Sleep-wake Transition Research Articles

Sleep disturbances and behavior in Smith-Magenis syndrome

BackgroundThe Smith-Magenis syndrome (SMS) shows a collection of neurodevelopmental problems including mild to moderate intellectual disability, change-related anxiety, impulsivity, speech delay, Attention-Deficit/Hyperactivity Disorder (ADH) and sleep disturbances. Sleep disorders, when present, have been treated in several populations with consecutive improvements in cognitive and behavioral aspects. AimsTo better understand the existing relationships between sleep disturbances and behavioral problems in SMS syndrome this study describes the sleep and behavior problems in the SMS and explores the possible relation between both. Methods and procedures17 individuals with SMS (50% males; 11.2 ± 4.9 years old) and 12 individuals with typical development (50% male; 11.1 ± 4.4 years old) were investigated using the Sleep Disturbance Scale for Children and the Child Behavior Checklist. ResultsA high percentage (60%) of individuals with SMS have an indication of sleep disorders, being the most frequent disorders the sleep-wake transition disorders, and disorders of initiating and maintaining sleep with sleep latency higher than acceptable and total sleep time below acceptable. More than 94% of the SMS group presented clinical or borderline scores on the total behavioral problems scale. The most common behavioral problems were Externalizing Problems, Thought and Attention, ADH and Aggressive problems. There was a positive correlation between disorders of initiating and maintaining sleep, sleep-wake transition disorders, disorders of arousal, disorders of excessive somnolence and behavioral problems. Conclusions and implicationsThe worse the sleep disturbances investigated, the more severe the behavioral problems characteristics reinforcing the importance to address the sleep problems in the treatment of SMS individuals.

Agonists and antagonists of the orexinergic system: therapeutic molecules of the future - a narrative review

<p>The orexinergic system involves orexin (OX) neurons, OX peptides, and OX receptors. OX neurons are located throughout the central nervous tissue (including many nuclei) and the peripheral nervous tissue and organs. These neurons are critically involved in the sleepwake transition, cardiorespiratory, and autonomic regulations. OX antagonists include selective OX type 1 receptor (OX1R) antagonists, selective OX type 2 receptor (OX2R) antagonists, and dual OX1/2R antagonists. Similarly, OX agonists include dual OX1/2R agonists and selective OX1R or OX2R agonists. Recent understandings of the therapeutic mechanism of OX have led to possible therapeutic options in diseases such as insomnia, narcolepsy, psychiatric disorders, and neurodegenerative diseases. This review focuses on the therapeutic roles of OXs as agonists or antagonists in animal models and human patients, which can lead to possible avenues related to their application in health and disease.</p>

0092 The Effects of Slow-Oscillatory Galvanic Vestibular Stimulation on Sleep Physiology in Healthy Humans

Abstract Introduction Recent studies have demonstrated that rocking promotes sleep in animals and humans. The application of an alternating current galvanic vestibular stimulation (GVS) can elicit body sway like rocking sensation. Here, we examined the effects of slow-oscillatory GVS, which can evoke the virtual rocking sensation in the brain, on objective and subjective sleep quality in healthy young adults. Methods We studied 14 healthy subjects (age: 22.7 p/m 1.4 years) who underwent 3 nap conditions (adaptation, sham [SHAM], and stimulation [STIM]), where SHAM and STIM were randomly allocated with a 1-week interval in general. The polysomnographic recordings were started at 2 pm and time in bed was restricted to 90 min for all subjects. In both conditions, electrodes were placed on both mastoids for GVS; in STIM condition, the slow-oscillatory (0.25 Hz sinusoidal) GVS was applied throughout the nap period with a current intensity of approximately 80% of sensory thresholds of each subject. The pattern of center of pressure during quiet standing was also measured using a force plate, with or without the same slow-oscillatory GVS. We analyzed sleep variables and electroencephalographic (EEG) spectral power and compared them between STIM and SHAM. Subjective sleep quality was also measured and compared between STIM and SHAM. Results We confirmed that subsensory slow-oscillatory GVS induced body sway corresponding to the stimulation frequency for all subjects. We found that sleep latency was significantly shorter and total sleep time as well as N2 duration were significantly longer in STIM than in SHAM. N3 duration did not differ significantly between the conditions. EEG power spectrum densities in delta, theta, and sigma bands were significantly greater in STIM than in SHAM. Subjective sleep quality was significantly better in STIM than in SHAM. Conclusion We demonstrated that subsensory slow-oscillatory GVS facilitated wake-sleep transition and improved objective and subjective sleep quality. The results suggest that weak periodic inputs into vestibular systems promote sleep by modulating the thalamocortical mechanisms in humans. This finding may open a new avenue toward a development of novel techniques for human sleep augmentation. Support (If Any) JST PRESTO (JPMJPR19J3) and JSPS KAKENHI (18K17891) to AK.

