1. A significant portion (12.9%) of sleep-related infant deaths occurred on sofas.
2. Infant deaths on sofas were associated with a non-supine initial sleeping position, bed-sharing, and in-utero tobacco exposure.
Evidence Rating Level: 2 (Good)
Study Rundown: The incidence of sudden infant death syndrome (SIDS) has declined more than 50% in the last decade as a result of the “Back to Sleep” campaign. Since then, the rate of other sleep-related deaths has increased in infants, such as deaths occurring while infants slept in unsafe environments, such as sofas. This study sought to examine sofa-related deaths and their relevant risk factors. The authors found that infants on sofas were more likely to be placed in a non-supine position for sleep or to be in a new or different sleep location when compared to infants who die from other sleep-related causes. They also found that sofa deaths were more likely to occur when surface sharing and in infants with in-utero tobacco exposure. This study was limited by the voluntary nature of reporting and differences in reporting standards to the database used. Also, some specific circumstances surrounding each death were not available. However, the large sample size and volume of information delivered by the database provides good data for the interpretation of risk factors around sofa sleeping in infants, providing further information for the discussion of safe sleep habits with parents.
Study Author, Dr. Jeffrey Colvin, MD, JD, talks to 2 Minute Medicine: Children’s Mercy Hospital, Kansas City, Associate Professor, University of Missouri-Kansas City.
“A sofa is an extremely hazardous sleep surface for infants. Nearly 90% of the infants who died on a sofa were sharing it with an adult. This research shows once again that parents should never bedshare with an infant, whether that location is an adult bed, a sofa, or anywhere else. The A-B-C’s of safe sleep must always be followed: infants must always sleep Alone, on their Back, and in a Crib, and Alone means no other people and no pillows, quilts, or other soft objects. Sofas are a soft sleeping surface, often with pillows or blankets, and many times with a slope of the seat cushions which makes it easy for an infant to become entrapped or wedged into or between the back and seat cushions. There’s nothing about sofas that follow the simple A-B-C’s of safe sleep for infants.”
In-Depth [retrospective cohort study]: This study examined a cohort of 7934 sleep-related deaths from 24 states between 2004 and 2012 from the National Center for the Review and Prevention of Child Deaths Child Death Review and Case Reporting System (CDR-CRS). Of these, 1024 (12.9%) occurred on sofas. Using a multivariable analysis, the authors found that infant sofa deaths were more likely to be associated with surface sharing (when an infant is sleeping on the same surface as another person) (aOR 2.4, 95% CI 1.9-3.0) and that infants were more likely to be placed to sleep in prone or side positions (aOR 2.2, 95% CI 1.0-1.8 and aOR 1.4, 95% CI 1.0-1.8, respectively) when compared to other sleep-related infant deaths. Furthermore, sofa-related deaths were more likely if the sofa was a new or different sleep location (aOR 6.5, 95% CI 5.2-8.2) and infants who died on sofas were more likely to have in-utero tobacco exposure (aOR 1.4, 95% CI 5.2-8.2).
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