Sleeping in a room with a fan lowers a baby’s risk of sudden infant death syndrome by 72%, a new study has found.
The finding, published in The Archives of Pediatrics and Adolescent Medicine, is the latest evidence to suggest that a baby’s sleep environment is a critical factor in the risk of SIDS, which is diagnosed when an infant’s sudden death cannot be explained by other factors.
The study was not designed to identify why fans make a difference, but researchers said they thought that by circulating air, fans lowered the risk of “rebreathing” exhaled carbon dioxide. That risk has been suggested as a reason the rate of SIDS is higher when children sleep on their stomach, in a soft bed or without a pacifier. Since 1992 the rate of SIDS deaths has dropped by more than half, to about one death per 2,000 live births from 2.4 per 1,000.
The decline is linked to a national “Back to Sleep” campaign that promotes putting babies on their back instead of their stomach, which has been shown to lower the risk of sudden death. The American Academy of Pediatrics also recommends that parents avoid soft bedding, allow babies to use a pacifier and avoid overheating a baby’s room. Despite the gains, SIDS continues to be the leading cause of death in babies under the age of 1, and researchers are looking for more measures to lower the risk. The latest study compared 185 babies who had died of SIDS with 312 randomly selected babies and matched them by age, race, ethnic group and country of origin. “Even though we don’t know why certain babies are more susceptible, sleeping environment matters,” said a co-author of the study, Dr. De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente’s division of research in Oakland, Calif. Parents who worry that their child will be chilled by a fan should know that fans do not cool the air; they just move air around. A baby will feel a chill only if he or she is perspiring, doctors say. Parents who use fans in a child’s room should make sure to take normal safety precautions, keeping cords out of the way and making sure the fan cannot be knocked down by a toddler or pet.
Dr. Li said the use of fans should not replace other sleeping strategies for lowering SIDS, like removing soft bedding and putting babies on their back. He noted that the gains shown in the study were an average for the whole group, including for babies whose care did not meet the guidelines. Still, even if a baby had a safe sleeping environment, the risk of SIDS was lowered by about 16% for those who had a fan in the room, although the trend was not statistically significant. “If parents wanted to do more to reduce the baby’s SIDS risk,” he said, “they can add a fan.”
The finding, published in The Archives of Pediatrics and Adolescent Medicine, is the latest evidence to suggest that a baby’s sleep environment is a critical factor in the risk of SIDS, which is diagnosed when an infant’s sudden death cannot be explained by other factors.
The study was not designed to identify why fans make a difference, but researchers said they thought that by circulating air, fans lowered the risk of “rebreathing” exhaled carbon dioxide. That risk has been suggested as a reason the rate of SIDS is higher when children sleep on their stomach, in a soft bed or without a pacifier. Since 1992 the rate of SIDS deaths has dropped by more than half, to about one death per 2,000 live births from 2.4 per 1,000.
The decline is linked to a national “Back to Sleep” campaign that promotes putting babies on their back instead of their stomach, which has been shown to lower the risk of sudden death. The American Academy of Pediatrics also recommends that parents avoid soft bedding, allow babies to use a pacifier and avoid overheating a baby’s room. Despite the gains, SIDS continues to be the leading cause of death in babies under the age of 1, and researchers are looking for more measures to lower the risk. The latest study compared 185 babies who had died of SIDS with 312 randomly selected babies and matched them by age, race, ethnic group and country of origin. “Even though we don’t know why certain babies are more susceptible, sleeping environment matters,” said a co-author of the study, Dr. De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente’s division of research in Oakland, Calif. Parents who worry that their child will be chilled by a fan should know that fans do not cool the air; they just move air around. A baby will feel a chill only if he or she is perspiring, doctors say. Parents who use fans in a child’s room should make sure to take normal safety precautions, keeping cords out of the way and making sure the fan cannot be knocked down by a toddler or pet.