The activation of C1 neurons during REM sleep is dependent on the arterial baroreflex

IntroductionNatural sleep‐wake patterns are associated with changes in sympathetic nerve activity (SNA) controlling cardiovascular function. The mechanisms underlying the effects of sleep‐wake state on SNA are not well understood. C1 neurons in the rostral ventrolateral medulla regulate cardiovascular function through SNA and mediate the sympathetic arterial baroreflex. In this study we determine the effect of sleep‐wake transitions on the activity of C1 neurons and investigate the contribution of the arterial baroreflex to these effects.MethodsThe activity of C1 neurons was measured using fiber photometry (calcium imaging) in freely behaving adult rats while monitoring the vigilance states. C1 neurons were targeted with GCaMP7s by microinjection of AAV1‐syn‐FLEX‐jGCaMP7s in the RVLM of Tyrosine Hydroxylase‐Cre transgenic rats, an optical fiber was implanted above the injection site, rats were fitted with a EEG/EMG head stage to monitor sleep‐wake state, and a radio telemetry probe to record BP. One month after the surgery, C1 neuron activity was recorded before and 7 days after sino‐aortic denervation to eliminate inputs from arterial baroreflex. Normalized fluorescence changes are expressed as Z‐score (mean ± SD) and t‐test was used to determine statistically significant differences.ResultsC1 activity was increased by acute hypotension induced by sodium nitroprusside (2.1 ± 0.5 vs. ‐0.92 ± 0.4, p<0.0001, n=5), indicating the barosensitive nature of the recorded cells. C1 activity increased during transitions from NREM to wake (‐0.60 ± 0.1 vs. 0.59 ± 0.2, p<0.0001, n=6) and decreased during transitions from wake to NREM (0.34 ± 0.2 vs. ‐0.32 ± 0.2, p<0.0001, n=6). C1 activity increased during transitions from NREM to REM sleep (‐0.74 ± 0.1 vs. 0.77 ± 0.1, p<0.0001, n=6) and decreased in transitions from REM to wake (0.58 ± 0.2 vs. ‐0.59 ± 0.2, p<0.0001, n=5). Baroreceptor denervation attenuates the increase in C1 neuron activity during REM sleep (0.4 ± 0.7 vs1.8 ± 0.4 Δ Z‐score, p=0.0054, n=4) and during wakefulness (0.59 ±0.6 vs 1.6 ± 0.4, p=0.0210, n=4) when compared to the increase before sino‐aortic denervation.ConclusionC1 neuron activity during sleep‐wake transitions mirrors the pattern of SNA. This observation indicates that C1 neurons contribute to changes in SNA associated with natural sleep‐wake patterns. Baroreceptor denervation attenuates the change in C1 activity observed during transitions to REM, indicating that the feedback from the arterial baroreflex contributes to the elevation in C1 activity in this sleep state.

Decoupling Sleep and Brain Size in Childhood: An Investigation of Genetic Covariation in the Adolescent Brain Cognitive Development Study

