A systematic review and meta-analysis of the cyclic alternating pattern across the lifespan

Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters accord...

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Bibliographic Details
Published in:	Sleep medicine Vol. 85; pp. 25 - 37
Main Authors:	Migueis, D.P., Lopes, M.C., Ignacio, P.S.D., Thuler, L.C.S., Araujo-Melo, M.H., Spruyt, K., Lacerda, G.C.B.
Format:	Journal Article
Language:	English
Published:	Elsevier B.V 01-09-2021
Subjects:	Brain maturation Cyclic alternating pattern Normative data Sleep instability Cyclic alternating pattern Sleep instability Normative data Brain maturation
Online Access:	Get full text
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Summary:	Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters according to the aging process in healthy subjects through a systematic review and meta-analysis. Two authors independently searched databases using PRISMA guidelines. Discrepancies were reconciled by a third reviewer. Subgroup analysis and tests for heterogeneity were conducted. Of 286 studies, 10 submitted a total of 168 healthy individuals to CAP analysis. Scoring of CAP can begin at 3 months of life, when K-complexes, delta bursts, or spindles can be recognized. Rate of CAP increased with age, mainly during the first 2 years of life, then decreased in adolescence, and increased in the elderly. The A1 CAP subtype and CAP rate were high in school-aged children during slow-wave sleep (SWS). A1 CAP subtypes were significantly more numerous in adolescents compared with other groups, while the elderly showed the highest amounts of A2 and A3 CAP subtypes. Our meta-analysis registered the lowest CAP rate in infants younger than 2 years old and the highest in the elderly. This review summarized the normative data of CAP in NREM sleep during the aging process. The CAP rate increased with age and sleep depth, especially during SWS. Parameters of CAP may reflect gender hormonal effects and neuroplasticity. More reports on CAP subtypes are needed for their reference values establishment. •This study is the first to provide reference values of CAP in healthy participants.•Cyclic alternating pattern (CAP) represents the neurodevelopment in the aging process.•Peripubertal and postmenopausal CAP rate suggests hormonal influence on the sleep EEG.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3
ISSN:	1389-9457 1878-5506
DOI:	10.1016/j.sleep.2021.06.026