Lipopolysaccharide challenge-induced suppression of Fos in hypothalamic orexin neurons: their potential role in sickness behavior

Orexin neurons in the lateral hypothalamus constitute a critical component in regulation of waking, feeding, and reward-related behaviors. In this study we examined the effects of lipopolysaccharide (LPS) challenge on Fos expression in orexin neurons in rats, to determine changes during sickness in two different behavioral contexts. One cohort of rats was treated with saline or LPS during the daytime, and then tested on an elevated plus maze (EPM) or left in their home cage until sacrifice. Another cohort received LPS or saline shortly before dark onset and was sacrificed 90min into the dark period. The brains were double-stained for Fos and orexin-A immunoreactivity (both cohorts) and for Fos and histidine decarboxylase (dark period cohort). Orexin neurons were strongly activated in context of exploratory behavior (double-labeled for Fos in both medial and lateral portions). LPS challenge prior to maze exposure diminished this activation, most notably among the lateral orexin neurons. In home cage controls, LPS challenge lead to increased Fos expression, most notably in the medial orexin neurons, when compared to saline-injected home cage controls that show little or no Fos during the daytime. In the dark period, Fos expression in both orexin and histaminergic neurons was abundant, which LPS challenge strongly suppressed. These findings are consistent with the hypothesis that the orexin neurons, in conjunction with the histaminergic system, represent a potential target of the neurocircuitry that drives sickness behavior due to peripheral inflammation, likely through functional inhibition of these hypothalamic cell groups.

Projections from auditory cortex to cholinergic cells in the midbrain tegmentum of guinea pigs

Anterograde and retrograde tracing techniques were used to characterize projections from the auditory cortex to the pedunculopontine and laterodorsal tegmental nuclei (PPT and LDT, respectively) in the midbrain tegmentum in guinea pigs. For anterograde tracing, tetramethylrhodamine dextran (FluoroRuby) was injected at several sites within auditory cortex. After sufficient time for transport, the brain was processed for immunohistochemistry with anti-choline acetyltransferase to reveal presumptive cholinergic cells. Anterogradely labeled axons were observed ipsilaterally and, in smaller numbers, contralaterally, in both the pedunculopontine and laterodorsal tegmental nuclei. In all four nuclei, tracer-labeled boutons appeared to contact immunolabeled (i.e., cholinergic) cells. The contacts occurred on cell bodies and dendrites. The results were similar following injections that spread across multiple auditory cortical areas or injections that were within primary auditory cortex. In order to confirm the anterograde results, in a second series of experiments, retrograde tracers were deposited in the pedunculopontine tegmental nucleus. These injections labeled layer V pyramidal cells in the auditory cortex. The results suggest an excitatory projection from primary auditory cortex bilaterally to cholinergic cells in the midbrain tegmentum. Such a pathway could allow auditory cortex to activate brainstem cholinergic circuits, possibly including the cholinergic pathways associated with arousal and gating of acoustic stimuli.

Sleep and headache

There is a strong interaction between sleep and headache. Sleep and headache disorders overlap epidemiologically, and share elements of anatomy and physiology. Perhaps as a result, their treatment is often mutually interdependent. Despite this, headache and sleep disorders tend to be treated separately, by different subspecialties of neurology. The headache disorders and their relationship to sleep, the commonalities of headache and sleep pathophysiology, and headache disorders that are particularly susceptible to sleep modulation (and vice versa) are reviewed. Practical management advice for sleep-modulated headaches is provided.

