Use of Fan During Sleep and the Risk of Sudden Infant Death Syndrome

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Use of Fan During Sleep and the Risk of Sudden
Infant Death Syndrome

• De-Kun Li, MD, PhD
• Division of Research
• Kaiser Permanente
• Oakland, California
• March 24, 2009

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Background

• What do we know about SIDS etiology?
• Heterogeneity in etiology diagnosis by
• exclusion

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Brain Stem
Heart Problem
Underlying Biological Susceptibility
SIDS RISK WITH AGE
SIDS RISK
Environmental Triggers
First 9 months
Sleep Environment
Infections
Air Pollution
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Maternal smoking
Resuscitation Capability
Infection
Brain Stem Deficiency
Prenatal Exposure
Preeclampsia
Gestational Diabetes
Thermoregulation
Genetic Factors?
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Sleep Position
Sleep Environment
Pacifier Use
Soft Bedding
Fan Use
Bed Sharing
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Background

• Sleep environment matters
• Oxygen deprivation
• CO2 re-breathing?
• Thermal factor?
• Other factors?

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Objectives

• To examine whether use of a fan in the room
  impacts the risk of SIDS
• To examine whether any other factors influence
  the relationship between use of a fan and the
  risk of SIDS
• To examine whether opening of a window also has a
  similar effect on the risk of SIDS as use of a
  fan

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Study Design

• Population-based case-control study
• Study population
• ? All confirmed SIDS cases in 11 counties in
  California
• ? Infant age-, ethnicity-matched controls in
  the same county
• ? English or Spanish speaking
• ? Participation rate 50 in cases and 41
  in controls

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Study Design

• In-person interview
• Use of a fan during the last sleep
• Sleep positions
• Sleep environment (co-sleep, pacifier, etc)
• Other risk factors for SIDS

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Statistical analysis

• Logistic regression to adjust for confounders
• Stratification for evaluating interaction
• Comparison with birth certificate data to
• assess participation bias

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Limitations

• Low participation rate
• Adjustment for socio-demographic factors
• Strong protective effect ---- strong
  participation bias
• Compare to birth certificate data
• Recall bias? Adjusting for recall interval

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Comparison between Participants and Source
Population
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Limitations

• Limited information related to fan use
• Duration
• Location
• Type of fan used (ceiling, floor, etc)
• Orientation of the fan (facing or away)

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Conclusions

• Use of fan in the sleeping room may reduce the
  risk of SIDS
• The finding is consistent with other known
  factors in the sleep environment that influence
  the SIDS risk
• Use of a fan could be another simple and
  effective way to further reduce SIDS