Presence Of Rapid Eye Movements Research Articles

Technical challenges in REM sleep microstructure classification: A study of patients with REM sleep behaviour disorder.

While commonly treated as a uniform state in practice, rapid eye movement sleep contains two distinct microstructures-phasic (presence of rapid eye movement) and tonic (no rapid eye movement). This study aims to identify technical challenges during rapid eye movement sleep microstructure visual classification in patients with rapid eye movement sleep behaviour disorder, and to propose solutions to enhance reliability between scorers. Fifty-seven sleep recordings were randomly allocated into three subsequent batches (n = 10, 13 and 34) for scoring. To reduce single-centre bias, we recruited three raters/scorers, with each trained from a different institution. Two raters independently scored each 30-s rapid eye movement sleep into 10 × fSEM3-s phasic/tonic microstructures based on the AASM guidelines. The third rater acted as an "arbitrator" to resolve opposite opinions persisting during the revision between batches. Besides interrater differences in artefact rejection rate, interrater variance frequently occurred due to transitioning between microstructures and moderate-to-severe muscular/electrode artefact interference. To enhance interrater agreement, a rapid eye movement scoring schematic graph was developed, incorporating proxy electrode use, filters and cut-offs for microstructure transitioning. To assess potential effectiveness of the schematic graph proposed, raters were instructed to systematically apply it in scoring for the third batch. Of the 34 recordings, 27 reached a Cohen's kappa score above 0.8 (i.e. almost perfect agreement between raters), significantly improved from the prior batches (p = 0.0003, Kruskal-Wallis test). Our study illustrated potential solutions and guidance for challenges that may be encountered during rapid eye movement sleep microstructure classification.

Nightmare Distress and Dream Recall in Patients With Obstructive Sleep Apnea

Objectives: We aimed to examine dream recall and nightmare distress in patients with obstructive sleep apnea (OSA), and identify the associating factors.Methods: This cross-sectional study retrospectively enrolled adult participants (age ≥18 years) with newly diagnosed OSA that was confirmed by full-night polysomnography between 2016 and 2022. Dreaming components were assessed using a nine-item dreaming questionnaire (nightmare distress and dream recall). We compared the clinical and polysomnographic findings according to OSA severity and the presence of rapid eye movement (REM)-dependent OSA. Additionally, we assessed factors that related to nightmare distress and dream recall in patients with OSA.Results: Patients with mild OSA had significantly higher nightmare distress than those with moderate to severe OSA (<i>p</i>=0.044). Univariate linear regression analysis showed negative correlations between the apnea-hypopnea index (AHI) and nightmare distress (β=-0.105; <i>p</i>=0.040). Conversely, multivariate analyses indicated that the AHI and the presence of REM-dependent OSA were not significantly associated with nightmare distress and dream recall. Wakefulness after sleep onset (β=0.083; <i>p</i>=0.066), the Pittsburgh Sleep Quality Index (PSQI) (β=0.271; <i>p</i><0.001), the Beck Depression Inventory (β=0.242; <i>p</i><0.001), and the State-Trait Anxiety Inventory-State (STAI-S) (β=0.123; <i>p</i>=0.047) were related to nightmare distress. In contrast, younger age (β=-0.144; <i>p</i>=0.004), PSQI (β=0.098; <i>p</i>=0.058), STAI-S (β=0.156; <i>p</i>=0.003) were associated with dream recall.Conclusions: Depression, anxiety, and poor sleep quality were related to nightmare distress, while younger age and anxiety were associated with dream recall. OSA severity and the presence of REM-dependent OSA were not significantly associated with nightmare distress or dream recall.

85 Predicting Conversion to Mild Cognitive Impairment in Parkinson’s Disease: a Random Forest Machine Learning Model Based on Parkinson’s Progression Markers Initiative Dataset.

