History

Significant new information has been forthcoming in recent decades on sudden infant death syndrome (SIDS) and apnea during early infancy. This statement focuses on the epidemiologic aspects of SIDS, the lack of a proven association between episodic apnea and SIDS, strategies for prevention of SIDS, and appropriate use of home cardiorespiratory monitoring. Apnea monitors were first introduced in the mid-1960s for the management of apnea of prematurity in hospital settings. Subsequently, cardiorespiratory monitoring has become widely used in the care of infants with a variety of acute and chronic disorders.

The hypothesis that apnea is the pathophysiologic precursor to SIDS was first proposed in 1972. Apnea documented by cardiorespiratory monitoring during prolonged hospitalizations was reported for 2 infants, both of whom were siblings of 3 infants who had died suddenly at home. Both siblings subsequently died unexpectedly after discharge from the hospital. More than 2 decades later, evidence of infanticide for all 5 infants in the original report became known.

The apnea theory never has been proven despite extensive independent research in the several decades after that report. Nevertheless, the home cardiorespiratory monitoring industry, fueled by increasing demand from parents concerned about the risk of SIDS, rapidly developed products aimed at preventing SIDS. Despite the absence of a scientific foundation or evidence of efficacy, home cardiorespiratory monitoring continues to be a common practice in this country.

 It concluded in a 1985 statement that “a causal relationship between prolonged apnea and SIDS has not been established.”  .The recommendations left the use of home cardiorespiratory monitoring in individual situations to physician judgment. The costs of home monitoring are substantial. In 1999, 44% of 26 000 infants weighing 501 to 1500 g at birth and cared for in 325 neonatal units within the Vermont Oxford Network were discharged from the hospital on monitors.16 A conservative estimate of the annual cost of monitoring preterm infants weighing less than 1500 g in the United States is $24 million, and this projection does not include physician fees, repeat pneumograms or sleep studies, other ancillary medical costs, or the costs of other populations of infants who are monitored. In this context, the question of efficacy of home monitoring becomes even more important. Infant death is a tragedy no matter what the cause. This could be due to infant sleep apnea, Sudden Infant Death Syndrome (SIDS), or other pre-existing condition.