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.
,
From the * Department of Pediatrics, Stanford University School
of Medicine, Stanford, California; the 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:
 |
|
 |
|
  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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
