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Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2005 Jul;90(4):F311–F315. doi: 10.1136/adc.2004.055327

Sleeping position and electrocortical activity in low birthweight infants

R Sahni, K Schulze, S Kashyap, K Ohira-Kist, W Fifer, M Myers
PMCID: PMC1721905  PMID: 15857877

Abstract

Objective: To evaluate the effects of prone and supine sleeping positions on electrocortical activity during active (AS) and quiet (QS) sleep in low birthweight infants.

Design: Randomised/crossover study.

Setting: Infant Physiology Laboratory at Children's Hospital of New York.

Patients: Sixty three healthy, growing, low birthweight (birth weight 795–1600 g) infants, 26–37 weeks gestational age.

Interventions: Six hour continuous two channel electrocortical recordings, together with minute by minute behavioural state assignment, were performed. The infants were randomly assigned to prone or supine position during the first three hours, and positions were reversed during the second three hours.

Outcome measures and results: Fast Fourier transforms of electroencephalograms (EEGs) were performed each minute and the total EEG power (TP), spectral edge frequency (SEF), absolute (AP) and relative (RP) powers in five frequency bands (0.01–1.0 Hz, 1–4 Hz, 4–8 Hz, 8–12 Hz, 12–24 Hz) were computed. Mean values for TP, SEF, AP, and RP in the five frequency bands in the prone and supine positions during AS and QS were then compared. In the prone sleeping position, during AS, infants showed significantly lower TP, decreased AP in frequency bands 0.01–1.0 Hz, 4–8 Hz, 8–12 Hz, 12–24 Hz, increased RP in 1–4 Hz, and a decrease in SEF. Similar trends were observed during QS, although they did not reach statistical significance.

Conclusions: The prone sleeping position promotes a shift in EEG activity towards slower frequencies. These changes in electrocortical activity may be related to mechanisms associated with decreased arousal in the prone position and, in turn, increased risk of sudden infant death syndrome.

