Full Arousal Research Articles

Complementary therapy with Chinese aromatic herbs to promote awakening in a comatose patient: A case report.

Traumatic brain injury frequently leads to prolonged coma, posing significant medical management challenges. Complementary therapies, including traditional Chinese herbal medicine, have been investigated as potential interventions in comatose patients. Chinese aromatic herbs, such as Borneolum (Bingpian), Moschus (Shexiang), and Acori tatarinowii rhizoma (Shichangpu), have long been believed to be "resuscitation with aromatics" based on traditional Chinese medicines theory. A 16-year-old male was admitted to the intensive rehabilitation unit for further treatment due to prolonged coma and frequent seizures following traumatic brain injury. Western medicine diagnosed the patient as coma, diffuse axonal injury, and epilepsy. According to traditional Chinese medicine theory, the syndrome differentiation indicates a Yin-closed disease. According to the patient's condition, we use the Chinese aromatic herbs as a complementary therapy. Following a month-long administration, the patient's consciousness and electroencephalogram (EEG) background progressively improved. A 6-month follow-up demonstrated full arousal, though with ambulatory EEG revealing mild to moderate abnormality in the background. The addition of Chinese aromatic herbs appears to have a beneficial effect on the patient's consciousness and EEG background. This could be attributed to the herbs' inherent pharmacological properties, as well as their potential to enhance the permeability of the blood-brain barrier to other drugs. This makes them a promising option for complementary therapy.

Field immobilization using alfaxalone and alfaxalone–medetomidine in free-ranging koalas (Phascolarctos cinereus): a randomized comparative study

ObjectiveTo characterize and compare two intramuscular drug protocols using alfaxalone and alfaxalone–medetomidine combination for the field immobilization of free-ranging koalas. Study designBlinded, randomized, comparative field study. AnimalsA total of 66 free-ranging koalas from the Mount Lofty Ranges, South Australia. MethodsKoalas were randomly allocated into two groups. Group A animals were given alfaxalone alone at 3.5 mg kg–1. Group AM animals were given alfaxalone 2 mg kg–1 and medetomidine 40 μg kg–1, reversed with atipamezole at 0.16 mg kg–1. Blinded operators recorded heart rate (HR), respiratory rate (fR), cloacal temperature, depth of sedation and times to: first effect, sedation suitable for clinical interventions, first arousal and full recovery. Data were analysed using independent t test, Mann–Whitney U test, chi-square analysis and log-rank test at 5% level of significance. ResultsSuitable immobilization for clinical examination and sample collection was achieved in all animals. In groups A and AM, median time to working depth was 6.5 minutes (range: 3.4–15) and 8.1 minutes (range: 4.3–24) and time to complete recovery was 66 minutes (range: 12–138) and 34 minutes (range: 4–84), respectively, following reversal. Time to first effect was significantly shorter in group A (p = 0.013), whereas time to full arousal was significantly shorter in group AM (p = 0.007) probably due to the administration of atipamezole. Maximum HR was 117 ± 28 beats minute–1 in group A, which was a significant increase from baseline values (p < 0.0001), whereas group AM showed a significant tachypnoea of 67 ± 25 (normal fR 10–15; p < 0.0001). Conclusions and clinical relevanceBoth the protocols produced immobilization, enabling clinical examination and sample collection; however, protocol AM was more suitable for field work due to shorter recovery times.

Body temperatures of hibernating little brown bats reveal pronounced behavioural activity during deep torpor and suggest a fever response during white-nose syndrome.

