Cyclic alternating pattern: A window into pediatric sleep

Oliviero Bruni, Luana Novelli, Silvia Miano, Liborio Parrino, Mario Giovanni Terzano, Raffaele Ferri

Research output: Contribution to journalArticlepeer-review


Cyclic alternating pattern (CAP) has now been studied in different age groups of normal infants and children, and it is clear that it shows dramatic changes with age. In this review we first focus on the important age-related changes of CAP from birth to peripubertal age and, subsequently, we describe the numerous studies on CAP in developmental clinical conditions such as pediatric sleep disordered breathing, disorders of arousal (sleep walking and sleep terror), pediatric narcolepsy, learning disabilities with mental retardation (fragile-X syndrome, Down syndrome, autistic spectrum disorder, Prader-Willi syndrome) or without (dyslexia, Asperger syndrome, attention-deficit/hyperactivity disorder). CAP rate is almost always decreased in these conditions with the exception of the disorders of arousal and some cases of sleep apnea. Another constant result is the reduction of A1 subtypes, probably in relationship with the degree of cognitive impairment. The analysis of CAP in pediatric sleep allows a better understanding of the underlying neurophysiological mechanisms of sleep disturbance. CAP can be considered as a window into pediatric sleep, allowing a new vision on how the sleeping brain is influenced by a specific pathology or how sleep protecting mechanisms try to counteract internal or external disturbing events.

Original languageEnglish
Pages (from-to)628-636
Number of pages9
JournalSleep Medicine
Issue number7
Publication statusPublished - 2010


  • Children
  • Cyclic alternating pattern
  • Disorder of arousal
  • Infants
  • Narcolepsy
  • Neuropsychological deficits
  • Sleep disordered breathing
  • Spectral analysis

ASJC Scopus subject areas

  • Medicine(all)


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