BackgroundChildhood sleep problems are common and among the most frequent and impairing comorbidities of childhood psychiatric disorders. In adults, sleep disturbances are heritable and show strong genetic associations with brain morphology; however, little is known about the genetic architecture of childhood sleep and potential etiological links between sleep, brain development, and pediatric-onset psychiatric symptoms. MethodsUsing data from the Adolescent Brain Cognitive Development Study (nPhenotype = 4428 for discovery/replication, nGenetics = 4728; age 9–10 years), we assessed phenotypic relationships, heritability, and genetic correlations between childhood sleep disturbances (insomnia, arousal, breathing, somnolence, hyperhidrosis, sleep-wake transitions), brain size (surface area, cortical thickness, volume), and dimensional psychopathology. ResultsSleep disturbances showed widespread positive associations with multiple domains of childhood psychopathology; however, only insomnia showed replicable associations with smaller brain surface area. Among the sleep disturbances assessed, only insomnia showed significant heritability (h2SNP = 0.15, p < .05) and showed substantial genetic correlations with externalizing and attention-deficit/hyperactivity disorder symptomatology (rGs > 0.80, ps < .05). We found no evidence of genetic correlation between childhood insomnia and brain size. Furthermore, polygenic risk scores calculated from genome-wide association studies of adult insomnia and adult brain size did not predict childhood insomnia; instead, polygenic risk scores trained using attention-deficit/hyperactivity disorder genome-wide association studies predicted decreased surface area at baseline as well as insomnia and externalizing symptoms longitudinally. ConclusionsFindings demonstrate a distinct genetic architecture underlying childhood insomnia and brain size and suggest genetic overlap between childhood insomnia and attention-deficit/hyperactivity disorder symptomatology. Additional research is needed to examine how genetic risk manifests in altered developmental trajectories and comorbid sleep/psychiatric symptoms across adolescence.

Sleep disorders in children and adolescents with tension-type headaches

Introduction. Tension-type headache (TTH) represents a widespread and recurrent disease in adults, children, and adolescents, adversely affecting the quality of life, learning achievements, and social functioning. In recent publications, a high incidence of comorbid disorders in patients with TTH is discussed, in particular sleep disorders. The aim of the study was to assess the nature and prevalence of sleep disorders in children and adolescents with frequent episodic TTH and chronic TTH. Materials and methods. One hundred fifty patients aged from 8 years to 16 years 11 months with TTH were examined. Of them, 91 (49 boys, 42 girls) had frequent episodic TTH, 59 (26 boys, 33 girls) had chronic TTH. There was used Sleep Disturbance Scale for Children including 26 questions for parents. Results. The present study confirms the high incidence of sleep disorders among TTH children and adolescents. TTH was diagnosed in 129 (86.0%) out of 150 patients. The most frequently diagnosed varying degrees of severity (clinically relevant and borderline, when assessing sleep disorders in children) were insomnia (disorders of initiating and maintaining sleep) - in 65.3% of patients (including 60.4% with frequent episodic TTH and 72.9% with chronic TTH), excessive somnolence - in 74.7% (67.1% and 86.4%), sleep breathing disorders - in 26.7% (23.1% and 32.2%), disorders of arousal/nightmares - in 46.0% (42.9% and 50.8%), sleep-wake transition disorders - in 65.3% (67.1% and 62.7%), sleep hyperhidrosis - in 31.3% (26.4% and 39.0%). Thus, all sleep disorders (except for sleep-wake transition disorders) were significantly more common among the patients with chronic TTH. At the same time, in the subgroup of patients with TTH and any sleep disorders, significantly more prominent indicators of the frequency, the intensity of TTH and its negative impact on the daily activity were revealed, compared to patients with TTH lacking sleep disorders. Conclusion. The results of the assessment of children and adolescents with TTH show that when planning preventive therapy for TTH and evaluating its results, not only main clinical characteristics of TTH should be taken into account, but also the manifestations and severity of comorbid disorders, including sleep disorders observed in most patients with TTH. The revealed prevalence of various sleep disorders in the subgroup of patients with chronic TTH confirms that sleep disorders and anxiety disorders refer to significant risk factors for the transition of TTH to a chronic form, and such patients need more active multimodal treatment.

Low sleep quality and morningness-eveningness scale score may impair ball placement but not kicking velocity in youth academy soccer players

