The majority of sudden unexpected death in epilepsy (SUDEP) cases occur at night and often the person is found face down in bed. The rate at which SUDEP victims are found prone (58 to 86%) far exceeds the proportion expected rate that sleeping face down is observed in the general population (5 to 6%). This observation has lead to speculation that many SUDEP deaths are a consequence of total or partial obstruction of breathing by the bedding or mattress when an individual turns face down during a seizure and cannot wake up in response to rising carbon dioxide (CO2) levels in the blood stream because of the post-ictal state.
Based on this theory, some have advocated the use of special “anti-suffocation” lattice pillows, designed with a foam mesh with large air channels to allow the passage of air, as a way to reduce SUDEP risk. While these pillows are not approved by the Food and Drug Administration, they are marketed in the United Kingdom and elsewhere for use by people with epilepsy and other conditions. However, there is no evidence that they prevent SUDEP or even prevent asphyxia.
In a recent study, Catcheside and colleagues examined whether these “anti-suffocation” pillows could theoretically prevent the build up of dangerous levels of carbon dioxide using a specially designed apparatus. In their experiment, they tested two lattice pillows, one conventional cotton pillow and one latex pillow. In their simulations, the authors found that the lattice pillows and the latex pillows had significantly lower levels of airflow resistance compared to cotton pillows. They also found that when they used simulated CO2 exhalation, the lattice pillows had significantly lower rebreathing potential; levels of measured CO2 following 10 minutes of simulated rebreathing were 8%, less than the 10% levels that can be very dangerous.
These findings provide some theoretical support to the claim that lattice pillows may reduce the risk of fatal asphyxia from lying face down in the pillow. However, the authors note that even the 8% CO2 levels obtained using lattice pillows with simulated rebreathing could be harmful. Additional tests in humans are needed do determine the degree to which these pillows reduce asphyxia risk under more realistic circumstances. Until then, the data supporting the use of these pillows to prevent SUDEP remains limited, especially since the role of positional asphyxia as a mechanism of SUDEP is not well established.