Dr. Li said the use of fans should not replace other sleeping strategies for lowering SIDS, like removing soft bedding and putting babies on their back. He noted that the gains shown in the study were an average for the whole group, including for babies whose care did not meet the guidelines. Still, even if a baby had a safe sleeping environment, the risk of SIDS was lowered by about 16% for those who had a fan in the room, although the trend was not statistically significant. “If parents wanted to do more to reduce the baby’s SIDS risk,” he said, “they can add a fan.”
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SIDS deaths in the U.S. decreased from 4,895 in 1992 to 2,247 in 2004. But, during a similar time period, 1989 to 2004, SIDS being listed as the cause of death for sudden infant death (SID) decreased from 80% to 55%. According to Dr. John Kattwinkel, chairman of the Center for Disease Control (CDC) Special Task Force on SIDS "A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of it is just code shifting”.
In a 2006 letter to the editor in the Journal of Pediatrics Dr. Rafael Pelayo, Dr. Judith Owens, Dr. Jodi Mindell, and Dr. Stephen Sheldon asked the following question of the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome after their Pacifier and Co-sleeping report was published:
"...from the perspective of the field of pediatric sleep medicine, the policy statement's laudable but narrow focus on SIDS prevention raises a number of important issues that need to be addressed. In particular, the revised recommendations regarding cosleeping and pacifier use have the potential to lead to unintended consequences on both the sleep and the health of the infant. The potential implications of a SIDS risk-reduction strategy that is based on a combination of maintaining a low arousal threshold and reducing quiet (equivalent to Delta or slow-wave sleep) in infants must be considered. Because slow-wave sleep is considered the most restorative form of sleep and is believed to have a significant role in neurocognitive processes and learning, as well as in growth, what might be the neurodevelopmental consequences of chronically reducing deep sleep in the first critical 12 months of life?"
In a currently utilized model that explains the process in which slow wave sleep is involved in memory consolidation the hippocampus acts as a temporary storage facility for new memories which are then transferred to the neocortex during slow wave sleep (SWS) [8]. In this model, acetylcholine acts a feedback loop inhibitor inside the hippocampus during REM sleep and wakefulness. The activity during the high cholinergic wakefulness period is believed to provide an environment which allows for the encoding within the hippocampus of new declarative memories. The low cholinergic environment during SWS is thought to then allow these memories to be transferred from the temporary storage of the hippocampus to their permanent storage environment in the neocortex and for memory consolidation [9, 10].
A significant way of decreasing slow wave sleep in infants is by changing their sleeping position from prone to supine. It has been shown in studies of preterm infants [11, 12], full-term infants [13, 14], and older infants [15], that they have greater time periods of quiet sleep and also decreased time awake when they are positioned to sleep in the prone position.
8. Hasselmo, M.E. 1999. Neuromodulation: Acetylcholine and memory consolidation. Trends Cogn. Sci. 3: 351–359.
9. Buzsáki, G. 1989. Two-stage model of memory trace formation: A role for “noisy” brain states. Neuroscience 31: 551–570.
10. Hasselmo, M.E. 1999. Neuromodulation: Acetylcholine and memory consolidation. Trends Cogn. Sci. 3: 351–359.
11. Myers MM, Fifer WP, Schaeffer L, et al. Effects of sleeping position and time after feeding on the organization of sleep/wake states in prematurely born infants. Sleep 1998;21:343–9.
12. Sahni R, Saluja D, Schulze KF, et al. Quality of diet, body position, and time after feeding influence behavioral states in low birth weight infants. Pediatr Res 2002;52:399–404.
13. Brackbill Y, Douthitt TC, West H. Psychophysiologic effects in the neonate of prone versus supine placement. J Pediatr 1973;82:82–4.
14. Amemiya F, Vos JE, Prechtl HF. Effects of prone and supine position on heart rate, respiratory rate and motor activity in full term infants. Brain Dev 1991;3:148–54.
15. Kahn A, Rebuffat E, Sottiaux M, et al. Arousal induced by proximal esophageal reflux in infants. Sleep 1991;14:39–42.
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