ABSTRACT Purpose: The current study examined the possible relationships between one-off single night sleep metrics and subsequent kicking performance in a youth soccer context. Methods: Twenty-eight under-17 academy players (15.9 ± 0.8 years-old) completed a kick testing protocol consisting in 20 attempts, 18 m from the goal and against a goalkeeper. Four digital video cameras (240 Hz) allowed to determine 3-D approach run, lower limb and ball velocities. Two additional cameras (60 Hz) were used to calculate 2-D mean radial error, bivariate variable error and accuracy. Over 24 h prior to testing, players were monitored by wrist actigraphy to determine their sleep indices. Self-reported sleep quality, sleepiness and chronotype scale scores (Horne and Östberg morningness-eveningness questionnaire) were also collected immediately before kicking experiment. Results: Multiple linear regressions indicated that wake up time and chronotype contributed to 40% of mean radial error. Self-reported sleep quality influenced respectively on 19% and 24% of accuracy and bivariate variable error variances. Taken together self-reported sleep quality and wake up time explained 33% of accuracy (all p < 0.05). Indicators of kicking velocity were non-significantly correlated with sleep (r = −0.30–0.29; p > 0.05). Conclusion: One-off sleep measures showed some sensitivity to acutely detect inter-individual oscillations in kicking performance. Low perceived sleep quality, later wake up time and a chronotype toward evening preference seem either related to immediately subsequent worst ability of ball placement when kicking. Monitoring sleep-wake transition and perceived sleep quality may be important to help prevent acute performance declines in targeting the goal during kick attempts from the edge of penalty area.

Exposure to second-hand smoke during early life and subsequent sleep problems in children: a population-based cross-sectional study

BackgroundPrevious studies have revealed that current secondhand smoke exposure showed highly suggestive evidence for increased risk of simultaneous sleep problems in children. Data on the associations between early-life exposure to SHS with subsequent sleep problems in children were scarce. We aimed to evaluate the associations of early-life SHS exposure with sleep problems in children.MethodsIn this cross-sectional study, children were recruited from elementary and middle schools in Liaoning Province, China between April 2012 and January 2013. We assessed early-life SHS exposure (pregnancy and the first 2 years of life) via questionnaires. Sleep problems and different types of sleep-related symptoms were measured based on the validated tool of the Sleep Disturbance Scale for Children (SDSC). Generalized linear mixed models were applied to estimate the associations of early-life SHS exposure with sleep problems.ResultsWe included a total of 45,562 children (22,657 [49.7%] males; mean [SD] age, 11.0 [2.6] years) and 6167 of them (13.5%) were exposed to early-life SHS during both pregnancy and the first 2 years of life. Compared with unexposed counterparts, children exposed to early-life SHS had higher total T-scores of SDSC (β = 4.32; 95%CI: 4.06, 4.58) and higher odds of increased sleep problems (OR = 2.14; 95%CI: 1.89, 2.42). When considering different sleep-related symptoms, the associations between early-life SHS exposure and symptom of sleep-wake transition disorders (i.e., bruxism) were the strongest in all analyses.ConclusionsEarly-life SHS exposure was associated with higher odds of global sleep problems and different sleep-related symptoms in children aged 6–18 years. Our findings highlight the importance to strengthen efforts to support the critical importance of maintaining a smoke-free environment especially in early life.

Sleep and daytime behavior in individuals with Christianson Syndrome

BackgroundThe objectives of this study were to: 1) characterize the sleep behaviors and symptoms of individuals with Christianson Syndrome (CS) by means of validated questionnaires; and 2) determine their associations with daytime emotional and behavioral symptoms in this population. MethodsParticipants included 16 boys genetically diagnosed with CS, between 2.5 and 40 years of age (M = 14.5 ± 8.08). Parents completed questionnaires regarding the sleep, daytime behavior, and health of their child. ResultsOf the participants, 31% did not obtain the recommended amount of sleep for their age, 43% experienced a prolonged sleep latency, and 88% had a clinical or sub-clinical score for at least one subscale of the Sleep Disturbance Scale for Children (SDSC). Specific problems detected included insomnia, sleep–wake transition disorders, periodic limb movements in sleep, and sleep related breathing disorders. About half of the participants manifested emotional and behavioral problems at clinical levels. Higher levels of sleep disturbances were associated with higher levels of behavioral and emotional daytime symptoms. ConclusionsSleep problems are common in individuals with CS and are associated with daytime behavioral and emotional symptoms.

