Sleep State Changes Research Articles

Sleep: Hemispheres fight for dominance.

A new study shows that bearded dragons have a peculiar way to coordinate sleep state changes between brain hemispheres. The hemisphere that acts first imposes its activity on the other during their REM sleep-like state.

The effect of swaddling on infant sleep and arousal: A systematic review and narrative synthesis.

Western parents swaddle infants to promote sleep and reduce night-waking, however recent evidence of the effects of swaddling on the sleep of healthy infants has not been systematically reviewed. To investigate the effect of swaddling on the sleep of infants up to 1 year of age using a narrative synthesis approach. We systematically searched five academic databases, including the Cochrane trial registry (Pubmed, PsycINFO, Embase, the Cochrane library, and Blackwell Synergy). We manually searched reference lists and citations of included studies and reference lists of existing reviews. Studies of any type, published since 2007, reporting primary data whose subjects were humans up to 12 months of age with outcome measures relating to the impact of swaddling on sleep and arousal. By hand using a customized template. A narrative synthesis is used to present the results. In total 171 studies were retrieved with 115 studies discarded at title. A further 43 were discarded at abstract, and six were discarded at full text. Two papers were combined as they reported on the same study giving a total of 6 studies that met the inclusion criteria for the review. An evidence hierarchy was used to assess Risk of Bias in the included studies; the results are presented via a narrative synthesis. Swaddling was associated with increased duration of quiet sleep in infants and a significantly reduced number of sleep state changes among infants naïve to the intervention. The integrity of the intervention (swaddling) including its baseline characteristics, was defined broadly across the included studies limiting the interpretation and transferability of the results of this review. Swaddling appears to increase quiet sleep duration in infants and reduces the number of sleep state changes among infants naïve to the intervention. Parents should be made aware that implementing conditions unfavorable to arousability may increase SUDI risk among infant who have not previously been swaddled. This review has relevance for informing future practice recommendations and parent advice as well as in designing future studies.

Sleep Disorders in Patients with Psoriatic Arthritis

Sleep disorders are currently a major public health issue in Brazil, due to its high incidence and difficult diagnosis, identification of type and treatment.1 Rheumatic disorders have been associated with changes in sleep state, which cause reduction in quality of life, eventually reduced by the chronic inflammatory process of the primary disease.2–6 This study aimed to identify and describe the existence of sleep disturbances in patients with psoriatic arthritis, as well as to verify possible association of sleep disorders with metabolic syndrome and other parameters in these individuals. Thirty one patients with psoriatic arthritis from a Rheumatology Outpatient Clinic were analyzed. Three sleep assessment questionnaires were employed: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (EPW) and The Berlin Questionnaire (BQ). Sleep walking or talking were also inquired as a complementary scale. Sociodemographic variables and the presence of hypertension, obesity, diabetes, dyslipidemia and metabolic syndrome have also been investigated. On average, sleep disorders were found in 54.83% of the studied patients (64.5% from PSQI, 51.6% from EPW and 48.4% from Berlin) and around 70% of sleep disorders in patients with simultaneous diagnosis of metabolic syndrome and psoriatic arthritis. From these results, it is notable that sleep disorders are common in patients diagnosed with psoriatic arthritis. Thus, this pathology demands greater attention in clinical practice and search for ideal and complete therapy, in addition to simultaneous control of arthritis, sleep, hypertension, dyslipidemia and obesity.

Connectivity dynamics from wakefulness to sleep

Interest in time-resolved connectivity in fMRI has grown rapidly in recent years. The most widely used technique for studying connectivity changes over time utilizes a sliding windows approach. There has been some debate about the utility of shorter versus longer windows, the use of fixed versus adaptive windows, as well as whether observed resting state dynamics during wakefulness may be predominantly due to changes in sleep state and subject head motion. In this work we use an independent component analysis (ICA)-based pipeline applied to concurrent EEG/fMRI data collected during wakefulness and various sleep stages and show: 1) connectivity states obtained from clustering sliding windowed correlations of resting state functional network time courses well classify the sleep states obtained from EEG data, 2) using shorter sliding windows instead of longer non-overlapping windows improves the ability to capture transition dynamics even at windows as short as 30 ​s, 3) motion appears to be mostly associated with one of the states rather than spread across all of them 4) a fixed tapered sliding window approach outperforms an adaptive dynamic conditional correlation approach, and 5) consistent with prior EEG/fMRI work, we identify evidence of multiple states within the wakeful condition which are able to be classified with high accuracy. Classification of wakeful only states suggest the presence of time-varying changes in connectivity in fMRI data beyond sleep state or motion. Results also inform about advantageous technical choices, and the identification of different clusters within wakefulness that are separable suggest further studies in this direction.

