title: Heartbeat evoked potentials during sleep and daytime behavior in children with sleep-disordered breathing.
abstract: BACKGROUND
  Event-related brain potentials allow probing of cortical information processing, but when evoked with externally induced stimuli may disrupt sleep homeostasis and do not provide insight into intrinsic cortical information processing. To investigate if cortical processing of intrinsic information in children with sleep-disordered breathing (SDB) is different from healthy children and, if so, whether it resolves with treatment, we used heartbeat as a source of interoceptive event-related brain potentials.
  
  
  OBJECTIVE
  To investigate heartbeat evoked potentials (HEP) during sleep in healthy children and in children with SDB before and after treatment and to explore if there are any associations between HEP and daytime behavioral deficits in children with SDB.
  
  
  METHODS
  Heartbeat-aligned EEG was assessed for presence of HEP within stage 2, slow-wave sleep, and REM sleep in 40 children with primarily mild to moderate SDB before and after adenotonsillectomy and in 40 matched control subjects at similar time points.
  
  
  RESULTS
  In both groups, nonrandom HEP were present in all sleep stages analyzed; however, amplitude of HEP were significantly lower in children with SDB during non-REM sleep (stage 2: P = 0.03; slow-wave sleep: P = 0.001). This between-group difference was not significant post adenotonsillectomy. Significant negative associations between HEP and daytime behavioral scores were observed at baseline.
  
  
  CONCLUSIONS
  Children with SDB displayed reduced HEP amplitude during sleep, which might be indicative of changes in afferent sensory inputs to the brain and/or signify differences in sensory gating of cardiac-related information in the insular cortex. Adenotonsillectomy appears to reverse this effect.
authors.affiliation: 1 School of Electrical and Electronic Engineering.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Immanuel
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Pamula
authors.forename: Mark
authors.initials: M
authors.lastname: Kohler
authors.forename: James
authors.initials: J
authors.lastname: Martin
authors.forename: Declan
authors.initials: D
authors.lastname: Kennedy
authors.forename: Eugene
authors.initials: E
authors.lastname: Nalivaiko
authors.forename: David A
authors.initials: DA
authors.lastname: Saint
authors.forename: Mathias
authors.initials: M
authors.lastname: Baumert
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002653:Child Behavior Disorders / Q000150:complications / Q000503:physiopathology*; D002675:Child, Preschool; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D012894:Sleep Stages / Q000502:physiology*; D014068:Tonsillectomy
keywords: adenotonsillectomy; behavior; cardiac cycle; children; heartbeat evoked potential