Working memory performance after acute exposure to the cold pressor stress in healthy volunteers

Effects of acute stress exposure on learning and memory have been frequently studied in both animals and humans. However, only a few studies have focused specifically on working memory performance and the available data are equivocal. The present study examined working memory performance during the Sternberg item recognition task after exposure to a predominantly adrenergic stressor. Twenty four healthy subjects were randomly assigned to a stress group or a control group. The stress group was exposed to the cold pressor stress test (CPS; i.e. insertion of the dominant hand into ice water for 60s),while 37 degrees C warm water was used with the control group. Twenty minutes after the stress exposure, working memory performance was tested with the Sternberg item recognition task with three levels of cognitive load. Sympathetic nervous system and hypothalamic pituitary adrenocortical (HPA) axis activation during CPS, were assessed by measuring heart rate and salivary cortisol before and during (heart rate) or 30 min after (cortisol) the stress procedure. Exposure to the CPS test was associated with a significant increase in heart rate but no increase in salivary cortisol. Participants exposed to the stress procedure showed significantly shorter reaction times during trials with higher cognitive load but tended to show higher false alarm rates than control subjects. The present results indicate that exposure to CPS can be associated with signs of both enhanced and impaired working memory performance. The observed behavioral pattern might represent a form of streamlined information processing advantageous in a threatening situation.

Maternal smoking impairs arousal patterns in sleeping infants

OBJECTIVE

Impairment of the arousal process from sleep is thought to be involved in the pathogenesis of sudden infant death syndrome (SIDS). We hypothesized that a greater propensity for cortical arousal in the prone position may, in a normal infant, be a protective mechanism to promote complete arousal in a vulnerable sleeping position, a protection that is absent in SIDS victims. We aimed to examine the arousal process in a group of infants exposed to maternal smoking, who are thus at higher risk for SIDS.

DESIGN

Twelve healthy, full-term infants born to smoking mothers were studied using daytime polysomnography at 2 to 4 weeks, 2 to 3 months and 5 to 6 months postnatal age. Data were compared with 13 healthy infants born to nonsmoking mothers. Arousal was induced by pulsatile air-jet stimulation to the nostrils during active and quiet sleep, in both supine and prone positions. For each stimulus, physiologic and electroencephalogram changes were visually assessed and arousal responses were classified as sub-cortical activation or cortical arousal.

RESULTS

In smoke-exposed infants, the progression from sub-cortical activation to cortical arousal was depressed at 2 to 4 weeks and 5 to 6 months. There was no effect of maternal smoking observed at 2 to 3 months; however, a significant dose-dependent relationship between cortical activation proportions and urinary cotinine levels was present in both supine and prone positions.

CONCLUSION

We have shown that maternal smoking is associated with impaired arousal processes to trigeminal stimulation that may increase the risk for SIDS. This further highlights the importance of public education of the risks of maternal smoking.

Larger tonic pupil size in young children with autism spectrum disorder

The symptoms of Autism Spectrum Disorder (ASD) have been suggested to manifest from atypical functioning of the autonomic nervous system (ANS), leading to altered arousal and atypical processing of salient stimuli. Coherent with this, persons with ASD show heightened autonomic activity, sleep difficulties, and structural and neurochemical alterations within the ANS. Recently, we observed decreased pupil responses to human faces in children with ASD. In the current study, we found differences in baseline (tonic) pupil size, with the ASD group exhibiting a larger pupil size than age-matched controls. Pupil responses are sensitive and reliable measures of ANS functioning, thus, this finding highlights the role of the ANS, and may provide clues about underlying neuropathology.

Circuit projection from suprachiasmatic nucleus to ventral tegmental area: a novel circadian output pathway

The suprachiasmatic nucleus (SCN) is a circadian pacemaker that synchronizes a number of vital processes. Although a great deal of research has focused on input pathways to SCN and on the central clock itself, relatively little is known about SCN output signaling pathways. The ventral tegmental area (VTA) has been extensively studied for its influence in motivated learning and, recently, for a potential role in arousal and sleep-wake regulation. Here we present data that SCN indirectly projects to VTA via the medial preoptic nucleus (MPON). Microinjection of the retrograde, transynaptic tracer pseudorabies virus (PRV) in rat VTA consistently labeled SCN neurons at time points indicative of an indirect circuit projection. To specify intermediate relay nuclei between SCN and VTA, putative relays were lesioned 1 week prior to PRV injections in VTA. Unilateral lesions of MPON reduced PRV labeling in SCN by 81.6% in the ipsilateral hemisphere and 75.8% in the contralateral hemisphere. Bilateral lesions of the caudal-dorsal lateral septum, another putative relay nucleus and dorsal injection control, did not significantly reduce PRV labeling in the SCN. Single-unit extracellular recordings under halothane anesthesia revealed a novel population of VTA neurons that selectively fired during the active circadian phase. These results show that SCN provides an indirect circuit pathway to VTA via MPON, and that VTA neurons exhibit a circadian rhythm in their impulse activity. This pathway may function in the circadian regulation of numerous behavioral processes including arousal and motivation.

