Infant Arousals During Mother-Infant Bed Sharing: Implications for Infant Sleep and Sudden Infant Death Syndrome Research

Abstract

Objective. Normative values for infant sleep architecture have been established exclusively in the solitary sleeping environment. However, most of the world's cultures practice some form of parent-infant cosleeping. In addition, no previous polysomnographic studies in infants examined the frequency of electroencephalogram (EEG) arousals. This is the first study to assess (a) EEG arousals in infants and their relationship to sleep stages; (b) the impact on arousals of mother-infant bed sharing; and (c) the temporal overlap of infant with maternal arousals during bed sharing. Methodology. Three nights of polysomnography were performed in 35 breastfeeding mother-infant pairs when the infants were 11 to 15 weeks old. An adaptation night was followed by one bed sharing night and one solitary sleeping night. Twenty infants had been bed sharing since birth and 15 were routine solitary sleepers. Both epochal awakenings (EWs), based on 30-second epoch scoring of sleep-wake stages, and more transient arousals (TAs) ≥3 seconds were quantified. Results. Stage 3–4 sleep was associated with a striking paucity of EWs and TAs compared with stages 1–2 or rapid eye movement sleep. Bed sharing facilitated EWs and TAs selectively during stage 3–4 sleep. EWs from stage 3–4 sleep were more frequent on the bed sharing night than on the solitary night in both infant groups. Routinely bed sharing infants also exhibited more frequent TAs in stage 3–4 than the routine solitary sleepers in both conditions. In both groups, the number of infant arousals (EWs + TAs) that overlapped the mother's was doubled during bed sharing, with infant arousals leading most often. Conclusions. Mother-infant bed sharing promotes infant arousals. Together with a previous report that bed sharing reduces stage 3–4 sleep, this suggests that normative values for infant sleep must be interpreted within the context of the sleeping environment in which they were established. Given that arousability is diminished in stage 3–4, we speculate that, under otherwise safe conditions, the observed changes in stage 3–4 sleep and arousals associated with bed sharing might be protective to infants at risk for SIDS because of a hypothesized arousal deficit. The responsivity of the mother to infant arousals during bed sharing might also be protective.