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Front. Physiol. | doi: 10.3389/fphys.2018.00468

Sleep instabilities assessed by cardiopulmonary coupling analysis increase during childhood and adolescence

 Dirk Cysarz1*, Maijana Linhard2, Georg Seifert2 and Friedrich Edelhäuser1
  • 1Faculty of Health, Universität Witten/Herdecke, Germany
  • 2Department of Pediatric Oncology/Hematology, Otto-Heubner-Center for Pediatric and Adolescent Medicine, Charité Universitätsmedizin Berlin, Germany

The electrocardiogram-based cardiopulmonary coupling 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: 70% to 48% ETST). Unstable sleep (low frequency coupling: 9% to 19% ETST), sleep fragmentation or disordered breathing (elevated low frequency coupling: 4% to 12% ETST) and wake/REM states (very low frequency coupling: 20% to 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.

Keywords: Cardiopulmonary coupling analysis, childhood and adolescence, sleep electrocardiogram, sleep quality, Chronobiology Phenomena

Received: 28 Jul 2017; Accepted: 13 Apr 2018.

Edited by:

Jerzy Sacha, Opole University of Technology, Poland

Reviewed by:

Ilkka H. Heinonen, University of Turku, Finland
Phyllis K. Stein, Washington University in St. Louis, United States  

Copyright: © 2018 Cysarz, Linhard, Seifert and Edelhäuser. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Dirk Cysarz, Universität Witten/Herdecke, Faculty of Health, Gerhard-Kienle-Weg 4, 58313 Herdecke, Witten, Germany,