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. 2002 Sep;87(2):F100–F105. doi: 10.1136/fn.87.2.F100

Effects of maternal tobacco smoking, sleeping position, and sleep state on arousal in healthy term infants

R Horne, D Ferens, A Watts, J Vitkovic, B Lacey, S Andrew, S Cranage, B Chau, R Greaves, T Adamson
PMCID: PMC1721454  PMID: 12193515

Abstract

Objectives: To investigate whether a history of maternal tobacco smoking affected the maturation of arousal responses and whether sleeping position and infant age alters these relations.

Design: Healthy term infants (13 born to mothers who did not smoke and 11 to mothers who smoked during pregnancy) were studied using daytime polysomnography on three occasions: (a) two to three weeks after birth, (b) two to three months after birth, and (c) five to six months after birth. Multiple measurements of arousal threshold in response to air jet stimulation were made in both active sleep (AS) and quiet sleep (QS) when infants slept both prone and supine.

Results: Maternal smoking significantly elevated arousal threshold in QS when infants slept supine at 2–3 months of age (p<0.05). Infants of smoking mothers also had fewer spontaneous arousals from QS at 2–3 months in both prone (p<0.05) and supine (p<0.001) sleeping positions. In infants of non-smoking mothers, arousal thresholds were elevated in the prone position in AS at 2–3 months (p<0.01) and QS at 2–3 weeks (p<0.05) and 2–3 months (p<0.001).

Conclusions: Maternal tobacco smoking significantly impairs both stimulus induced and spontaneous arousal from QS when infants sleep in the supine position, at the age when the incidence of sudden infant death syndrome is highest.

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Figure 1 .

Figure 1

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Mean arousal thresholds for smoking and non-smoking groups sleeping both prone and supine in quiet (QS) and active (AS) sleep. (A) Prone AS; (B) supine AS; (C) prone QS; (D) supine QS.