0282 Correlation Between Sleep Depth in the Right and Left Cerebral Hemispheres Following Sleep Deprivation, Restriction or Noise Exposure

Abstract Introduction The Odds-Ratio-Product (ORP) is a highly-validated continuous index of sleep depth (range 0=deep sleep; 2.5=full wakefulness). ORP values fluctuate within this range as sleep state changes between wake and different sleep stages. In healthy non-sleep deprived adults, intra-class correlation coefficient of concurrent right vs. left ORP values (R / L coefficient) is typically >0.80. In a recent study R / L coefficient was markedly reduced in many critically-ill patients and these patients failed to be weaned from mechanical ventilation. Given the high prevalence of sleep loss in such patients we hypothesized that reduction in R/L coefficient might result from sleep loss. This retrospective EEG analysis of data from 3 independent research studies investigated if R / L coefficient decreases in pure models of sleep deprivation, restriction or noise exposure during sleep in healthy subjects. Methods Polysomnograms were obtained from three studies: A) 200 subjects who underwent 36 hours of total sleep deprivation; B) 21 subjects who underwent 4 consecutive nights of sleep restriction (5 hrs. / night); C) 72 subjects who were exposed to intermittent traffic noise events with maximum sound pressure levels ranging from 45–65 dB(A) for 10 consecutive nights. For study A, R / L coefficient was calculated from pre- and post-deprivation sleep studies and the two values were compared. For study B, coefficient was calculated at baseline and in each restriction night. For study C, the coefficient was calculated in each of the 10 exposure nights and the slope of the change was calculated. Results In study A, the coefficient decreased from 0.82±0.12 at baseline to 0.74±0.16 after sleep deprivation (p &lt 0.0001). In study B, the coefficient decreased from 0.83±0.11 at baseline to 0.75±0.15 on the 4th restriction night (p &lt 0.01). In study C, coefficient decreased at a rate of 0.003±0.001 per exposure night (p &lt 0.001). Conclusion The correlation between sleep depth in the right and left hemispheres deteriorates following sleep deprivation, restriction or noise-induced sleep fragmentation. Support NIH P50 HL060287

Sleep Is Compromised in -12° Head Down Tilt Position.

Recent studies are elucidating the interrelation between sleep, cranial perfusion, and cerebrospinal fluid (CSF) circulation. Head down tilt (HDT) as a simulation of microgravity reduces cranial perfusion. Therefore, our aim was to assess whether HDT is affecting sleep (clinicaltrials.gov; identifier NCT 02976168). 11 male subjects were recruited for a cross-over designed study. Each subject participated in two campaigns each comprising 3 days and 2 nights. Intervention started on the second campaign day and consisted of maintenance of horizontal position or −12° HDT for 21 h. Ultrasound measurements were performed before, at the beginning and the end of intervention. Polysomnographic measurements were assessed in the second night which was either spent in horizontal posture or at −12° HDT. Endpoints were sleep efficiency, sleep onset latency, number of sleep state changes and arousals, percentages of N3, REM, light sleep stages and subjective sleep parameters. N3 and REM sleep reduced by 25.6 and 19.1 min, respectively (P = 0.002, g = -0.898; P = 0.035, g = -0.634) during −12° HDT. Light sleep (N1/2) increased by 33.0 min at −12° HDT (P = 0.002, g = 1.078). On a scale from 1 to 9 subjective sleep quality deteriorated by 1.3 points during −12° HDT (P = 0.047, g = -0.968). Ultrasonic measurement of the venous system showed a significant increase of the minimum (P = 0.009, P < 0.001) and maximum (P = 0.004, P = 0.002) cross-sectional area of the internal jugular vein at −12° HDT. The minimum cross-sectional area of the external jugular vein differed significantly between conditions over time (P = 0.001) whereas frontal skin tissue thickness was not significantly different between conditions (P = 0.077, P = 0.811). Data suggests venous congestion at −12° HDT. Since subjects felt comfortable with lying in −12° HDT under our experimental conditions, this posture only moderately deteriorates sleep. Obviously, the human body can almost compensate the several fold effects of gravity in HDT posture like an affected CSF circulation, airway obstruction, unusual patterns of propioception and effects on the cardiovascular system.

