Vicki L. Schechtman

Dynamic Analysis of Cardiac R-R Intervals in Normal Infants and in Infants Who Subsequently Succumbed to the Sudden Infant Death Syndrome

ABSTRACTS: Infants who subsequently succumb to the sudden infant death syndrome (SIDS) have higher heart rates and reduced heart rate variation compared with other infants. We examined dynamic changes in cardiac interbeat intervals to explore these differences in cardiac control. Recordings of electrocardiographic activity and respiratory movement were acquired from 13 SIDS victims before their deaths. Moment-to-moment changes in R-R intervals during quiet sleep, rapid eye movement sleep, and waking were compared with values of 13 matched control infants. For each sleep-waking state, every R-R interval was plotted against the previous interval (Poincaré plots), and each change in interbeat interval was plotted against the previous change. Dispersion of interbeat intervals at different heart rates was reduced in SIDS victims, resulting in Poincaré plots markedly different from those of controls. The dispersion, sampled at the 10th and 90th percentiles of heart rates, was reduced across all sleep-waking states in SIDS victims. At high heart rates, the difference between groups disappeared after correcting for basal rate; however, the reduced range at low heart rates was independent of basal rate. SIDS victims also showed smaller beat-to-beat changes in heart rate and fewer sustained runs of consistenl heart rate changes during waking relative to controls. The differences in cardiac rate dynamics suggest altered autonomic control in infants who succumb to SIDS. We speculate that the autonomic disturbance may lead to cardiac instability or may indicate CNS alterations with the potential to affect other vital functions.

Spectral Analysis Assessment of Respiratory Sinus Arrhythmia in Normal Infants and Infants Who Subsequently Died of Sudden Infant Death Syndrome

ABSTRACT: Reduced heart rate variability has been found in infants who later succumb to the sudden infant death syndrome (SIDS). To determine whether respiratory sinus arrhythmia, a major component of heart rate variability, is also reduced in SIDS victims, nighttime portions of eighteen 24-h recordings of ECG and respiration from infants who later died of SIDS and 52 recordings from control infants were assessed using spectral analysis. Two aspects of respiratory sinus arrhythmia were examined: “extent” (the absolute heart rate variation at the respiratory frequency) and “coherence” (the degree to which heart rate follows respiration regardless of the absolute amount of variation). Respiratory parameters were used to classify each 1-min epoch as quiet sleep, rapid eye movement sleep, waking, or indeterminate state. Median extent and coherence values across the night were then computed for each sleep-waking state. Two-way (group × state) repeated measures analysis of variance tests were then used to compare respiratory sinus arrhythmia values for 13 SIDS victims and 13 control infants matched by postnatal age, birth weight, sex, and gestational age. Extent of respiratory sinus arrhythmia was significantly lower in the SIDS victims across all sleep-waking states, a finding that persisted after adjusting for heart rate. Coherence values did not differ significantly. These results suggest that even before the time of maximal risk for the syndrome, SIDS victims, as a group, differ from controls in the extent to which cardiac and respiratory activity couple, and this difference is independent of basal heart rate.

Machine classification of infant sleep state using cardiorespiratory measures

We examined the potential to classify sleep and waking state over the first 6 months of life in normal infants using only cardiac and respiratory measures. Twelve hour all-night polygraph recordings which included EEG, eye movement, whole body movement, facial muscle electromyographic, cardiac, and respiratory activity from 25 normal infants were collected at 1 week, and at 1, 2, 3, 4, and 6 months of age. Each minute of these recordings was classified into quiet sleep, waking, or rapid eye movement sleep by trained observers using EEG and somatic criteria. Respiratory rate and variability, heart rate and variability, and cardiac interbeat interval variation at respiratory and lower frequencies from 12 of the 25 infants were used as measures in discriminant analyses of sleep state for test on the 13 remaining infants. Using all 7 cardiac and respiratory measures, sleep states were classified with an accuracy approximating that attained by trained observers who had available all polygraph tracings (84.8% overall correct classification). Using only cardiac measures, the accuracy of classification decreased slightly, with an overall correct classification of 82.0%. Using only respiratory measures, the accuracy of classification diminished further, with an overall correct classification of 80.0%. Cardiac and respiratory measures provide quantifiable indications of sleep and waking states over the first 6 months of life in normal infants.

