title: Fewer spontaneous arousals in infants with apparent life-threatening event.
abstract: OBJECTIVE
  A deficit in arousal process has been implicated as a mechanism of sudden infant death syndrome (SIDS). Compared with control infants, SIDS victims showed significantly more subcortical activations and fewer cortical arousals than matched control infants. Apparent life-threatening event (ALTE) is often considered as an aborted SIDS event. The aim of this study was to study the arousal characteristics of ALTE infants during the first months of life.
  
  
  METHODS
  35 ALTE infants were studied with nighttime polysomnography at 2-3, 5-6, and 8-9 months of age. Eighteen of the infants had mothers who smoked. The infants were born full term and were usually supine sleepers. Sleep state and cardiorespiratory parameters were scored according to recommended criteria. Arousals were differentiated into subcortical activations or cortical arousals, according to the presence of autonomic and/or electroencephalographic changes. The results were compared with those of 19 healthy infants with nonsmoking mothers.
  
  
  RESULTS
  During NREM sleep, the ALTE infants had fewer total arousals, cortical arousals, and subcortical activations at 2-3 and 5-6 months (P < 0.001) than control infants. ALTE infants with smoking mothers had more obstructive apnea (P = 0.009) and more subcortical activations during REM sleep at 2-3 months of age (P < 0.001) than ALTE infants with nonsmoking mothers.
  
  
  CONCLUSIONS
  Spontaneous arousals were differently altered in ALTE infants than in SIDS infants, suggesting an entity different from SIDS. ALTE infants with smoking mothers had arousal and respiratory characteristics that were similar to future SIDS victims, suggesting some common abnormalities in brainstem dysfunction.
authors.affiliation: Pediatric Sleep Unit, Hôpital Femme Mère Enfant & INSERM U628, Claude Bernard University Lyon 1, Lyon, France. Patricia.Franco@chu-lyon.fr
authors.forename: Patricia
authors.initials: P
authors.lastname: Franco
authors.forename: Enza
authors.initials: E
authors.lastname: Montemitro
authors.forename: Sonia
authors.initials: S
authors.lastname: Scaillet
authors.forename: Jose
authors.initials: J
authors.lastname: Groswasser
authors.forename: Ineko
authors.initials: I
authors.lastname: Kato
authors.forename: Jian-Sheng
authors.initials: JS
authors.lastname: Lin
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Villa
mesh_terms: D000367:Age Factors; D001143:Arousal / Q000502:physiology*; D016022:Case-Control Studies; D003643:Death; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017286:Polysomnography; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D012907:Smoking