Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease

[Rheumatism, jet lag and the body clock]

Circadian rhythms play an important role in the function of the body. Among others, the activity of the immune system is subject to daily variability which explains the different intensity of rheumatic symptoms during the day (e.g. morning stiffness). Circadian rhythms are subject to continuous adaptation via external time signals (zeitgebers), such as light-dark periods, time of food intake, as well as daily activity and resting periods. Following an acute phase shift of these external zeitgebers, e.g. via transmeridian travel (east-west or west-east), the body has to adjust all circadian systems to these new circumstances during an adjustment response, which lasts for several days. The classical symptoms of jet lag, such as tiredness during the day, mood swings and cognitive malfunction occur during this adjustment period. The impact of acute phase shifts as a result of transmeridian travel in subjects with rheumatic disorders, as well as strategies to prevent jet lag will be discussed in the following article.

Daily variations in sleep-wake patterns and severity of psychopathology: a pilot study in community-dwelling individuals with chronic schizophrenia

The daily co-occurrence of change in sleep characteristics and psychopathology was examined in six individuals with schizophrenia and seven healthy controls using a prospective assessment of rest-activity patterns conducted in the person's home for up to 28 days. The results provide preliminary evidence that a change in sleep-wake timing is followed by a change in symptom severity.

Phase advance of the light-dark cycle perturbs diurnal rhythms of brain-derived neurotrophic factor and neurotrophin-3 protein levels, which reduces synaptophysin-positive presynaptic terminals in the cortex of juvenile rats

In adult rat brains, brain-derived neurotrophic factor (BDNF) rhythmically oscillates according to the light-dark cycle and exhibits unique functions in particular brain regions. However, little is known of this subject in juvenile rats. Here, we examined diurnal variation in BDNF and neurotrophin-3 (NT-3) levels in 14-day-old rats. BDNF levels were high in the dark phase and low in the light phase in a majority of brain regions. In contrast, NT-3 levels demonstrated an inverse phase relationship that was limited to the cerebral neocortex, including the visual cortex, and was most prominent on postnatal day 14. An 8-h phase advance of the light-dark cycle and sleep deprivation induced an increase in BDNF levels and a decrease in NT-3 levels in the neocortex, and the former treatment reduced synaptophysin expression and the numbers of synaptophysin-positive presynaptic terminals in cortical layer IV and caused abnormal BDNF and NT-3 rhythms 1 week after treatment. A similar reduction of synaptophysin expression was observed in the cortices of Bdnf gene-deficient mice and Ca(2+)-dependent activator protein for secretion 2 gene-deficient mice with abnormal free-running rhythm and autistic-like phenotypes. In the latter mice, no diurnal variation in BDNF levels was observed. These results indicate that regular rhythms of BDNF and NT-3 are essential for correct cortical network formation in juvenile rodents.

Genetic and metabolic characterization of insomnia

Insomnia is reported to chronically affect 10∼15% of the adult population. However, very little is known about the genetics and metabolism of insomnia. Here we surveyed 10,038 Korean subjects whose genotypes have been previously profiled on a genome-wide scale. About 16.5% reported insomnia and displayed distinct metabolic changes reflecting an increase in insulin secretion, a higher risk of diabetes, and disrupted calcium signaling. Insomnia-associated genotypic differences were highly concentrated within genes involved in neural function. The most significant SNPs resided in ROR1 and PLCB1, genes known to be involved in bipolar disorder and schizophrenia, respectively. Putative enhancers, as indicated by the histone mark H3K4me1, were discovered within both genes near the significant SNPs. In neuronal cells, the enhancers were bound by PAX6, a neural transcription factor that is essential for central nervous system development. Open chromatin signatures were found on the enhancers in human pancreas, a tissue where PAX6 is known to play a role in insulin secretion. In PLCB1, CTCF was found to bind downstream of the enhancer and interact with PAX6, suggesting that it can probably inhibit gene activation by PAX6. PLCB4, a circadian gene that is closely located downstream of PLCB1, was identified as a candidate target gene. Hence, dysregulation of ROR1, PLCB1, or PLCB4 by PAX6 and CTCF may be one mechanism that links neural and pancreatic dysfunction not only in insomnia but also in the relevant psychiatric disorders that are accompanied with circadian rhythm disruption and metabolic syndrome.

