2 sleep in infancy development of sleep cross cultural differences in sleep behavior infant apnea...
TRANSCRIPT
![Page 1: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/1.jpg)
![Page 2: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/2.jpg)
2
Sleep in Infancy
• Development of sleep
• Cross cultural differences in sleep behavior
• Infant Apnea and Sudden Infant Death Syndrome (SIDS)
• Congenital Central Hypoventilation Syndrome
![Page 3: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/3.jpg)
3
0
2
4
6
8
10
12
14
16
18
20
1 6 12 18 24 36 48 60
Age (Months)
Ho
urs
of
Sle
ep
/da
y
98th Percentile Mean 2nd Percentile
How much do Infants Sleep?
Iglowstein et al, Pediatrics, 2003
![Page 4: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/4.jpg)
4
Total Daytime Sleep (Napping)
0
1
2
3
4
5
6
7
0.5 0.75 1 1.5 2 3 4Years
Ho
urs
/da
y
98th Percentile Mean 2nd Percentile
Iglowstein et al, Pediatrics, 2003
Naps per day 2 1 - 2 1 0 - 1
![Page 5: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/5.jpg)
5
Night Awakenings
0
1
2
3
4
5
3 6 9 12
Age (Months)
# A
wak
enin
gs/
nig
ht
Goodlin-Jones et al, J Dev Behav Pediatr, 2001
![Page 6: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/6.jpg)
6
Determinants of Infant Sleep Behavior
• Biological• Homeostasis
• Circadian factors
• Cultural • Parental values
• Societal norms
![Page 7: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/7.jpg)
7
Variations in Sleep Behavior
• Sleeping arrangements
• Bedtime routines
• Transitional objects
• Naps
• Sleep problems
![Page 8: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/8.jpg)
8
Sleeping Arrangements:Co-sleeping
• Co-sleeping includes: • Room sharing (sharing a room with a parent, another
adult or sibling) and/or bed sharing
• Co-sleeping is prevalent in many cultures• Tribal (e.g. Samoa, Mayan, Bali)
• Eastern (e.g. Korea, China, Japan, India)
• Southern Europe (e.g. Italy, Portugal)
• Scandinavia (e.g. Sweden)
![Page 9: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/9.jpg)
9
Co-sleeping in the United States
• Prevalence of co-sleeping varies with ethnicity, race and socioeconomic class. • African Americans were reported to co-sleep
more often than Caucasians (57% vs. 17%).
• Among Caucasian families only, co-sleeping was associated with lower socioeconomic class.
![Page 10: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/10.jpg)
10
Sleeping ArrangementsIndependent Sleeping
• Definition: infants and children sleep in their bed in their own rooms
• Rationale: promotes autonomy
• Independent sleeping is prevalent in western societies such as:• Northern Europe: Germany, Holland,
Switzerland, France
• United States
![Page 11: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/11.jpg)
11
Bed Sharing
Bed sharing is prevalent in many cultures:
• It is more common with breast feeding
• It is more common among certain racial and ethnic groups
![Page 12: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/12.jpg)
12
Bed Sharing
Most Western health care providers advocate against bed sharing in infancy
• Safety risks for SIDS
• No long term psychosocial consequences
![Page 13: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/13.jpg)
13
Prevalence of Bed Sharing (>1 times/week) Among Swiss Children
0
5
10
15
20
25
30
35
40
45
50
3 mos 9 mos 1 yr 2 yrs 3 yrs 4 yrs 5yrs 6 yrs
Age
% o
f C
hild
ren
Jenni et al, Pediatrics, 2005
![Page 14: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/14.jpg)
14
• Infants should sleep in a crib or bassinet conforming with standards of Consumer Product Safety Commission.
• Infants may be brought to bed for nursing or comforting but should not bed share for sleep.
• The crib or bassinet should be placed in parents’ room close to their bed.
American Academy of Pediatrics Task Force on Sudden Infant Death
Syndrome
![Page 15: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/15.jpg)
15
Bedtime
• Many tribal societies have no formalized “bedtime.”
• Infants and children in Southern European countries often have unstructured bedtime routines and later bedtimes.
![Page 16: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/16.jpg)
16
Bedtime Routine (Northern European/American)
In child’s own bedroom…
• Ritual: bath, dressing in pajamas, story/lullaby
• Child is placed in own bed with goodnight kisses and left alone for the night.
• Frequent use of nightlight and transitional objects
![Page 17: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/17.jpg)
17
Transitional Objects
• Industrialized societies - frequent use of sleep aids e.g. pacifier, teddy etc• American Academy of Pediatrics Task Force (11/05)
recommends pacifiers be used for infants when they are put down to sleep to reduce the incidence of SIDS.
• Non-industrialized cultures - low prevalence of transitional objects
![Page 18: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/18.jpg)
18
Naps
• Naps are common in Southern Europe, South America, Africa and Asia, but are disappearing with globalization and 24/7 societies.
• American children typically stop naps by age 4 - 5 yrs.
• African American children nap until older ages than Caucasian children.
![Page 19: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/19.jpg)
19
Racial Differences in Napping
0
20
40
60
80
100
2 3 4 5 6 7 8
Age (years)
% o
f C
hild
ren
BlackWhite
Crosby et al, Pediatrics, 2005
![Page 20: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/20.jpg)
20
International Pediatric Sleep Education Task Force
Across cultures:• Parenting practices, cultural values and lifestyles vary and
influence sleep behavior.
• Sleep problems (e.g. bedtime resistance, nighttime wakings) are universally present.
• Prevalence of sleep problems is similar (20 - 25%) but differs for individual issues.
