Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2000 Nov;83(5):423–428. doi: 10.1136/adc.83.5.423

Ventilatory sensitivity to mild asphyxia: prone versus supine sleep position

B Galland 1, D Bolton 1, B Taylor 1, R Sayers 1, S Williams 1
PMCID: PMC1718529  PMID: 11040153

Abstract

AIMS—To compare the effects of prone and supine sleep position on the main physiological responses to mild asphyxia: increase in ventilation and arousal.
METHODS—Ventilatory and arousal responses to mild asphyxia (hypercapnia/hypoxia) were measured in 53 healthy infants at newborn and 3 months of age, during quiet sleep (QS) and active sleep (AS), and in supine and prone sleep positions. The asphyxial test mimicked face down rebreathing by slowly altering the inspired air: CO2, maximum 5% and O2, minimum 13.5%. The change in ventilation with inspired CO2 was measured over 5-6 minutes of the test. The slope of a linear curve fit relating inspired CO2 to the logarithm of ventilation was taken as a quantitative measure of ventilatory asphyxial sensitivity (VAS). Sleep state and arousal were determined by behavioural criteria.
RESULTS—At 3 months of age, prone positioning in AS lowered VAS (0.184 prone v 0.269 supine, p = 0.050). At newborn age, sleep position had no effect on VAS. Infants aged 3 months were twice as likely to arouse to the test than newborns (p = 0.013). Placing infants prone as opposed to supine increased the chances of arousal 1.57-fold (p = 0.035).
CONCLUSION—Our findings show 3 month old babies sleeping prone compared to supine have poorer ventilatory responses to mild asphyxia, particularly in AS, but the increased prevalence of arousal is a protective factor.