Global cognitive performance is associated with sleep efficiency measured by polysomnography in patients with Parkinson's disease.

Sleep disorders can be associated with an increased risk for cognitive decline in patients with Parkinson's disease (PD). The aim of this study was to examine the association between cognitive status and presence of sleep symptoms and sleep disorders in PD patients. We evaluated excessive sleepiness, other sleep symptoms, and performed polysomnography and neuropsychological evaluation in 79 patients. They were classified as having normal cognition (PDNC), mild cognitive impairment (PDMCI), or dementia (PDD). There were 29 PDNC, 39 PDMCI, and 11 PDD patients. PDD patients were older, had higher scores on the Unified Parkinson's Disease Rating Scale, and lower Schwab and England Activities of Daily Living scores than PDNC patients. After analysis of the polysomnographic variables, it was also found that PDD patients had a lower sleep efficiency, lower total sleep time, and lower number of sleep state changes than PDNC patients. In a stepwise analysis, defining Mattis Dementia Rating Scale scores as the dependent variable, the results were a model that selected three variables that accounted for 59% of the variation in the Mattis Dementia Rating Scale score: wake time after sleep onset, number of state changes, and schooling. We found a significant association between global cognitive performance and wake time after sleep onset and the number of state changes during sleep measured in the polysomnography of PD patients. However, we did not find any other association between sleep disorders or symptoms and cognitive status or cognitive performance of PD patients.

Harnessing olfactory bulb oscillations to perform fully brain-based sleep-scoring and real-time monitoring of anaesthesia depth.

Real-time tracking of vigilance states related to both sleep or anaesthesia has been a goal for over a century. However, sleep scoring cannot currently be performed with brain signals alone, despite the deep neuromodulatory transformations that accompany sleep state changes. Therefore, at heart, the operational distinction between sleep and wake is that of immobility and movement, despite numerous situations in which this one-to-one mapping fails. Here we demonstrate, using local field potential (LFP) recordings in freely moving mice, that gamma (50–70 Hz) power in the olfactory bulb (OB) allows for clear classification of sleep and wake, thus providing a brain-based criterion to distinguish these two vigilance states without relying on motor activity. Coupled with hippocampal theta activity, it allows the elaboration of a sleep scoring algorithm that relies on brain activity alone. This method reaches over 90% homology with classical methods based on muscular activity (electromyography [EMG]) and video tracking. Moreover, contrary to EMG, OB gamma power allows correct discrimination between sleep and immobility in ambiguous situations such as fear-related freezing. We use the instantaneous power of hippocampal theta oscillation and OB gamma oscillation to construct a 2D phase space that is highly robust throughout time, across individual mice and mouse strains, and under classical drug treatment. Dynamic analysis of trajectories within this space yields a novel characterisation of sleep/wake transitions: whereas waking up is a fast and direct transition that can be modelled by a ballistic trajectory, falling asleep is best described as a stochastic and gradual state change. Finally, we demonstrate that OB oscillations also allow us to track other vigilance states. Non-REM (NREM) and rapid eye movement (REM) sleep can be distinguished with high accuracy based on beta (10–15 Hz) power. More importantly, we show that depth of anaesthesia can be tracked in real time using OB gamma power. Indeed, the gamma power predicts and anticipates the motor response to stimulation both in the steady state under constant anaesthetic and dynamically during the recovery period. Altogether, this methodology opens the avenue for multi-timescale characterisation of brain states and provides an unprecedented window onto levels of vigilance.