Effect of continuous positive airway pressure on sleep structure in heart failure patients with central sleep apnea

STUDY OBJECTIVES

At termination of obstructive apneas, arousal is a protective mechanism that facilitates restoration of upper airway patency and airflow. Treating obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) reduces arousal frequency indicating that such arousals are caused by OSA. In heart failure (HF) patients with central sleep apnea (CSA), however, arousals frequently occur several breaths after apnea termination, and there is uncertainty as to whether arousals from sleep are a consequence of CSA. If so, they should diminish in frequency when CSA is attenuated. We therefore sought to determine whether attenuation of CSA by CPAP reduces arousal frequency.

DESIGN

Randomized controlled clinical trial.

PATIENTS AND SETTING

We examined data from 205 HF patients with CSA (apnea-hypopnea index [AHI] > or =15, > 50% were central) randomized to CPAP or control who had polysomnograms performed at baseline and 3 months later.

MEASUREMENTS AND RESULTS

In the control group, there was no change in AHI or frequency of arousals. In the CPAP-treated group, the AHI decreased significantly (from [mean +/- SD] 38.9 +/- 15.0 to 17.6 +/- 16.3, P < 0.001) but neither the frequency of arousals nor sleep structure changed significantly.

CONCLUSION

These data suggest that attenuation of CSA by CPAP does not reduce arousal frequency in HF patients. We conclude that arousals were not mainly a consequence of CSA, and may not have been acting as a defense mechanism to terminate apneas in the same way they do in OSA.

Development of NREM sleep instability-continuity (cyclic alternating pattern) in healthy term infants aged 1 to 4 months

STUDY OBJECTIVES

To evaluate non-rapid eye movement (NREM) sleep instability, as measured by the cyclic alternating pattern (CAP), in the first months of life in a group of normal healthy infants, in order to obtain more information on the maturation of arousal mechanisms during NREM sleep and to set normative data of CAP parameters in this age range (from 1 to 4 months of life).

DESIGN

Retrospective study.

SETTING

Sleep unit of an academic centre.

PARTICIPANTS

Twenty-three healthy newborns and infants with a mean conceptional age (gestational age plus postnatal age) of 47.6 + 3.8 weeks, age range 42 to 55 weeks, 10 boys (43.47%), were studied while they slept in the morning between feedings, by means of a 3-hour video-electroencephalographic (EEG)-polygraphic recording. Sleep was visually scored for sleep architecture and CAP in a blinded fashion, using standard criteria.

MEASUREMENTS AND RESULTS

We found 3 different sleep EEG patterns in our infants, according to their age, and we subdivided the entire group into 3 subgroups. Group 1-Tracé alternant mixed with high-voltage slow activity included 9 subjects (3 boys), with a mean conceptional age of 43.9 +/- 1.3 weeks; Group 2 (high-voltage slow activity and rudimentary spindles) included 6 subjects (4 boys), with a mean conceptional age of 49.4 +/- 3.1 weeks; and Group 3 (slow-wave activity and spindles, scored as NREM sleep) included 8 subjects (3 boys), with a mean conceptional age of 50.4 +/- 2.9 weeks. CAP rate was 6.83 +/- 3.58 in infants belonging to Group 2 and increased to 12.91 +/- 2.21 in Group 3. We found a statistically significant higher A1 index in only Group 3. The relative percentages of the A1, A2, and A3 subtypes showed non significant changes with age. The duration of CAP events and the cortical and subcortical arousal indexes were not statistically different between Groups 2 and 3.

