{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:51:03Z","timestamp":1787028663688,"version":"build-2736575974"},"reference-count":47,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"kinderherzen F\u00f6rdergemeinschaft Deutsche Kinderherzzentren e.V."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Adults with congenital heart disease (CHD) are living longer but face increasing comorbidities. Sleep is a key health determinant, yet objective data in CHD remain limited. This study compared sleep characteristics of adults with CHD and controls using wearable technology and a Health Application Programming Interface (API). Methods: A total of 175 CHD patients (33.1 \u00b1 10.3 years, 49.2% women) and 52 controls (34.4 \u00b1 12.4 years, 40.4% women) completed seven continuous days of wrist-worn Garmin Vivosmart\u00ae 5 during routine follow-up at the TUM Klinikum Deutsches Herzzentrum. Sleep duration, phases, Sleep Scores, and weekday-weekend differences were analyzed, and multivariate models examined clinical and demographic predictors. Results: Total sleep duration and rapid eye movement (REM) sleep did not differ between groups. CHD patients had more deep sleep (83 \u00b1 19 vs. 75 \u00b1 16 min, p = 0.004) but lower Sleep Scores (74 \u00b1 9 vs. 77 \u00b1 9, p = 0.041). Within CHDs, deep sleep was higher on weekends than on weekdays (p = 0.033). Multivariate analyses showed no overall group effect, but age (p = 0.016), sex (p = 0.013), and body mass index (BMI; p &lt; 0.001) significantly predicted sleep outcomes. Regression analyses in CHDs revealed female sex associated with longer REM sleep (p &lt; 0.001), while higher BMI consistently predicted poorer outcomes. Disease severity was linked to lower Sleep Scores. Conclusions: Sleep in CHDs is broadly comparable to controls, but BMI, sex, and disease severity significantly shape outcomes. The additional variability between weekends and weekdays and a higher risk of sleep-disordered breathing, according to the literature, underscores that sleep is an underestimated target for prevention and clinical care in CHD.<\/jats:p>","DOI":"10.3390\/jcm14228097","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T11:17:27Z","timestamp":1763551047000},"page":"8097","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sleep Stage Monitoring in Congenital Heart Disease (CHD) Using a Digital Health Application Programming Interface (API)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2295-1526","authenticated-orcid":false,"given":"Charlotte","family":"Sch\u00f6neburg","sequence":"first","affiliation":[{"name":"Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technische Universit\u00e4t M\u00fcnchen, Am Olympiacampus 11, 80809 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Uphoff","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease and Pediatric Cardiology, TUM Klinikum Deutsches Herzzentrum, Lazarettstrasse 36, 80636 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8199-4585","authenticated-orcid":false,"given":"Viktoria","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease and Pediatric Cardiology, TUM Klinikum Deutsches Herzzentrum, Lazarettstrasse 36, 80636 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3166-0488","authenticated-orcid":false,"given":"Renate","family":"Oberhoffer-Fritz","sequence":"additional","affiliation":[{"name":"Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technische Universit\u00e4t M\u00fcnchen, Am Olympiacampus 11, 80809 M\u00fcnchen, Germany"},{"name":"Department of Congenital Heart Disease and Pediatric Cardiology, TUM Klinikum Deutsches Herzzentrum, Lazarettstrasse 36, 80636 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0253-1190","authenticated-orcid":false,"given":"Peter","family":"Ewert","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease and Pediatric Cardiology, TUM Klinikum Deutsches Herzzentrum, Lazarettstrasse 36, 80636 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7530-2025","authenticated-orcid":false,"given":"Jan","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technische Universit\u00e4t M\u00fcnchen, Am Olympiacampus 11, 80809 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1161\/CIRCULATIONAHA.122.060834","article-title":"Adults with congenital heart disease: Trends in event-free survival past middle age","volume":"147","author":"Dellborg","year":"2023","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1093\/eurheartj\/eht257","article-title":"Congenital heart disease beyond the age of 60: Emergence of a new population with high resource utilization, high morbidity, and high mortality","volume":"35","author":"Tutarel","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Faizan, M., Han, C., and Lee, S.W. (2025). Policy-Driven Digital Health Interventions for Health Promotion and Disease Prevention: A Systematic Review of Clinical and Environmental Outcomes. Healthcare, 13.","DOI":"10.3390\/healthcare13182319"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jsmc.2022.03.001","article-title":"Sleep, health, and society","volume":"17","author":"Grandner","year":"2022","journal-title":"Sleep Med. Clin."},{"key":"ref_5","unstructured":"Grandner, M.A. (2019). Sleep and Health, Academic Press."