Full Text

The Full Text of this article is available as a PDF (169.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams J. A., Zabaleta I. A., Sackner M. A. Comparison of supine and prone noninvasive measurements of breathing patterns in fullterm newborns. Pediatr Pulmonol. 1994 Jul;18(1):8–12. doi: 10.1002/ppul.1950180105. [DOI] [PubMed] [Google Scholar]
  2. Bolton D. P., Nelson E. A., Taylor B. J., Weatherall I. L. Thermal balance in infants. J Appl Physiol (1985) 1996 Jun;80(6):2234–2242. doi: 10.1152/jappl.1996.80.6.2234. [DOI] [PubMed] [Google Scholar]
  3. Bolton D. P., Taylor B. J., Campbell A. J., Galland B. C., Cresswell C. Rebreathing expired gases from bedding: a cause of cot death? Arch Dis Child. 1993 Aug;69(2):187–190. doi: 10.1136/adc.69.2.187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bolton D. P. The prevalence of immature respiratory control in a neonatal population. N Z Med J. 1990 Mar 14;103(885):89–92. [PubMed] [Google Scholar]
  5. Campbell A. J., Bolton D. P., Taylor B. J., Sayers R. M. Responses to an increasing asphyxia in infants: effects of age and sleep state. Respir Physiol. 1998 Apr;112(1):51–58. doi: 10.1016/s0034-5687(98)00008-5. [DOI] [PubMed] [Google Scholar]
  6. Chiodini B. A., Thach B. T. Impaired ventilation in infants sleeping facedown: potential significance for sudden infant death syndrome. J Pediatr. 1993 Nov;123(5):686–692. doi: 10.1016/s0022-3476(05)80841-8. [DOI] [PubMed] [Google Scholar]
  7. Dolfin T., Duffty P., Wilkes D. L., Bryan M. H. Calibration of respiratory induction plethysmography (Respitrace) in infants. Am Rev Respir Dis. 1982 Sep;126(3):577–579. doi: 10.1164/arrd.1982.126.3.577. [DOI] [PubMed] [Google Scholar]
  8. Dunne K. P., Fox G. P., O'Regan M., Matthews T. G. Arousal responses in babies at risk of sudden infant death syndrome at different postnatal ages. Ir Med J. 1992 Mar;85(1):19–22. [PubMed] [Google Scholar]
  9. Engelberts A. C., de Jonge G. A. Choice of sleeping position for infants: possible association with cot death. Arch Dis Child. 1990 Apr;65(4):462–467. doi: 10.1136/adc.65.4.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Filiano J. J., Kinney H. C. A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk model. Biol Neonate. 1994;65(3-4):194–197. doi: 10.1159/000244052. [DOI] [PubMed] [Google Scholar]
  11. Franco P., Groswasser J., Sottiaux M., Broadfield E., Kahn A. Decreased cardiac responses to auditory stimulation during prone sleep. Pediatrics. 1996 Feb;97(2):174–178. [PubMed] [Google Scholar]
  12. Galland B. C., Reeves G., Taylor B. J., Bolton D. P. Sleep position, autonomic function, and arousal. Arch Dis Child Fetal Neonatal Ed. 1998 May;78(3):F189–F194. doi: 10.1136/fn.78.3.f189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Honma Y., Wilkes D., Bryan M. H., Bryan A. C. Rib cage and abdominal contributions to ventilatory response to CO2 in infants. J Appl Physiol Respir Environ Exerc Physiol. 1984 May;56(5):1211–1216. doi: 10.1152/jappl.1984.56.5.1211. [DOI] [PubMed] [Google Scholar]
  14. Kahn A., Groswasser J., Sottiaux M., Rebuffat E., Franco P., Dramaix M. Prone or supine body position and sleep characteristics in infants. Pediatrics. 1993 Jun;91(6):1112–1115. [PubMed] [Google Scholar]
  15. Kaneko K., Milic-Emili J., Dolovich M. B., Dawson A., Bates D. V. Regional distribution of ventilation and perfusion as a function of body position. J Appl Physiol. 1966 May;21(3):767–777. doi: 10.1152/jappl.1966.21.3.767. [DOI] [PubMed] [Google Scholar]
  16. Kemp J. S., Thach B. T. Sudden death in infants sleeping on polystyrene-filled cushions. N Engl J Med. 1991 Jun 27;324(26):1858–1864. doi: 10.1056/NEJM199106273242605. [DOI] [PubMed] [Google Scholar]
  17. Killian K. J., Gandevia S. C., Summers E., Campbell E. J. Effect of increased lung volume on perception of breathlessness, effort, and tension. J Appl Physiol Respir Environ Exerc Physiol. 1984 Sep;57(3):686–691. doi: 10.1152/jappl.1984.57.3.686. [DOI] [PubMed] [Google Scholar]
  18. Kinney H. C., Filiano J. J., Sleeper L. A., Mandell F., Valdes-Dapena M., White W. F. Decreased muscarinic receptor binding in the arcuate nucleus in sudden infant death syndrome. Science. 1995 Sep 8;269(5229):1446–1450. doi: 10.1126/science.7660131. [DOI] [PubMed] [Google Scholar]
  19. Konno K., Mead J. Measurement of the separate volume changes of rib cage and abdomen during breathing. J Appl Physiol. 1967 Mar;22(3):407–422. doi: 10.1152/jappl.1967.22.3.407. [DOI] [PubMed] [Google Scholar]
