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Effects of Sleep Stage and Age on Short-term Heart Rate Variability During Sleep in Healthy Infants and Children^*

^* From the II Department of Pediatrics (Drs. Villa, Pagani, Paggi, Massa, and Ronchetti), University of Rome "La Sapienza," Rome, Italy; and the Department of Information and Systems Science (Dr. Calcagnini), University of Rome "La Sapienza," Rome, Italy.

Correspondence to: Professor Roberto Ronchetti, MD, II Cattedra Clinica Pediatrica, Università "La Sapienza," Viale Regina Elena, 324, 00161-Rome, Italy; e-mail: villamp{at}uniroma1.it

Study design: Power spectrum analysis of heart rate variability (HRV) is a noninvasive technique that provides a quantitative assessment of cardiovascular neural control. Using this technique, we studied the autonomic nervous system changes induced by sleep in 14 healthy subjects: 7 infants (mean age, 9.40 ± 2.32 months) and 7 children (mean age, 8.93 ± 0.65 years) during a standard all-night polysomnographic recording. Our primary aim was to assess the effect of sleep stage and age on short-term HRV during sleep in healthy infants and children. Power spectral density was estimated by autoregressive modeling over 250 consecutive R-R intervals. In this study, we mainly considered two spectral components: the high-frequency (HF) component (0.15 to 0.40 Hz), which reflects parasympathetic cardiovascular modulation; and the low-frequency (LF) component (0.04 to 0.15 Hz), generally considered due to both parasympathetic and sympathetic modulation.

Results: Heart rate was higher (p < 0.01 in all sleep stages) and total power lower (p < 0.02) in infants than in children. HF power was higher in children than in infants (p < 0.05). In infants and children, the ratio between LF and HF powers changed with the various sleep stages (p < 0.02 in infants; p < 0.01 in children): it decreased during deep sleep and increased during rapid eye movement sleep. However, it was invariably lower in children than in infants.

Conclusion: These findings show that the sleep stage and age both significantly influence short-term HRV during sleep in healthy infants and children. Hence, to provide unbiased results, HRV studies investigating the effects of age on autonomic nervous system activity should segment sleep into the five stages. In addition, despite a relatively small study sample, our data confirm greater parasympathetic control during sleep in children than in infants.

Key Words: autonomic nervous system • power spectrum analysis • sleep stages

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