# Associations between nocturnal autonomic activity in infancy and later neurocognitive development: the AuBE cohort study

Lisa Brunel, Aurore Guyon, Laurianne Coutier, Hugues Patural, Vincent

Pichot, Marion Comajuan, Sabine Plancoulaine, Patricia Franco

► To cite this version:

Lisa Brunel, Aurore Guyon, Laurianne Coutier, Hugues Patural, Vincent Pichot, et al. Associations between nocturnal autonomic activity in infancy and later neurocognitive development: the AuBE cohort study. World Sleep 2025, Sep 2025, Singapore, Singapore. *hal-05401013*

HAL Id: hal-05401013

https://hal.science/hal-05401013v1

Submitted on 5 Dec 2025

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
# Associations between nocturnal autonomic activity in infancy and later neurocognitive development: the AuBE cohort study

L. Brunel¹, A. Guyon¹,², L. Coutier¹,², H. Patural³, V. Pichot³, M. Comajuan¹,², M. Thieux¹, S. Plancoulaine¹, P. Franco¹,²

1. Université Claude Bernard Lyon 1, INSERM, Centre de Recherche en Neurosciences de Lyon (CRNL) U1028/UMR5292 (France)

2. Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle, Hôpital Femme-Mère Enfant, Hospices Civils de Lyon (France);

3. Neonatal and Pediatric Intensive Care Unit, CHU Saint-Etienne and UMR Inserm 1059 SAINBIOSE laboratory, University Jean Monnet of Saint-Etienne (France)

## Introduction

Understanding how the **autonomic nervous system** (ANS) activity relates to **neurocognitive outcomes** is essential. **Heart rate variability (HRV)** is a non-invasive tool to assess ANS activity. HRV is often assessed over 24h, therefore limiting insights into sleep-specific ANS activity.

Objectives:

1. Compare **ANS activity according to sleep stage** (active sleep – AS, vs quiet sleep – QS) in infants;

2. Evaluate **ANS maturation during sleep** from birth to 6 months;

3. Investigate **associations between ANS activity during sleep** in early infancy and **neurocognitive performance** at 3 years of age.

## Methods

Inclusion criteria:

- Healthy children from the French AuBE birth cohort (recruited in St-Etienne, France, 2009-2011);

- Born full-term;

- No maternal smoking during pregnancy;

- Sufficient EEG and ECG signal quality on polysomnography (PSG) at birth;

- IQ scores available at 3 years of age.

<figure><img src="image_2.png" /><figcaption>**Figure 1.** Study design</figcaption></figure>

Assessment of **HRV** at M0 and M6 during sleep (8pm-8am):

- Time-domain variables = RR, HR, pNN50, RMSSD, SDNN;

- Frequency-domain variables = total power (Ptot), low frequency power (LF), high frequency power (HF), normalized LF and HF (LFnu, HFnu), LF/HF ratio.

Assessment of **IQ** (verbal – VIQ, performance – PIQ, and total – TIQ) via the Weschler Preschool and Primary Scale of Intelligence 3rd edition (WPPSI-III).

Between-group comparisons were computed through Mann-Whitney and Wilcoxon signed rank tests for HRV, and independent t-tests for IQ. Correlations were assessed using Spearman p.

P-values were corrected using the Benjamini-Hockberg method.

Differences between girls and boys were not significant regarding HRV and IQ; the analyses were thus conducted on the whole group.

## Results

A total of 56 infants were included, among whom 34 also had follow-up data at M6.

<table><caption>**Table 1.** Demographic and sleep characteristics at M0 and M6.</caption><thead><tr><th></th><th>M0 (n = 56)</th><th>M6 (n = 34)</th></tr></thead><tbody><tr><td>Sex (girl)</td><td>27 (48.2)</td><td>20 (58.8)</td></tr><tr><td>Age at PSG (weeks)</td><td>0.4 (0.3-0.4)</td><td>26.8 (26.1-28.1)</td></tr><tr><td>Sleep architecture</td><td></td><td></td></tr><tr><td>Wake (min)</td><td>324.0 (242.0-402.0)</td><td>118.0 (74.0-143.0)</td></tr><tr><td>TST (min)</td><td>377.5 (3118-447.5)</td><td>577.0 (462.5-621.0)</td></tr><tr><td>AS (% of TST)</td><td>46.9 (33.9-53.4)</td><td>38.6 (33.2-44.6)</td></tr><tr><td>QS (% of TST)</td><td>53.1 (46.6-66.1)</td><td>61.4 (55.3-66.8)</td></tr></tbody></table>

From M0 to M6, TST and proportion of QS at night significantly increased, while wake and proportion of AS decreased.

### 1) HRV in AS vs QS, at M0 and M6

All HRV indices were different between AS and QS at both visits: HR, SDNN, Ptot, LF, LFnu and LF/HF were higher in AS, whereas RR, pNN50, RMSSD, HF and HFnu were higher in QS.

### 2) HRV at M0 vs M6, in AS and QS

In QS, RR and HFnu increased from M0 to M6, whereas HR, LFnu, and LF/HF decreased. In AS, no significant evolution was observed.

### 3) Correlations between HRV (M0 and M6) and IQ (M36)

At M36, PIQ positively correlated with Ptot measured in QS at M0 ($p = 0.3$, **Fig. 2**). No correlation was found with HRV at M6.

<figure><img src="image_3.png" /><figcaption>**Figure 2.** Relationship between performance IQ at M36 and Ptot in QS at M0.</figcaption></figure>

## Conclusions

- **ANS activity was influenced by sleep stage**, with a higher sympathetic activity in AS and a higher parasympathetic activity in QS.

- From birth to 6 months, ANS maturation occurred primarily during QS, with an **increase in parasympathetic regulation** and a **decrease in sympathetic dominance** in this sleep stage.

- Total power in QS at birth was associated with later cognitive outcomes, suggesting that **early sleep-specific ANS markers** could serve as **indicators of neurodevelopmental trajectories**.

<figure><img src="image_4.png" /></figure>