CONCLUSIONS

With this study, we provide the first data on CAP analysis in infants from 1 to 4 months of life, and we found that there is a transitory period when trace alternant disappears and CAP events begin to occur. Furthermore, we suggest that the more appropriate time of life when CAP analysis can be first performed is related to the appearance of mature stage 2 NREM with spindles and slow delta waves mixed with theta waves, at approximately 3 months of life.

Atypical modulation of cognitive control by arousal in autism

We examined the effects of viewing high-arousal pictures on regional brain activations elicited by a cognitive control task in participants with high-functioning autism and neurotypical controls. Specifically, using event-related functional magnetic resonance imaging, we assessed the effects of brief presentations of highly arousing pictures (i.e., both very pleasant and very unpleasant) on the processing of stimuli requiring cognitive control. Similar to previous findings, when stimuli with high cognitive control demands were preceded by low-arousal pictures, individuals with autism demonstrated regional brain activations that were comparable to neurotypical control individuals. When the presentation of the cognitive control stimuli was preceded by high-arousal pictures, however, the control group was characterized by relatively greater activation in the right lateral midfrontal cortex in response to cognitive control stimuli. In contrast, preceding high-arousal stimuli did not modulate activity elicited in this region by cognitive control stimuli in the autism group. Differential modulation of right lateral midfrontal activation by high-arousal stimuli in autism is consistent with the "inefficiency model" of brain functioning in autism spectrum disorders, and contributes to a growing body of evidence that autism may be characterized by anomalous sensitivity of cognitive control brain regions to social-emotional context.

Activation of orexin/hypocretin projections to basal forebrain and paraventricular thalamus by acute nicotine

Orexin/hypocretin neurons of the lateral hypothalamus/perifornical area project to a diverse array of brain regions and are responsive to a variety of psychostimulant drugs. It has been shown that orexin neurons are activated by systemic nicotine administration suggesting a possible orexinergic contribution to the effects of this drug on arousal and cognitive function. The basal forebrain and paraventricular nucleus of the dorsal thalamus (PVT) both receive orexin inputs and have been implicated in arousal, attention and psychostimulant drug responses. However, it is unknown whether orexin inputs to these areas are activated by psychostimulant drugs such as nicotine. Here, we infused the retrograde tract tracer cholera toxin B subunit (CTb) into either the basal forebrain or PVT of adult male rats. Seven to 10 days later, animals received an acute systemic administration of (-) nicotine hydrogen tartrate or vehicle and were euthanized 2h later. Triple-label immunohistochemistry/immunofluorescence was used to detect Fos expression in retrogradely-labeled orexin neurons. Nicotine increased Fos expression in orexin neurons projecting to both basal forebrain and PVT. The relative activation in lateral and medial banks of retrogradely-labeled orexin neurons was similar following basal forebrain CTb deposits, but was more pronounced in the medial bank following PVT deposits of CTb. Our findings suggest that orexin inputs to the basal forebrain and PVT may contribute to nicotine effects on arousal and cognition and provide further support for the existence of functional heterogeneity across the medial-lateral distribution of orexin neurons.

Modafinil increases arousal determined by P13 potential amplitude: an effect blocked by gap junction antagonists

STUDY OBJECTIVES

We recorded the effects of administration of the stimulant modafinil on the amplitude of the sleep state-dependent auditory P13 evoked potential in freely moving rats, a measure of arousal thought to be generated by the cholinergic arm of the reticular activating system, specifically the pedunculopontine nucleus (PPN).

DESIGN

Groups of rats were implanted for recording auditory evoked responses and the effects on P13 potential amplitude of intracranial injections into the PPN of neuroactive agents determined.