Hibernating animals use torpor [reduced body temperature (T b) and metabolic rate] to reduce energy expenditure during winter. Periodic arousals to normal T b are energetically expensive, so hibernators trade off arousal benefits against energetic costs. This is especially important for bats with white-nose syndrome (WNS), a fungal disease causing increased arousal frequency. Little brown bats (Myotis lucifugus) with WNS show upregulation of endogenous pyrogens and sickness behaviour. Therefore, we hypothesized that WNS should cause a fever response characterized by elevated T b. Hibernators could also accrue some benefits of arousals with minimal T b increase, thus avoiding full arousal costs. We compared skin temperature (T sk) of captive Myotis lucifugus inoculated with the WNS-causing fungus to T sk of sham-inoculated controls. Infected bats re-warmed to higher T sk during arousals which is consistent with a fever response. Torpid T sk did not differ. During what we term "cold arousals", bats exhibited movement following T sk increases of only 2.2 ± 0.3°C, compared to >20°C increases during normal arousals. Cold arousals occurred in both infected and control bats, suggesting they are not a pathophysiological consequence of WNS. Fever responses are energetically costly and could exacerbate energy limitation and premature fat depletion for bats with WNS. Cold arousals could represent an energy-saving mechanism for both healthy and WNS-affected bats when complete arousals are unnecessary or too costly. A few cold arousals were observed mid-hibernation, typically in response to disturbances. Cold arousals may, therefore, represent a voluntary restriction of arousal temperature instead of loss of thermoregulatory control.

Sleep-related eating disorder and its associated conditions.

Sleep-related eating disorder (SRED) is a condition characterized by recurrent episodes of eating at the transition from night-time sleep to arousal. SRED patients describe eating in an out-of-control manner with preference for high-caloric foods and sometimes with inedible or toxic items. Level of consciousness during SRED episodes ranges from partial consciousness to dense unawareness typical of somnambulistic episodes. SRED is sometimes associated with psychotropic medication, in particular sedative hypnotics, and other sleep disorders, including parasomnias, narcolepsy, and restless legs syndrome. Night eating syndrome (NES) is another important condition in the disordered night-time eating spectrum showing hyperphagia episodes at full arousal from nocturnal sleep without accompanying amnesia. NES could be considered an abnormality in the circadian rhythm of meal timing with a normal circadian timing of sleep onset. The two conditions often overlap and possibly share a common pathophysiology. Studies have suggested that central nervous system serotonin modulation may lead to an effective treatment of NES, while the anti-seizure medication topiramate may be an effective SRED treatment.

Habituation of Arctic ground squirrels (Urocitellus paryii) to handling and movement during torpor to prevent artificial arousal

Hibernation is a unique physiological adaptation characterized by periods of torpor that consist of repeated, reversible, and dramatic reductions of body temperature, metabolism, and blood flow. External and internal triggers can induce arousal from torpor in the hibernator. Studies of hibernating animals often require that animals be handled or moved prior to sampling or euthanasia but this movement can induce changes in the hibernation status of the animal. In fact, it has been demonstrated that movement of animals while they are hibernating is sufficient to induce an artificial arousal, which can detrimentally alter experimental findings obtained from animals assumed to be torpid. Therefore, we assessed a method to induce habituation of torpid hibernators to handling and movement to reduce inadvertent arousals. A platform rocker was used to mimic motion experienced during transfer of an animal and changes in respiratory rate (RR) were used to assess responsiveness of torpid Arctic ground squirrels (AGS, Urocitellus parryii). We found that movement alone did not induce a change in RR, however, exposure to handling induced an increase in RR in almost all AGS. This change in RR was markedly reduced with increased exposures, and all AGS exhibited a change in RR ≤ 1 by the end of the study. AGS habituated faster mid-season compared to early in the season, which mirrors other assessments of seasonal variation of torpor depth. However, AGS regained responsiveness when they were not exposed to daily handling. While AGS continued to undergo natural arousals during the study, occurrence of a full arousal was neither necessary for becoming habituated nor detrimental to the time required for habituation. These data suggest that even when torpid, AGS are able to undergo mechanosensory habituation, one of the simplest forms of learning, and provides a reliable way to reduce the sensitivity of torpid animals to handling.

Circumferential change scores in phallometric assessment: normative data.

