina, C. E. Hunt, H. J. Hoffman, M. Willinger, and A. A. Mitchell
Sleep Position of Low Birth Weight Infants
Pediatrics, March 1, 2003; 111(3): 633 - 640.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. H. Malloy, D. H. Freeman, and J. PhD
Birth Weight- and Gestational Age-Specific Sudden Infant Death Syndrome Mortality: United States, 1991 Versus 1995
Pediatrics, June 1, 2000; 105(6): 1227 - 1231.
[Abstract] [Full Text]