Objective:Mild cognitive impairment (MCI) is common in Parkinson’s disease (PD). Recent scientific advances show that MCI in PD could also be impacted by neuropsychiatric symptoms (such as apathy, anxiety, depression), dopaminergic deficiency (more striatal denervation associated with MCI) and certain genotypes such as in APOE E4, MAPT H1 or SNCA C/C carriers. We used a python-based random forest machine-learning algorithm (scikit-learn) in order to evaluate the factors that are mostly involved in the MCI conversion over a 5-year follow-up period.Participants and Methods:Baseline data of healthy individuals and participants with Parkinson’s disease were extracted from the PPMI dataset. All participants also had the evaluations of their cognitive status, neuropsychiatric symptoms (hallucinations, anxiety, apathy, depression, sleepiness, impulse control disorders and rapid eye movement behaviors), dopaminergic uptake (DaT-Scan) and genetic status (APOE, MAPT and SNCA) at baseline and after 5 years. Baseline demographic (age, sex, education years) and clinical values (duration of disease, age of onset) were also included in the model. The algorithm defined (1) the most important variables in predicting MCI, (2) the threshold values to distinguish “converting” vs. “non-converting” subgroups.Results:The algorithm showed that (1) age onset of disease, (2) dopaminergic uptake, (3) age, (4) anxiety, and (5) years of education were the most important factors in predicting MCI over 5 years. Among the factors involved in predicting conversion to MCI, a lower number of years of education associated with lower dopaminergic uptake in the right putamen increased the risk of conversion. Individuals with more years of education are at higher risk of conversion if they have symptoms of depression, anxiety, and lower right striatal dopamine uptake. Other factors that were involved in increasing the risk, were the presence of sleepiness and the presence of rapid eye movement disorders. Interestingly, the genetic factors were of negligible importance and were not considered by the algorithm. Finally, the model showed an accuracy of classification of participants (converters vs. non-converters) of 92.53%.Conclusions:Random forest algorithm shows that (1) depression and anxiety are probably important factors for MCI conversion; (2) years of education influences the conversion; (3) presence of sleepiness and rapid eye movement increases the risk of conversion to MCI. Since the algorithm considers the disease’s age onset, but not the diagnosis of individuals, it would be necessary to generate a model for each group (Healthy on the one hand, Parkinson’s on the other).

Sleep Disturbances and Associated Factors in Drug-Naïve Patients with Parkinson's Disease.

PurposeSleep disturbance is one of the common symptoms in Parkinson’s disease (PD). The study of sleep disturbance used to concentrate on treated PD. This study aimed to investigate the factors that are associated with the sleep quality of drug-naïve patients with PD.Patients and MethodsAll participants were interviewed using a standard questionnaire to collect basic information. PD severity, depression symptoms, anxiety symptoms, sleep quality, cognitive status, life quality, and the presence of rapid eye movement (REM) sleep behavior disorder (RBD) and minor hallucination were assessed using corresponding rating scales. The patients with a Pittsburgh Sleep Quality Index score ≤6 fell into the poor sleep group, and those with REM Sleep Behavior Disorder Screening Questionnaire score ≥5 were considered to have probable RBD.ResultsSeventy drug-naive patients with PD and 30 healthy controls matched for age, sex, and education were recruited. Up to 41.4% of the patients suffered from sleep disturbance, and 24.3% of the patients had RBD. Poor sleepers were more likely to have left-side predominant motor symptoms. Compared with good sleepers, poor sleepers, particularly female patients, had more burden in the aspect of anxiety and depression. RBD was associated with more nonmotor symptoms, poor sleep quality, bad performance in cognition orientation domain, anxiety, depression, presence of minor hallucination, and poor life quality.ConclusionSleep disturbances are common in drug-naïve PD and require wide attention. Motor symptom laterality and gender difference in mood are associated with sleep quality. Depression, anxiety, and RBD are highly related to sleep disturbance. RBD has many comorbidities, which can influence the cognitive function and life quality of the patients.

Risk Disclosure in Prodromal Parkinson's Disease.