Phallometric testing is a procedure that has enjoyed considerable popularity as an objective component in the assessment of sexual offenders. The value of this procedure may be most notably compromised in the realm of interpretation, and problems in interpretation are particularly acute for those participants where full arousal is not obtained during testing. The calculation of Percent Full Erection (PFE) scores has of necessity involved a speculative component in such cases. Eliminating this speculation through empirical investigation was the purpose of the current research. Circumferential change scores (from flaccidity to full erection) were obtained for 724 respondents at nine North American correctional facilities, allowing for the calculation of descriptive statistics and a determination of the distribution characteristics of these scores. The results provide an empirical basis for calculating PFE scores and interpreting phallometric data in those cases where full arousal is not obtained, and specific confidence levels associated with interpretation are offered. It is suggested that only through a more rigorous application of the principles of science will the procedure of phallometric assessment fulfill its true potential.

The Application of the Wavelet Transform to Polysomnographic Signals

Polysomnographic (sleep) signals are recorded from patients exhibiting symptoms of a suspected sleep disorder such as Obstructive Sleep Apnoea (OSA). These non-stationary signals are characterised by having both quantitative information in the frequency domain and rich, dynamic data in the time domain. The collected data is subsequently analysed by skilled visual evaluation to determine whether arousals are present, an approach which is both time-consuming and subjective. This paper presents a wavelet-based methodology which seeks to alleviate some of the problems of the above method by providing: (a) an automated mechanism by which the appropriate stage of sleep for disorder observation may be extracted from the composite electroencephalograph (EEG) data set and (b) an ensuing technique to assist in the diagnosis of full arousal by correlation of wavelet-extracted information from a number of specific patient data sources (e.g. pulse oximetry, electromyogram [EMG] etc.).

Graded arousal responses in infants: advantages and disadvantages of a low threshold for arousal

Objective: To review studies of upper airway protective reflexes and other aspects of arousal from sleep. Methods: Discussion of pertinant physiological studies. Conclusions: Infant arousal from sleep incorporates two systems. The first comprises a group of periodically occurring reflexes serving cardiorespiratory homeostatic functions as well as providing for several aspects of normal growth and development. The second system is organized to respond to acute threats to survival during sleep. Both systems are integrated in a single arousal network originating in the brainstem. Full arousal occurs as a progression of events occurring sequentially and manifested by various innate motor and cardiovascular responses. During an arousal, rostral progression from brainstem to cortex is retarded by increasing inhibition which serves to decrease cortical arousals thereby preserving the integrity of rapid eye movement and non-rapid eye movement sleep states. Activation of brainstem arousal reflexes alone can cause recovery from obstruction sleep apnea episodes without the need for cortical arousal, a phenomenon more characteristic of infants than adults.

Spontaneous eyelid movements during human sleep: a possible ponto-geniculo-occipital analogue?

The aim of the present study was to investigate whether eye lid movements (ELMs) were temporally related to the activity of other skeletal musculature and to proposed analogues of ponto-geniculo-occipital (PGO) waves during human sleep. Electroencephalogram (EEG), laryngeal-masseter electromyogram (EMG), electrooculgram (EOG), peri-orbital integrated potentials (PIPs), middle ear muscle activity (MEMA), ankle flexion (AF) and respiration (RESP) were monitored with ELMs during one night's sleep. Results showed that ELMs always occurred during full arousal and movement time. The ELMs that occurred during sleep were most prominent during rapid eye movement (REM) sleep, occurred at higher frequency just before REM, and were observed synchronously with other PGO analogues, supporting the notion that ELMs may be an indicator of PGO activity in humans. Of the ELMs observed during sleep, 16% showed changes in EOG, PIP, MEMA, AF and RESP simultaneously, suggesting generalized muscle activation. This coactivation of muscle activity suggested that the relationship between the muscular measures and PGO activity might be an indirect one, possibly mediated by alerting mechanisms, previously shown to be related to PGO waves in animals. Such an interpretation is consistent with the use of ELM as a widely accepted measure of the eye-blink startle response in awake human subjects.

Prevalence of sleepiness and its relation to autonomic evidence of arousals and increased inspiratory effort in a community based population of men and women.

