{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T22:45:51Z","timestamp":1776465951086,"version":"3.51.2"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,8,1]]},"abstract":"<jats:p>Objective. Sleep deprivation is a risk factor for sudden infant death syndrome (SIDS). Recent changes in normal life routines were more common among SIDS victims, compared with control infants. Sleep deprivation can result from handling conditions or from sleep fragmentation attributable to respiratory or digestive conditions, fever, or airway obstructions during sleep. Compared with matched control infants, future SIDS victims exhibited fewer complete arousals by the end of the night, when most SIDS cases occur. Arousal from sleep could be an important defense against potentially dangerous situations during sleep. Because the arousal thresholds of healthy infants were increased significantly under conditions known to favor SIDS, we evaluated the effects of a brief period of sleep deprivation on sleep and arousal characteristics of healthy infants.<\/jats:p><jats:p>Design. Fourteen healthy infants, with a median age of 8 weeks (range: 6\u201318 weeks), underwent polygraphic recording during a morning nap and an afternoon nap, in a sleep laboratory. The infants were sleep-deprived for 2 hours before being allowed to fall asleep. Sleep deprivation was achieved by keeping the infants awake, with playing, handling, and mild tactile or auditory stimulations, for as long as possible beyond their habitual bedtimes. To avoid any confounding effect attributable to differences in sleep tendencies throughout the day, sleep deprivation was induced before either the morning nap or the afternoon nap. Seven infants were sleep-deprived before the morning nap and 7 before the afternoon nap. The sleep and arousal characteristics of each infant were compared for the non-sleep-deprived condition (normal condition) and the sleep-deprived condition. During each nap, the infants were exposed, during rapid eye movement (REM) sleep, to white noise of increasing intensity, from 50 dB(A) to 100 dB(A), to determine their arousal thresholds. Arousal thresholds were defined on the basis of the lowest auditory stimuli needed to induce arousal. After the induced arousal, the infants were allowed to return to sleep to complete their naps.<\/jats:p><jats:p>Results. Sleep deprivation lasted a median of 120 minutes (range: 90\u2013272 min). Most sleep characteristics were similar for the normal and sleep-deprived conditions, including sleep efficiency, time awake, percentages of REM sleep and non-REM sleep, frequency and duration of central apnea and of periodic breathing, duration of obstructive apnea, mean heart rate and variability, and mean breathing rates during REM sleep and non-REM sleep. After sleep deprivation, the duration of the naps increased, whereas there were decreases in the latency of REM sleep and in the density of body movements. More-intense auditory stimuli were needed for arousal when the infants were sleep-deprived, compared with normal nap sleep. Sleep deprivation was associated with a significant increase in the frequency of obstructive sleep apnea episodes, especially during REM sleep. No significant differences were noted when the effects of morning and afternoon sleep deprivation were compared. No correlation was found between the duration of sleep deprivation and either the frequency of obstructive apnea or the changes in arousal thresholds, although the infants who were more sleep-deprived exhibited tendencies toward higher auditory arousal thresholds and shorter REM sleep latencies, compared with less sleep-deprived infants. There were tendencies for a negative correlation between the auditory arousal thresholds and REM sleep latencies and for a positive correlation between the auditory arousal thresholds and the frequencies of obstructive apnea during REM sleep.