Impressive progress in the understanding of the prodromal phase of Parkinson's disease (PD) in recent years has enabled the generation of disease prediction models. However, a remaining diagnostic uncertainty and lack of therapeutic options for affected individuals has resulted in a variety of ethical issues that have not to date been addressed sufficiently. Moreover, differences in the specificity of prodromal symptoms and possible subtypes of PD, especially the presence of rapid eye movement (REM) sleep behavior disorder (RBD), may have an important impact on prognostic counseling. To derive a guideline for risk disclosure in prodromal PD based on the current literature and expert opinion. We performed (1) a literature review on prognostic counseling in PD and (2) consulted with international experts on prodromal PD using a semi-structured questionnaire based on a Delphi approach to evaluate recommendations for risk disclosure in PD. The literature research revealed only 11 publications addressing prognostic counseling, with only two studies directly addressing affected individuals and most studies focusing on risk disclosure in RBD. The expert survey revealed the importance of distinguishing between individuals with and without RBD in prognostic counseling. Based on the current literature and expert recommendations, a guideline for risk disclosure in prodromal PD for clinical care and research could be elaborated. Prognostic counseling should include differentiation between individuals with and without RBD, taking into account the high uncertainty of risk calculation in RBD-negative prodromal PD. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Cognitive Impairments and Self-Reported Sleep in Early-Stage Parkinson's Disease with Versus without Probable REM Sleep Behavior Disorder.

Parkinson’s disease (PD) is associated with cognitive and sleep impairments. The presence of rapid eye movement (REM) sleep behavior disorder (RBD) symptoms may represent a worse disease prognosis for PD individuals. We investigated cognitive functioning and self-reported sleep in early-stage PD individuals with (n = 19) or without (n = 31) probable RBD. Probable RBD was defined as >5 on the REM Sleep Behavior Disorder Screening Questionnaire. Inhibition, visuospatial cognitive abilities, working memory, sustained visual attention, verbal fluency, and episodic memory were assessed. Sleep impairments were assessed using the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, and Patient-Reported Outcomes Measurement Information System questionnaires. Chi-squared, Mann-Whitney U, and independent sample t-tests were employed to assess group differences. Participants with PD and probable RBD performed significantly worse on word reading and switching verbal fluency tasks than PD participants without probable RBD (p < 0.05). No significant differences were found in mood, PD severity, or sleep measures between PD individuals with or without probable RBD. Cognitive tasks that involve verbal or switching components may be most impaired in PD individuals with probable RBD. Larger samples are needed to determine whether other cognitive domains and sleep features are significantly associated with RBD in PD.

Smiling asleep: A study of happy emotional expressions during adult sleep.

Human foetuses and newborns smile first during sleep, before they smile while awake and interacting with caregivers. Whether smiling persists during adult sleep, and expresses inner joy, is yet unknown. Smiles were looked for during night-time video-polysomnography combined with electromyography of the zygomatic and orbicularis oculi muscles in 100 controls, 22 patients with sleepwalking and 52 patients with rapid eye movement (REM) sleep behaviour disorder. Autonomous reactions (heart rate and level of vasoconstriction) and the presence of rapid eye movements were examined during smiles and laughs. On visual examination of the face video clips synchronous with zygomatic contraction, 8% of controls smiled while asleep (7% in REM sleep and 1% in non-REM sleep). Some patients with sleepwalking also smiled and laughed during N2 sleep and N3 parasomnia. Half of the patients with REM sleep behaviour disorder smiled and one-third laughed, mostly during REM sleep. The 173 happy faces included mild smiles (24.8%), open-mouth smiles (29.5%) and laughs (45.7%). More than half of the smiles were the Duchenne (genuine) type, including an active closure of the eyelids. Approximately half of the smiles and laughs were temporally associated with rapid eye movements. There was no increased heart rate variability during smiles and laughs. Two scenic behaviours including smiles and laughs suggested that the happy facial expression was associated with a happy dreaming scenario. Smiling and laughing occasionally persist during adult sleep. There are several lines of evidence suggesting that these happy emotional expressions reflect a true inner mirth.

Continued Presence of Period Limb Movements During REM Sleep in Patients With Chronic Static Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS).