Degrees of sleep apnoea and daytime sleepiness are quite common in community populations. However the relationship between the two is poor, although sleepiness does correlate better with a history of snoring. It has been suggested that sleep can be fragmented by upper airways obstructive events, short of full apnoeas or hypopnoeas, and that these events may not provoke full cortical arousal, but be detectable through activation of the autonomic system. Failure to detect both these could mask a relationship between 'sleep apnoea' and daytime sleepiness. We have therefore measured sleepiness (Epworth Sleepiness Scale) in addition to both autonomic 'arousals' and inspiratory effort (using pulse transit time) in 473 men and women at home. Although sleepiness was related to a history of snoring, it was not significantly predicted by the measures of autonomic 'arousal', or inspiratory effort. Reported snoring and objectively measured snoring correlated poorly. As in other studies, nocturnal hypoxic dips were correlated with obesity, age, alcohol consumption, drug usage and a history of snoring. These data make it unlikely that sleep fragmentation from subtle variants of sleep apnoea and 'autonomic' (or 'subcortical') arousals are an important source of daytime sleepiness in the community.

Confirmation of pleisiomorphic daily torpor in mammals: the round-eared elephant shrew Macroscelides proboscideus (Macroscelidea).

The characteristics of daily torpor were measured in the round-eared elephant shrew Macroscelides proboscideus (Macroscelidea) in response to ambient temperature and food deprivation. Elephant shrews are an ancient mammal order within a superordinal African clade including hyraxes, elephants, dugongs and the aardvark. M. proboscideus only employed torpor when deprived of food; torpor did not occur under an ad libitum diet at ambient temperatures of 10, 15 and 25 degrees C. Torpor bout duration ranged from < 1 h to ca. 18 h. The times of entry into torpor were restricted to the scotophase, despite normothermic body temperature patterns indicating a rest phase coincident with the photophase. Full arousal was always achieved within the first 3 h of the photophase. When food deprived, the onset of the rest phase, and hence torpor, advanced with respect to the experimental photoperiod. The lowest torpor body temperature measured was 9.41 degrees C. Daily torpor in M. proboscideus confirms a pleisiomorphic origin of daily heterothermy. Torpor facilitates risk-averse foraging behaviour in these small omnivores by overcoming long-term energy shortfalls generated by the inherent variability of food availability in their semiarid, El Niño-afflicted habitats.

Plethysmographic Assessment of Incarcerated Nonsexual Offenders: A Comparison with Rapists

Plethysmographic testing was completed on 100 research participants from the same medium-security prison population, 50 of whom were incarcerated for nonsexual offenses. In order to strengthen the validity of the research, only participants who achieved full arousal were included in the sample, and the percentage of full erection scores, as well as the Rape Index, were examined. The resulting sexual arousal profiles revealed striking similarities between rapists and control participants, indicating that deviant arousal alone did not distinguish these sexual offenders from nonsexual offenders. The only marked difference between the two groups was in the almost-perfect ability of control participants to inhibit deviant arousal and the weak ability of sexual offenders to accomplish this. The suggestion was advanced that a determination of an offender's ability to inhibit deviant arousal may be the only aspect of plethysmographic testing which has practical application in the assessment of rapists.