Thalamocortical dynamics of sleep: roles of purinergic neuromodulation

Thalamocortical dynamics, the millisecond to second changes in activity of thalamocortical circuits, are central to perception, action and cognition. Generated by local circuitry and sculpted by neuromodulatory systems, these dynamics reflect the expression of vigilance states. In sleep, thalamocortical dynamics are thought to mediate "offline" functions including memory consolidation and synaptic scaling. Here, I discuss thalamocortical sleep dynamics and their modulation by the ascending arousal system and locally released neurochemicals. I focus on modulation of these dynamics by electrically silent astrocytes, highlighting the role of purinergic signaling in this glial form of communication. Astrocytes modulate cortical slow oscillations, sleep behavior, and sleep-dependent cognitive function. The discovery that astrocytes can modulate sleep dynamics and sleep-related behaviors suggests a new way of thinking about the brain, in which integrated circuits of neurons and glia control information processing and behavioral output.

Sleep-wake changes and cognition in neurodegenerative disease

With the increasing aging population, neurodegenerative disorders will become more common in clinical practice. These disorders involve multiple pathophysiological mechanisms that differentially affect cognition, mood, and physical functions. Possibly due to the involvement of common underlying neurobiological circuits, sleep and/or circadian (sleep-wake) changes are also common in this disease group. Of significance, sleep-wake changes are often a prodromal feature and are predictive of cognitive decline, psychiatric symptoms, quality of life, need for institutional care, and caregiver burden. Unfortunately, in neurodegenerative disease, few studies have included detailed polysomnography or neuropsychological assessments although some data indicate that sleep and neurocognitive features are related. Further studies are also required to address the effects of pharmacological and nonpharmacological treatments on cognitive functioning. Such research will hopefully lead to targeted early intervention approaches for cognitive decline in older people.

The genetics of the human circadian clock

Daily rhythms of behavioral and physiological processes are believed to arise from endogenous circadian clocks. Unlike model organisms, genetic studies of human behavioral traits present extra challenges due to many factors such as the heterogeneous genetic background and environmental influences. Identifying molecular components of the human circadian clock were not possible until the recognition of Mendelian circadian traits in human subjects in recent years. Characterizing these rare Mendelian traits therefore established the foundation for identification of the genetic components for human circadian and sleep mechanisms. This line of investigation has proven fruitful and provided new insights into these pathways. Genetic association studies have also offered many possible genetic contributions to these mechanisms. Studies of these genes/proteins in conjunction with modeling human mutations in model organisms afford the opportunity to unravel the molecular mechanisms which in time will lead to pharmacological interventions that may not only help modify these behavioral traits but also may prove effective for treating other sleep-related disorders.

Glial cell modulation of circadian rhythms

Studies of Drosophila and mammals have documented circadian changes in the morphology and biochemistry of glial cells. In addition, it is known that astrocytes of flies and mammals contain evolutionarily conserved circadian molecular oscillators that are similar to neuronal oscillators. In several sections of this review, I summarize the morphological and biochemical rhythms of glia that may contribute to circadian control. I also discuss the evidence suggesting that glia-neuron interactions may be critical for circadian timing in both flies and mammals. Throughout the review, I attempt to compare and contrast findings from these invertebrate and vertebrate models so as to provide a synthesis of current knowledge and indicate potential research avenues that may be useful for better understanding the roles of glial cells in the circadian system.

Drosophila Models of Huntington's Disease exhibit sleep abnormalities

The complex pathology of neurodegenerative diseases presents a challenge to researchers who model the disease, and clinicians who treat patients. The identification of early, perhaps even prodromal, biomarkers is important for developing strategies to ameliorate disease progression. Sleep disturbances are a clinical feature of Huntington’s disease (HD) as well as a part of normal aging. Whether sleep dysfunctions in HD patients are epiphenomenal or central to the neurodegenerative disease process is unclear. We show that sleep fragmentation is shared among Drosophila transgenic models that express mutant forms of huntingtin (mHtt), and flies with RNAi-mediated knockdown of the endogenous gene (dhtt). Our data suggest that sleep disturbances in HD may represent loss of function in the endogenous dhtt gene and that sleep perturbations in Drosophila HD models present an opportunity for screening therapeutic interventions.

Sleep and circadian rhythm disturbances: multiple genes and multiple phenotypes

Sleep is regulated by two broad mechanisms: the circadian system, which generates 24-h rhythms of sleep propensity and a wake-dependent homeostatic sleep process whereby sleep pressure increases during wake and dissipates during sleep. These, in turn, regulate multiple brain structures and neurotransmitter systems. In view of the complexity of sleep it is not surprising that there is considerable variation between individuals in both sleep timing and propensity. Furthermore, marked abnormalities in sleep are commonly encountered in psychiatric and neurodegenerative disorders. Teasing apart the genetic versus environmental contributions to normal and abnormal sleep is complex. Here we attempt to summarise what recent progress has been made, and what will be needed in the future to gain a more complete understanding of this fundamental aspect of physiology.