MEASUREMENTS AND RESULTS

The effects of intracranial injections into the PPN of modafinil showed that P13 potential amplitude increased in a dose-dependent manner at doses of 100, 200, and 300 microM. The effect was blocked by pretreatment with either of the gap junction antagonists carbenoxolone (300 microM) or mefloquine (25 microM), which by themselves slightly decreased P13 potential amplitude.

CONCLUSIONS

These results suggest that modafinil increases arousal levels as determined by the amplitude of the P13 potential, an effect blocked by gap junction antagonists, suggesting that one mechanism by which modafinil increases arousal may be by increasing electrical coupling.

The melanocortin-3 receptor is required for entrainment to meal intake

Entrainment of anticipatory activity and wakefulness to nutrient availability is a poorly understood component of energy homeostasis. Restricted feeding (RF) paradigms with a periodicity of 24 h rapidly induce entrainment of rhythms anticipating food presentation that are independent of master clocks in the suprachiasmatic nucleus (SCN) but do require other hypothalamic structures. Here, we report that the melanocortin system, which resides in hypothalamic structures required for food entrainment, is required for expression of food entrainable rhythms. Food anticipatory activity was assessed in wild-type (WT) and melanocortin-3 receptor-deficient (Mc3r-/-) C57BL/J mice by wheel running, spontaneous locomotory movement, and measurement of wakefulness. WT mice housed in wheel cages subject to RF exhibited increased wheel activity during the 2 h preceding meal presentation, which corresponded with an increase in wakefulness around meal time and reduced wakefulness during the dark. WT mice also exhibited increased x- and z-movements centered around food initiation. The activity-based responses to RF were significantly impaired in mice lacking Mc3r. RF also failed to increase wakefulness in the 2 h before food presentation in Mc3r-/- mice. Food entrainment requires expression of Neuronal PAS domain 2 (Npas2) and Period2 (Per2) genes, components of the transcriptional machinery maintaining a clock rhythm. Analysis of cortical gene expression revealed severe abnormalities in rhythmic expression of clock genes (Bmal1, Npas2, Per2) under ad libitum and RF conditions. In summary, Mc3r are required for expression of anticipatory patterns of activity and wakefulness during periods of limited nutrient availability and for normal regulation of cortical clock function.

Entropy-based measures of EEG arousals as biomarkers for sleep dynamics: applications to hypertension

STUDY OBJECTIVES

We propose a generation of PSG-derived measures that using entropy can quantify temporal patterns of sleep, and investigate the role of these measures as predictors of hypertension. We also investigate the influence of age on these entropy-based measures as compared to traditional indices.

DESIGN AND SETTING

Cross-sectional analyses of the association between hypertension status with traditional PSG and novel measures using adjusted and unadjusted logistic regression models. The novel measures were developed to quantify variability of the arousal event process.

PATIENTS OR PARTICIPANTS

Analyses were based on a subsample of subjects from the Cleveland Family Study with clearly disparate hypertension status.

MEASUREMENTS AND RESULTS

Among traditional PSG indices, the apnea hypopnea index (AHI) has the highest Odds Ratio (unadjusted and adjusted for age, gender, race, BMI: OR = 2.36 (95% CI: 1.48, 3.75, P = 0.0003) and 1.18, (95% CI: 0.76, 1.84, P = 0.46), respectively). The best predictor among the entropy-based measures is derived from analysis of the temporal patterns of arousal duration with unadjusted and adjusted ORs of 1.36 (95% CI: 1.08, 1.71, P = 0.0085) and 2.08 (95% CI: 1.19, 3.64, P = 0.01), respectively.

CONCLUSIONS

Our findings suggest that when adjusted for common confounders such as age, gender, race, and BMI, the entropy-based features that quantify the variability of the arousal event process are more strongly associated with hypertension as compared to traditional PSG indices; they are not as strongly influenced by age as are the traditional indices. The result implies that the regularity of arousals may be an important feature associated with hypertension. These measures may provide a powerful tool for discriminating individuals at risk for comorbidities, such as hypertension, associated with sleep disturbances.