The Mechanism of Sleep Arousal in Infants: Relevance of Sleep Startles• 1834

Defective arousal mechanisms are viewed as contributory to sleep hypopnea disorders and Sudden Infant Death Syndrome. Arousal has traditionally been viewed as an “all or none” event defined behaviorally as“full arousal” (eyes open, cry) or electrophysiologically as >3 sec of altered EEG-activity. In contrast, our own recent studies suggest that arousal is a stepwise process beginning with a sleep startle which then may or may not progress to “full arousal”. However startles have not traditionally been viewed as arousal related phenomena in infants since the associated EEG changes last < 3sec and are mostly due to movement artifacts. We hypothesized that, if startles are the initial event in a sequential arousal process, then they might be associated with less obvious electrophysiological events intermediate between those of sleep and“full arousal”. We monitored EEG sleep spindles since activation of the primary arousal mechanisms in the brainstem reticular activating system eliminates spindle activity generated in the thalamus. We studied spontaneous sleep startles (n=23) as well as those elicited by briefly occluding the infants face mask airway (n=128) in 12 normal infants (age 10-19 weeks) during sleep. We recorded EEG (C3-P3), ECG, O2-Saturation, limb and nuchal EMG and video of the infant. The intensity of startles was scored on a scale of 0 to 3 based on the limb EMG magnitude and video recorded movements. We focused on the β-spindle frequency range (13-18 Hz). Spindle periodicity was analysed by using a threshold over a compressed spectral band array. Spontaneous sleep startles were immediately followed by a prolongation of the inter spindle interval from a mean of 7.9 sec (+/- 0.16 SE) during the control period to 20.4 sec (+/- 0.94 SE) after startle (p<0.005); following occlusion related startles inter spindle period increased to 24.8 sec (+/- 0.92 SE) (p<0.001). Furthermore the intensity of evoked startles was positively correlated with the inter spindle interval period (p<0.01). Conclusion: Spontaneous as well as evoked startles are immediately followed by elimination of sleep spindles. This phenomenon strongly suggests a linkage between sleep startles and increased activity in subcortical arousal mechanisms. These findings support the concept that infant arousal is not an“all or none” event but a process that begins as a series of subcortical events and reflex behaviors that potentially progress to a“full” or unambiguous EEG arousal.HD 10993

Flumazenil in intensive care The duration of arousal after an assessment dose

The effect of an assessment dose of the benzodiazepine antagonist flumazenil was studied in 20 patients in an intensive care unit. The patients had been sedated with alfentanil and midazolam, and were ready to be weaned from mechanical ventilation. In 10 patients flumazenil was titrated just to produce full arousal whilst the midazolam infusion was continued; flumazenil administration was repeated one hour later after the infusion of midazolam had been stopped. In another 10 patients, flumazenil was administered only once, coinciding with the cessation of sedation. The duration of full arousal in both groups was less than 15 minutes in 75% of patients given a single dose of flumazenil (median dose 0.4 mg) although some effect persisted for up to 60 minutes. The cardiovascular effects of arousal were transient and probably not clinically significant. A brief duration of action is advantageous if the patient is found still to require sedation.

Circannual fluctuations of the serum cortisol in the european ground squirrel, Citellus citellus L

1. 1. Serum cortisol levels were measured throughout an annual cycle in male European ground squirrels, Citellus citellus L. 2. 2. A circannual rhythm of these levels in euthermic animals was found: the highest being in late October, November and December, the lowest in May, early October and March. 3. 3. The levels varied in the hibernating period as well: strongly reduced during the first part (October-December) and significantly elevated in the second one (January-March). 4. 4. A significant elevation of the cortisol levels was marked 18–20 hr after full arousal from hibernation in October.

Time-course of blood acid-base state during arousal from hibernation in the European hamster.

1. Arterial blood was sampled at 15 min-intervals in European hamsters Cricetus cricetus fitted with indwelling catheters, from deep hibernation to full arousal. Temperature-corrected pH and PCO2, respectively pH* and P*CO2, were directly measured at 37 degrees C. 2. Deep hibernation corresponded to a respiratory acidosis: pH* = 7.01 +/- 0.01 (mean +/- SE), P*CO2 = 160 +/- 4 Torr (n = 9 animals). 3. Three periods could be distinguished in the arousal: (i) a period of hyperventilation (28 +/- 5 min), in which P*CO2 was reduced to 79 +/- 4 Torr, while cheek pouch temperature increased only by 0.9 +/- 0.2 degrees C; (ii) a period of metabolic acidification by lactate accumulation (84 +/- 6 min), corresponding to the period of peak thermogenesis; (iii) a progressive return to euthermic conditions (104 +/- 10 min), by simultaneous respiratory and metabolic alkalinization. 4. Over 60% of the blood CO2 stores accumulated at the beginning of the hibernation bout were released by hyperventilation during the first period, prior to the full development of thermogenesis. This is in agreement with the hypothesis of an inhibitory role of the respiratory acidosis in hibernation.