Selected References

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  1. Browne C. A., Colditz P. B., Dunster K. R. Infant autonomic function is altered by maternal smoking during pregnancy. Early Hum Dev. 2000 Sep;59(3):209–218. doi: 10.1016/s0378-3782(00)00098-0. [DOI] [PubMed] [Google Scholar]
  2. Bureau M. A., Shapcott D., Berthiaume Y., Monette J., Blouin D., Blanchard P., Begin R. Maternal cigarette smoking and fetal oxygen transport: a study of P50, 2,3-diphosphoglycerate, total hemoglobin, hematocrit, and type F hemoglobin in fetal blood. Pediatrics. 1983 Jul;72(1):22–26. [PubMed] [Google Scholar]
  3. Byard R. W. Sudden infant death syndrome - a 'diagnosis' in search of a disease. J Clin Forensic Med. 1995 Sep;2(3):121–128. doi: 10.1016/1353-1131(95)90079-9. [DOI] [PubMed] [Google Scholar]
  4. Dwyer T., Ponsonby A. L. The decline of SIDS: a success story for epidemiology. Epidemiology. 1996 May;7(3):323–325. [PubMed] [Google Scholar]
  5. Franco P., Groswasser J., Hassid S., Lanquart J. P., Scaillet S., Kahn A. Prenatal exposure to cigarette smoking is associated with a decrease in arousal in infants. J Pediatr. 1999 Jul;135(1):34–38. doi: 10.1016/s0022-3476(99)70324-0. [DOI] [PubMed] [Google Scholar]
  6. Franco P., Pardou A., Hassid S., Lurquin P., Groswasser J., Kahn A. Auditory arousal thresholds are higher when infants sleep in the prone position. J Pediatr. 1998 Feb;132(2):240–243. doi: 10.1016/s0022-3476(98)70438-x. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. Greaves R., Trotter L., Brennecke S., Janus E. A simple high-pressure liquid chromatography cotinine assay: validation of smoking status in pregnant women. Ann Clin Biochem. 2001 Jul;38(Pt 4):333–338. doi: 10.1258/0004563011900849. [DOI] [PubMed] [Google Scholar]
  9. Grenhoff J., Svensson T. H. Pharmacology of nicotine. Br J Addict. 1989 May;84(5):477–492. doi: 10.1111/j.1360-0443.1989.tb00604.x. [DOI] [PubMed] [Google Scholar]
  10. Hoffman H. J., Hillman L. S. Epidemiology of the sudden infant death syndrome: maternal, neonatal, and postneonatal risk factors. Clin Perinatol. 1992 Dec;19(4):717–737. [PubMed] [Google Scholar]
  11. Horne R. S., Ferens D., Watts A. M., Vitkovic J., Lacey B., Andrew S., Cranage S. M., Chau B., Adamson T. M. The prone sleeping position impairs arousability in term infants. J Pediatr. 2001 Jun;138(6):811–816. doi: 10.1067/mpd.2001.114475. [DOI] [PubMed] [Google Scholar]
  12. Horne R. S., Sly D. J., Cranage S. M., Chau B., Adamson T. M. Effects of prematurity on arousal from sleep in the newborn infant. Pediatr Res. 2000 Apr;47(4 Pt 1):468–474. doi: 10.1203/00006450-200004000-00010. [DOI] [PubMed] [Google Scholar]
  13. Horner R. L. Autonomic consequences of arousal from sleep: mechanisms and implications. Sleep. 1996 Dec;19(10 Suppl):S193–S195. doi: 10.1093/sleep/19.suppl_10.s193. [DOI] [PubMed] [Google Scholar]
  14. Hunt C. E. The cardiorespiratory control hypothesis for sudden infant death syndrome. Clin Perinatol. 1992 Dec;19(4):757–771. [PubMed] [Google Scholar]
  15. Jarvis M. J., Russell M. A., Benowitz N. L., Feyerabend C. Elimination of cotinine from body fluids: implications for noninvasive measurement of tobacco smoke exposure. Am J Public Health. 1988 Jun;78(6):696–698. doi: 10.2105/ajph.78.6.696. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. 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]
  17. Kinney H. C., O'Donnell T. J., Kriger P., White W. F. Early developmental changes in [3H]nicotine binding in the human brainstem. Neuroscience. 1993 Aug;55(4):1127–1138. doi: 10.1016/0306-4522(93)90326-b. [DOI] [PubMed] [Google Scholar]
  18. Lambers D. S., Clark K. E. The maternal and fetal physiologic effects of nicotine. Semin Perinatol. 1996 Apr;20(2):115–126. doi: 10.1016/s0146-0005(96)80079-6. [DOI] [PubMed] [Google Scholar]
  19. Lewis K. W., Bosque E. M. Deficient hypoxia awakening response in infants of smoking mothers: possible relationship to sudden infant death syndrome. J Pediatr. 1995 Nov;127(5):691–699. doi: 10.1016/s0022-3476(95)70155-9. [DOI] [PubMed] [Google Scholar]
  20. Loy C. S., Horne R. S., Read P. A., Cranage S. M., Chau B., Adamson T. M. Immunization has no effect on arousal from sleep in the newborn infant. J Paediatr Child Health. 1998 Aug;34(4):349–354. doi: 10.1046/j.1440-1754.1998.00244.x. [DOI] [PubMed] [Google Scholar]
  21. Luck W., Nau H. Nicotine and cotinine concentrations in serum and urine of infants exposed via passive smoking or milk from smoking mothers. J Pediatr. 1985 Nov;107(5):816–820. doi: 10.1016/s0022-3476(85)80427-3. [DOI] [PubMed] [Google Scholar]
  22. Milerad J., Sundell H. Nicotine exposure and the risk of SIDS. Acta Paediatr Suppl. 1993 Jun;82 (Suppl 389):70–72. doi: 10.1111/j.1651-2227.1993.tb12882.x. [DOI] [PubMed] [Google Scholar]
  23. Mitchell E. A. Sleeping position of infants and the sudden infant death syndrome. Acta Paediatr Suppl. 1993 Jun;82 (Suppl 389):26–30. doi: 10.1111/j.1651-2227.1993.tb12870.x. [DOI] [PubMed] [Google Scholar]
  24. Peacock J. L., Bland J. M., Anderson H. R., Brooke O. G. Cigarette smoking and birthweight: type of cigarette smoked and a possible threshold effect. Int J Epidemiol. 1991 Jun;20(2):405–412. doi: 10.1093/ije/20.2.405. [DOI] [PubMed] [Google Scholar]
  25. Phillipson E. A., Sullivan C. E. Arousal: the forgotten response to respiratory stimuli. Am Rev Respir Dis. 1978 Nov;118(5):807–809. doi: 10.1164/arrd.1978.118.5.807. [DOI] [PubMed] [Google Scholar]
  26. Read P. A., Horne R. S., Cranage S. M., Walker A. M., Walker D. W., Adamson T. M. Dynamic changes in arousal threshold during sleep in the human infant. Pediatr Res. 1998 May;43(5):697–703. doi: 10.1203/00006450-199805000-00020. [DOI] [PubMed] [Google Scholar]
  27. Schoendorf K. C., Kiely J. L. Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics. 1992 Dec;90(6):905–908. [PubMed] [Google Scholar]
  28. 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]

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