The cardiovascular response to arousal from sleep decreases with age in healthy adults

STUDY OBJECTIVES

To investigate age and gender effects on the acute blood pressure (BP) and heart rate (HR) response to arousal from sleep in healthy adults.

DESIGN

Healthy young and older male and female adults were aroused from stage 2 sleep throughout the night using an auditory tone. The magnitude of the cardiovascular responses to arousal were assessed using 2 (young v older) by 2 (male v female) ANOVAs with repeated measures over time.

SETTING

Sleep laboratory at the Royal Brompton Hospital, London.

PATIENTS OR PARTICIPANTS

25 healthy young (< or = 40 years, n = 15 males) and 20 healthy older adults (> or = 60 years, n = 11 males).

INTERVENTIONS

Arousals (> 10 seconds) from undisturbed stage 2 sleep were induced by an auditory tone throughout the night.

MEASUREMENTS AND RESULTS

Overnight polysomnography (PSG) with HR, continuous beat-by-beat arterial BP and respiratory measurements was performed. Older adults had smaller and delayed initial mean BP and HR responses to arousal compared to young adults (both P < 0.001), whereas changes in ventilation and tidal volume responses to arousal were similar between age groups (P = 0.3 and P = 0.6 respectively). There were no differences between females and males in the cardiovascular or respiratory responses to arousal from sleep.

CONCLUSION

The cause of the smaller and delayed response in healthy older adults is unknown; however, we speculate that for older people with sleep apnea, in whom nocturnal arousals occur frequently, the reduced cardiovascular response may be protective against the link between sleep apnea and hypertension.

Variability of QT interval duration in obstructive sleep apnea: an indicator of disease severity

STUDY OBJECTIVE

To determine OSA-related changes in variability of QT interval duration and in heart rate variability (HRV), and to evaluate the relationship of these parameters to disease severity.

DESIGN

Retrospective analysis of diagnostic sleep records.

SETTINGS

Clinical sleep laboratory in a hospital setting.

PATIENTS

Twenty patients (12 males and 8 females) without significant comorbidities who were undergoing polysomnography were studied.

MEASUREMENTS AND RESULTS

Standard heart rate variability measures and QT variability (Berger algorithm) were computed over consecutive 5-minute ECG epochs throughout the night. The effect of sleep stage and the relationship between these parameters and the severity of OSA as determined by the respiratory disturbance index (RDI) were explored. Further, a linear regression model of QT variability was developed. Severity of OSA (RDI) was 49 +/- 28 (range from 17-107) events/ hr. QT variability was the only ECG measure significantly correlated with RDI (both log-transformed; r = 0.6, P = 0.006). Further, QT variability was correlated with the minimum oxygen saturation (r = -0.55, P = 0.01). Sleep stage showed a significant effect on HRV, but not on QT variability. In the regression model, RDI was the strongest predictor of QT variability (R2 increase 38%), followed by high and low frequency power of HRV (R2 increase 10% each).

CONCLUSION

Obstructive sleep apnea is associated with changes in QT interval variability during sleep. The variance of beat-to-beat QT intervals correlates more strongly with the severity of OSA (as determined by RDI) than standard measures of heart rate variability, and is correlated with blood oxygenation, but not sleep stage.

The role of arousal related brainstem reflexes in causing recovery from upper airway occlusion in infants

