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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.

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Presentation on theme: "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."— Presentation transcript:

1 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

2 Background  What do we know about SIDS etiology?  Heterogeneity in etiology – diagnosis by exclusion

3 Underlying Biological Susceptibility Underlying Biological Susceptibility Brain Stem Heart Problem Environmental Triggers Environmental Triggers Sleep Environment Air Pollution SIDS RISK First 9 months SIDS RISK WITH AGE Infections

4 Brain Stem Deficiency Brain Stem Deficiency Resuscitation Capability Thermoregulation Prenatal Exposure Prenatal Exposure Genetic Factors? Genetic Factors? Gestational Diabetes Gestational Diabetes Preeclampsia Infection Maternal smoking Maternal smoking

5 Sleep Environment Sleep Environment Sleep Position Pacifier Use Soft Bedding Fan Use Bed Sharing

6 Background  Sleep environment matters  Oxygen deprivation  CO 2 re-breathing?  Thermal factor?  Other factors?

7 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

8 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

9 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

10 Statistical analysis  Logistic regression to adjust for confounders  Stratification for evaluating interaction  Comparison with birth certificate data to assess participation bias

11 Table 1. Characteristics of the Study Population Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI)* N (%) Maternal Characteristics Race/ Ethnicity White59 (31.9)119 (38.1)1.00 † Black34 (18.4)59 (18.9)0.96(0.52, 1.76) Latino61 (33.0)98 (31.4)1.22(0.67, 2.19) Other31 (16.8)36 (11.5)2.23(1.13, 4.39) Age (years) < 2025 (13.5)27 (8.7)1.80(0.88, 3.70) 20 - 2455 (29.7)54 (17.3)1.86(1.12, 3.09) ≥ 25 105 (56.8)231 (74.0)1.00 †

12 Table 1. Characteristics of the Study Population (Cont.) Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI)* N (%) Maternal Characteristics (cont.) Education ≤ 12 113 (61.1) 141 (45.2)1.31(0.81, 2.13) > 1272 (38.9)171 (54.8)1.00 † Marital Status Married93 (50.3)206 (66.0)1.00 † Cohabiting61 (33.0)72 (23.1)1.49(0.87, 2.52) Single31 (16.8)34 (10.9)1.79(0.93, 3.47) Region Northern CA 115 (35.3) 211 (64.7)1.00 † Southern CA 70 (40.9) 101 (59.1)1.07(0.68, 1.68)

13 Table 1. Characteristics of the Study Population (Cont.) Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI)* N (%) Maternal Characteristics (cont.) Parity (Prior To Index Birth) 0 57 (30.81)132 (42.3)1.00 † 1 69 (37.3)96 (30.8)1.51(0.91, 2.51) 2 32 (17.3)52 (16.7)1.46(0.77,2.80) ≥ 3 27 (14.6)32 (10.3)2.16(1.02, 4.59) Smoked During Pregnancy No 137 (74.5)265 (85.2)1.00 † Yes 47 (25.4)46 (14.8)1.91(1.14, 3.28) Wks Gestation at First Prenatal Visit < 12 120 (65.6)238 (77.8)1.00 † ≥ 12 63 (34.4)68 (22.2)1.59(1.00, 2.53)

14 Table 1. Characteristics of the Study Population (Cont.) Characteristic CasesControls ( n = 185)(n = 312)aOR (95% CI)* N (%) Infant Characteristics Age (Months) < 2 45 (24.3)62 (19.9)1.57(0.87, 2.81) 2 - 3 90 (48.7)155 (49.7)1.08(0.66, 1.76) ≥ 4 Months 50 (27.0)95 (30.5)1.00 † Birth Weight (Grams) ≥ 2500 148 (81.8)297 (95.5)1.00 † < 2500 33 (18.2)14 (4.5)4.90(2.34, 10.26) Infant Health During Previous 48 Hours No Illness 107 (58.5)196 (62.8)1.00 † Sick, No Fever 67 (36.6)109 (34.9)1.20(0.78, 1.85) Sick with Fever9 (4.9)7 (2.2)2.6(0.84, 8.03)

15 Table 1. Characteristics of the Study Population (Cont.) Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI)* N (%) Infant Characteristics (cont.) Premature (< 37 Wks Gestation) No 150 (81.2)287 (92.0)1.00 † Yes 35 (18.9)25 (8.0)2.96(1.58, 5.54) Sleep Environment Last Sleep Position On Back 52 (31.1)175 (56.1)1.00 † On Stomach or Side 115 (68.9)137 (43.9)2.74(1.79, 4.21) Used a Pacifier No 162 (95.9)236 (76.4)1.00 † Yes 7 (4.1)73 (23.6)0.10(0.04, 0.23)

