THE PREVALENCE OF CENTRAL APNEA IN HIGH RISK SIDS INFANTS
.Aaron Curns, MPH, Alfred Steinschneider, MD, PhD, Heidi Shoemake, MPH
American SIDS Institute, 2480 Windy Hill Road, Suite 380, Marietta, GA 30067 USA.
Phone:770-612-1030. Fax: 770-612-8277. Email: prevent@SIDS.org
Data were collected retrospectively on 733 infants identified epidemiologically to be at high risk for SIDS: 1)siblings of SIDS victims (SibSIDS N=215), 2) ALTEs at home (ALTE N=237), and 3) premature infants with a history of apnea or bradycardia in the newborn nursery (Premie Apnea N=281). The objectives of this retrospective study were to determine: a) the prevalence of at least one episode of prolonged central apnea, b) if central apnea prevalence differed by group, and c) the temporal interval of monitoring before an infant
=s initial episode of central apnea. All infants were followed at home on a event recording cardiorespiratory monitor. The monitor was set to record any central apnea at least 16 seconds in duration. Episodes were confirmed and measured from recorded waveforms obtained by the home apnea/bradycardia monitor. Infants were required to have at least 140 hours of monitor use (an average of 5 hours per day) for each of four successive 28 day cycles, with our total observation period being 112 days. If monitor usage was not adequate for a 28 day cycle, subjects were excluded from further analysis and observation was considered terminated at the end of the preceding 28 day cycle. A survival analysis was used to accommodate the censoring of infants due to inadequate monitor compliance. The following estimates of central apnea prevalence were obtained for 112 days of observation.|
Group |
|||
|
Duration |
ALTE |
SibSIDS |
Premie |
|
(s) |
% |
% |
% |
|
15 |
25.3 |
21.4 |
29.7* |
|
18 |
4.1 |
6.1 |
14.5* |
|
20 |
3.0 |
3.1 |
8.5* |
|
PA-15** |
6.4 |
5.3 |
16.4* |
|
PA-18** |
3.0 |
3.1 |
12.1* |
The Premie Apnea group had significantly more infants that had at least one episode of prolonged apnea than the two other groups. This difference remained significant after controlling for the potential confounding variables of gender, race, postnatal age, and the interval between hospital discharge and the first visit to the Institute. There were no significant differences in central apnea prevalence between the ALTE and SibSIDS groups.
*p<0.05
** Defined as apnea at least 15 seconds (PA-15) or 18 seconds (PA-18) in duration when associated with bradycardia at least 5 seconds in duration.
In the spring of 1998, at the 5th SIDS International Conference in Rouen, France, the American SIDS Institute presented the results from a study complementary in design to the paper described above. In this particular study, researchers evaluated the prevalence of bradycardia in infants at high-risk for SIDS. To learn more about what was presented by the Institute in France, click on the link below.
A. Curns, A. Steinschneider, C. Richmond. The prevalence of bradycardia in high risk SIDS infants.