RoWDI: rolling window detection of sleep intrusions in the awake brain using fMRI

Objective. Brief episodes of sleep can intrude into the awake human brain due to lack of sleep or fatigue—compromising the safety of critical daily tasks (i.e. driving). These intrusions can also introduce artefactual activity within functional magnetic resonance imaging (fMRI) experiments, prompting the need for an objective and effective method of removing them. Approach. We have developed a method to track sleep-like events in awake humans via rolling window detection of intrusions (RoWDI) of fMRI signal template. These events can then be used in voxel-wise event-related analysis of fMRI data. To test this approach, we generated a template of fMRI activity associated with transition to sleep via simultaneous fMRI and electroencephalogram (EEG) (N = 10). RoWDI was then used to identify sleep-like events in 20 individuals performing a cognitive task during fMRI after a night of partial sleep deprivation. This approach was further validated in an independent fMRI dataset (N = 56). Main results. Our method (RoWDI) was able to infer frequent sleep-like events during the cognitive task performed after sleep deprivation. The sleep-like events were associated with on average of 20% reduction in pupil size and prolonged response time. The blood-oxygen-level-dependent activity during the sleep-like events covered thalami-cortical regions, which although spatially distinct, co-existed with, task-related activity. These key findings were validated in the independent dataset. Significance. RoWDI can reliably detect spontaneous sleep-like events in the human brain. Thus, it may also be used as a tool to delineate and account for neural activity associated with wake-sleep transitions in both resting-state and task-related fMRI studies.

Prevalence of Sleep Disorders in Children with Cerebral Palsy; A Questionnaire-based Observational Study.

Cerebral palsy (CP), the most common developmental disorder, has many comorbidities (epilepsy and behavioral issues). Sleep disturbances are common complaints of parents and are usually neglected in pediatric populations in comparison to other well-documented co-morbidities of CP but may have a significant effect on the quality of life of children and their parents. To study the prevalence and pattern of sleep disorders (SD) in children with CP. Questionnaire-based observational study. Pediatric tertiary care center. The study was done over 6 months. In total, 200 children with CP between the ages of 1 year to 14 years were included in the study by convenience sampling. Co-morbid health problems involving cardiorespiratory system, other illness (e.g. epilepsy and gastroesophageal reflux disease), or children on anticonvulsant medications altering sleep patterns were excluded. The Sleep Disturbance Scale for Children (SDSC) was administered to assess the presence of pathological sleep and type of SD ranging between Disorders of Initiation and Maintenance of Sleep (DIMS), Sleep Breathing disorders (SBD), Disorders of Arousal (DA), Sleep-Wake Transition Disorders (SWTD), Disorders of Excessive Somnolence (DES), and Sleep Hyperhydrosis (SHY). Sixty-two percentage of children (124) had a pathological total sleep score (score >39). DIMS are the most common, occurring in 78.2% of subjects with a pathological sleep score (score >39). Quadriplegics [n = 96, mean score = 49.86(16.38)] and GMFCS V [n = 19, mean score = 58.00(17.10)] are most severely affected. Children with CP have under-reported SD and DIMS is the most common type of SD. There is a linear correlation between the extent of topographical and motor afflictions and SD.

Sleep-wake dynamics pre- and post-exposure to chronic social stress

SummaryAn analytical approach combining the statistical distributions of the sleep-wake bouts and the Markov transition matrix is used to explain the under-examined association between the microarchitecture of the sleep-wake cycle and susceptibility to chronic social stress in C57BL/6J mice. We separated the sleep-wake transitions into distinct sleep-wake sequences, NREM↔Wake and NREM→REM→Wake, which are controlled by independent neural circuits. Our findings imply greater pull toward the wake leading to early termination and fragmentation of the sleep bouts in the light in both sleep-wake sequences pre- and post-stress. Moreover, the stability of NREM in the NREM↔Wake transition was lower, and the probability of transitioning to wake was higher in susceptible relative to resilient or stress-naïve mice pre- and post-stress. Our findings help elucidate the mechanistic interplay between sleep and mood by suggesting the potential neural underpinnings of sleep disturbances responsible the aberrant transitions of sleep-wake bouts exhibited by the stress-susceptible phenotype.

The Regional EEG Pattern of the Sleep Onset Process in Older Adults.