Developmental nicotine exposure alters glycinergic neurotransmission to hypoglossal motoneurons in neonatal rats.

We tested the hypothesis that nicotine exposure in utero and after birth [developmental nicotine exposure (DNE)] disrupts development of glycinergic synaptic transmission to hypoglossal motoneurons (XIIMNs). Glycinergic spontaneous and miniature inhibitory postsynaptic currents (sIPSC/mIPSC) were recorded from XIIMNs in brain stem slices from 1- to 5-day-old rat pups of either sex, under baseline conditions and following stimulation of nicotinic acetylcholine (ACh) receptors with nicotine (i.e., an acute nicotine challenge). Under baseline conditions, there were no significant effects of DNE on the amplitude or frequency of either sIPSCs or mIPSCs. In addition, DNE did not alter the magnitude of the whole cell current evoked by bath application of glycine, consistent with an absence of change in postsynaptic glycine-mediated conductance. An acute nicotine challenge (bath application of 0.5 μM nicotine) increased sIPSC frequency in the DNE cells, but not control cells. In contrast, nicotine challenge did not change mIPSC frequency in either control or DNE cells. In addition, there were no significant changes in the amplitude of either sIPSCs or mIPSCs in response to nicotine challenge. The increased frequency of sIPSCs in response to an acute nicotine challenge in DNE cells reflects an enhancement of action potential-mediated input from glycinergic interneurons to hypoglossal motoneurons. This could lead to more intense inhibition of hypoglossal motoneurons in response to exogenous nicotine or endogenous ACh. The former would occur with smoking or e-cigarette use while the latter occurs with changes in sleep state and with hypercapnia. NEW & NOTEWORTHY Here we show that perinatal nicotine exposure does not impact baseline glycinergic neurotransmission to hypoglossal motoneurons but enhances glycinergic inputs to hypoglossal motoneurons in response to activation of nicotinic acetylcholine (ACh) receptors with acute nicotine. Given that ACh is the endogenous ligand for nicotinic ACh receptors, the latter reveals a potential mechanism whereby perinatal nicotine exposure alters motor function under conditions where ACh release increases, such as the transition from non-rapid-eye movement to rapid-eye movement sleep, and during hypercapnia.

Afferent neural feedback overrides the modulating effects of arousal, hypercapnia and hypoxaemia on neonatal cardiorespiratory control.

Evidence obtained at whole animal, organ-system, and cellular and molecular levels suggests that afferent volume feedback is critical for the establishment of adequate ventilation at birth. As a result of the irreversible nature of the vagal ablation studies performed to date, it was difficult to quantify the roles of afferent volume input, arousal and changes in blood gas tensions on neonatal respiratory control. During reversible perineural vagal block, profound apnoeas and hypoxaemia and hypercarbia were observed, necessitating the termination of perineural blockade. Respiratory depression and apnoeas were independent of sleep state. We demonstrate that profound apnoeas and life-threatening respiratory failure in vagally denervated animals do not result from a lack of arousal or hypoxaemia. A change in sleep state and concomitant respiratory depression result from a lack of afferent volume feedback, which appears to be critical for the maintenance of normal breathing patterns and adequate gas exchange during the early postnatal period. Afferent volume feedback plays a vital role in neonatal respiratory control. Mechanisms for the profound respiratory depression and life-threatening apnoeas observed in vagally denervated neonatal animals remain unclear. We investigated the roles of sleep states, hypoxic-hypercapnia and afferent volume feedback on respiratory depression using reversible perineural vagal block during the early postnatal period. Seven lambs were instrumented during the first 48h of life to record/analyse sleep states, diaphragmatic electromyograph, arterial blood gas tensions, systemic arterial blood pressure and rectal temperature. Perineural cuffs were placed around the vagi to attain reversible blockade. Postoperatively, during the awake state, both vagi were blocked using 2% xylocaine for up to 30min. Compared to baseline values, pHa , and decreased and increased during perineural blockade (P<0.05). Four of seven animals exhibited apnoeas of ≥20s requiring the immediate termination of perineural blockade. Breathing rates decreased from the baseline value of 53±12 to 24±20breathsmin-1 during blockade despite an increased (P<0.001). Following blockade, breathing patterns returned to baseline values despite marked hypocapnia ( 33±3torr; P=0.03). Respiratory depression and apnoeas were independent of sleep states. The present study provides the much needed physiological evidence indicating that profound apnoeas and life-threatening respiratory failure in vagally denervated animals do not result from a lack of arousal or hypoxaemia. Rather, a change in sleep state and concomitant respiratory depression result from a lack of afferent volume feedback, which appears to be critical for the maintenance of normal breathing patterns and adequate gas exchange during the early postnatal period.

