Dynamic coupling between the central and autonomic nervous systems during sleep: A review

•Central (CNS) and autonomic (ANS) nervous systems are tightly coupled during sleep.•Complex regulatory mechanisms (CNS commands and ANS reflexes) drive the coupling.•Analytic methods reveal a complex interplay between cortico-cardiac dynamics.•Analysis of coupling between CNS events and ANS changes gives physiological insight.•Changes in ANS-CNS coupling might be useful as a biomarker of disease. Sleep is characterized by coordinated cortical and cardiac oscillations reflecting communication between the central (CNS) and autonomic (ANS) nervous systems. Here, we review fluctuations in ANS activity in association with CNS-defined sleep stages and cycles, and with phasic cortical events during sleep (e.g., arousals, K-complexes). Recent novel analytic methods reveal a dynamic organization of integrated physiological networks during sleep and indicate how multiple factors (e.g., sleep structure, age, sleep disorders) affect “CNS-ANS coupling”. However, these data are mostly correlational and there is a lack of clarity of the underlying physiology, making it challenging to interpret causality and direction of coupling. Experimental manipulations (e.g., evoking K-complexes or arousals) provide information on the precise temporal sequence of cortical-cardiac activity, and are useful for investigating physiological pathways underlying CNS-ANS coupling. With the emergence of new analytical approaches and a renewed interest in ANS and CNS communication during sleep, future work may reveal novel insights into sleep and cardiovascular interactions during health and disease, in which coupling could be adversely impacted.