Healthy aging is characterized by macrostructural sleep changes and alterations of regional electroencephalographic (EEG) sleep features. However, the spatiotemporal EEG pattern of the wake-sleep transition has never been described in the elderly. The present study aimed to assess the topographical and temporal features of the EEG during the sleep onset (SO) in a group of 36 older participants (59–81 years). The topography of the 1 Hz bins’ EEG power and the time course of the EEG frequency bands were assessed. Moreover, we compared the delta activity and delta/beta ratio between the older participants and a group of young adults. The results point to several peculiarities in the elderly: (a) the generalized post-SO power increase in the slowest frequencies did not include the 7 Hz bin; (b) the alpha power revealed a frequency-specific pattern of post-SO modifications; (c) the sigma activity exhibited only a slight post-SO increase, and its highest bins showed a frontotemporal power decrease. Older adults showed a generalized reduction of delta power and delta/beta ratio in both pre- and post-SO intervals compared to young adults. From a clinical standpoint, the regional EEG activity may represent a target for brain stimulation techniques to reduce SO latency and sleep fragmentation.

A series of 8 cases of sleep-related psychogenic dissociative disorders and proposed updated diagnostic criteria.

To identify the most relevant clinical and video-polysomnographic characteristics of patients with sleep-related dissociative disorders (SRDDs) and to propose a framework for new diagnostic criteria. We searched potential SRDD cases from the scientific literature and from a database of patients referred for clinical and video-polysomnographic assessment in a single sleep disorders center for disruptive nocturnal behaviors (n = 731). The most relevant clinical and neurophysiological characteristics of the cases were extracted and a descriptive analysis was performed. Twenty-six SRDD cases (8 new and 18 previously published cases) were reviewed. Almost all cases of SRDDs occurred in a context of past traumatic events or abuse and were associated with at least 1 comorbid psychiatric disorder. We highlighted 4 relevant clinical characteristics of SRDD useful for the differential diagnosis with parasomnias: episodes of long duration of more than 1 hour (90.9%), self-inflicted injuries (83.3%), occurrence while awake close to bedtime (35.7%), and the presence of daytime dissociative symptoms (72.7%). The video-polysomnography documented typical episodes of SRDD with prolonged wakefulness before, during, and after the event in 11/26 cases. New diagnostic criteria for SRDD were proposed, with 3 levels of certainty for the diagnosis based on clinical, video-polysomnographic, and homemade video findings. More than 30 years after its formal identification, SRDD is not currently recognized as an official diagnostic entity. We better delineate the clinical and neurophysiological features of SRDD and propose a framework for its reinstatement in the next revisions of the sleep and psychiatric disorders classifications. Lopez R, Lefevre L, Barateau L, Micoulaud-Franchi J-A, Dauvilliers Y, Schenck CH. A series of 8 cases of sleep-related psychogenic dissociative disorders and proposed updated diagnostic criteria. J Clin Sleep Med. 2022;18(2):563-573.

Melatonin supplementation in the subacute phase after ischemia alleviates postischemic sleep disturbances in rats.

BackgroundSleep disorders are highly prevalent among stroke survivors and impede stroke recovery. It is well established that melatonin has neuroprotective effects in animal models of ischemic stroke. However, as a modulator of endogenous physiological circadian rhythms, the effects of melatonin on poststroke sleep disorders remain unclear. In the present study, we investigated how melatonin delivered intraperitoneally once daily in the subacute phase after stroke onset, influencing neuronal survival, motor recovery, and sleep–wake profiles in rats.MethodsTransient ischemic stroke in male Sprague–Dawley rats was induced with 30 min occlusion of the middle cerebral artery. Melatonin or vehicle was delivered intraperitoneally once daily in the subacute phase, from 2 to 7 days after stroke. Electroencephalogram and electromyogram recordings were obtained simultaneously.ResultsCompared to the effects observed in the vehicle‐treated ischemic group, after 6 daily consecutive treatment of melatonin at 10 mg/kg starting at ischemic/reperfusion day 2, the infarct volume was significantly decreased (from 39.6 to 26.2%), and the degeneration of axons in the ipsilateral striatum and the contralateral corpus callosum were significantly alleviated. Sensorimotor performances were obviously improved as evidenced by significant increases in the latency to falling off the wire and in the use of the impaired forelimb. In addition to those predictable results of reducing brain tissue damage and mitigating behavioral deficits, repeated melatonin treatment during the subacute phase of stroke also alleviated sleep fragmentation through reducing sleep‐wake stage transitions and stage bouts, together with increasing stage durations. Furthermore, daily administration of melatonin at 9 a.m. significantly increased the nonrapid eye movement sleep delta power during both the light and dark periods and decreased the degree of reduction of the circadian index.ConclusionsMelatonin promptly reversed ischemia‐induced sleep disturbances. The neuroprotective effects of melatonin on ischemic injury may be partially associated with its role in sleep modulation.