Parallel changes in brain GABA levels, sleep and mood state during acute cocaine withdrawal: Predictors of “readiness for treatment”?

Parallel changes in brain GABA levels, sleep and mood state during acute cocaine withdrawal: Predictors of “readiness for treatment”?

Sleep Neurophysiological Dynamics Through the Lens of Multitaper Spectral Analysis.

During sleep, cortical and subcortical structures within the brain engage in highly structured oscillatory dynamics that can be observed in the electroencephalogram (EEG). The ability to accurately describe changes in sleep state from these oscillations has thus been a major goal of sleep medicine. While numerous studies over the past 50 years have shown sleep to be a continuous, multifocal, dynamic process, long-standing clinical practice categorizes sleep EEG into discrete stages through visual inspection of 30-s epochs. By representing sleep as a coarsely discretized progression of stages, vital neurophysiological information on the dynamic interplay between sleep and arousal is lost. However, by using principled time-frequency spectral analysis methods, the rich dynamics of the sleep EEG are immediately visible-elegantly depicted and quantified at time scales ranging from a full night down to individual microevents. In this paper, we review the neurophysiology of sleep through this lens of dynamic spectral analysis. We begin by reviewing spectral estimation techniques traditionally used in sleep EEG analysis and introduce multitaper spectral analysis, a method that makes EEG spectral estimates clearer and more accurate than traditional approaches. Through the lens of the multitaper spectrogram, we review the oscillations and mechanisms underlying the traditional sleep stages. In doing so, we will demonstrate how multitaper spectral analysis makes the oscillatory structure of traditional sleep states instantaneously visible, closely paralleling the traditional hypnogram, but with a richness of information that suggests novel insights into the neural mechanisms of sleep, as well as novel clinical and research applications.

Changes in circadian rhythm, sleep and psychological state of Chinese Antarctic winter-over expeditioners

Changes in circadian rhythm, sleep and psychological state of Chinese Antarctic winter-over expeditioners

Changes in excitability of midbrain micturition control circuitry during alterations in sleep-like brain states in rats – implications for nocturnal enuresis

In humans micturition typically does not occur during sleeping but the bladder may accumulate a large volume of urine, which during wakefulness would be suprathreshold for triggering a need to void. The mechanism underlying this effect is not known but could include inhibition of sensory input from the bladder during sleep and/or a resetting of the excitability of the micturition control circuit. Micturition requires the functional integrity of a spino-midbrain-spinal loop that relays in the caudal ventrolateral periaqueductal grey (vlatPAG). We investigated whether the excitability of the micturition circuitry within the vlatPAG changed with arousal state. The urethane anaesthetised rat preparation was used, which shows spontaneous cyclical changes in EEG waveform that resemble changes in sleep state in unanesthetised animals. During infusion of saline into the bladder (6ml h−1) we found that transition from ‘arousal’ (desynchronised, low amplitude high frequency (3-5Hz) EEG) to synchronized high amplitude, slow wave (1Hz) activity (slow wave ‘sleep’) was accompanied by increases in micturition bladder pressure threshold and voided volume, and decreased end filling compliance, typical of natural sleep. The spontaneous firing of single units in the vlatPAG also slowed (8.0±3.2-3.0±1.9 Hz, n=15, p<0.01). These included 7 ‘micturition control’ neurons, which showed phasic changes in firing time-locked to changes in bladder pressure or external urethral sphincter EMG activity that were also depressed (n=6) or completely abolished (n=1) during SWS-like EEG activity. The results suggest that the micturition reflex is reset centrally during sleep. Failure of this mechanism could contribute to the development of nocturnal enuresis.

