An oculo-cardiac hypothesis of sudden unexpected death in infants. 1979

R W Hayes, and E McBrearty

The oculo-cardiac hypothesis presented here draws attention to the evidence for links between Sudden Unexpected Death in Infants (SUD) - known in America as the Sudden Infant Death Syndrome, also as "cot death" or "crib death" - and the vagally mediated reflex slowing of the heart beat following pressure on the eye. A brief review is made of epidemiologic findings on SUD, including the fact that around 9000 infant fatalities per year are attributed to SUD in the U.S.A. alone. Evidence for excessive vagal discharge as a likely factor in SUD is discussed. The nature of the oculo-cardiac reflex discovered by Aschner is described, with particular attention to those factors which appear to make specific categories of sleeping infant more vulnerable to cardiac arrest in circumstances where this reflex is elicited. The factors include prematurity and an existing electrical instability of the heart. Regarding the manner in which such an oculo-cardiac reflex might in practice be set off, it is suggested that this could occur if the infant slept in such a position that the weight of the head could press the eye against any irregular surface which might exist on the mattress, or any object which was resting on the mattress. Evidence is cited for SUD infants being in fact more likely than controls to sleep in such a position. Children with exophthalmos would be more at risk in this respect. It is stressed that all this evidence is already published, but has not previously been drawn together to show the likelihood of a link between Sudden Dath and the oculo-cardiac reflex.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D009799 Ocular Physiological Phenomena Processes and properties of the EYE as a whole or of any of its parts. Ocular Physiologic Processes,Ocular Physiological Processes,Ocular Physiology,Eye Physiology,Ocular Physiologic Process,Ocular Physiological Concepts,Ocular Physiological Phenomenon,Ocular Physiological Process,Physiology of the Eye,Physiology, Ocular,Visual Physiology,Concept, Ocular Physiological,Concepts, Ocular Physiological,Ocular Physiological Concept,Phenomena, Ocular Physiological,Phenomenon, Ocular Physiological,Physiologic Process, Ocular,Physiologic Processes, Ocular,Physiological Concept, Ocular,Physiological Concepts, Ocular,Physiological Process, Ocular,Physiological Processes, Ocular,Physiology, Eye,Physiology, Visual,Process, Ocular Physiologic,Process, Ocular Physiological,Processes, Ocular Physiologic,Processes, Ocular Physiological
D011312 Pressure A type of stress exerted uniformly in all directions. Its measure is the force exerted per unit area. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed) Pressures
D012018 Reflex An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord.
D012024 Reflex, Oculocardiac Change of heartbeat induced by pressure on the eyeball, manipulation of extraocular muscles, or pressure upon the tissue remaining in the orbital apex after enucleation. Oculocardiac Reflex
D006321 Heart The hollow, muscular organ that maintains the circulation of the blood. Hearts
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012890 Sleep A readily reversible suspension of sensorimotor interaction with the environment, usually associated with recumbency and immobility. Sleep Habits,Sleeping Habit,Sleeping Habits,Habit, Sleep,Habit, Sleeping,Habits, Sleep,Habits, Sleeping,Sleep Habit
D013398 Sudden Infant Death The abrupt and unexplained death of an apparently healthy infant under one year of age, remaining unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. (Pediatr Pathol 1991 Sep-Oct;11(5):677-84) Cot Death,Crib Death,SIDS,Death, Sudden Infant,SID,Sudden Infant Death Syndrome,Cot Deaths,Death, Cot,Death, Crib,Infant Death, Sudden

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