Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.


Monday, June 10, 2013

Preemies' Risk for SIDS Jumps with Prone Sleep


A well designed research study reinforces the importance of "back to sleep", showing that oxygen saturations in newborn infants tend to be lower in the prone position.  Dr. Susarla


Preemies' Risk for SIDS Jumps with Prone Sleep


BALTIMORE -- Preterm infants who sleep in the prone position may be at additional risk for sudden infant death syndrome (SIDS) due to decreased cerebral oxygenation, researchers reported here.
Measures of cerebral tissue oxygenation in preterm infants showed prone position sleeping was associated with significantly 7% reduced tissue oxygenation during quiet sleep at weeks 2 to 4, and months 2 to 3 (P<0.05), according to Karinna Fyfe, PhD, of the Ritchie Center of Monash University in Melbourne, Australia, and colleagues.
The preterm infants also had 3% significantly lower cerebral oxygenation during quiet (P<0.01) and active sleep (P<0.05) when sleeping in the prone position at 5 to 6 months, Fyfe said during an oral presentation at the Associated Professional Sleep Societies meeting.
The authors noted that preterm infants are at 9.6% increased risk for SIDS, which may be associated with cardiovascular instability and failure of arousal from sleep. Preterm births are also associated with lower blood pressure, abnormal blood pressure control, higher heart rate, and reduced heart rate control in infants.
The prone sleeping position has been associated with reduced blood pressure and cerebral oxygenation in full-term infants, which increases risk for SIDS.
The authors studied cerebral oxygenation and continuous blood pressure in a population of 25 otherwise healthy preterm infants who had 27 to 36 weeks gestation. Special attention was paid to months 2 and 3, as they are considered the highest risk period for SIDS, Fyfe noted.
Participants received daytime polysomnography at ages 2 to 4 weeks, 2 to 3 months, and 5 to 6 months at corrected developmental age, during which the researchers measured continuous blood pressure, heart rate, oxygen saturation, body temperature, and cerebral tissue oxygenation index.
Vital signs were measured in 2-minute intervals and were validated through continuous, noninvasive, measures.
The authors collected data on infants while in the prone and supine sleeping positions, as well as during active and quiet sleep, and all comparisons were done between prone and supine sleeping positions.
Prone sleep was significantly associated with lower oxygenation during active and quiet sleep in preterm infants at ages 2 to 4 weeks and 2 to 3 months. Oxygenation was lower, but not significantly so, at months 5 and 6 in the prone position while sleeping.
Blood pressure and peripheral oxygen saturation did not differ significantly between sleep positions.
Heart rate was significantly elevated in prone versus supine sleeping position at weeks 2 to 4 during quiet sleep (P<0.05), although this association was not seen at months 2 to 3, 5 to 6, or during active sleep.
Preemies also had a significantly higher skin temperature across all ages in the prone position versus supine position (P<0.05 for all).
Fyfe suggested the effects on oxygenation and body temperature were associated with neck blood vessels while in the prone position, as well as immature cerebral autoregulation, based on post-mortem and Doppler flow studies.
"Reduced cerebral oxygenation in the prone position may leave preterm infants vulnerable to critically low cerebral oxygenation during a cardiorespiratory event during sleep," Fyfe said, adding that these changes based on sleep position "may underpin the risks of SIDS amongst preterm infants."
She also noted that oxygenation outcomes were worse in preterm infants than full-term infants in a comparison of data from a separate study.
Session moderator Ann Halbower, MD, of Children's Hospital Colorado in Aurora noted that follow-up research should look at carbon dioxide levels of infants in a prone sleeping position.Read article here.

Tuesday, June 4, 2013

ATS: Adenotonsillectomy Offers Relief to Kids With Sleep Apnea

Are some cognitive deficits associated with obstructive sleep apnea inevitable, or are we not detecting this problem early enough? Dr. Susarla


ATS: Adenotonsillectomy Offers Relief to Kids With Sleep Apnea


TUESDAY, May 21 (HealthDay News) -- Compared to watchful waiting, early adenotonsillectomy improves some symptoms, but not attention or executive function, in school-age children with obstructive sleep apnea syndrome, according to a study published online May 21 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American Thoracic Society, held from May 17 to 22 in Philadelphia.
Carole L. Marcus, M.B., B.Ch., from the Children's Hospital of Philadelphia, and colleagues randomized 464 children (aged 5 to 9 years) with obstructive sleep apnea syndrome to either early adenotonsillectomy or watchful waiting. At baseline and after seven months, polysomnographic, cognitive, behavioral, and health outcomes were assessed.
The researchers found that the change in attention and executive function score on the Developmental Neuropsychological Assessment did not significantly differ between study groups (mean improvement, 7.1 in the early-adenotonsillectomy group and 5.1 in the watchful-waiting group). In the behavioral, quality-of-life, and polysomnographic findings, there were significant reductions in symptoms in the early-adenotonsillectomy group. A larger proportion of children in the intervention group had normalization of polysomnographic findings than did in the watchful waiting group (79 versus 46 percent).
"As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by means of neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy," the authors write.