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.sleh.2015.10.004","article-title":"National Sleep Foundation\u2019s updated sleep duration recommendations: Final report","volume":"1","author":"Hirshkowitz","year":"2015","journal-title":"Sleep Health"},{"key":"ref_7","unstructured":"Chen, Y., Kartsonaki, C., Clarke, R., Guo, Y., Du, H., Yu, C., Yang, L., Pei, P., Stevens, R., and Burgess, S. (2023). Sleep duration and risk of stroke and coronary heart disease: A 9-year community-based prospective study of 0.5 million Chinese adults. BMC Neurol., 23."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kohyama, J. (2021). Which Is More Important for Health: Sleep Quantity or Sleep Quality?. Children, 8.","DOI":"10.3390\/children8070542"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lipinska, G., and Thomas, K.G. (2019). The interaction of REM fragmentation and night-time arousal modulates sleep-dependent emotional memory consolidation. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.01766"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1136\/thoraxjnl-2015-207231","article-title":"Obstructive sleep apnoea during REM sleep and incident non-dipping of nocturnal blood pressure: A longitudinal analysis of the Wisconsin Sleep Cohort","volume":"70","author":"Mokhlesi","year":"2015","journal-title":"Thorax"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zhang, S., Niu, X., Ma, J., Wei, X., Zhang, J., and Weiping, D. (2025). Effects of sleep deprivation on heart rate variability: A systematic review and meta-analysis. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1556784"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Salzillo, C., La Verde, M., Imparato, A., Molitierno, R., Luc\u00e0, S., Pagliuca, F., and Marzullo, A. (2024). Cardiovascular diseases in public health: Chromosomal abnormalities in congenital heart disease causing sudden cardiac death in children. Medicina, 60.","DOI":"10.3390\/medicina60121976"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.acvd.2018.11.013","article-title":"Prognosis of severe congenital heart diseases: Do we overestimate the impact of prenatal diagnosis?","volume":"112","author":"Vincenti","year":"2019","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_14","first-page":"100532","article-title":"Sleep disordered breathing and adult congenital heart disease","volume":"18","author":"Vakali","year":"2024","journal-title":"Int. J. Cardiol. Congenit. Heart Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1590\/S1807-59322009001200011","article-title":"Sleep in infants with congenital heart disease","volume":"64","author":"Ykeda","year":"2009","journal-title":"Clinics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1007\/s00246-024-03565-y","article-title":"Adaptive Functioning and Sleep Quality: Associations in Young Children with Congenital Heart Disease","volume":"46","author":"Caissie","year":"2024","journal-title":"Pediatr. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.ppedcard.2012.05.011","article-title":"Cardiopulmonary exercise testing in adults with congenital heart disease","volume":"34","author":"Johnson","year":"2012","journal-title":"Prog. Pediatr. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S93","DOI":"10.1513\/AnnalsATS.201611-876FR","article-title":"Cardiopulmonary exercise testing in adult congenital heart disease","volume":"14","author":"Mantegazza","year":"2017","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1016\/j.jacc.2018.08.1028","article-title":"2018 AHA\/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"73","author":"Stout","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/S0735-1097(01)01272-4","article-title":"Task force 1: The changing profile of congenital heart disease in adult life","volume":"37","author":"Warnes","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","unstructured":"Patel, A.K., Reddy, V., Shumway, K.R., and Araujo, J.F. (2024). Physiology, sleep stages. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_22","unstructured":"Garmin Ltd. (2025, August 05). Schlaf\u00fcberwachung. Available online: https:\/\/www.garmin.com\/de-DE\/garmin-technology\/health-science\/sleep-tracking\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"zpac026","DOI":"10.1093\/sleepadvances\/zpac026","article-title":"Minimum number of nights for reliable estimation of habitual sleep using a consumer sleep tracker","volume":"3","author":"Lau","year":"2022","journal-title":"Sleep Adv."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1164\/arrd.1984.129.2P2.S47","article-title":"Gas exchange response to exercise in children","volume":"129","author":"Cooper","year":"1984","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_25","first-page":"58","article-title":"The Study of Health in Pomerania (SHIP) reference values for cardiopulmonary exercise testing","volume":"67","author":"Ittermann","year":"2012","journal-title":"Pneumologie"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/HCR.0000000000000511","article-title":"Reduced Parasympathetic Activity in Patients With Different Types of Congenital Heart Disease and Associations to Exercise Capacity","volume":"41","author":"Fritz","year":"2021","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1136\/heartjnl-2016-310828","article-title":"Physical activity in adults with congenital heart disease and associations with functional outcomes","volume":"103","author":"Amberger","year":"2017","journal-title":"Heart"},{"key":"ref_28","unstructured":"Tukey, J.W. (1977). Exploratory Data Analysis, Reading\/Addison-Wesley."