A major component of pediatric acute-onset neuropsychiatric syndrome (PANS) is disruption of sleep. These disturbances have been reported in the acute phase of diagnosis but it is unknown if these sleep disruptions persist, especially in patients with chronic static symptoms. This retrospective chart review sought to review polysomnography (PSG) tests of patients in whom PANS has been clinically diagnosed in order to assess sleep architecture, periodic limb movements, and presence of rapid eye movement (REM) sleep without atonia (RSWA) after a chronic static course of symptoms, which were refractory to immunomodulatory interventions. Patients were retrospectively identified through the PANS clinic at our institution and had to have fully completed a PSG study and be younger than 18 years. PSG with video were reviewed and scored based on established criteria. We identified 9 patients who met inclusion criteria. The median time from presentation to PSG was 4 years. This study identified PSG-measured periodic limb movement index (PLMI) > 5 events/h in REM sleep in 7 of 9 patients. Two patients with elevated PLMI also demonstrated RSWA, although neither fit a clinical diagnosis of REM sleep behavior disorder. This cohort also demonstrated increased onset of REM sleep (median 134 minutes), insomnia (median total sleep time of 389 minutes), and decreased sleep efficiency (77%). This study identifies continued sleep disturbances in patients with refractory PANS symptoms several years after diagnosis and treatment. Continued sleep disturbances after presentation and treatment in patients with chronic static PANS may be a contributing factor in prolonged symptomatology of this disease process.

Sleep disorders in neurological diseases

Sleep disorders can be diagnosed in approximately 15 % of the population and have been shown to increase with age. The relationship between sleep disorders and neurological disorders, however, is still insufficiently considered in the clinical practice. Sleep disorders can be an early symptom of the disease, such as the presence of rapid eye movement (REM) sleep behavior disorder (RBD) as an early indicator of neurodegeneration. Sleep disorders have also been shown to be a main symptom of various neurological syndromes, such as in restless legs syndrome (RLS), periodic limb movement disorder (PLMD) and narcolepsy. The international classification of sleep disorders 2nd edition (ICSD 2) describes the main diagnoses, insomnia, circadian rhythm sleep disorders, sleep-related breathing disorders and hypersomnia but all of these can also appear as symptoms in various neurological diseases. Parasomnias are largely considered a differential diagnosis to nocturnal epilepsy. In this review, the main sleep disorders are described with a particular focus on how they relate to neurological diseases; in particular, how they influence disease-related symptoms and how they affect the course of the disease.

Neurobiologic Mechanisms of Sleep and Wakefulness

Neurobiologic Mechanisms of Sleep and Wakefulness

Avaliação do estado comportamental durante o sono em recém-nascidos

INTRODUÇÃO: A identificação dos estados comportamentais é um fator determinante na avaliação clínica e neurofisiológica de neonatos e apresenta-se como indicador importante do desenvolvimento normal e anormal do sistema nervoso central. As variáveis fisiológicas importantes na avaliação comportamental são: freqüência cardíaca, freqüência respiratória, presença de movimentos oculares rápidos, eletromiograma (EMG), eletroencefalograma (EEG). As variáveis comportamentais são abertura e fechamento dos olhos, movimentos corporais e choro. MÉTODOS: Neste artigo, foi feita uma revisão da literatura no período de 1970-2008 utilizando os unitermos: estado comportamental e recém-nascidos, sono e recém-nascidos e, EEG e comportamento. Utilizou-se os banco de dados Medline, Scielo e Web of Science. Esta revisão foi desenvolvida no período de agosto a novembro de 2008. CONCLUSÕES: A sistematização dos achados do comportamento em recém-nascidos associado à organização bioelétrica e grafoelementos permite identificar precocemente o comprometimento encefálico e prognóstico de recém-nascidos de risco e de muito baixo peso. Na literatura existem controvérsias em relação à padronização e sistematização dos estados comportamentais de crianças prematuras, diferente do que ocorre em neonatos a termo onde estes aspectos já estão definidos.