<\/jats:p><jats:p>Conclusions. Short-term sleep deprivation among infants is associated with the development of obstructive sleep apnea and significant increases in arousal thresholds. As already reported, sleep deprivation may induce effects on respiratory control mechanisms, leading to impairment of ventilatory and arousal responses to chemical stimulation and decreases in genioglossal electromyographic activity during REM sleep. These changes in respiratory control mechanisms could contribute to the development of obstructive apnea. The relationship between the development of obstructive apnea and increases in arousal thresholds remains to be evaluated. Adult subjects with obstructive sleep apnea exhibited both sleep fragmentation and increases in arousal thresholds. Conversely, sleep deprivation increased the frequency and severity of obstructive sleep apnea. In this study, the increases in arousal thresholds and the development of obstructive apnea seemed to result from the preceding sleep deprivation. The depressed arousals that follow sleep deprivation have been attributed to central mechanisms, rather than decreases in peripheral sensory organ function. Such mechanisms could include disturbances within the reticular formation of the brainstem, which integrates specific facilitory inputs, such as ascending pathways from auditory receptors, and inhibitory inputs from the cortex. It remains to be determined whether the combination of upper airway obstruction and depressed arousability from sleep contributes to the increased risk of sudden death reported for sleep-deprived infants.<\/jats:p>","DOI":"10.1542\/peds.114.2.e192","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:53:04Z","timestamp":1092444784000},"page":"e192-e197","source":"Crossref","is-referenced-by-count":43,"title":["Decreased Arousals Among Healthy Infants After Short-Term Sleep Deprivation"],"prefix":"10.1542","volume":"114","author":[{"given":"Patricia","family":"Franco","sequence":"first","affiliation":[{"name":"Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Seret","sequence":"additional","affiliation":[{"name":"Pediatric Sleep Unit, Clinique St. Joseph, Lie\u0300ge, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Noe\u0308l Van","family":"Hees","sequence":"additional","affiliation":[{"name":"Pediatric Sleep Unit, Clinique St. Joseph, Lie\u0300ge, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Scaillet","sequence":"additional","affiliation":[{"name":"Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franc\u0327oise","family":"Vermeulen","sequence":"additional","affiliation":[{"name":"Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose\u0301","family":"Groswasser","sequence":"additional","affiliation":[{"name":"Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andre\u0301","family":"Kahn","sequence":"additional","affiliation":[{"name":"Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2004,8,1]]},"reference":[{"key":"2021121006430104400_R1","doi-asserted-by":"crossref","unstructured":"Emery JL. Epidemiology of \u201csudden, unexpected or rapid\u201d deaths in children. Br Med J.1959;2:925","DOI":"10.1136\/bmj.2.5157.925"},{"key":"2021121006430104400_R2","unstructured":"Fleming PJ, Blair PS, Berry J, Bacon C. Potentially modifiable risk factors of SIDS. In: Fleming P, ed. Sudden Unexpected Deaths in Infancy: The CESDI SUDI Studies 1993\u20131996. London, United Kingdom: Her Majesty\u2019s Stationery Office; 2000:20\u201321"},{"key":"2021121006430104400_R3","doi-asserted-by":"crossref","unstructured":"Ford RP, Hassall IB, Mitchell EA, et al. Life events, social support and the risk of sudden infant death syndrome. J Child Psychol Psychiatry.1996;37:835\u2013840","DOI":"10.1111\/j.1469-7610.1996.tb01479.x"},{"key":"2021121006430104400_R4","doi-asserted-by":"crossref","unstructured":"Hoffman HJ, Hillman LS. Epidemiology of the sudden infant death syndrome: maternal, neonatal, and postnatal risk factors. In: Hunt CE, ed. Clinics in Perinatology: Apnea and SIDS. Philadelphia, PA: WB Saunders; 1992:717\u2013738","DOI":"10.1016\/S0095-5108(18)30427-5"},{"key":"2021121006430104400_R5","doi-asserted-by":"crossref","unstructured":"Gilbert R, Rudd P, Berry PJ, et al. Combined effect of infection and heavy wrapping on the risk of sudden unexpected infant death. Arch Dis Child.1992;67:171\u2013177","DOI":"10.1136\/adc.67.2.171"},{"key":"2021121006430104400_R6","doi-asserted-by":"crossref","unstructured":"Platt MW, Blair PS, Fleming PJ, et al. A