During obstructive sleep apnea (OSA) in adults upper airway reopening coincides with a sudden burst in activity of pharyngeal dilating muscles. This has been attributed to arousal from sleep as indicated by increased EEG activity. Recovery from OSA in infants often occurs in the absence of cortical arousal. To investigate mechanisms involved in recovery, we performed experimental airway occlusions in sleeping infants. Based on past work, our hypothesis was that a sleep startle combined with an augmented breath and heart rate acceleration would occur during the occlusion, and that such brainstem mediated reflexes might provide an explanation for recovery from OSA in the absence of cortical arousal. However, this is contrary to expectations, since lung inflation is believed to be necessary for occurrence of an augmented breath. We studied 16 healthy infants during sleep. We recorded EEG, EOG, ECG, oxygen saturation, diaphragmatic, nuchal and limb electromyograms, face mask pressure, and airflow. A startle, accompanied by neck extension, limb and nuchal EMG activation, as well as heart rate acceleration occurred during all airway occlusions. The startle occurred simultaneously with a large biphasic inspiratory effort, having characteristics of an augmented breath (sigh). In more than a third of cases, this occurred without any evidence of cortical arousal activity. The magnitude of startles as well as the increase in heart rate correlated positively with peak airway negative pressure, indicating that arousal processes are graded in intensity. We conclude that the neck extension and pharyngeal dilating muscle activity associated with the startle and augmented breath may account for recovery of airway patency in infants as they do adults. Lung inflation is not a prerequisite for the reflex to occur.

Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment-development study

This treatment-development study is a Stage I evaluation of an intervention that combines mindfulness meditation with cognitive-behavior therapy for insomnia (CBT-I). Thirty adults who met research diagnostic criteria for Psychophysiological Insomnia (Edinger et al., 2004) participated in a 6-week, multi-component group intervention using mindfulness meditation, sleep restriction, stimulus control, sleep education, and sleep hygiene. Sleep diaries and self-reported pre-sleep arousal were assessed weekly while secondary measures of insomnia severity, arousal, mindfulness skills, and daytime functioning were assessed at pre-treatment and post-treatment. Data collected on recruitment, retention, compliance, and satisfaction indicate that the treatment protocol is feasible to deliver and is acceptable for individuals seeking treatment for insomnia. The overall patterns of change with treatment demonstrated statistically and clinically significant improvements in several nighttime symptoms of insomnia as well as statistically significant reductions in pre-sleep arousal, sleep effort, and dysfunctional sleep-related cognitions. In addition, a significant correlation was found between the number of meditation sessions and changes on a trait measure of arousal. Together, the findings indicate that mindfulness meditation can be combined with CBT-I and this integrated intervention is associated with reductions in both sleep and sleep-related arousal. Further testing of this intervention using randomized controlled trials is warranted to evaluate the efficacy of the intervention for this population and the specific effects of each component on sleep and both psychological and physiological arousal.

Perception of arousal in social anxiety: effects of false feedback during a social interaction

Cognitive models suggest that during social interactions, socially anxious individuals direct their attention to internal cues of arousal and use this information to erroneously infer how they appear to others. High (N=36) and low (N=36) socially anxious adults had a conversation with a stooge, and were led to believe by false feedback that they were experiencing either an increase or decrease in arousal, or evaluating the comfort level of the feedback equipment. Compared to the other groups, participants who believed their arousal had increased, reported greater anxiety, poorer perceived performance, more physical cues of anxiety, and greater underestimation of their performance and overestimation of the visibility of their anxiety. The effects were not specific to participants with high social anxiety. Observers rated the behaviour of participants who believed that their arousal had decreased most favourably. The results have implications for the treatment of social phobia.

Chronic psychophysiological insomnia: hyperarousal and/or inhibition deficits? An ERPs investigation

STUDY OBJECTIVES

Chronic primary insomnia has been hypothesized to result from conditioned arousal or the inability to initiate normal sleep processes. The event-related potentials (ERPs) N1, P2, and N350 are useful indexes of arousal. The objective is to compare these ERPs in primary chronic psychophysiological insomniacs (INS) and good sleepers (GS) during multiple recordings.

PARTICIPANTS

Participants were 15 INS (mean age = 46 years, SD = 7.5) and 16 GS (mean age = 37 years, SD = 10.1).

METHODS AND PROCEDURE

Following a multistep clinical evaluation, INS and GS participants underwent 4 consecutive nights of PSG recordings (N1 to N4). ERPs were recorded on the 3rd and 4th nights in the sleep laboratory (N3 and N4). ERPs recordings were made during wake on both nights (in the evening and upon awakening), with the addition of sleep-onset recordings on N4. Auditory stimuli consisted of "standard" and "deviant" tones.