Differential effects of Diabetes mellitus on Nerve Fibers by Type of Diabetes

spinal loop that relays in the caudal ventrolateral periaqueductal grey (vlatPAG). We investigated whether the excitability of the micturition circuitry within the vlatPAG changed with arousal state. The urethane anaesthetised rat preparation was used, which shows spontaneous cyclical changes in EEG waveform that resemble changes in sleep state in unanesthetised animals. During infusion of saline into the bladder (6ml h) we found that transition from ‘arousal’ (desynchronised, low amplitude high frequency (3-5Hz) EEG) to synchronized high amplitude, slow wave (1Hz) activity (slow wave ‘sleep’) was accompanied by increases in micturition bladder pressure threshold and voided volume, and decreased end filling compliance, typical of natural sleep. The spontaneous firing of single units in the vlatPAG also slowed (8.0±3.2-3.0±1.9 Hz, n=15, pb0.01). These included 7 ‘micturition control’ neurons, which showed phasic changes in firing time-locked to changes in bladder pressure or external urethral sphincter EMG activity that were also depressed (n=6) or completely abolished (n=1) during SWS-like EEG activity. The results suggest that the micturition reflex is reset centrally during sleep. Failure of this mechanism could contribute to the development of nocturnal enuresis.

Formation of functional associations across time scales in the fetal autonomic control system--a multifractal analysis.

During fetal development, different control systems mediated by the autonomic nervous system form functional connections over a wide range of time scales. Using multiscale multifractal analysis (MMA) of fetal heart rate variability (HRV), we describe fundamental relationships in the developing scale-wide adjustments within fetal behavior states as well as across state changes. MMA yields the local Hurst exponent surface h(q,s) with q as the multifractal parameter and s as the scale. In 30-minute recordings of healthy fetuses between 24 and 36weeks of gestation (n=25 in quiet sleep, n=29 in active sleep, n=30 changing sleep state) we investigated the dependency of h(q,s) on gestation age. In univariate models, we found a decreasing persistence for short scales and small amplitudes in the quiet (s1=39, q1=-0.7, R(2)=0.52) and in the active (s1=69, q1=-1.4, R(2)=0.23) sleep in contrast to an increasing persistency for long scales and large amplitudes (s1=147, q1=2.4, R(2)=0.29) in the mixed state. Bivariate models (additional scales considered) presented increased coefficients of determination R(2)=0.56, 0.4, and 0.43, respectively. Persistency increasing with age in connection with the sleep state changes (independent of the age related short range dependencies within the separate homogeneous sleep states) is reported here for the first time. The MMA indices obtained for the fetal HRV represent characteristics of the maturating scale-wide cardiovascular control in the context of the evolving sleep state dynamics, which have so far not been considered. They should be incorporated in the search for HRV indices for prenatal diagnosis of developmental disorders and risk assessment.

Model-based estimation of loop gain using spontaneous breathing: A validation study

Non-invasive assessment of ventilatory control stability or loop gain (which is a key contributor in a number of sleep-related breathing disorders) has proven to be cumbersome. We present a novel multivariate autoregressive model that we hypothesize will enable us to make time-varying measurements of loop gain using nothing more than spontaneous fluctuations in ventilation and CO2. The model is adaptive to changes in the feedback control loop and therefore can account for system non-stationarities (e.g. changes in sleep state) and it is resistant to artifacts by using a signal quality measure. We tested this method by assessing its ability to detect a known increase in loop gain induced by proportional assist ventilation (PAV). Subjects were studied during sleep while breathing on continuous positive airway pressure (CPAP) alone (to stabilize the airway) or on CPAP+PAV. We show that the method tracked the PAV-induced increase in loop gain, demonstrating its time-varying capabilities, and it remained accurate in the face of measurement related artifacts. The model was able to detect a statistically significant increase in loop gain from 0.14±10 on CPAP alone to 0.21±0.13 on CPAP+PAV (p<0.05). Furthermore, our method correctly detected that the PAV-induced increase in loop gain was predominantly driven by an increase in controller gain. Taken together, these data provide compelling evidence for the validity of this technique.

