PEDIATRICS Vol. 80 No. 2 August 1987, pp. 245-250
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Transepidermal Water Loss During Sleep in Infants at Risk for Sudden Death

A. Kahn MD1, C. Van de Merckt 1, M. Dramaix 1, P. Magrez FNRS Fellow1, D. Blum MD1, E. Rebuffat MD1, and L. Montauk 1

1 From the Pediatric Sleep Unit, Departments of Pediatrics, Epidemiology and Social Medicine, and Medical Statistics, Free University of Brussels, Brussels

To search for excessive sweating during sleep in infants considered at risk for sudden infant death syndrome (SIDS), we studied 258 infants during one night. There were 134 normal infants (controls), 85 siblings of SIDS victims (siblings), and 39 infants who survived an apparent life-threatening event (ALTE) with no cause found for the incident. Mean postnatal ages were between 10 and 16 weeks. Transepidermal water evaporation rate was measured from the forehead using an evaporimeter during one night's polygraphic sleep recording. Measurements were made before feedings, during the first part of the night, and evaporation rate values were expressed as grams per square meter of body surface area per hour. In the three groups of patients evaporation rates were significantly lower during rapid eye movement (REM) sleep, compared with values measured during quiet wakefulness or nonrapid eye movement (NREM) sleep. Infants with an ALTE had significantly higher evaporation rate values during NREM sleep than the two other groups (20.1 ± 1.93, 11.3 ± 0.68, and 11.5 ± 0.98 for the ALTE, control, and sibling infants, respectively). The differences were not related to age, sex, weight, or rectal temperature. During NREM sleep, evaporation rate values greater than 25 mg/m2/h were seen in 10/190 (5.3%) of the asymptomatic infants and in 11/36 (30.6%) of the infants with an ALTE. The results are in agreement with reports in the literature of repeated night sweating in infants who eventually died of SIDS. Although we are unable to conclude why evaporation rate values are higher in the ALTE group than in the two other groups, we cannot exclude that it reflects differences in autonomous system activity. Further studies are needed to establish whether at least a subgroup of infants at higher risk for SIDS have increased transcutaneous water evaporation rates during NREM sleep and whether its measurement could contribute to risk prediction for SIDS.

Key Words: sudden infant death syndrome • sleep • sweating • evaporation • hyperhydroses

Submitted on March 11, 1986
Accepted on August 8, 1986




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