Objective sleep quality and metabolic risk in healthy weight children results from the randomized Childhood Adenotonsillectomy Trial (CHAT)

Background We hypothesized that cardiopulmonary coupling (CPC) sleep quality reflects cardiovascular and cardiometabolic health, in healthy weight children. Methods Retrospective signal analysis of existing ECG data utilizing CPC, FDA cleared, software as medical device (SaMD). ECG signals were extracted from baseline polysomnography studies in the prospective Childhood Adenotonsillectomy Trial database, multicenter, single-blind, randomized controlled trial of 5.0-9.9-year-old children identified with obstructive sleep apnea syndrome without severe hypoxemia. Healthy weight was defined as age- and gender-specific BMI in the 5th-85th percentile range and overweight above the 85th percentile. The cohort was stratified based on CPC sleep quality Index (SQI) defined as high sleep quality (SQI >= 80) or low sleep quality (SQI < 60). Cardiovascular, cardiometabolic, quality of life, and cognition were compared between the sleep quality groups. Results Healthy weight children with low sleep quality had more fragmented sleep with significantly higher arousal index (10.0 +/- 4.3 vs.7.2 +/- 3.1; p = 0.00) and eLFCBB (12.4 +/- 4.9 vs. 0.9 +/- 1.0; p < 0.001) CPC indicator of sleep fragmentation, higher average heart rate during sleep (84.5 +/- 10.6 vs. 79.4 +/- 7.1; p = 0.03) and worse insulin/glucose ratio (1.7 +/- 1.6 vs. 1.1 +/- 1.1; p = 0.03) and fasting insulin levels (7.9 +/- 7.2 vs.5.3 +/- 5.5; p = 0.05) when compared to healthy weight children with high sleep quality. SQI significantly correlates with average heart rate during sleep, insulin and triglyceride levels; for a unit increase in SQI, there is 0.154 unit decrease in average heart rate during sleep, 0.109 unit in insulin levels and 0.332 unit in triglyceride levels, respectively. Conclusion CPC sleep quality offers insights into pediatric sleep and how it affects cardiovascular and cardiometabolic health. ECG is simple signal to collect, which makes this method practical for testing sleep, over multiple nights, and on multiple occasions providing information on sleep dynamics not possible before.