STATISTICAL ANALYSIS

Repeated measures ANOVAs were computed for each ERP for each recording for each type of stimulus.

RESULTS

The amplitude of P2 and N350 was greater for the deviant than for the standard stimulus in both groups. The amplitude of N1 was larger in INS than GS in the morning and the evening. While the amplitude of N350 was larger in GS than in INS at sleep onset, the amplitude of P2 was greater in INS than in GS at that time.

CONCLUSION

Signs of greater cortical arousal in psychophysiological insomnia individuals are observed, especially upon awakening in the morning. However, at sleep onset, difficulties from disengaging from wake processes and some inability at initiating normal sleep processes appear also present in individuals with insomnia compared to good sleepers.

The developmental decrease in REM sleep: the role of transmitters and electrical coupling

STUDY OBJECTIVES

This mini-review considers certain factors related to the developmental decrease in rapid eye movement (REM) sleep, which occurs in favor of additional waking time, and its relationship to developmental factors that may influence its potential role in brain development.

DESIGN

Specifically, we discuss some of the theories proposed for the occurrence of REM sleep and agree with the classic notion that REM sleep is, at the least, a mechanism that may play a role in the maturation of thalamocortical pathways. The developmental decrease in REM sleep occurs gradually from birth until close to puberty in the human, and in other mammals it is brief and coincides with eye and ear opening and the beginning of massive exogenous activation. Therefore, the purported role for REM sleep may change to involve a number of other functions with age.

MEASUREMENTS AND RESULTS

We describe recent findings showing that morphologic and physiologic properties as well as cholinergic, gamma amino-butyric acid, kainic acid, n-methyl-d-aspartic acid, noradrenergic, and serotonergic synaptic inputs to mesopontine cholinergic neurons, as well as the degree of electrical coupling between mostly noncholinergic mesopontine neurons and levels of the neuronal gap-junction protein connexin 36, change dramatically during this critical period in development. A novel mechanism for sleep-wake control based on well-known transmitter interactions, as well as electrical coupling, is described.

CONCLUSION

We hypothesize that a dysregulation of this process could result in life-long disturbances in arousal and REM sleep drive, leading to hypervigilance or hypovigilance such as that observed in a number of disorders that have a mostly postpubertal age of onset.

Physiological arousal: a role for hypothalamic systems

The lateral hypothalamus (LH) has long been known as a homeostasis center of the brain that modulates feeding behavior, arousal and reward. The hypocretins (Hcrts, also called orexins) and melanin-concentrating hormone (MCH) are neuropeptides produced in two intermingled populations of a few thousand neurons in the LH. The Hcrts have a prominent role in regulating the stability of arousal, since Hcrt system deficiency leads to narcolepsy. MCH is an important modulator of energy balance, as MCH system deficiency in mice leads to leanness and increased metabolism. Recently, MCH has been proposed to modulate rapid eye movement sleep in rodents. In this review, we propose a working model of the cross-talk between Hcrt and MCH circuits that may provide an arousal balance system to regulate complex goal-oriented behaviors.

Affective picture processing: an integrative review of ERP findings

The review summarizes and integrates findings from 40 years of event-related potential (ERP) studies using pictures that differ in valence (unpleasant-to-pleasant) and arousal (low-to-high) and that are used to elicit emotional processing. Affective stimulus factors primarily modulate ERP component amplitude, with little change in peak latency observed. Arousal effects are consistently obtained, and generally occur at longer latencies. Valence effects are inconsistently reported at several latency ranges, including very early components. Some affective ERP modulations vary with recording methodology, stimulus factors, as well as task-relevance and emotional state. Affective ERPs have been linked theoretically to attention orientation for unpleasant pictures at earlier components (<300 ms). Enhanced stimulus processing has been associated with memory encoding for arousing pictures of assumed intrinsic motivational relevance, with task-induced differences contributing to emotional reactivity at later components (>300 ms). Theoretical issues, stimulus factors, task demands, and individual differences are discussed.