Department of Pediatrics, Sleep Disease Centre, University of Rome La Sapienza-S. Andrea Hospital, Rome, Italy.
Clin Neurophysiol. 2012 Jul;123(7):1346-52. doi: 10.1016/j.clinph.2011.11.261. Epub 2012 Jan 5.
Non-REM sleep is characterized by a physiologic oscillating pattern that exhibits different levels of arousal, coded as cyclic alternating pattern. The aim of this study was to analyze the development of cyclic alternating pattern parameters in a group of infants with apparent life-threatening events.
A total of 26 infants with apparent life-threatening events (14 females, mean age 3.4 months, 2.37 S.D., age range 0.5-9 months) were studied while they slept in the morning between feedings, by means of a 3-h video-electroencephalographic-polygraphic recording. Sleep was visually scored using standard criteria. The control group was composed of 36 healthy infants (16 females, mean age 3.2 months, 2.17 S.D., age range 0.5-9 months).
Children with apparent life-threatening events showed an increased frequency of periodic breathing, gastroesofageal reflux and of other risk conditions. They presented also an increased obstructive apnoea/hypopnea index. A full NREM sleep development was found in a significantly smaller percentage of patients, and they showed a significant reduction of the percentage of REM sleep, of cyclic alternating pattern A1 subtypes, an increased percentage of A2 and A3 subtypes and increased index of A2, A3 subtypes and arousal, compared to normal controls. Cyclic alternating pattern rate showed a significant positive correlation with age, only in controls.
Our results show a higher level of arousal and an increased non-REM sleep discontinuity in babies with apparent life-threatening events, compared to controls.
The enhanced mechanism of arousal might counteract life-threatening events and represent an important neurophysiologic distinction from future victims of sudden infant death syndrome who also experience similar events.
非快速眼动睡眠的特征是表现出不同唤醒水平的生理振荡模式，编码为周期性交替模式。本研究旨在分析一组有明显生命威胁事件的婴儿中周期性交替模式参数的发育情况。
共研究了 26 名有明显生命威胁事件的婴儿（14 名女性，平均年龄 3.4 个月，2.37 标准差，年龄范围 0.5-9 个月），他们在早上喂奶之间通过 3 小时的视频脑电图 - 多导睡眠描记术进行睡眠。使用标准标准对睡眠进行视觉评分。对照组由 36 名健康婴儿（16 名女性，平均年龄 3.2 个月，2.17 标准差，年龄范围 0.5-9 个月）组成。
有明显生命威胁事件的儿童表现出周期性呼吸、胃食管反流和其他风险情况的频率增加。他们还表现出阻塞性呼吸暂停/低通气指数增加。在明显较小比例的患者中发现了完全非快速眼动睡眠发育，并且与正常对照组相比，他们表现出 REM 睡眠、周期性交替模式 A1 亚型、A2 和 A3 亚型的百分比增加、A2、A3 亚型和觉醒指数增加，以及 REM 睡眠的百分比显著降低。与对照组相比，周期性交替模式率与年龄呈显著正相关，仅在对照组中。
与对照组相比，有明显生命威胁事件的婴儿表现出更高的觉醒水平和非快速眼动睡眠不连续性。
增强的觉醒机制可能对抗有生命威胁的事件，并与未来患有突发性婴儿死亡综合征的受害者区分开来，后者也经历类似的事件。