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"658","DOI":"10.3390\/clockssleep4040050","article-title":"Differences in Sleep Offset Timing between Weekdays and Weekends in 79,161 Adult Participants in the UK Biobank","volume":"4","author":"Kelly","year":"2022","journal-title":"Clocks Sleep"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s41606-024-00109-4","article-title":"Weekday-to-weekend sleep duration patterns among young adults and outcomes related to health and academic performance","volume":"8","author":"Vestergaard","year":"2024","journal-title":"Sleep Sci. Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.sleep.2021.04.006","article-title":"Association of weekday-to-weekend sleep differences and stress response among a Japanese working population: A cross-sectional study","volume":"82","author":"Adachi","year":"2021","journal-title":"Sleep Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"zsaa076","DOI":"10.1093\/sleep\/zsaa076","article-title":"Sleep inconsistency between weekends and weekdays is associated with changes in brain function during task and rest","volume":"43","author":"Zhang","year":"2020","journal-title":"Sleep"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1007\/s00246-020-02289-z","article-title":"Prevalence, Risk Factors, and Impact of Obstructive Sleep Apnea in Adults with Congenital Heart Disease","volume":"41","author":"Drake","year":"2020","journal-title":"Pediatr. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1097\/HCO.0000000000000329","article-title":"Cardiovascular consequences of obstructive sleep apnea","volume":"31","author":"Ayas","year":"2016","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"A14771","DOI":"10.1161\/circ.142.suppl_3.14771","article-title":"Obstructive Sleep Apnea is Associated With Cardiac Dysfunction in Children With Congenital Heart Disease","volume":"142","author":"Combs","year":"2020","journal-title":"Circulation"},{"key":"ref_36","first-page":"38","article-title":"Obstructive Sleep Apnea Syndrome: Implications for Primary Care","volume":"30","author":"Holman","year":"2005","journal-title":"Nurse Pract."},{"key":"ref_37","first-page":"487","article-title":"Gender Issues in Obstructive Sleep Apnea","volume":"94","author":"Geer","year":"2021","journal-title":"Yale J. Biol. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"A238","DOI":"10.1093\/sleep\/zsab072.603","article-title":"605 Sleep problems are associated with behavioral problems and decreased quality of life in children with Fontan circulation","volume":"44","author":"Robertson","year":"2021","journal-title":"Sleep"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"zsaa291","DOI":"10.1093\/sleep\/zsaa291","article-title":"Performance of seven consumer sleep-tracking devices compared with polysomnography","volume":"44","author":"Chinoy","year":"2021","journal-title":"Sleep"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1123\/jmpb.2019-0035","article-title":"Review of Validity and Reliability of Garmin Activity Trackers","volume":"3","author":"Evenson","year":"2020","journal-title":"J. Meas. Phys. Behav."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.5664\/jcsm.7932","article-title":"Validation of a Consumer Sleep Wearable Device With Actigraphy and Polysomnography in Adolescents Across Sleep Opportunity Manipulations","volume":"15","author":"Lee","year":"2019","journal-title":"J. Clin. Sleep Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"zsaa045","DOI":"10.1093\/sleep\/zsaa045","article-title":"Detecting sleep using heart rate and motion data from multisensor consumer-grade wearables, relative to wrist actigraphy and polysomnography","volume":"43","author":"Roberts","year":"2020","journal-title":"Sleep"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Fine, J., Branan, K.L., Rodriguez, A.J., Boonya-Ananta, T., Ramella-Roman, J.C., McShane, M.J., and Cote, G.L. (2021). Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring. Biosensors, 11.","DOI":"10.3390\/bios11040126"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S1836-9553(12)70106-6","article-title":"Exercise training improves sleep quality in middle-aged and older adults with sleep problems: A systematic review","volume":"58","author":"Yang","year":"2012","journal-title":"J. Physiother."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Miller, D.J., Sargent, C., and Roach, G.D. (2022). A validation of six wearable devices for estimating sleep, heart rate and heart rate variability in healthy adults. Sensors, 22.","DOI":"10.3390\/s22166317"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Park, S. (2014). Associations of physical activity with sleep satisfaction, perceived stress, and problematic Internet use in Korean adolescents. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-1143"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1080\/21679169.2019.1623314","article-title":"The effect of physical activity on sleep quality: A systematic review","volume":"23","author":"Wang","year":"2021","journal-title":"Eur. J. Physiother."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8097\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T11:45:06Z","timestamp":1763552706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,15]]},"references-count":47,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14228097"],"URL":"https:\/\/doi.org\/10.3390\/jcm14228097","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,15]]}}}