The effect of multilevel upper airway surgery on continuous positive airway pressure therapy in obstructive sleep apnea/hypopnea syndrome

To investigate the effect of multilevel upper airway surgery (USA) on subsequent continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Fifty-two patients who underwent multilevel UAS with persistent symptoms of OSAHS represent the cohort for this study. All patients had undergone manual CPAP titrations both pre- and postoperatively. Patients were used as their own controls and were compared pre- and postoperatively with regard to body mass index, full night polysomnography (PSG), optimal CPAP pressure settings, presence of rapid eye-movement (REM) sleep, identification of mouth leakage, and CPAP compliance. Postoperative values for apnea index (AI), apnea hypopnea index (AHI), and minimum oxygen saturation (min SaO(2)) were all significantly decreased from their preoperative levels. Compliance with CPAP therapy significantly increased from a mean 0.02 +/- 0.14 hours per night prior to surgery to a 3.2 +/- 2.6 hours per night following surgery (P < .001). In addition, the optimal CPAP pressure setting decreased significantly for a preoperative value of 10.6 +/- 2.1 cm H(2)O to 9.8 +/- 2.1 cm H(2)O following surgery. Fifty of the 52 patients (96.2%) studied were able to maintain optimal pressure settings without mouth leak, postoperatively. In this study, most patients who had persistent symptoms of OSAHS after multilevel UAS did not have significant mouth leak that would preclude CPAP therapy. In this cohort of patients, CPAP pressure setting as well as compliance was significantly improved postoperatively.

Polysomnographic pattern recognition for automated classification of sleep-waking states in infants.

A robust, automated pattern recognition system for polysomnography data targeted to the sleep-waking state and stage identification is presented. Five patterns were searched for: slow-delta and theta wave predominance in the background electro-encephalogram (EEG) activity; presence of sleep spindles in the EEG; presence of rapid eye movements in an electro-oculogram; and presence of muscle tone in an electromyogram. The performance of the automated system was measured indirectly by evaluating sleep staging, based on the experts' accepted methodology, to relate the detected patterns in infants over four months of post-term age. The set of sleep-waking classes included wakefulness, REM sleep and non-REM sleep stages I, II, and III-IV. Several noise and artifact rejection methods were implemented, including filters, fuzzy quality indices, windows of variable sizes and detectors of limb movements and wakefulness. Eleven polysomnographic recordings of healthy infants were studied. The ages of the subjects ranged from 6 to 13 months old. Six recordings counting 2665 epochs were included in the training set. Results on a test set (2,369 epochs from five recordings) show an overall agreement of 87.7% (kappa 0.840) between the automated system and the human expert. These results show significant improvements compared with previous work.

Spectral Features of EEG Alpha Activity in Human REM Sleep: Two Variants with Different Functional Roles?

Evidence suggests that an important contribution of spectral power in the alpha range is characteristic of human REM sleep. This contribution is, in part, due to the appearance of well-defined bursts of alpha activity not associated with arousals during both tonic and phasic REM fragments. The present study aims at determining if the REM-alpha bursts constitute a different alpha variant from the REM background alpha activity. Since previous findings showed a selective suppression of background alpha activity over occipital regions during phasic REM fragments and, on the other hand, the density of alpha bursts seem to be independent of the presence or absence of rapid eye movements, one expects to find the same spectral power contribution of alpha bursts in tonic and phasic REM fragments. The results indicated that REM-alpha bursts showed a similar power contribution and topographic distribution (maximum energy over occipital regions) both in tonic and phasic REM fragments. This suggests that two variants of alpha activity with different functional roles are present during the human REM sleep: i) background alpha activity, modulated over occipital regions by the presence of rapid eye movements, which may be an electrophysiological correlate of the visual dream contents; and ii) REM-alpha bursts, independent of the presence of rapid eye movements, which could be facilitating the connection between the dreaming brain and the external world, working as a micro-arousal in this brain state.

Narcolepsy in Hong Kong Chinese--a preliminary experience.

