The Inconsistent Nature of Heart Rate Variability During Sleep in Normal Children and Adolescents
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Key result
Heart rate variability parameters varied significantly across sleep stages and cycles throughout the night, with mean NN being lowest during pre-sleep and increasing significantly across slow wave sleep cycles (p<0.001).
Why the study?
Evaluating heart rate variability during sleep was intended to better understand the influence of exogenous circadian rhythm and endogenous ultradian sleep cycles on cardiac activity in healthy children and adolescents.
Does heart rate variability change significantly across different sleep stages and cycles in healthy children and adolescents?
Population
75 healthy children and adolescents
Comparison
Pre-sleep vs progressive slow wave sleep (SWS1-3) and REM sleep stages
Design
Observational polysomnography study
Authors
Discussion
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Implication
Pediatric HRV assessments must account for sleep stage and timing; leaves open prognostic relevance and validation in disease.
Study Design
Type
Observational (n=75)
Multicenter
No
Structured PICO
Does heart rate variability change significantly across different sleep stages and cycles in healthy children and adolescents?
P
Population
75 healthy children and adolescents aged 3.1 to 13.2 years underwent overnight polysomnography to evaluate heart rate variability across different sleep stages and cycles.
E
Exposure
Observation of electrocardiography during progressive cycles of slow wave sleep (SWS1, SWS2, SWS3) and rapid eye movement sleep (REM1, REM2, REM3).
C
Comparator
Pre-sleep baseline (3-minute segment of electrocardiography just prior to sleep onset) and comparisons between different sleep stages.
O
Outcome
Heart rate variability (HRV) parameters including time domain values (mean NN, SDNN, RMSSD) and frequency domain values (LF, HF, LF:HF) across sleep stages.surrogate
Main Result
p-value: p=<0.001
Heart rate variability parameters fluctuate significantly across different sleep stages and cycles in healthy children, indicating that time of night and sleep stage must be accounted for in HRV assessments.
Limitations
- Vascular resistance was not measured directly during sleep.
- Some high frequency (HF) power may have been excluded in very small children due to higher breathing rates (>0.4 Hz).
- Analysis was restricted to children whose REM3 period preceded SWS3, reducing the sample size from 118 to 75.
- Possible exclusion of some HF power in very small children due to higher breathing rates (>0.4 Hz)
Cite This Study
Kontos et al. (2020) conducted an observational in Healthy (n=75). Sleep stages and cycles (SWS vs REM) vs. Pre-sleep and between sleep stages was evaluated on Heart rate variability (HRV) parameters (Mean NN, SDNN, rMSSD, LF, HF, LF:HF) across sleep stages (p=<0.001). Heart rate variability parameters varied significantly across sleep stages and cycles throughout the night, with mean NN being lowest during pre-sleep and increasing significantly across slow wave sleep cycles (p<0.001).
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