The value of cardiorespiratory parameters for sleep state classification in preterm infants: A systematic review

Eline R. de Groot, Marit S. Knoop, Agnes van den Hoogen, Xiaowan Wang, Xi Long, Sigrid Pillen, Manon J.N.L. Benders, Jeroen Dudink (Corresponding author)

Research output: Contribution to journalArticleAcademicpeer-review

17 Citations (Scopus)


Cardiorespiratory activity is highly associated with infants’ sleep duration and quality. We performed a systematic literature search of PubMed and EMBASE databases to investigate if and how cardiorespiratory parameters can be used for sleep state classification in preterm infants and in what way maturation influences this relation. All retrieved citations were screened against predetermined inclusion and exclusion criteria. Only studies of preterm infants (<37 wk postmenstrual age during sleep state classification) admitted to a neonatal ward and of whom at least one sleep state and one cardiorespiratory parameter was measured, were included. Two researchers independently reviewed the included studies on methodological quality. Of the 1097 initially retrieved studies, 23 were included for analysis. Heart rate and respiration frequency are strongly correlated with active sleep and quiet sleep. In quiet sleep, as compared to active sleep, respiratory frequency is more stable, and the heart rate is lower and less variable. This association, however, differed across preterm birth subtypes (i.e., extremely, very or late preterm), indicating that maturation – in the form of both gestational and postnatal age – influences the cardiorespiratory characteristics of preterm sleep states. The knowledge gained from this review can help improve behavioral sleep classification and automated sleep classification algorithms for preterm infants.
Original languageEnglish
Article number101462
Number of pages10
JournalSleep Medicine Reviews
Publication statusPublished - Aug 2021


  • Classification
  • Heart rate
  • NICU
  • Preterm infant
  • Respiration
  • Sleep


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