clinical comparison of SIDS and explained sudden infant deaths: how healthy and how normal?Arch Dis Child.2000;82:98\u2013106","DOI":"10.1136\/adc.82.2.98"},{"key":"2021121006430104400_R7","doi-asserted-by":"crossref","unstructured":"Guilleminault C, Ariagno RL, Forno LS, Lynn N, Baldwin R, Owen M. Obstructive sleep apneas and near miss SIDS: I. Report of an infant with sudden death. Pediatrics.1979;63:837\u2013843","DOI":"10.1542\/peds.63.6.837"},{"key":"2021121006430104400_R8","doi-asserted-by":"crossref","unstructured":"Kahn A, Groswasser J, Rebuffat E, et al. Sleep and cardiorespiratory characteristics of infant victims of sudden death: a prospective case-control study. Sleep.1992;15:287\u2013292","DOI":"10.1093\/sleep\/15.4.287"},{"key":"2021121006430104400_R9","doi-asserted-by":"crossref","unstructured":"Naeye RL, Messmer J III, Specht T, Merritt TA. Sudden infant death syndrome temperament before death. J Pediatr.1976;88:511\u2013515","DOI":"10.1016\/S0022-3476(76)80283-1"},{"key":"2021121006430104400_R10","unstructured":"Phillipson EA, Sullivan CE. Arousal: the forgotten response to respiratory stimuli. Am Rev Respir Dis.1978;118:807\u2013809"},{"key":"2021121006430104400_R11","doi-asserted-by":"crossref","unstructured":"Kahn A, Groswasser J, Franco P, et al. Sudden infant deaths: arousal as a survival mechanism. Sleep Med.2003;3(suppl):S11\u2013S14","DOI":"10.1016\/S1389-9457(02)00157-0"},{"key":"2021121006430104400_R12","doi-asserted-by":"crossref","unstructured":"Valdes-Dapena M. The sudden infant death syndrome: pathologic findings. In: Hunt CE, ed. Clinics in Perinatology: Apnea and SIDS. Philadelphia, PA: WB Saunders; 1992:701\u2013717","DOI":"10.1016\/S0095-5108(18)30426-3"},{"key":"2021121006430104400_R13","doi-asserted-by":"crossref","unstructured":"Kinney HC, Filiano JJ, White WF. Medullary serotonergic network deficiency in the sudden infant death syndrome: review of a 15-year study of a single dataset. J Neuropathol Exp Neurol.2001;60:228\u2013247","DOI":"10.1093\/jnen\/60.3.228"},{"key":"2021121006430104400_R14","doi-asserted-by":"crossref","unstructured":"Schechtman V, Harper RM, Wilson JW, Southall DP. Sleep state organization in normal infants and victims of the sudden infant death syndrome. Pediatrics.1992;89:865\u2013870","DOI":"10.1542\/peds.89.5.865"},{"key":"2021121006430104400_R15","doi-asserted-by":"crossref","unstructured":"Kato I, Franco P, Groswasser J, et al. Incomplete arousal processes in infants with sudden death. Am J Respir Crit Care Med.2003;164:1464\u20131469","DOI":"10.1164\/ajrccm.164.8.2009001"},{"key":"2021121006430104400_R16","doi-asserted-by":"crossref","unstructured":"Franco P, Pardou A, Hassid S, Lurquin P, Kahn A. Auditory arousal thresholds are higher when infants sleep in the prone position. J Pediatr.1998;132:240\u2013243","DOI":"10.1016\/S0022-3476(98)70438-X"},{"key":"2021121006430104400_R17","doi-asserted-by":"crossref","unstructured":"Franco P, Groswasser J, Hassid S, Lanquart JP, Scaillet S, Kahn A. Prenatal exposure to cigarettes is associated with decreased arousal propensity in infants. J Pediatr.1999;135:34\u201338","DOI":"10.1016\/S0022-3476(99)70324-0"},{"key":"2021121006430104400_R18","doi-asserted-by":"crossref","unstructured":"Franco P, Scaillet S, Valente F, Chabanski S, Groswasser J, Kahn A. Ambient temperature is associated with changes in infants' arousability from sleep. Sleep.2001;24:325\u2013329","DOI":"10.1093\/sleep\/24.3.325"},{"key":"2021121006430104400_R19","doi-asserted-by":"crossref","unstructured":"Franco P, Seret N, Van Hees JN, Lanquart JP, Groswasser J, Kahn A. Cardiac changes during sleep in sleep-deprived infants. Sleep.2003;26:845\u2013848","DOI":"10.1093\/sleep\/26.7.845"},{"key":"2021121006430104400_R20","unstructured":"Guilleminault C, Souquet M. Sleep states and related pathology. In: Korobkin R, Guilleminault C, eds. Advances in Perinatal Neurology. New York, NY: Spectrum Publications; 1979:225\u2013247"},{"key":"2021121006430104400_R21","unstructured":"Carskadon MA, Rechtschaffen A. Monitoring and staging human sleep. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. Philadelphia, PA: WB Saunders; 2000:1197\u20131217"},{"key":"2021121006430104400_R22","doi-asserted-by":"crossref","unstructured":"Sleep Disorders Atlas Task Force of the American Sleep Disorders Association (ASDA). EEG arousals: scoring rules and examples. Sleep.1992;15:173\u2013184","DOI":"10.1093\/sleep\/15.2.173"},{"key":"2021121006430104400_R23","doi-asserted-by":"crossref","unstructured":"Rosenthal L, Bishop C, Helmus T, Krstevska S, Roehrs T, Roth T. Auditory awakening thresholds in sleepy and alert individuals. Sleep.1996;19:290\u2013295","DOI":"10.1093\/sleep\/19.4.290"},{"key":"2021121006430104400_R24","doi-asserted-by":"crossref","unstructured":"Thomas DA, Poole K, McArdle EK, et al. The effect of sleep deprivation on sleep states, breathing events, peripheral chemoresponsiveness and arousal propensity in healthy 3 month old infants. Eur Respir J.1996;9:932\u2013938","DOI":"10.1183\/09031936.96.09050932"},{"key":"2021121006430104400_R25","doi-asserted-by":"crossref","unstructured":"Canet E, Gaultier C, D'Allest A, et al. Effects of sleep deprivation on respiratory events during sleep in healthy infants. J Appl Physiol.1989;66:1158\u20131163","DOI":"10.1152\/jappl.1989.66.3.1158"},{"key":"2021121006430104400_R26","unstructured":"White DP, Douglas NJ, Picket CK, Zwillich CW, Weil JV. Sleep deprivation and the control of ventilation. Am Rev Respir Dis.1983;128:984\u2013986"},{"key":"2021121006430104400_R27","unstructured":"Bowes G, Woolf GM, Sullivan CE, Phillipson EA. Effect of sleep fragmentation on ventilatory and arousal responses in sleeping dogs to respiratory stimuli. Am Rev Respir Dis.1980;122:899\u2013909"},{"key":"2021121006430104400_R28","unstructured":"Leiter JC, Knuth SL, Bartlett D. The effect of sleep deprivation on activity of the genioglossus muscle. Am Rev Respir Dis.1985;132:1242\u20131245"},{"key":"2021121006430104400_R29","doi-asserted-by":"crossref","unstructured":"Le\u0301tourneau P, Niyonsenga T, Carrier E, Praud E, Praud JP. Influence of 24-hour sleep deprivation on respiration in lambs. Pediatr Res.2002;52:697\u2013705","DOI":"10.1203\/00006450-200211000-00015"},{"key":"2021121006430104400_R30","unstructured":"Guilleminault C, Rosekind M. The arousal threshold: sleep deprivation, sleep fragmentation, and obstructive sleep apnea syndrome. Bull Eur Physiopathol Respir.1981;17:341\u2013349"},{"key":"2021121006430104400_R31","doi-asserted-by":"crossref","unstructured":"Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet.1999;354:1435\u20131439","DOI":"10.1016\/S0140-6736(99)01376-8"},{"key":"2021121006430104400_R32","unstructured":"Frederickson CJ, Rechtschaffen A. Effects of sleep deprivation on awakening thresholds and sensory potentials in the rat. Sleep.1978;1:69\u201382"},{"key":"2021121006430104400_R33","doi-asserted-by":"crossref","unstructured":"Di Nisi J, Muzet A, Ehrhart J, Libert JP. Comparison of cardiovascular responses to noise during waking and sleeping in humans. Sleep.1990;13:108\u2013120","DOI":"10.1093\/sleep\/13.2.108"},{"key":"2021121006430104400_R34","doi-asserted-by":"crossref","unstructured":"Sanford LD, Morrison AR, Ball WA, Ross RJ, Mann GL. Varying expression of alerting mechanisms in wakefulness and across sleep states. Electroenceph Clin Neurophysiol.1992;82:458\u2013468","DOI":"10.1016\/0013-4694(92)90052-J"},{"key":"2021121006430104400_R35","doi-asserted-by":"crossref","unstructured":"Manganotti P, Palermo A, Patuzzo S, Zanette G, Fiaschi A. Decrease in motor cortical excitability in human subjects after sleep deprivation. Neurosci. Lett.2001;304:153\u2013156","DOI":"10.1016\/S0304-3940(01)01783-9"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/2\/e192\/1017319\/zpe0080400e192.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/2\/e192\/1017319\/zpe0080400e192.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:36:16Z","timestamp":1682746576000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/114\/2\/e192\/64601\/Decreased-Arousals-Among-Healthy-Infants-After"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,8,1]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2004,8,1]]},"published-print":{"date-parts":[[2004,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.114.2.e192","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,8,1]]}}}