Trastornos del sueño en niños con epilepsia

IntroductionChildren with epilepsy present greater prevalence of sleep disorders than the general population. Their diagnosis is essential, since epilepsy and sleep disorders have a bidirectional relationship. ObjectiveDetermine the incidence of sleep disorders and poor sleep habits in children with epilepsy. MethodsWe conducted a cross-sectional study of patients under 18 years of age with epilepsy, assessing sleep disorders using the Spanish-language version of the Sleep Disturbance Scale for Children (SDSC), and sleep habits using an original questionnaire. ResultsThe sample included 153 patients. Eighty-four percent of our sample presented some type of sleep alteration. The most frequent alterations were sleep-wake transition disorders (53%), sleep initiation and maintenance disorders (47.7%), and daytime sleepiness (44.4%). In 70% of cases, the patients’ parents reported that their child “slept well,” although sleep disorders were detected in up to 75.7% of these patients. Many patients had poor sleep habits, such as using electronic devices in bed (16.3%), requiring the presence of a family member to fall asleep (39%), or co-sleeping or sharing a room (23.5% and 30.5%, respectively). Those with generalised epilepsy, refractory epilepsy, nocturnal seizures, and intellectual disability were more likely to present sleep disorders. In contrast, poor sleep habits were frequent regardless of seizure characteristics. ConclusionsSleep disorders and poor sleep habits are common in children with epilepsy. Their treatment can lead to an improvement in the quality of life of the patient and his/her family, as well as an improvement in the prognosis of epilepsy.

Different underlying mechanisms for high and low arousal in probabilistic learning in humans

Humans are uniquely capable of adapting to highly changing environments by updating relevant information and adjusting ongoing behaviour accordingly. Here we show how this ability —termed cognitive flexibility— is differentially modulated by high and low arousal fluctuations. We implemented a probabilistic reversal learning paradigm in healthy participants as they transitioned towards sleep or physical extenuation. The results revealed, in line with our pre-registered hypotheses, that low arousal leads to diminished behavioural performance through increased decision volatility, while performance decline under high arousal was attributed to increased perseverative behaviour. These findings provide evidence for distinct patterns of maladaptive decision-making on each side of the arousal inverted u-shaped curve, differentially affecting participants' ability to generate stable evidence-based strategies, and introduces wake-sleep and physical exercise transitions as complementary experimental models for investigating neural and cognitive dynamics.

GABAergic Neurons in the Dorsal-Intermediate Lateral Septum Regulate Sleep-Wakefulness and Anesthesia in Mice.

The γ-aminobutyric acid-mediated (GABAergic) inhibitory system in the brain is critical for regulation of sleep-wake and general anesthesia. The lateral septum contains mainly GABAergic neurons, being cytoarchitectonically divided into the dorsal, intermediate, and ventral parts. This study hypothesized that GABAergic neurons of the lateral septum participate in the control of wakefulness and promote recovery from anesthesia. By employing fiber photometry, chemogenetic and optogenetic neuronal manipulations, anterograde tracing, in vivo electrophysiology, and electroencephalogram/electromyography recordings in adult male mice, the authors measured the role of lateral septum GABAergic neurons to the control of sleep-wake transition and anesthesia emergence and the corresponding neuron circuits in arousal and emergence control. The GABAergic neurons of the lateral septum exhibited high activities during the awake state by in vivo fiber photometry recordings (awake vs. non-rapid eye movement sleep: 3.3 ± 1.4% vs. -1.3 ± 1.2%, P < 0.001, n = 7 mice/group; awake vs. anesthesia: 2.6 ± 1.2% vs. -1.3 ± 0.8%, P < 0.001, n = 7 mice/group). Using chemogenetic stimulation of lateral septum GABAergic neurons resulted in a 100.5% increase in wakefulness and a 51.2% reduction in non-rapid eye movement sleep. Optogenetic activation of these GABAergic neurons promoted wakefulness from sleep (median [25th, 75th percentiles]: 153.0 [115.9, 179.7] s to 4.0 [3.4, 4.6] s, P = 0.009, n = 5 mice/group) and accelerated emergence from isoflurane anesthesia (514.4 ± 122.2 s vs. 226.5 ± 53.3 s, P < 0.001, n = 8 mice/group). Furthermore, the authors demonstrated that the lateral septum GABAergic neurons send 70.7% (228 of 323 cells) of monosynaptic projections to the ventral tegmental area GABAergic neurons, preferentially inhibiting their activities and thus regulating wakefulness and isoflurane anesthesia depth. The results uncover a fundamental role of the lateral septum GABAergic neurons and their circuit in maintaining awake state and promoting general anesthesia emergence time.