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Selected References

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  1. Adams E. J., Chavez G. F., Steen D., Shah R., Iyasu S., Krous H. F. Changes in the epidemiologic profile of sudden infant death syndrome as rates decline among California infants: 1990-1995. Pediatrics. 1998 Dec;102(6):1445–1451. doi: 10.1542/peds.102.6.1445. [DOI] [PubMed] [Google Scholar]
  2. Alfonso I., Howard C., Lopez P. F., Palomino J. A., Gonzalez C. E. Linear nevus sebaceous syndrome. A review. J Clin Neuroophthalmol. 1987 Sep;7(3):170–177. [PubMed] [Google Scholar]
  3. Amemiya F., Vos J. E., Prechtl H. F. Effects of prone and supine position on heart rate, respiratory rate and motor activity in fullterm newborn infants. Brain Dev. 1991 May;13(3):148–154. doi: 10.1016/s0387-7604(12)80020-9. [DOI] [PubMed] [Google Scholar]
  4. Ariagno Ronald L., Mirmiran Majid, Adams Marian M., Saporito Anna G., Dubin Anne M., Baldwin Roger B. Effect of position on sleep, heart rate variability, and QT interval in preterm infants at 1 and 3 months' corrected age. Pediatrics. 2003 Mar;111(3):622–625. doi: 10.1542/peds.111.3.622. [DOI] [PubMed] [Google Scholar]
  5. Bell A. H., McClure B. G., McCullagh P. J., McClelland R. J. Spectral edge frequency of the EEG in healthy neonates and variation with behavioural state. Biol Neonate. 1991;60(2):69–74. doi: 10.1159/000243390. [DOI] [PubMed] [Google Scholar]
  6. Brackbill Y., Douthitt T. C., West H. Psychophysiologic effects in the neonate of prone versus supine placement. J Pediatr. 1973 Jan;82(1):82–84. doi: 10.1016/s0022-3476(73)80017-4. [DOI] [PubMed] [Google Scholar]
  7. Brodsky M. C., Kincannon J. M., Nelson-Adesokan P., Brown H. H. Oculocerebral dysgenesis in the linear nevus sebaceous syndrome. Ophthalmology. 1997 Mar;104(3):497–503. doi: 10.1016/s0161-6420(97)30285-1. [DOI] [PubMed] [Google Scholar]
  8. Chong A., Murphy N., Matthews T. Effect of prone sleeping on circulatory control in infants. Arch Dis Child. 2000 Mar;82(3):253–256. doi: 10.1136/adc.82.3.253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dreyfus-Brisac C. Ontogenesis of sleep in human prematures after 32 weeks of conceptional age. Dev Psychobiol. 1970;3(2):91–121. doi: 10.1002/dev.420030203. [DOI] [PubMed] [Google Scholar]
  10. Dwyer T., Ponsonby A. L., Newman N. M., Gibbons L. E. Prospective cohort study of prone sleeping position and sudden infant death syndrome. Lancet. 1991 May 25;337(8752):1244–1247. doi: 10.1016/0140-6736(91)92917-q. [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. 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]
  13. Galland B. C., Bolton D. P., Taylor B. J., Sayers R. M., Williams S. M. Ventilatory sensitivity to mild asphyxia: prone versus supine sleep position. Arch Dis Child. 2000 Nov;83(5):423–428. doi: 10.1136/adc.83.5.423. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. 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]
  15. Goto K., Mirmiran M., Adams M. M., Longford R. V., Baldwin R. B., Boeddiker M. A., Ariagno R. L. More awakenings and heart rate variability during supine sleep in preterm infants. Pediatrics. 1999 Mar;103(3):603–609. doi: 10.1542/peds.103.3.603. [DOI] [PubMed] [Google Scholar]
  16. Groswasser J., Simon T., Scaillet S., Franco P., Kahn A. Reduced arousals following obstructive apneas in infants sleeping prone. Pediatr Res. 2001 Mar;49(3):402–406. doi: 10.1203/00006450-200103000-00015. [DOI] [PubMed] [Google Scholar]
  17. Harper R. M., Kinney H. C., Fleming P. J., Thach B. T. Sleep influences on homeostatic functions: implications for sudden infant death syndrome. Respir Physiol. 2000 Feb;119(2-3):123–132. doi: 10.1016/s0034-5687(99)00107-3. [DOI] [PubMed] [Google Scholar]
  18. Harper R. M., Leake B., Hoffman H., Walter D. O., Hoppenbrouwers T., Hodgman J., Sterman M. B. Periodicity of sleep states is altered in infants at risk for the sudden infant death syndrome. Science. 1981 Aug 28;213(4511):1030–1032. doi: 10.1126/science.7268406. [DOI] [PubMed] [Google Scholar]
  19. Herman T. E., Siegel M. J. Hemimegalencephaly and linear nevus sebaceous syndrome. J Perinatol. 2001 Jul-Aug;21(5):336–338. doi: 10.1038/sj.jp.7210525. [DOI] [PubMed] [Google Scholar]
  20. 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]
  21. Hunt C. E. Impaired arousal from sleep: relationship to sudden infant death syndrome. J Perinatol. 1989 Jun;9(2):184–187. [PubMed] [Google Scholar]
  22. 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]
  23. Kahn A., Rebuffat E., Sottiaux M., Dufour D., Cadranel S., Reiterer F. Arousals induced by proximal esophageal reflux in infants. Sleep. 1991 Feb;14(1):39–42. [PubMed] [Google Scholar]
  24. MacDorman Marian F., Minino Arialdi M., Strobino Donna M., Guyer Bernard. Annual summary of vital statistics--2001. Pediatrics. 2002 Dec;110(6):1037–1052. doi: 10.1542/peds.110.6.1037. [DOI] [PubMed] [Google Scholar]
  25. Mitchell E. A., Tuohy P. G., Brunt J. M., Thompson J. M., Clements M. S., Stewart A. W., Ford R. P., Taylor B. J. Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study. Pediatrics. 1997 Nov;100(5):835–840. doi: 10.1542/peds.100.5.835. [DOI] [PubMed] [Google Scholar]
