The Role of NREM Sleep Instability in Child Cognitive Performance

STUDY OBJECTIVES: Based on recent reports of the involvement of cyclic alternating pattern (CAP) in cognitive functioning in adults, we investigated the association between CAP parameters and cognitive performance in healthy children. DESIGN: Polysomnographic assessment and standardized neurocognitive testing in healthy children. SETTINGS: Sleep laboratory. PARTICIPANTS: Forty-two children aged 7.6 ± 2.7 years, with an even distribution of body mass percentile (58.5 ± 25.5) and SES reflective of national norms. MEASUREMENTS: Analysis of sleep macrostructure following the R&K criteria and of cyclic alternating pattern (CAP). The neurocognitive tests were the Stanford Binet Intelligence Scale (5th edition) and a Neuropsychological Developmental Assessment (NEPSY). RESULTS: Fluid reasoning ability was positively associated with CAP rate, particularly during SWS and with A1 total index and A1 index in SWS. Regression analysis, controlling for age and SES, showed that CAP rate in SWS and A1 index in SWS were significant predictors of nonverbal fluid reasoning, explaining 24% and 22% of the variance in test scores, respectively. CONCLUSIONS: This study shows that CAP analysis provides important insights on the role of EEG slow oscillations (CAP A1) in cognitive performance. Children with higher cognitive efficiency showed an increase of phase A1 in total sleep and in SWS.Oliviero Bruni, Mark Kohler, Luana Novelli, Declan Kennedy, Kurt Lushington, James Martin and Raffaele Ferr