Sleep Diagnostics for Home Monitoring of Sleep Apnea Patients.

Objectives: Sleep time information is essential for monitoring of obstructive sleep apnea (OSA), as the severity assessment depends on the number of breathing disturbances per hour of sleep. However, clinical procedures for sleep monitoring rely on numerous uncomfortable sensors, which could affect sleeping patterns. Therefore, an automated method to identify sleep intervals from unobtrusive data is required. However, most unobtrusive sensors suffer from data loss and sensitivity to movement artifacts. Thus, current sleep detection methods are inadequate, as these require long intervals of good quality. Moreover, sleep monitoring of OSA patients is often less reliable due to heart rate disturbances, movement and sleep fragmentation. The primary aim was to develop a sleep-wake classifier for sleep time estimation of suspected OSA patients, based on single short-term segments of their cardiac and respiratory signals. The secondary aim was to define metrics to detect OSA patients directly from their predicted sleep-wake pattern and prioritize them for clinical diagnosis.Methods: This study used a dataset of 183 suspected OSA patients, of which 36 test subjects. First, a convolutional neural network was designed for sleep-wake classification based on healthier patients (AHI < 10). It employed single 30 s epochs of electrocardiograms and respiratory inductance plethysmograms. Sleep information and Total Sleep Time (TST) was derived for all patients using the short-term segments. Next, OSA patients were detected based on the average confidence of sleep predictions and the percentage of sleep-wake transitions in the predicted sleep architecture.Results: Sleep-wake classification on healthy, mild and moderate patients resulted in moderate κ scores of 0.51, 0.49, and 0.48, respectively. However, TST estimates decreased in accuracy with increasing AHI. Nevertheless, severe patients were detected with a sensitivity of 78% and specificity of 89%, and prioritized for clinical diagnosis. As such, their inaccurate TST estimate becomes irrelevant. Excluding detected OSA patients resulted in an overall estimated TST with a mean bias error of 21.9 (± 55.7) min and Pearson correlation of 0.74 to the reference.Conclusion: The presented framework offered a realistic tool for unobtrusive sleep monitoring of suspected OSA patients. Moreover, it enabled fast prioritization of severe patients for clinical diagnosis.

Influence of the practice of sports, sleep disorders, and habits on probable sleep bruxism in children with mixed dentition.

Investigate the association between sleep disorders and probable sleep bruxism (SB) in children eight to ten years of age. A cross-sectional study was conducted with 739 schoolchildren in Brazil. Parents/guardians answered a sociodemographic questionnaire, the sleep disturbance scale for children, and the Circadian Energy Scale. Parafunctional habits were evaluated using the Nordic Orofacial Test-Screening. Multivariate logistic regression was performed (α=5%), and a directed acyclic graph was used in the statistical model. The prevalence of probable SB was 9.1% and 58.6% of the children had sleep disorders. In the final model, having unmarried parents/guardians (OR=1.98; 95% CI: 1.07-3.65), exhibiting parafunctional habits (OR=2.02; CI: 1.01-4.06), not practicing sports (OR=1.92; CI: 1.04-3.54), sleep-wake transition disorders (SWTD) (OR=2.01; 95%CI: 1.12-3.62), and excessive daytime sleepiness (EDS) (OR=2.17; 95%CI: 1.11-4.29) were significant associated with probable SB. The occurrence of probable sleep bruxism was influenced by the marital status of the parents/guardians, parafunctional habits, the non-practice of sports, and sleep disturbance (SWTD and EDS). This research contributes to the planning of public policies that include educational regimens at school to prevent sleep disorders and favor the reduction in sleep bruxism prevalence.