  26. Myers M. M., Fifer W. P., Schaeffer L., Sahni R., Ohira-Kist K., Stark R. I., Schulze K. F. Effects of sleeping position and time after feeding on the organization of sleep/wake states in prematurely born infants. Sleep. 1998 Jun 15;21(4):343–349. [PubMed] [Google Scholar]
  27. Neckelmann D., Ursin R. Sleep stages and EEG power spectrum in relation to acoustical stimulus arousal threshold in the rat. Sleep. 1993 Aug;16(5):467–477. [PubMed] [Google Scholar]
  28. Newman N. M., Trinder J. A., Phillips K. A., Jordan K., Cruickshank J. Arousal deficit: mechanism of the sudden infant death syndrome? Aust Paediatr J. 1989 Aug;25(4):196–201. [PubMed] [Google Scholar]
  29. Nowaczyk M. J., Mernagh J. R., Bourgeois J. M., Thompson P. J., Jurriaans E. Antenatal and postnatal findings in encephalocraniocutaneous lipomatosis. Am J Med Genet. 2000 Apr 10;91(4):261–266. [PubMed] [Google Scholar]
  30. Peterson D. R. Evolution of epidemiology of sudden infant death syndrome. Epidemiol Rev. 1980;2:97–112. doi: 10.1093/oxfordjournals.epirev.a036228. [DOI] [PubMed] [Google Scholar]
  31. Rechtschaffen A., Hauri P., Zeitlin M. Auditory awakening thresholds in REM and NREM sleep stages. Percept Mot Skills. 1966 Jun;22(3):927–942. doi: 10.2466/pms.1966.22.3.927. [DOI] [PubMed] [Google Scholar]
  32. Sahni R., Schulze K. F., Kashyap S., Ohira-Kist K., Fifer W. P., Myers M. M. Postural differences in cardiac dynamics during quiet and active sleep in low birthweight infants. Acta Paediatr. 1999 Dec;88(12):1396–1401. doi: 10.1080/080352599750030158. [DOI] [PubMed] [Google Scholar]
  33. Sahni R., Schulze K. F., Kashyap S., Ohira-Kist K., Myers M. M., Fifer W. P. Body position, sleep states, and cardiorespiratory activity in developing low birth weight infants. Early Hum Dev. 1999 Apr;54(3):197–206. doi: 10.1016/s0378-3782(98)00104-2. [DOI] [PubMed] [Google Scholar]
  34. Sahni R., Schulze K. F., Stefanski M., Myers M. M., Fifer W. P. Methodological issues in coding sleep states in immature infants. Dev Psychobiol. 1995 Mar;28(2):85–101. doi: 10.1002/dev.420280203. [DOI] [PubMed] [Google Scholar]
  35. Sahni Rakesh, Saluja Deepak, Schulze Karl F., Kashyap Sudha, Ohira-Kist Kiyoko, Fifer William P., Myers Michael M. Quality of diet, body position, and time after feeding influence behavioral states in low birth weight infants. Pediatr Res. 2002 Sep;52(3):399–404. doi: 10.1203/00006450-200209000-00016. [DOI] [PubMed] [Google Scholar]
  36. Schechtman V. L., Harper R. K., Harper R. M. Aberrant temporal patterning of slow-wave sleep in siblings of SIDS victims. Electroencephalogr Clin Neurophysiol. 1995 Feb;94(2):95–102. doi: 10.1016/0013-4694(94)00263-k. [DOI] [PubMed] [Google Scholar]
  37. Scher M. S., Sun M., Steppe D. A., Banks D. L., Guthrie R. D., Sclabassi R. J. Comparisons of EEG sleep state-specific spectral values between healthy full-term and preterm infants at comparable postconceptional ages. Sleep. 1994 Feb;17(1):47–51. doi: 10.1093/sleep/17.1.47. [DOI] [PubMed] [Google Scholar]
  38. Schramm D., Scheidt B., Hübler A., Frenzel J., Holthausen K., Breidbach O. Spectral analysis of electroencephalogram during sleep-related apneas in pre-term and term born infants in the first weeks of life. Clin Neurophysiol. 2000 Oct;111(10):1788–1791. doi: 10.1016/s1388-2457(00)00417-x. [DOI] [PubMed] [Google Scholar]
  39. Stefanski M., Schulze K., Bateman D., Kairam R., Pedley T. A., Masterson J., James L. S. A scoring system for states of sleep and wakefulness in term and preterm infants. Pediatr Res. 1984 Jan;18(1):58–62. [PubMed] [Google Scholar]
  40. Steriade Mircea. The corticothalamic system in sleep. Front Biosci. 2003 May 1;8:d878–d899. doi: 10.2741/1043. [DOI] [PubMed] [Google Scholar]
  41. Sterman M. B., Harper R. M., Havens B., Hoppenbrouwers T., McGinty D. J., Hodgman J. E. Quantitative analysis of infant EEG development during quiet sleep. Electroencephalogr Clin Neurophysiol. 1977 Sep;43(3):371–385. doi: 10.1016/0013-4694(77)90260-7. [DOI] [PubMed] [Google Scholar]
  42. Sterman M. B., McGinty D. J., Harper R. M., Hoppenbrouwers T., Hodgman J. E. Developmental comparison of sleep EEG power spectral patterns in infants at low and high risk for sudden death. Electroencephalogr Clin Neurophysiol. 1982 Feb;53(2):166–181. doi: 10.1016/0013-4694(82)90021-9. [DOI] [PubMed] [Google Scholar]
  43. Sweeney W. J., Kuller J. A., Chescheir N. C., Veness-Meehan K. Prenatal ultrasound findings of linear nevus sebaceous and its association with cystic adenomatoid malformation of the lung. Obstet Gynecol. 1994 May;83(5 Pt 2):860–862. [PubMed] [Google Scholar]
  44. Watanabe K., Iwase K., Hara K. Development of slow-wave sleep in low-birthweight infants. Dev Med Child Neurol. 1974 Feb;16(1):23–31. doi: 10.1111/j.1469-8749.1974.tb02707.x. [DOI] [PubMed] [Google Scholar]
  45. Willinger M., Ko C. W., Hoffman H. J., Kessler R. C., Corwin M. J. Factors associated with caregivers' choice of infant sleep position, 1994-1998: the National Infant Sleep Position Study. JAMA. 2000 Apr 26;283(16):2135–2142. doi: 10.1001/jama.283.16.2135. [DOI] [PubMed] [Google Scholar]
  46. Wulbrand H., McNamara F., Thach B. T. Suppression of sigma spindle electroencephalographic activity as a measure of transient arousal after spontaneous and occlusion-evoked sighs and startles. Pediatr Res. 1998 Nov;44(5):767–773. doi: 10.1203/00006450-199811000-00021. [DOI] [PubMed] [Google Scholar]

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