16 Table 1. Characteristics of the Study Population (Cont.) Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI)* N (%) Sleep Environment (cont.) Room Temp (°F) ≤ 70 96 (69.1)176 (61.5)1.00 † > 70 43 (30.9)110 (38.5)0.65(0.40, 1.06) Soft Bedding Under Infant No 125 (76.2)250 (80.4)1.00 † Yes 39 (23.8)61 (19.6)0.95(0.57, 1.59) Soft Sleep Surface No 153 (87.9)289 (93.2)1.00 † Yes 21 (12.1)21 (6.8)1.36(0.68, 2.71) Covers Over Head No 147 (88.6)297 (95.5) 1.00 † Yes 19 (11.5)14 (4.5) 3.13(1.40, 7.02)

17 Table 1. Characteristics of the Study Population (Cont.) Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI)* N (%) Sleep Environment (cont.) Bed Sharing Status Slept Alone 103 (59.9)195 (67.2)1.00 † Slept with Parent(s) Only 45 (26.2)79 (27.2)1.01(0.61, 1.68) Slept with Non-Parent(s) # 24 (14.0)16 (5.5)2.86(1.35, 6.07) Regular Smoking in Home Postpartum No 164 (89.1)291 (94.2)1.00 † Yes 20 (10.9)18 (5.8)1.50(0.68, 3.31) * Odds ratio and 95% confidence interval adjusted for race/ethnicity, maternal age, education, region, smoking during pregnancy, infant age, birth year and last sleep position unless the variable itself was the exposure of interest. Maternal race/ethnicity, infant age at last sleep, and region are matching variables. † Reference group # Presence of other individuals (with or without parents)

18 Table 2. Use of a Fan or having an open window in Relations to SIDS Risk* Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI) † N (%) Fan on in Room at Last Sleep No 161 (96.4)273 (88.4)1.00 ‡ Yes 6 (3.6)36 (11.7)0.28(0.10, 0.77) Window Open in Room at Last Sleep No 136 (84.0)232 (75.1)1.00 ‡ Yes 26 (16.1)77 (24.9)0.64(0.33, 1.21)

19 Table 3. The Effect of Fan Use on SIDS Risk by Sleep Environment Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI) † N (%) Room Temperature Room Temperature ≤ 70° F at Last Sleep No Fan 91 (94.8)163 (93.1)1.00 ‡ Fan On 5 (5.2)12 (6.9)0.77(0.22, 2.73) Room Temperature > 70° F at Last Sleep No Fan 41 (97.6)88 (80.0)1.00 ‡ Fan On 1 (2.4)22 (20.0)0.06(0.01, 0.52)

20 Table 3. The Effect of Fan Use on SIDS Risk by Sleep Environment (Cont.) Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI) † N (%) Window Closure Room with Window Closed at Last Sleep No Fan 132 (98.5)211 (91.0)1.00 ‡ Fan On 2 (1.5)21 (9.1)0.15(0.03, 0.71) Room with Window Open at Last Sleep No Fan 22 (84.6)62 (80.5)1.00 ‡ Fan on 4 (15.4)15 (19.5)0.73(0.17, 3.08) Placed on Back at Last Sleep No Fan 48 (94.1)156 (90.2)1.00 ‡ Fan On 3 (5.9)17 (9.8)0.84(0.21, 3.39) Placed Prone or on Side at Last Sleep No Fan 108 (97.3)117 (86.0)1.00 ‡ Fan on 3 (2.7)19 (14.0)0.14(0.03, 0.55)

21 Table 3. The Effect of Fan Use on SIDS Risk by Sleep Environment (Cont.) Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI) † N (%) Bed Sharing Slept Alone at Last Sleep No Fan 93 (96.9)169 (86.7)1.00 ‡ Fan On 3 (3.1)26 (13.3)0.23(0.06, 0.90) Slept with Parents only at Last Sleep No Fan 44 (47.8)75 (94.9)1.00 ‡ Fan On 1 (2.2)4 (5.1)0.40(0.03, 4.68) Slept with Non-Parents at Last Sleep § No Fan 22 (95.6)11 (68.8)1.00 ‡ Fan on 1 (4.3)5 (31.3)0.15(0.01, 1.85)

22 Table 3. The Effect of Fan Use on SIDS Risk by Sleep Environment (Cont.) Characteristic CasesControls (n = 185)(n = 312)aOR (95% CI) † N (%) Pacifier Use Used Pacifier at Last Sleep No Fan6 (85.7)65 (89.0)1.00 ‡ Fan On1 (14.3)8 (11.0)1.99(0.16, 24.4) No Pacifier Used at Last Sleep No Fan153 (96.8)206 (88.0)1.00 ‡ Fan On5 (3.2)28 (12.0)0.22(0.07, 0.69)

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

24 Comparison between Participants and Source Population

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

26 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

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