Sleep Instabilities Assessed by Cardiopulmonary Coupling Analysis Increase During Childhood and Adolescence

Abstract

The electrocardiogram-based cardiopulmonary coupling (CPC) technique may be used to track sleep instabilities. With progressing age, maturational changes during childhood and adolescence affect sleep. The objective was to assess developmental changes in sleep instabilities in a natural setting. ECGs during nighttime sleep on regular school days were recorded from 363 subjects aged 4 to 22 years (204 females). The estimated total sleep time (ETST) decreased from 598 to 445 min during childhood and adolescence. Stable sleep linearly decreased with progressing age (high frequency coupling (HFC): 70–48% ETST). Unstable sleep [low frequency coupling (LFC): 9–19% ETST], sleep fragmentation or disordered breathing (elevated LFC: 4–12% ETST), and wake/REM states [very low frequency coupling (VLFC): 20–32% ETST] linearly increased with age. Hence, with progressing age the sleep of children and adolescents shortens, becomes more unstable and is more often affected by fragmentation or sleep disordered breathing, especially in the age group >13 years. It remains to be clarified whether some of the changes are caused by a social jetlag, i.e., the misalignment of body clock and social time especially in adolescents.

Family contexts and sleep during adolescence

“…Most are sleeping less than the recommended 9 h per night (Hirshkowitz et al, 2015), with almost 70% of U.S. adolescents categorized as sleep deprived (Healthy People, 2020). Recent research also highlights the high level of variability in nightly sleep duration during adolescence (Cysarz et al, 2018, Urbanek et al, 2018). Nightly sleep variability is associated with multiple health risks in adolescents; including, increased risk of obesity and poor diet (He et al, 2015; Malone et al, 2016), chronic inflammation (Park et al, 2016), substance use (Haynie et al, 2017, Nguyen-Louie et al, 2018), behavioral disorders (Zhang et al 2017), and mental health problems/negative mood (Bei et al, 2017, Fuligni and Hardway, 2006, Zhang et al, 2017).…”

Multicomponent Analysis of Sleep Using Electrocortical, Respiratory, Autonomic and Hemodynamic Signals Reveals Distinct Features of Stable and Unstable NREM and REM Sleep

“…We did not study children, who have an abundance of slow wave activity, or the elderly, who have reduced slow wave activity. However, HFC dominates healthy sleep in children ( Lee et al, 2012 ; Cysarz et al, 2018 ) and adults including the elderly ( Thomas et al, 2009 ).…”

Effects of sound environment on the sleep of college students in China

“…The sleep monitoring technology adopted by the wristband is based on an electrocardiogram-based technique named cardiopulmonary coupling technology (CPC; Thomas et al, 2005), which can take exact measurements of sleep patterns, including timing and duration of sleep as well as awakenings (Sadeh, 2011). CPC has been proposed recently as an indicator of sleep stability and as an alternative way of characterising sleep (Thomas et al, 2005), and has been used in some sleep-related studies (Chen et al, 2018;Cysarz et al, 2018;Schramm et al, 2013). Although it cannot replace traditional polysomnography due to imperfect sensitivity and specificity to detect wake periods, this tool can provide reasonable estimates for assessing subjects objectively with minimal participant burden for more prolonged periods of time than conventional assessment tools (Martin and Hakim, 2011).…”