  20. Lijowska A. S., Reed N. W., Chiodini B. A., Thach B. T. Sequential arousal and airway-defensive behavior of infants in asphyxial sleep environments. J Appl Physiol (1985) 1997 Jul;83(1):219–228. doi: 10.1152/jappl.1997.83.1.219. [DOI] [PubMed] [Google Scholar]
  21. Martin R. J., DiFiore J. M., Korenke C. B., Randal H., Miller M. J., Brooks L. J. Vulnerability of respiratory control in healthy preterm infants placed supine. J Pediatr. 1995 Oct;127(4):609–614. doi: 10.1016/s0022-3476(95)70125-7. [DOI] [PubMed] [Google Scholar]
  22. Mitchell E. A., Taylor B. J., Ford R. P., Stewart A. W., Becroft D. M., Thompson J. M., Scragg R., Hassall I. B., Barry D. M., Allen E. M. Four modifiable and other major risk factors for cot death: the New Zealand study. J Paediatr Child Health. 1992;28 (Suppl 1):S3–S8. doi: 10.1111/j.1440-1754.1992.tb02729.x. [DOI] [PubMed] [Google Scholar]
  23. Moriette G., Van Reempts P., Moore M., Cates D., Rigatto H. The effect of rebreathing CO2 on ventilation and diaphragmatic electromyography in newborn infants. Respir Physiol. 1985 Dec;62(3):387–397. doi: 10.1016/0034-5687(85)90093-3. [DOI] [PubMed] [Google Scholar]
  24. Nelson E. A., Taylor B. J., Weatherall I. L. Sleeping position and infant bedding may predispose to hyperthermia and the sudden infant death syndrome. Lancet. 1989 Jan 28;1(8631):199–201. doi: 10.1016/s0140-6736(89)91211-7. [DOI] [PubMed] [Google Scholar]
  25. Orr W. C., Stahl M. L., Duke J., McCaffree M. A., Toubas P., Mattice C., Krous H. F. Effect of sleep state and position on the incidence of obstructive and central apnea in infants. Pediatrics. 1985 May;75(5):832–835. [PubMed] [Google Scholar]
  26. Poets C. F., Rudolph A., Neuber K., Buch U., von der Hardt H. Arterial oxygen saturation in infants at risk of sudden death: influence of sleeping position. Acta Paediatr. 1995 Apr;84(4):379–382. doi: 10.1111/j.1651-2227.1995.tb13654.x. [DOI] [PubMed] [Google Scholar]
  27. Ponsonby A. L., Dwyer T., Kasl S. V., Cochrane J. A., Newman N. M. An assessment of the impact of public health activities to reduce the prevalence of the prone sleeping position during infancy: the Tasmanian Cohort Study. Prev Med. 1994 May;23(3):402–408. doi: 10.1006/pmed.1994.1055. [DOI] [PubMed] [Google Scholar]
  28. Praud J. P., Egreteau L., Benlabed M., Curzi-Dascalova L., Nedelcoux H., Gaultier C. Abdominal muscle activity during CO2 rebreathing in sleeping neonates. J Appl Physiol (1985) 1991 Mar;70(3):1344–1350. doi: 10.1152/jappl.1991.70.3.1344. [DOI] [PubMed] [Google Scholar]
  29. Sackner M. A., Watson H., Belsito A. S., Feinerman D., Suarez M., Gonzalez G., Bizousky F., Krieger B. Calibration of respiratory inductive plethysmograph during natural breathing. J Appl Physiol (1985) 1989 Jan;66(1):410–420. doi: 10.1152/jappl.1989.66.1.410. [DOI] [PubMed] [Google Scholar]
  30. Shannon D. C., Kelly D. H., O'Connell K. Abnormal regulation of ventilation in infants at risk for sudden-infant-death syndrome. N Engl J Med. 1977 Oct 6;297(14):747–750. doi: 10.1056/NEJM197710062971403. [DOI] [PubMed] [Google Scholar]
  31. Skadberg B. T., Markestad T. Behaviour and physiological responses during prone and supine sleep in early infancy. Arch Dis Child. 1997 Apr;76(4):320–324. doi: 10.1136/adc.76.4.320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Stone J. G., Khambatta H. J. Pulmonary shunts in the prone position. Anaesthesia. 1978 Jun;33(6):512–517. doi: 10.1111/j.1365-2044.1978.tb08387.x. [DOI] [PubMed] [Google Scholar]
  33. Tabachnik E., Muller N., Toye B., Levison H. Measurement of ventilation in children using the respiratory inductive plethysmograph. J Pediatr. 1981 Dec;99(6):895–899. doi: 10.1016/s0022-3476(81)80012-1. [DOI] [PubMed] [Google Scholar]
  34. Uchigasaki S., Mukai T., Yamaguchi N., Tsukamoto S., Oshida S., Sato Y., Suzuki T. [Arterial oxygen saturation monitoring of sleeping infants by pulse-oximeter--effect of sleeping position on arterial oxygen saturation in infants]. Nihon Hoigaku Zasshi. 1995 Apr;49(2):87–91. [PubMed] [Google Scholar]
  35. Ward S. L., Bautista D. B., Keens T. G. Hypoxic arousal responses in normal infants. Pediatrics. 1992 May;89(5 Pt 1):860–864. [PubMed] [Google Scholar]
  36. White M., Beckett M., O'Regan M., Matthews T. Autonomic function and SIDS. Acta Paediatr Suppl. 1993 Jun;82 (Suppl 389):105–106. doi: 10.1111/j.1651-2227.1993.tb12893.x. [DOI] [PubMed] [Google Scholar]
  37. Wolfson M. R., Greenspan J. S., Deoras K. S., Allen J. L., Shaffer T. H. Effect of position on the mechanical interaction between the rib cage and abdomen in preterm infants. J Appl Physiol (1985) 1992 Mar;72(3):1032–1038. doi: 10.1152/jappl.1992.72.3.1032. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES