Occurrence and mechanisms of sudden oxygen desaturation in infants who sleep face down.
OBJECTIVE
Infants who sleep prone and face down on soft bedding are particularly vulnerable for sudden infant death syndrome. It has been suggested that 1 mechanism of death in this situation involves rebreathing of expired air. Many infants tolerate rebreathing while lying prone face down for long periods with stable saturations. Others occasionally have rapid desaturations and may require intervention to terminate rebreathing. The present study had 3 objectives: 1) to determine the frequency of rapid desaturations in a large group of healthy infants, 2) to elucidate the mechanism of these desaturations, and 3) to determine the timing of these events during periods of rebreathing.


METHODS
We studied respiratory tracings and videotapes of 56 healthy 1- to 6-month-old infants who were sleeping face down and rebreathing on soft bedding in our laboratory. We compared the frequency of desaturations during rebreathing and nonrebreathing periods. We measured respiratory frequency and apnea occurrence before desaturation and nonrebreathing control episodes. We also measured minute ventilation during steady state before desaturation and just before desaturation.


RESULTS
There were 25 desaturation episodes in infants while rebreathing, occurring in 11 (19.6%) of the 56 infants. Episodes were significantly more frequent during rebreathing than during nonrebreathing periods. Three desaturation episodes reached <85%; 2 required intervention to terminate rebreathing. The respiratory frequency was not different between nonrebreathing control and desaturation episodes. Brief apneas were significantly more frequent preceding desaturation than control episodes (44% vs 4%). Just before episodes, there was a transient decrease in minute volume despite increasing inspired carbon dioxide in 3 episodes. There was evidence of partial or complete pharyngeal airway obstruction in 3 episodes. Thirty-six percent of all episodes were immediately preceded by behavioral arousal.


CONCLUSIONS
Rebreathing in prone sleeping infants is associated with an increased frequency of episodic desaturations. Desaturation may result from respiratory pattern changes such as brief apneas often associated with evidence of behavioral arousal or failure to increase ventilation in the face of rising inspired carbon dioxide, also associated with behavioral arousal.
Patel
Aloka L
AL
St Louis Children's Hospital and the Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Paluszynska
Dorota
D
Harris
Kathleen A
KA
Thach
Bradley T
BT
D001512:Bedding and Linens / Q000009:adverse effects; D001784:Blood Gas Analysis / Q000379:methods; D002245:Carbon Dioxide / Q000097:blood; D005145:Face; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood*; D017286:Polysomnography / Q000379:methods; D016684:Prone Position; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012129:Respiratory Function Tests / Q000379:methods; D015656:Respiratory Mechanics / Q000502:physiology; D012890:Sleep / Q000502:physiology*; D013398:Sudden Infant Death / Q000209:etiology; D013990:Tidal Volume / Q000502:physiology; D013997:Time Factors; D014743:Videotape Recording / Q000379:methods
D002245:Carbon Dioxide; D010100:Oxygen