Consecutive transcranial magnetic stimulation twitches reduce flow limitation during sleep in apnoeic patients

What is the central question of this study? A transcranial magnetic stimulation (TMS)-induced twitch applied on isolated single breaths over the motor cortex somatotopic representation of the tongue briefly recruits submental muscles and improves airflow dynamics of flow-limited respiratory cycles without arousing sleep apnoea patients. However, the mechanical impact of the TMS-induced twitch applied during consecutive breathing cycles on airflow dynamics remains unknown. What is the main finding and what is its importance? Our results show that application of TMS with the stimulator output set at the sleep submental motor threshold intensity on consecutive respiratory cycles increases inspiratory flow and reduces the turbulent airflow component. These results indicate an improvement of airflow pattern after two single consecutive TMS-induced twitches without arousing sleep apnoea patients. Transcranial magnetic stimulation (TMS)-induced twitches applied on isolated breaths briefly recruit upper airway dilator muscles and improve airflow and inspiratory volume without arousing apnoeic patients from sleep, but the effects of applying such twitches consecutively on airflow dynamics is unknown. The objective of this study was to quantify the effects of five consecutive TMS-induced twitches applied on sleep-induced obstructive hypopnoeic breaths in 10 obstructive sleep apnoea patients. Submental muscle motor threshold (SUBMT) and motor-evoked potential were measured during wakefulness and sleep. The TMS-induced twitches were applied during stable non-rapid eye movement (NREM) sleep, at the beginning of inspiration of consecutive flow-limited respiratory cycles, with the stimulator output set at sleep SUBMT. Maximal inspiratory flow, inspiratory volume, inspiratory time, shifts of electroencephalogram frequency and pulse rate variability were assessed. During sleep, SUBMT increased (wakefulness, 25.3 ± 4.9%; NREM sleep, 27.0 ± 6.2%; P = 0.02). During each series of stimulations there was a rise in maximal inspiratory flow (from 306.7 ± 123.2 to 359.8 ± 154.1 ml s(-1); P = 0.0002) and in inspiratory volume (from 346.1 ± 128.1 to 414.9 ± 171.2 ml; P = 0.02) without differences in thoraco-abdominal efforts and inspiratory time. These responses were observed in the absence of arousals and ceased immediately after TMS interruption. Transcranial magnetic stimulation-induced cortical and/or autonomic arousal was observed in 30.2% of all series of stimulation. Consecutive twitch TMS of submental muscles may lead to arousals in a minority of patients but can be applied on consecutive respiratory cycles during sleep and can significantly improve maximal inspiratory flow and inspiratory volume of flow-limited cycles.

Fractal dimension of the sleep state waveform in obstructive sleep apnea

Question of the study Sleep represents a complex interplay of biological processes. This study examines whether the dynamics of the sleep state changes exhibit fractal properties and the implications of such changes in obstructive sleep apnea.

Antidepressant suppression of REM and spindle sleep impairs hippocampus-dependent learning and memory but fosters striatal-dependent strategies

AbstractREM sleep enhances hippocampus-dependent associative memory but has little impact on striatal-dependent procedural learning. Antidepressant medications like desipramine (DMI) inhibit rapid-eye-movement (REM) sleep but it is little understood how antidepressant treatments affect learning. We found that DMI strongly suppressed REM sleep in rats for several hours and impaired reconsolidation of a familiar maze and consolidation of moved baited positions (reversal learning) in a sleep-dependent fashion. Unexpectedly, DMI also reduced the spindle-rich transition-to-REM sleep state (TR) and spatial memory changes were more related to TR than to REM sleep. Working memory was unaffected, but overnight reference memory was significantly impaired and subjects increased reliance on non-hippocampal strategies. Procedural memory performance was positively correlated with increases in non-REM sleep after DMI serving to offset memory declines, partially preserving performance. Our results suggest that familiar memories are re-consolidated during REM sleep, reversal memories consolidated during TR, and procedural memories consolidated during non-REM sleep.