Hypothalamic Thermosensitivity in Hibernating Chipmunks, Tamias striatus

Water-perfused thermodes were employed to examine the thermosensitivity of the preoptic/anterior hypothalamus (POAH) in hibernating eastern chipmunks, Tamias striatus. The metabolic rate of mammals in hibernation has been shown to increase linearly as POAH temperatures are manipulated below a threshold temperature ($T_{set}$). In this study, $T_{set}$ was observed only in the initial one or two hibernation bouts monitored in two individuals. $T_{set}$ was not observed in any of the other hibernation bouts monitored. Metabolic rates remained stable until POAH temperatures were decreased to $T_{alarm}$. At the $T_{alarm}$ level, a full arousal from the hibernation bout was precipitated. $T_{alarm}$ ranged from 1.0 to 3.5 C. Suppression of some of these induced arousals was achieved by elevating POAH temperatures to 7.3 to 8.3 C. The results of this study suggest that centrally mediated proportional thermogenesis is not a general characteristic of the hibernation bout in the eastern chipmunk. However, hypoth...

Thermal changes produced by intrahypothalamic injections of acetylcholine during hibernation and euthermia in Citellus lateralis

1. 1. Changes in hypothalamic temperature following ACh stimulation of the preoptic/anterior hypothalamus of ground squirrels were measured during hibernation and euthermia. 2. 2. Bilateral, 1 μl injections of ACh (10–50 μg/μl) were delivered through removable stainless steel injection tubes, inserted into chronically implanted guide tubes. 3. 3. During hibernation, transient, small-magnitude thermogenic responses and full arousal from hibernation were produced. Higher dose levels elicited responses earlier in the hibernation bout, but did not affect the magnitude of the transient response. Full arousal occurred only in the 2nd half of the bout. 4. 4. During euthermia, dose-dependent decreases in temperature were produced at ambient temperatures of 22 and 5.5°C. Increases in temperature were also observed which were dose-dependent at 5.5°C, but not at 22°C. The direction of response was correlated with brain temperature at the time of injection.

Inhibition of the CNA trigger process for arousal from hibernation.

Ground squirrels (Citellus lateralis) produced three distinct types of thermogenic response during hibernation. These responses were evoked spontaneously as well as after stimulation produced by brief handling, or after microinjection of acetylcholine into the midbrain reticular formation. Type I responses were characterized by small magnitude and a slow (mean rate, 0.03 degrees C/min), variable rising phase. Type II responses were characterized by a smooth, rapid rising phase with a mean rate of increase of 0.11 degrees C/min and by an abrupt reversal of the rising phase within a restricted ceiling temperature band with a mean value of 9.4 degrees C. The third type of response, full arousal, was characterized by a return of body temperature to euthermic (nonhibernating) levels and by an early rising phase that was indistinguishable from the rising phase of type II responses. This indicates that the rising phase of type II responses and the duplicate portion of full arousals are produced by a common neuronal mechanism that functions as the trigger for arousal from hibernation, and that this mechanism can be spontaneously inhibited when increasing internal temperature reaches a hibernation ceiling level.

Characterization of midbrain component of the trigger for arousal from hibernation.

The ability of the midbrain reticular formation (MRF) to trigger arousal from hibernation and to change body temperature (Tb) during euthermia was tested in golden-mantled ground squirrels (Citellus lateralis). During hibernation (ambient temperature 5-6 degrees C) microinjections of cholinomimetic compounds (acetylcholine and carbachol) triggered full arousal or produced transient increases in Tb in 15 out of 19 tests; MRF microinjections of norepinephrine (NE) and 5-hydroxytryptamine (5-HT), at the same concentrations that produced full arousal when microinjected into the preoptic/anterior hypothalamus (PO/AH) area in previous experiments, has no effect on Tb in 13 out of 16 tests. In experiments on euthermic ground squirrels tested at an ambient temperature of 25 degrees C, MRF microinjections of acetylcholine raised Tb, whereas the monoamines had no significant effects. These results show that cholinoceptive neurons in the MRF can trigger arousal from hibernation and increase Tb during euthermia. The failure of NE and 5-HT to produce any significant effects at the same doses that were reported to be effective in the PO/AH indicates that the functional organization of the MRF portion of the arousal mechanism is different from that reported for the PO/AH.