Narcolepsy is a sleep disorder of unknown aetiology. Despite the widely reported strong association with HLA DR2 among different ethnic groups and their varying prevalence rates, there has never been any series of laboratory documented narcolepsy in Chinese. To report the preliminary experience with Chinese narcoleptic patients and their HLA typing. The records of 342 patients who presented to our sleep laboratory for various sleep problems from 1986 to 1992 were examined. Both clinical and polysomnographic data were analysed. The criteria for a diagnosis of narcolepsy is based on shortened mean sleep latency of less than 5 minutes and presence of rapid eye movement (REM) sleep in two or more of the five 20-minute naps during multiple sleep latency test (MSLT). There were five narcoleptic patients documented resulting in an overall laboratory prevalence of 1.5% or 2.3% of patients presenting with hypersomnia. All patients were HLA DR2 positive. There is 100% association with HLA DR2 in Hong Kong Chinese narcoleptic patients. Based on the laboratory prevalence, the prevalence rate of narcolepsy among Hong Kong Chinese population is estimated to be within the range of four in 10,000 to one in 100,000.

Respiratory function of the larynx in developing sheep and the influence of sleep state

The activities of laryngeal abductor and adductor muscles were recorded in conjunction with other respiratory muscles in unanaesthetized chronically monitored foetal, newborn and adult sheep. In foetuses, rhythmical breathing movements occurred in the presence of rapid eye movements and a low voltage electrocorticogram (REM state) and were accompanied by phasic laryngeal abduction; adductor muscles and intercostals were largely inactive. During the foetal non-REM state laryngeal adductor muscles were tonically active at a low level, but the glottis remained open. Deep inspiratory efforts which occurred at low frequency in this behavioural state were not accompanied by abductor activity and resembled inspiratory efforts associated with regurgitation in ruminants. After birth, expiratory adductive activity of the larynx was also maximal during non-REM sleep and negligible during REM sleep. Active laryngeal adduction was accompanied by delayed expiratory airflow, prolonged T e and reduced respiratory frequency. Adduction of the larynx is dependent on behavioural state and appears to be the principal means of regulating T e in sheep, particularly during early post-natal development.

EXPERIMENTAL STUDY OF SUPERVISION OF PSYCHOTHERAPY.

Teaching psychotherapy by supervision is an integral part of the training program of most residency centers.^{2,12,14,21,26}Supervision has both intellectual and emotional components. However, because there are status and evaluative components to the relationship between the supervisor and supervisee, it is difficult to get valid information about all the emotional overtones of the supervisory process. Since dreams provide a rapid entree into emotional attitudes, we decided to use dreams as a method of evaluating and formulating the triad of patient-therapist-supervisor. <h3>Procedure</h3> In order to insure sufficient numbers of dreams, and also their simultaneity of occurrence in the various members of the triad, we used a modified Kleitman technique^3,4,7,27of collecting dreams. This consists of awakening the patient when the presence of rapid eye movements indicates dreaming. The patient and the therapist each slept in different dream laboratories in different buildings on the

REPORTS OF MENTAL ACTIVITY DURING SLEEP.

The variety of mental activity during sleep was investigated by obtaining reports of this activity upon awakening from two different kinds of sleep: (1) REM (rapid eye-movement) periods, which are characterized by a low voltage, random EEG and the presence of rapid eye-movements, and (2) NREM periods, which are characterized by 12–14 cps sleep spindles and/or slow, high amplitude delta EEG activity and the absence of rapid eye-movements. A total of 186 awakening reports were obtained from 17 subjects who spent from one to three nights each sleeping in the laboratory. As had been described in earlier investigations, reports of mental activity during sleep were obtained more frequently on awakenings from REM periods than on awakenings from NREM periods. However, a considerable amount of mental activity was obtained on NREM awakenings. As compared with REM period mentation, this NREM mental activity was described as more like thinking and less like dreaming, less vivid, less visual, more conceptual, under greater volitional control, more plausible, more concerned with the contemporary life of the subject, occurring in lighter sleep, less emotional, and more pleasant. The NREM mental activity was interpreted as resembling the unfocused, floating, background mentation of waking life, and it was hypothesized that the poor recall for this type of mentation might be related to its relative lack of perceptual intensity.