Wong Shi-Bing, Zhao Lu-Lu, Chuang Shu-Hua, Tsai Wen-Hsin, Yu Chun-Hsien, Tsai Li-Ping
Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2019 Apr-Jun;31(2):113-117. doi: 10.4103/tcmj.tcmj_29_18.
Prone sleep is an identified risk factor for sudden infant death syndrome, possibly due to reduced blood pressure, cerebral oxygenation, and impaired cerebral vascular control. Cardiac and respiratory responses in neonates during supine and prone sleep have not been reported.
In this study, daytime polysomnography (PSG) data from 17 neonates aged 2-3 days during supine and prone sleep were reported and the NDN gene, an important gene for neonatal respiratory control, was sequenced for correlation with neonatal respiratory parameters. Heart rate (HR), oxygen saturation, carbon dioxide concentration, sleep stages, central apnea index (CAI), obstructive apnea/hypopnea index (OAHI), and oxygen nadir were compared between supine and prone sleep and between participants with different single-nucleotide polymorphisms (SNPs) in the NDN gene.
During prone sleep, neonates had a faster HR, decreased oxygen saturation, and a longer duration of oxygen saturation <90% than during supine sleep, suggesting that cardiopulmonary responsiveness was impaired. Sleep efficiency, sleep stages, oxygen nadir, and carbon dioxide tension were not different during supine and prone sleep. Central apnea occurred more significantly than obstructive apnea. During supine and prone sleep, the CAI was 3.3 ± 2.9/h and 2.3 ± 2.6/h and the OAHI was 0.6 ± 0.7/h and 0.6 ± 0.8/h, respectively. We found one SNP rs3743340 in the NDN gene that had no effect on the sleep and respiratory parameters of PSG.
Tachycardia and respiratory instability were recorded in neonates during prone sleep, suggesting that neonates are vulnerable to cardiopulmonary events during prone sleep. Therefore, young neonates should be kept in the supine sleep position unless there are contraindications.
俯卧睡眠是婴儿猝死综合征的一个已确定的风险因素，可能是由于血压降低、脑氧合作用以及脑血管控制受损。尚未有关于新生儿仰卧位和俯卧位睡眠期间心脏和呼吸反应的报道。
在本研究中，报告了17例2 - 3日龄新生儿在仰卧位和俯卧位睡眠期间的白天多导睡眠图（PSG）数据，并对新生儿呼吸控制的重要基因NDN基因进行测序，以与新生儿呼吸参数进行相关性分析。比较了仰卧位和俯卧位睡眠之间以及NDN基因中具有不同单核苷酸多态性（SNP）的参与者之间的心率（HR）、血氧饱和度、二氧化碳浓度、睡眠阶段、中枢性呼吸暂停指数（CAI）、阻塞性呼吸暂停/低通气指数（OAHI）和最低血氧饱和度。
与仰卧位睡眠相比，俯卧位睡眠期间新生儿的心率更快、血氧饱和度降低且血氧饱和度<90%的持续时间更长，这表明心肺反应性受损。仰卧位和俯卧位睡眠期间的睡眠效率、睡眠阶段、最低血氧饱和度和二氧化碳分压没有差异。中枢性呼吸暂停比阻塞性呼吸暂停更显著。仰卧位和俯卧位睡眠期间，CAI分别为3.3±2.9次/小时和2.3±2.6次/小时，OAHI分别为0.6±0.7次/小时和0.6±0.8次/小时。我们在NDN基因中发现了一个单核苷酸多态性rs3743340，它对PSG的睡眠和呼吸参数没有影响。
在新生儿俯卧位睡眠期间记录到心动过速和呼吸不稳定，这表明新生儿在俯卧位睡眠期间易发生心肺事件。因此，除非有禁忌症，年幼的新生儿应保持仰卧位睡眠姿势。
