Obstructive sleep apnea in infants: Relation to family history of sudden infant death syndrome, apparent life-threatening events, and obstructive sleep apnea

doi:10.1067/mpd.2000.103568

The Journal of Pediatrics

Volume 136, Issue 3, March 2000, Pages 318-323

https://doi.org/10.1067/mpd.2000.103568 Get rights and content

Abstract

Objectives: Familial aggregation of obstructive sleep apnea (OSA) has been shown to be associated with sudden infant death syndrome (SIDS) and apparent life-threatening events (ALTE) in infants. We wanted to determine the incidence of OSA in infants with siblings with ALTE and SIDS referred to our sleep clinic and to ascertain whether OSA was more common in infants who have family histories of SIDS, ALTE, and OSA. Study design: We studied 125 infants (mean age, 11.5 ± 0.6 weeks) who were separated into 2 groups on the basis of their family history; polysomnographic studies were performed on each infant. Results: Twenty infants had a multiple family history of SIDS, ALTE, or OSA (group 1), whereas the other 105 infants (group 2) had only one case of SIDS or ALTE within the family and no known history of OSA. We found that 19 of 20 infants in group 1 had OSA, whereas only 31 of 105 infants in group 2 had OSA (chi-squared analysis, P <.05). The OSA recorded was more frequent in infants of group 1 than in those of group 2. Follow-up studies in some infants with OSA demonstrated a progressive decrease in OSA, which resolved between 6 and 12 months of age. Conclusion: We conclude that infants of families with multiple histories of SIDS, ALTE, and OSA are more likely to have OSA than infants of families with only one case of SIDS or ALTE. (J Pediatr 2000;136:318-23)

Section snippets

Patients

We prospectively studied 125 infants <6 months of age (mean age 11.5 ± 0.6 weeks, range 1 to 25 weeks) who had been referred to our sleep clinic for investigation of OSA. These infants were initially referred because of either a family history of SIDS accompanied by symptoms suggestive of OSA, for example, noisy breathing during sleep, or they had had an ALTE, where no cause for the event could be determined. The ALTEs reported in infants typically involved an apneic event accompanied by pallor

Patients

Group 1 included 20 infants from 13 families with multiple cases of SIDS, ALTE, or adult OSA (Table I).Within these infants 7 sets of siblings and 6 single infants had been studied. Of the 13 families, 4 families had multiple cases of SIDS, and there was a history of OSA in their adult members, 3 families had multiple cases of SIDS with no known history of OSA, and 6 families had multiple cases of ALTEs in infants and a history of OSA in adult family members. Group 2 included 105 infants who

DISCUSSION

A strong history of SIDS, ALTE, and OSA within family members possibly predisposes their infants to have OSA during their first year of life. Strohl et al² first reported the aggregation of OSA within one family, in which OSA was diagnosed in several members, and an infant within this family had died of SIDS. It was speculated that the SIDS case may have been related to the OSA within the family. The potential link among SIDS, ALTE, and OSA in infants is unclear; however, an increased incidence

Acknowledgements

The authors acknowledge the nursing assistance of Teri Barnes, Sara Cooper, Helen Gemmell, Kerrie Borthwick, and Christiane Lomas.

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^☆: Supported by the National Health and Medical Research Council (NH and MRC) of Australia.

^☆☆: Reprint requests: Frances McNamara, PhD, David Read Laboratory, Department of Medicine (D06), University of Sydney, NSW 2006, Australia.

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Original ArticlesObstructive sleep apnea in infants: Relation to family history of sudden infant death syndrome, apparent life-threatening events, and obstructive sleep apnea☆,☆☆

Abstract

Section snippets

Patients

Patients

DISCUSSION

Acknowledgements

Clin Chest Med

Chest

Lancet

Lancet

J Pediatr

Chest

Obstructive sleep apnea in family members

N Engl J Med

The familial aggregation of obstructive sleep apnea

Am J Respir Crit Care Med

family study of sleep apnea, anatomic and physiologic interactions

Chest

Assessment of the role of inheritance in sleep apnea syndrome

Am J Respir Crit Care Med

The association of sudden unexpected infant death with obstructive sleep apnea

Am J Respir Crit Care Med

Familial occurrence of sudden infant death syndrome and apnea of infancy

Pediatrics

Evolution of sleep-disordered breathing and sleep in infants

J Paediatr Child Health

Sleep and cardiorespiratory characteristics of infant victims of sudden death: a prospective case-control study

Sleep

Original Articles
Obstructive sleep apnea in infants: Relation to family history of sudden infant death syndrome, apparent life-threatening events, and obstructive sleep apnea☆,☆☆