http://www.pediatrics.org/cgi/content/full/110/6/e70
PEDIATRICS Vol. 110 No. 6 December 2002, pp. e70
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ELECTRONIC ARTICLE
Spontaneous Arousals in Supine Infants While Swaddled and Unswaddled
During Rapid Eye Movement and Quiet Sleep
Claudia M. Gerard, MD, Kathleen A. Harris and Bradley T. Thach, MD
From the Edward Mallinckrodt Department of Pediatrics, Washington
University School of Medicine, St Louis, Missouri
Objective. Supine sleep is recommended for infants to decrease the risk
of sudden infant death syndrome, but many parents report that their
infants seem uncomfortable supine. Many cultures swaddle infants for
sleep in the supine position. Swaddled infants are said to "sleep
better"; presumably they sleep longer or with fewer arousals. However,
there have been no studies of the effect of swaddling on spontaneous
arousals during sleep. Arousal is initiated in brainstem centers and
manifests as a sequence of reflexes: from sighs to startles and then to
thrashing movements. Such "brainstem arousals" may progress to full
arousal, but most do not.
Methods. Twenty-six healthy infants, aged 80 ± 7 days, were studied
during normal nap times. Swaddled (cotton spandex swaddle) and
unswaddled trials were alternated for each infant. Sleep state (rapid
eye movement [REM] or quiet sleep [QS]) was determined by behavioral
criteria (breathing pattern, eye movements) and
electroencephalogram/electrooculogram (10 infants). Respitrace,
submental and biceps electromyogram, and video recording were used to
detect startles and sighs (augmented breaths). Full arousals were
classified by eye opening and/or crying. Frequencies of sighs, startles,
and full arousals per hour were calculated. Progression of events was
calculated as percentages in each sleep state, as was duration of sleep
state.
Results. Swaddling decreased startles in QS and REM, full arousal in QS,
and progression of startle to arousal in QS. It resulted in shorter
arousal duration during REM sleep and more REM sleep.
Conclusions. Swaddling has a significant inhibitory effect on
progression of arousals from brainstem to full arousals involving the
cortex in QS. Swaddling decreases spontaneous arousals in QS and
increases the duration of REM sleep, perhaps by helping infants return
to sleep spontaneously, which may limit parental intervention. For these
reasons, a safe form of swaddling that allows hip flexion/abduction and
chest wall excursion may help parents keep their infants in the supine
sleep position and thereby prevent the sudden infant death syndrome
risks associated with the prone sleep position.
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