![Page 21: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/21.jpg)
21
Infant Apnea and Sudden Infant Death Syndrome (SIDS)
![Page 22: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/22.jpg)
22
Sudden Infant Death Syndrome (SIDS)
• The sudden death of any infant under one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.
Willinger et al. Pediatr Pathol 1991;11:677
![Page 23: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/23.jpg)
23
Apparent Life-threatening Event (ALTE)
An episode that is frightening to the observer, and that is characterized by some combination of apnea (central or occasionally obstructive), color change, marked change in muscle tone, choking or gagging. In some cases, the observer fears that the infant has died.
![Page 24: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/24.jpg)
24
SIDS
• Most common cause of postneonatal infant death
• About 2,300 deaths/year
• SIDS rate: almost 0.6/1,000 live births
• Increased incidence in:• Winter• Males (60%)• Lower socioeconomic groups• Children whose parents smoke
![Page 25: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/25.jpg)
25
SIDS Antecedent Risk Factors
NIH Consensus Committee, 1987
Unknown (74% )
Death of Previous Sibling toSIDS (0.7% )
ALTE (7% )
Prematurity (18% )
![Page 26: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/26.jpg)
26
Relative Risk for SIDS by Age at Death
MMWR December 14, 1990;39
*first month as reference
![Page 27: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/27.jpg)
27
SIDS Postmortem Findings
• Right ventricular hypertrophy
• Periadrenal brown fat
• Extramedullary hematopoiesis
• Astroglial cell proliferation
• Intrathoracic petechiae
• Neurotransmitter deficits in brainstem
![Page 28: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/28.jpg)
28
Basis for the SIDS – Apnea Hypothesis
• Population• Three infants with recurrent apnea and cyanosis
• Two siblings of SIDS victims
• Methods• Serial PSG over three to six months
• Findings• “frequent brief, self-limited” apneas during REM
• Two infants died of SIDS approximately three months of age
• Commentary• small sample
• No control group
• Mother later convicted of murderSteinschneider A. Pediatrics 1972;50
![Page 29: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/29.jpg)
29
Collaborative Home Infant Monitoring Evaluation
• 1079 infants had PSG and home monitor (RIP, ECG, oximetry, position, expanded memory)
Idiopathic ALTE 152
SIDS sibling 178
Preterm (<34 weeks) 443
Healthy term 306
![Page 30: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/30.jpg)
30
CHIME Cardiorespiratory Events
Extreme Events Conventional Events
Group risk ratio p risk ratio p
Preterm
symptomatic 18.0 <.001 4.3 <.001
asymptomatic 10.1 <.001 2.7 <.001
ALTE 7.6 .001 1.5 .16
sibling 5.6 .007 1.2 .56
Term
sibling 2.6 .11 1.4 .07
ALTE 2.5 .18 1.1 .75
healthy 1 1
Only preterm infants had more events than healthy controls
Ramanathan, et al. JAMA 2001
![Page 31: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/31.jpg)
31
CHIME Cardiorespiratory Events
The likelihood of experiencing at least one ALTE decreased until about 43 weeks post conception, when all groups were similar.
Ramanathan, et al. JAMA 2001
![Page 32: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/32.jpg)
32
Ventilatory Drive
Respiratory control disorders in infants and children. Beckerman RC, Brouillette RT, Hunt CE (eds). Baltimore: Williams & Wilkins, 1992.
![Page 33: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/33.jpg)
33
Impaired Arousal Response
McCulloch et al. J Pediatr 1982
![Page 34: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/34.jpg)
34
Heart Rate Variability
Schechtman et al. Pediatr Res 1992
![Page 35: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/35.jpg)
35
Sleep Position and SIDS
Relative Risk (prone vs. others) = 8.8 (p<.001)
SIDS Control
Prone 62 76
Side 4 32
Supine 1 23
Unknown 0 3
Fleming et al. Br Med J 1990
![Page 36: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/36.jpg)
36
Change in SIDS Rate withChange in Sleep Position
Baseline Rate After Campaign
England 3.5 1.7
Netherlands 1.0 0.4
Norway 3.5 1.6
Tasmania 7.6 4.1
Fleming et al. Br Med J 1990
![Page 37: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/37.jpg)
37
• “Although prospective randomized clinical trials have not been performed, the weight of evidence implicates the prone position as a significant risk factor for SIDS.”
Sleep Position and SIDS
![Page 38: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/38.jpg)
38
Sleep Position and SIDS
• “It should be stressed that, although the relative risk of the prone position may be several times that of the lateral or supine position, the actual risk of SIDS when placing an infant in a prone position is still extremely low.”
![Page 39: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/39.jpg)
39
Lateral Positioning
• SIDS risk similar to prone position
• Lateral position unstable• High probability of rolling to prone
• Infants unaccustomed to prone position are at even greater risk when they are prone.
![Page 40: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/40.jpg)
40
U.S. SIDS Rate
![Page 41: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/41.jpg)
41
Sleep and Infant Position
• Prone positioning results in:• increased sleep
duration• increased quiet
(non-REM) sleep• fewer, shorter
arousals
• Prone positioning results in:• upper airway
occlusion• CO2 rebreathing• hyperthermia
– exacerbated by bundling, inappropriate bedding
![Page 42: 2 Sleep in Infancy Development of sleep Cross cultural differences in sleep behavior Infant Apnea and Sudden Infant Death Syndrome (SIDS) Congenital Central](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649cca5503460f94992dbf/html5/thumbnails/42.jpg)
42
Sleep Position and SIDSScandinavian Questionnaire Study
244 SIDS cases, 869 controls% of SIDS death that could be avoided if:
All infants slept supine 74%
No maternal smoking during pregnancy 47%
Pre-term birth eliminated 16%
Low birth weight eliminated 16%