Sleep-related risk and worrying behaviours: a retrospective review of a tertiary centre’s experience
This retrospective study aims at helping physicians select babies considered at risk for fatal events during sleep. It does so by describing the clinical features and outcome of worrying infants’ behaviour during sleep, with the activation of an emergency medical service and/or emergency department, subsequently referred to the Centre for Paediatric Sleep Medicine and sudden infant death syndrome, Regina Margherita Children’s Hospital, Turin, Italy. We analysed the medical records of infants < 12 months whose parents reported they had worrying behaviour during sleep in the period 1 January 2009– 31 December 2015. Regional guidelines suggest performing anamnesis and capillary blood gas analysis in case of apparent life-threatening events. There were 33 males, average age 55 ± 54.37 days. On arrival at the emergency medical service/emergency department 97 % infants were asymptomatic; 61 % patients had a capillary blood gas analysis as suggested by the regional guidelines. A clear acid-base disorder was observed in two infants, asymptomatic at medical evaluation, that had assumed an unsafe sleeping position. Two patients presented recurrence of the episode at 3 months.
What is Known:
• Events that happen during sleep often frighten the parents of newborns. This fear may be induced by the fact that Sudden Infant Death Syndrome typically occurs during sleep.
• This tragic event is unpredictable by any clinical features or findings in instrumental examinations and cannot be prevented with an early resuscitation.
What is New:
• In our retrospective study, most worrying infant behaviour during sleep can be related to paraphysiological phenomena.
• Capillary blood gas analysis and anamnesis collection were crucial to identify the only two life-threatening events.
KeywordsSleep Infants SIDS Cardiorespiratory monitor Capillary blood gas analysis
American Academy of Pediatrics
Apparent life-threatening events
Brief resolved unexplained event
Capillary blood gas analysis
Emergency medical services
Sudden infant death syndrome
In loving memory of Dr. Elisa Ferrero, who analysed the data, wrote the initial draft of the manuscript and could not see the final version of the work as she flew away too early.
The authors thank Barbara Wade, contract professor of English at the University of Torino, for her linguistic advice.
Alessandro Vigo conceptualized and designed the study, wrote the manuscript and approved the final manuscript as submitted.
Oliviero Bruni wrote and critically reviewed the manuscript and approved the final manuscript as submitted.
Giulia Costagliola was involved in the acquisition and the analysis of the data, wrote the manuscript and approved the final manuscript as submitted.
Silvia Noce was involved in the conception of the study, critically reviewed the manuscript and approved the final manuscript as submitted.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in compliance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 9.Horne RSC, Nixon GM (2014) The role of physiological studies and apnoea monitoring in infants. Paediatr Respir Rev 4:312–318Google Scholar
- 13.MacLean JE, Fitzgerald D, Waters KA (2015) Developmental changes in sleep and breathing across infancy and childhood. Paediatr Resp Rev 16:276–284Google Scholar
- 16.National Institutes of Health Consensus (1987) Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986. Pediatrics 79(2):292–299Google Scholar
- 19.Tieder JS, Bonkowsky JL, Etzel RA, Franklin WH, Gremse DA, Herman B, Katz ES, Krilov LR, Merritt JL, Norlin C, Percelay J, Sapien RE, Shiffman RN, Smith MBH, for the SUBCOMMITTEE ON APPARENT LIFE THREATENING EVENTS (2016) Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics 137:e20160590CrossRefGoogle Scholar
- 21.Vigo A, Noce S, Ravaglia A (2015) Per una corretta gestione del bambino con ALTE. Medico e Bambino 34:292–297Google Scholar