What is a normal heart rate (HR) for pediatric patients during sleep?

Normal Heart Rate for Pediatric Patients During Sleep

Normal heart rate during sleep in pediatric patients ranges from approximately 40 to 180 beats per minute (bpm), with specific values varying significantly by age, sleep stage, and developmental maturity. 1

Age-Specific Sleep Heart Rate Ranges

Infants (First Year of Life)

The heart rate during sleep decreases progressively throughout infancy:

• 1st month of life:

  • Active sleep (REM): 118-151 bpm (5th-95th percentiles) 2
  • Quiet sleep (non-REM): 116-150 bpm 2

• Beyond 9 months:

  • Active sleep: 101-126 bpm 2
  • Quiet sleep: 94-120 bpm 2

Heart rate is consistently lower during quiet sleep compared to active sleep across all ages in infancy (p<0.05). 2

Newborns (1-6 Days Old)

• Maximum heart rate during sleep: 125-210 bpm (mean 168 ± 23) 3
• Minimum heart rate during sleep: 72-120 bpm (mean 92 ± 11) 3
• Maximum variation over 24 hours: 73-134 bpm (mean 100 ± 17) 3

These values demonstrate that newborns have higher baseline heart rates than older infants, with substantial physiologic variability. 3

Clinical Context for Ambulatory Monitoring

When interpreting heart rate data from ambulatory blood pressure monitoring (ABPM) or continuous monitoring in children, the American Heart Association provides technical parameters for data quality:

• Valid heart rate range for pediatric ABPM: 40-180 bpm 1
• Values outside this range should be discarded as outliers during data editing 1

This broad range accommodates the substantial age-related and sleep stage-related variations observed in pediatric populations. 1

Sleep Stage Considerations

Heart rate varies significantly between sleep stages and across sleep cycles throughout the night. 4

• Slow wave sleep (SWS): Heart rate progressively decreases from SWS1 to SWS3, with mean RR intervals (inverse of heart rate) significantly increasing across cycles 4
• REM sleep: Heart rate during REM periods is similar to SWS1 but significantly higher than SWS2 and SWS3 4
• Pre-sleep to deep sleep transition: Mean heart rate is highest during pre-sleep wakefulness, then decreases as the child enters deeper sleep stages 4

Premature and Term Infants

• Before 37 weeks gestational age: Periodic variations in heart rate (15-70 beats) occur in both active and quiet sleep 5
• After 37 weeks gestational age: Fast variations synchronous with respiratory cycles become predominant, particularly in quiet sleep 5

Important Clinical Caveats

Sleep quality and sleep phase significantly affect heart rate measurements. 6 When assessing whether a child's heart rate during sleep is normal:

• Consider the specific sleep stage (REM vs. non-REM) 4, 2
• Account for the child's corrected age and developmental maturity 2, 7
• Recognize that breathing rate correlates with heart rate variability 7
• Note that the lowest heart rates typically occur during deep, quiet sleep (non-REM) 1

Pathologic conditions can alter these normal patterns. For example, in children with chronic lung disease, even mild hypoxemia (oxygen saturation 90-94%) can adversely affect autonomic heart rate control during sleep. 1

Practical Application

When evaluating a pediatric patient's sleep heart rate:

• Use age-appropriate reference ranges rather than a single universal value 2
• Verify adequate sleep quality as poor sleep increases heart rate 1, 6
• Consider body position as supine positioning (typical during sleep) results in lower heart rates 6
• Account for recent illness, medications, or chronic conditions that may affect autonomic control 1

The 40-180 bpm range serves as a quality control parameter for monitoring equipment, but clinical interpretation requires age-specific normative data for accurate assessment. 1, 2