{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:48:28Z","timestamp":1786445308949,"version":"build-2736575974"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Strong developmental trends are well described in non-rapid eye movement (NREM) sleep characteristics but also seen in cyclic-alternating-pattern (CAP). The latter shows a bimodal distribution: slow wave dominant (A1) complexes early in life and A2\/A3 complexes later in life. This analysis aimed to assess trends in CAP-linked cardiopulmonary coupling (CPC) calculated Sleep Quality Index (SQI) from childhood through adolescence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Analysis of de-identified data from the SleepImage<jats:sup>\u00ae<\/jats:sup> System (MyCardio LLC, Denver, CO, United States), using CPC-calculations evaluating integrated electrocortical-autonomic-respiratory interactions to derive sleep states, SQI, and combined with oxygen saturation, an apnea hypopnea index (AHI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty-one thousand nights of continuous sleep recordings of \u2265 6 h in duration and \u2265 4 h of total sleep time (TST), with good signal quality (\u2265 80%) from individuals &amp;lt; 18 years of age were included in the analysis (48% girls-52% boys). Age groups were defined as 2\u20135 years (preschool-age, 39% girls-61% boys), 6\u20139 years (school-age, 47% girls-53% boys), 10\u201313 years (early-adolescent, 47% girls-53% boys), 14\u201317 years (late-adolescent, 52% girls-48% boys). In the cohort 20% had moderate- (AHI<jats:sub>3%<\/jats:sub> 5\u201310) and 8% severe sleep apnea (AHI<jats:sub>3%<\/jats:sub> \u2265 10). SQI is highest in school-aged children that are expected to sleep for 9\u201312\/24 h with no sex differences observed (75.8 \u00b1 15.8 and 75.3 \u00b1 16.2; <jats:italic>p<\/jats:italic> = 0.06). Preschool-aged children are expected to sleep for 10\u201313\/24 h, have a slightly lower SQI compared to school-aged children, with SQI higher in girls (73.4 \u00b1 17.5 and 71.6 \u00b1 19.2; <jats:italic>p<\/jats:italic> &amp;lt; 0.001). During early adolescence, when sleep duration is expected to be 8\u201310\/24 h, SQI is significantly lower in girls compared to boys (70.5 \u00b1 17.4 and 71.8 \u00b1 17.0; <jats:italic>p<\/jats:italic> &amp;lt; 0.001). In late adolescence, SQI decline continues, but at a slower rate in girls who, at this age, girls have higher SQI than boys (63.1 \u00b1 18.3 and 60.5 \u00b1 18.2); <jats:italic>p<\/jats:italic> &amp;lt; 0:001. AHI<jats:sub>3%<\/jats:sub> is significantly lower in girls in all age-groups; it is lowest in school-age children and gradually increases during adolescence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Children seem to reach their full potential in sleep stability and quality around school-age. In early adolescence, measured sleep stability and quality start to gradually decline, with the decline starting earlier in girls while larger in boys during the adolescent years.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnins.2025.1581929","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T05:31:02Z","timestamp":1753853462000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Age-related and sex-specific trends in sleep quality in children and adolescents"],"prefix":"10.3389","volume":"19","author":[{"given":"Hugi","family":"Hilmisson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solveig Dora","family":"Magnusdottir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert Joseph","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1513\/AnnalsATS.202005-510OC","article-title":"Automated apnea-hypopnea index from oximetry and spectral analysis of cardiopulmonary coupling.","volume":"18","author":"Al Ashry","year":"","journal-title":"Ann. 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