Sudden infant deaths: arousal as a survival mechanism.
The mechanisms responsible for sudden infant death syndrome (SIDS) are still largely unknown. To explain what factors contribute to the deaths, we suggest a model: the '3 S model for SIDS' that includes 'sicknesses', 'stages of development' and 'surroundings': (1) 'sicknesses' refers to infectious diseases or other medical condition. (2) 'Stages of development' relates to the maturation of vital systems including respiratory, neurovegetative or sleep-wake behavioral controls. (3) 'Surroundings' refers to environmental conditions that enhance the deficiency of cardiorespiratory, vegetative and/or arousal controls. Such conditions were identified by epidemiological studies and include the following main risk factors: the prone body position during sleep, high environmental temperature, maternal smoking or sleep deprivation. An infant could be at higher risk for SIDS because of a deficiency in breathing and cardiac autonomic controls during sleep, inducing repeated episodes of hypoxia and hypoxemia. The risk is increased when the infant has a lower propensity to arouse from sleep and so, to autoresuscitate. The accident has a greater probability to occur when an infection, or an unfavorable environmental factor aggravates the immature cardiorespiratory and sleep/wake behaviors of the infant. The clinical findings could be related to the changes reported in the brainstems of SIDS victims.
Pediatric Sleep Unit, University Children's Hospital of Brussels, Free University of Brussels, Reine Fabiola, av. JJ Crocq 15, B-1020 Brussels, Belgium. akahn@ulb.ac.br
Andre
A
Kahn
Jose
J
Groswasser
Patricia
P
Franco
Sonia
S
Scaillet
Toshiko
T
Sawaguchi
Igor
I
Kelmanson
Dan
D
Bernanrd