Abstract
AIMS—To investigate and compare heart rate variability (HRV) and responses of heart rate and arousal to head-up tilting in infants sleeping prone and supine. METHODS—Thirty seven healthy infants aged 2-4 months were studied. HRV was measured for 500 beats while they were in a horizontal position. Subjects were then tilted 60° head-up, and heart rate recorded over 1 minute and arousal responses observed. Data were collected during both quiet and active sleep for both prone and supine sleep positions. RESULTS—HRV, as assessed by the point dispersion of Poincaré plots, was significantly reduced in the prone position for both sleep states. Sleep position did not influence the changes in heart rate seen during a head-up tilt. Full awakening to the tilt was common in active sleep but significantly less so in the prone position (15% of prone tests vs 54% supine). Full awakening to the tilt rarely occurred during quiet sleep in either sleep position. CONCLUSION—This study provides some evidence that blunted arousal responses and/or altered autonomic function are a feature of the prone sleeping position. Decreased HRV may be a sign of autonomic impairment. It is seen in many disease states and in infants who later die of sudden infant death syndrome (SIDS).
Full Text
The Full Text of this article is available as a PDF (171.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- 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]
- 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]
- 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]
- Dalton K. J., Dawes G. S., Patrick J. E. The autonomic nervous system and fetal heart rate variability. Am J Obstet Gynecol. 1983 Jun 15;146(4):456–462. doi: 10.1016/0002-9378(83)90828-1. [DOI] [PubMed] [Google Scholar]
- 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]
- Edner A., Katz-Salamon M., Lagercrantz H., Milerad J. Heart rate response profiles during head upright tilt test in infants with apparent life threatening events. Arch Dis Child. 1997 Jan;76(1):27–30. doi: 10.1136/adc.76.1.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fox G. P., Matthews T. G. Autonomic dysfunction at different ambient temperatures in infants at risk of sudden infant death syndrome. Lancet. 1989 Nov 4;2(8671):1065–1067. doi: 10.1016/s0140-6736(89)91080-5. [DOI] [PubMed] [Google Scholar]
- 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]
- Kahn A., Rebuffat E., Sottiaux M., Muller M. F., Bochner A., Grosswasser J. Brief airway obstructions during sleep in infants with breath-holding spells. J Pediatr. 1990 Aug;117(2 Pt 1):188–193. doi: 10.1016/s0022-3476(05)80528-1. [DOI] [PubMed] [Google Scholar]
- Kahn A., Van de Merckt C., Dramaix M., Magrez P., Blum D., Rebuffat E., Montauk L. Transepidermal water loss during sleep in infants at risk for sudden death. Pediatrics. 1987 Aug;80(2):245–250. [PubMed] [Google Scholar]
- Kamen P. W., Tonkin A. M. Application of the Poincaré plot to heart rate variability: a new measure of functional status in heart failure. Aust N Z J Med. 1995 Feb;25(1):18–26. doi: 10.1111/j.1445-5994.1995.tb00573.x. [DOI] [PubMed] [Google Scholar]
- Karakida T., Yamazaki Y., Homma S. Blood pressure and heart rate changes in streptozotocin diabetic rats, with special reference to postural hypotension. Jpn J Physiol. 1991;41(4):589–603. doi: 10.2170/jjphysiol.41.589. [DOI] [PubMed] [Google Scholar]
- 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]
- Malik M., Camm A. J. Components of heart rate variability--what they really mean and what we really measure. Am J Cardiol. 1993 Oct 1;72(11):821–822. doi: 10.1016/0002-9149(93)91070-x. [DOI] [PubMed] [Google Scholar]
- Malliani A., Lombardi F., Pagani M. Power spectrum analysis of heart rate variability: a tool to explore neural regulatory mechanisms. Br Heart J. 1994 Jan;71(1):1–2. doi: 10.1136/hrt.71.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mitchell E. A., Scragg R., Stewart A. W., Becroft D. M., Taylor B. J., Ford R. P., Hassall I. B., Barry D. M., Allen E. M., Roberts A. P. Results from the first year of the New Zealand cot death study. N Z Med J. 1991 Feb 27;104(906):71–76. [PubMed] [Google Scholar]
- 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]
- O'Marcaigh A. S., MacLellan-Tobert S. G., Porter C. J. Tilt-table testing and oral metoprolol therapy in young patients with unexplained syncope. Pediatrics. 1994 Feb;93(2):278–283. [PubMed] [Google Scholar]
- Pagani M., Lombardi F., Guzzetti S., Rimoldi O., Furlan R., Pizzinelli P., Sandrone G., Malfatto G., Dell'Orto S., Piccaluga E. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res. 1986 Aug;59(2):178–193. doi: 10.1161/01.res.59.2.178. [DOI] [PubMed] [Google Scholar]
- Schechtman V. L., Lee M. Y., Wilson A. J., Harper R. M. Dynamics of respiratory patterning in normal infants and infants who subsequently died of the sudden infant death syndrome. Pediatr Res. 1996 Oct;40(4):571–577. doi: 10.1203/00006450-199610000-00010. [DOI] [PubMed] [Google Scholar]
- Schechtman V. L., Raetz S. L., Harper R. K., Garfinkel A., Wilson A. J., Southall D. P., Harper R. M. Dynamic analysis of cardiac R-R intervals in normal infants and in infants who subsequently succumbed to the sudden infant death syndrome. Pediatr Res. 1992 Jun;31(6):606–612. doi: 10.1203/00006450-199206000-00014. [DOI] [PubMed] [Google Scholar]
- Taylor B. J., Williams S. M., Mitchell E. A., Ford R. P. Symptoms, sweating and reactivity of infants who die of SIDS compared with community controls. New Zealand National Cot Death Study Group. J Paediatr Child Health. 1996 Aug;32(4):316–322. doi: 10.1111/j.1440-1754.1996.tb02561.x. [DOI] [PubMed] [Google Scholar]
- Tonkin S. L., Partridge J., Beach D., Whiteney S. The pharyngeal effect of partial nasal obstruction. Pediatrics. 1979 Feb;63(2):261–271. [PubMed] [Google Scholar]
- Waters K. A., Gonzalez A., Jean C., Morielli A., Brouillette R. T. Face-straight-down and face-near-straight-down positions in healthy, prone-sleeping infants. J Pediatr. 1996 May;128(5 Pt 1):616–625. doi: 10.1016/s0022-3476(96)80125-9. [DOI] [PubMed] [Google Scholar]
- 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]
- Woo M. S., Woo M. A., Gozal D., Jansen M. T., Keens T. G., Harper R. M. Heart rate variability in congenital central hypoventilation syndrome. Pediatr Res. 1992 Mar;31(3):291–296. doi: 10.1203/00006450-199203000-00020. [DOI] [PubMed] [Google Scholar]