Singh Gyaninder Pal, Chowdhury Tumul, Bindu Barkha, Schaller Bernhard
Department of Neuro-Anesthesiology and Critical Care, All India Institute of Medical Sciences , New Delhi , India.
Department of Anesthesiology and Perioperative Medicine, University of Manitoba , Winnipeg, MB , Canada.
Front Neurol. 2016 Dec 5;7:221. doi: 10.3389/fneur.2016.00221. eCollection 2016.
Sudden infant death syndrome (SIDS) is an unexplained death in infants, which usually occurs during sleep. The cause of SIDS remains unknown and multifactorial. In this regard, the diving reflex (DR), a peripheral subtype of trigeminocardiac reflex (TCR), is also hypothesized as one of the possible mechanisms for this condition. The TCR is a well-established neurogenic reflex that manifests as bradycardia, hypotension, apnea, and gastric hypermotility. The TCR shares many similarities with the DR, which is a significant physiological adaptation to withstand hypoxia during apnea in many animal species including humans in clinical manifestation and mechanism of action. The DR is characterized by breath holding (apnea), bradycardia, and vasoconstriction, leading to increase in blood pressure. Several studies have described congenital anomalies of autonomic nervous system in the pathogenesis of SIDS such as hypoplasia, delayed neuronal maturation, or decreased neuronal density of arcuate nucleus, hypoplasia, and neuronal immaturity of the hypoglossal nucleus. The abnormalities of autonomic nervous system in SIDS may explain the role of TCR in this syndrome involving sympathetic and parasympathetic nervous system. We reviewed the available literature to identify the role of TCR in the etiopathogenesis of SIDS and the pathways and cellular mechanism involved in it. This synthesis will help to update our knowledge and improve our understanding about this mysterious, yet common condition and will open the door for further research in this field.
婴儿猝死综合征（SIDS）是指婴儿发生的不明原因死亡，通常发生在睡眠期间。SIDS的病因尚不清楚，是多因素的。在这方面，潜水反射（DR）作为三叉神经心脏反射（TCR）的一种外周亚型，也被认为是导致这种情况的可能机制之一。TCR是一种公认的神经源性反射，表现为心动过缓、低血压、呼吸暂停和胃动力亢进。TCR与DR有许多相似之处，DR是许多动物物种（包括人类）在呼吸暂停期间耐受缺氧的一种重要生理适应，在临床表现和作用机制方面均如此。DR的特征是屏气（呼吸暂停）、心动过缓和血管收缩，导致血压升高。几项研究描述了自主神经系统先天性异常在SIDS发病机制中的作用，如发育不全、神经元成熟延迟或弓状核神经元密度降低、舌下神经核发育不全和神经元不成熟。SIDS中自主神经系统的异常可能解释了TCR在涉及交感神经和副交感神经系统的该综合征中的作用。我们回顾了现有文献，以确定TCR在SIDS病因发病机制中的作用以及其中涉及的途径和细胞机制。这一综述将有助于更新我们的知识，增进我们对这种神秘但常见病症的理解，并为该领域的进一步研究打开大门。
