Sleep and Breathing

, Volume 15, Issue 3, pp 409–416 | Cite as

Risk factors and consequences of excessive autonomic activation during sleep in children

  • Pablo E. Brockmann
  • Michael S. Urschitz
  • Anke Noehren
  • Christiane Sokollik
  • Martin Schlaud
  • Christian F. Poets
Original Article



The aim of this study was to assess risk factors for excessive autonomic activation during sleep (EAAS) and its association with sleep problems, impaired behavior, and poor academic performance in primary school children.


Data from a community-based study on 997 primary school children were used. Based on nocturnal home pulse oximetry, autonomic activation during sleep was defined as a pulse rate increase by more than 20%. Children with ≥35.9 autonomic activations per hour (i.e., ≥the 95th centile) were classified as suffering from EAAS and compared with controls. Sleep problems, impaired behavior, and academic performance were assessed by parental questionnaires and analysis of school reports.


According to the abovementioned definition, EAAS was diagnosed in 52 children (67% male). Risk factors for EAAS were male gender (odds ratio [95% confidence interval]: 2.06 [1.14–3.72]) and presence of symptoms of sleep-disordered breathing (3.48 [1.29–9.43]). Children with EAAS had a higher prevalence of hyperactive behavior (39.2% vs. 26.0%; p = 0.05) and enuresis (5.8% vs. 0.8%; p = 0.017) but not of poor academic performance. The association with hyperactive behavior was confirmed in a subsample (n = 119) using the Strengths and Difficulties Questionnaire. Mean (SD) score of the hyperactive–inattentive scale was 4.5 (2.8) for EAAS and 3.4 (2.7) for non-EAAS (p = 0.04).


EAAS may be a marker of sleep disruption in children and may predict the occurrence of enuresis and hyperactive behavior.


Arousal Pulse oximetry Sleep-disordered breathing Snoring Enuresis Attention-deficit hyperactivity disorder 


Conflicts of interest

The authors have no conflict of interest to declare.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Pablo E. Brockmann
    • 1
    • 2
  • Michael S. Urschitz
    • 1
    • 6
  • Anke Noehren
    • 3
  • Christiane Sokollik
    • 4
  • Martin Schlaud
    • 5
  • Christian F. Poets
    • 1
  1. 1.Working Group on Pediatric Sleep Medicine, Department of NeonatologyUniversity Children’s HospitalTuebingenGermany
  2. 2.Department of PediatricsPontificia Universidad Catolica de ChileSantiago de ChileChile
  3. 3.Department of CardiologyKrankenhaus an der WeserHamelnGermany
  4. 4.Department of PediatricsUniversity Children’s HospitalTuebingenGermany
  5. 5.Department of Epidemiology and Health ReportingRobert Koch InstituteBerlinGermany
  6. 6.Working Group on Pediatric Sleep Medicine, Department of NeonatologyUniversity Children’s Hospital TuebingenTuebingenGermany

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