Time-domain system for assessing variation in heart rate

The paper presents an alternative to Fourier techniques for assessment of heart rate variation. The system operates on R-R interval data (intervals between successive R-waves of an ECG). Artefacts are first detected and corrected by recombination of deviant intervals. Next, the highest frequency variation is recognised by identifying changes in the sign of the slope of successive R-R intervals as ‘peaks’ and ‘troughs’. Lower frequency variation is determined from the variation in higher frequency peaks. The period of variation is computed as the sum of the intervals between two peaks, and extent of variation is represented by the peak-to-trough difference. Variation in a given frequency range is then quantified as the median extent of all variation within that range. Assessment of variation at the respiratory frequency by the peak/trough method is highly correlated with results derived from spectral techniques, while the two methods show consistently weaker correlations in the assessment of lower-frequency variation. Peak/trough assessment of three types of variation is consistently better correlated with heart rate than are analogous spectral measurements. Results suggest that the method described here may be preferable to spectral techniques for analysis of heart rate variation that is dependent on base heart rate.

Development of Heart Rate Variation Over the First 6 Months of Life in Normal Infants

ABSTRACT: Development of heart rate variation in three frequency ranges was examined during sleep-waking states in normal infants over the first 6 mo of life. Extent of all three types of heart rate variation decreased from 1 wk to 1 mo of age. Extent of respiratory sinus arrhythmia increased from 1 mo to 6 mo during all sleep-waking states, with the increase most pronounced during quiet sleep. Variation in two hands of lower frequencies showed increases in extent from 1 to 3 mo, then a slowing or reversal of the increase between 3 and 4 mo of age. During rapid eye movement sleep, the two types of lower frequency heart rate variation decreased in extent from 3 through 6 mo of age. These results suggest that alterations in autonomic control of heart rate occur at several time periods over the first 6 mo of life and that these alterations may have an effect only on particular types of heart rate variation and only during particular sleep-waking states. The diminution of all three types of heart rate variation at 1 mo may indicate a reduction in vagal tone at this age.

Dynamics of respiratory patterning in normal infants and infants who subsequently died of the sudden infant death syndrome.

Despite evidence that respiratory control mechanisms may be altered in infants who succumb to the sudden infant death syndrome (SIDS), overall respiratory variability in SIDS victims is comparable to that of control infants. We assessed dynamic characteristics of breathing in 16 recordings of apparently healthy infants who subsequently died of SIDS, and 35 recordings of age-matched control infants. Each breath-to-breath interval in 10-min epochs of quiet sleep and rapid eye movement sleep was plotted against the previous interval. Dispersion of next-intervals was determined after short, intermediate, and long interbreath intervals. In SIDS victims, dispersion after long intervals (slow respiratory rates) was significantly restricted relative to control infants. Moreover, after long breath-to-breath intervals, SIDS victims showed smaller mean breath-to-breath changes in respiratory rate than did controls. The findings indicate that breath-to-breath respiratory patterns differ in infants who succumb to SIDS, and the differences occur preferentially at low respiratory rates.

Cardiac and respiratory patterns during sleep in cocaine-exposed neonates

Four-hour recordings of heart rate and respiration during spontaneous sleep and wakefulness were obtained from 17 cocaine-exposed and 14 control infants at 2 weeks of age. The median values for heart and respiratory rate and variability were determined for each 1-min epoch of quiet and active sleep. Overall mean rates and variabilities were determined for each state. The cocaine-exposed infants showed significantly greater sleep state effects on heart rate relative to the control infants. Recency of cocaine exposure was not a factor in the differences; even those cocaine-exposed infants who tested negative for the drug perinatally differed significantly from those who had never been exposed. Heart rate variability was increased in cocaine-exposed infants relative to controls in both sleep states. Respiratory rate and variability were not significantly different in the cocaine-exposed and control infants. These results suggest differences in cardiovascular control in infants of cocaine-abusing mothers compared to infants without cocaine exposure. The mechanism responsible for these differences is unclear and may reflect cocaine-induced changes in the autonomic physiology of developing infants or some indirect effect of maternal cocaine use.

Sleep disorganization in cocaine-exposed neonates☆

Abstract The purpose of the study was to examine the effect of prenatal cocaine exposure on infant sleep and wakefulness. Four-hour recordings of sleep and wakefulness were obtained from 17 cocaine-exposed neonates and 14 control infants at 2 weeks of age. Each 1-min epoch was classified as quiet sleep, active sleep, indeterminate sleep, or waking based on eye and body movements and respiratory variability. Analyses of variance were performed on durations of total sleep versus wakefulness, and quiet sleep, active sleep, and indeterminate sleep. The cocaine-exposed infants showed proportions of sleep and wake time similar to those of the control infants. Sleep time was, however, distributed differently among the various sleep states in the cocaine-exposed infants. Infants with prenatal cocaine exposure showed significantly more indeterminate sleep and significantly less active sleep than the control infants, even when confounding variables were controlled statistically. Regression analyses indicated that infrequent cocaine use paradoxically increased indeterminate sleep time to a greater extent than frequent use, possibly due to differences in patterns of cocaine use of recency of exposure. These results suggest that active sleep is less organized at 2 weeks of age in infants of cocaine-abusing mothers than in infants without cocaine exposure.

Aberrant temporal patterning of slow-wave sleep in siblings of SIDS victims

We assessed the patterning of slow-wave EEG activity during sleep in siblings of sudden infant death syndrome (SIDS) victims over the first 6 months of life. Twelve hour overnight physiologic recordings were obtained from 25 apparently healthy subsequent siblings of SIDS victims and 25 control infants at 1 week, and 1, 2, 3, 4 and 6 months of age. The EEG activity was electronically bandpass filtered, leaving primarily activity ranging from 0.5 to 2.5 Hz (the delta frequency), and the filtered traces were full-wave rectified and integrated over 1 min periods. The recordings were divided into four 3 h segments beginning at sleep onset, and the mean integrated delta activity during quiet sleep was determined for each segment of the night. At 3 and 4 months postnatal age, SIDS siblings displayed increased integrated delta amplitude in the early morning hours relative to control infants. Most SIDS deaths occur in the early morning hours during the 2-4 month age range. We thus speculate that increased delta activity may be indicative of increased arousal thresholds in the early morning, which may contribute to SIDS deaths.

Developmental patterns of heart rate and variability in prematurely-born infants with apnea of prematurity

At equivalent post-conceptional ages, prematurely-born infants have higher heart rates and reduced heart rate variability, relative to full-term neonates. Premature birth might exert long-lasting effects on central and peripheral mechanisms that control cardiovascular activity. We assessed development of heart rate and heart rate variability in symptomatic preterm infants up to 6 months of age. Fifty 6.5-h evening recordings of EKG and breathing were obtained from prematurely-born infants (gestational ages: 24-35 weeks). Cardiac R-R intervals were captured with a resolution of +/- 0.5 msec. One-min epochs were selected from three periods of regular respiration in recordings from premature infants and 72 recordings of full-term infants at comparable post-conceptional ages. Mean heart rate and heart rate variability were determined for each recording. At 40 weeks post-conception, prematurely-born infants with apnea of prematurity showed higher heart rates and reduced heart rate variability than did full-term neonates. These differences between premature and full-term infants persisted throughout the next 6 months in those infants born prior to 30 weeks gestation, and in those infants born at 30-35 weeks who experienced respiratory distress syndrome (RDS) during the neonatal period. The findings suggest that premature delivery, or complications thereof, exerts long-lasting effects on cardiac control.