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Simor P, Bogdány T, Sifuentes-Ortega R, Rovai A, Peigneux P. Lateralized tactile stimulation during NREM sleep globally increases both slow and fast frequency activities. Psychophysiology 2023; 60:e14191. [PMID: 36153813 PMCID: PMC10078489 DOI: 10.1111/psyp.14191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/06/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
Slow frequency activity during non-rapid eye movement (NREM) sleep emerges from synchronized activity of widely distributed thalamo-cortical and cortico-cortical networks, reflecting homeostatic and restorative properties of sleep. Slow frequency activity exhibits a reactive nature, and can be increased by acoustic stimulation. Although non-invasive brain stimulation is a promising technique in basic and clinical sleep research, sensory stimulation studies focusing on modalities other than the acoustic are scarce. We explored here the potential of lateralized vibro-tactile stimulation (VTS) of the finger to locally modify electroencephalographic activity during nocturnal NREM sleep. Eight seconds-long sequences of vibro-tactile pulses were delivered at a rate of 1 Hz either to the left or to the right index finger, in addition to a sham condition, in fourteen healthy participants. VTS markedly increased slow frequency activity that peaked between 1-4 Hz but extended to higher (~13 Hz) frequencies, with fronto-central dominance. Enhanced slow frequency activity was accompanied by increased (14-22 Hz) fast frequency power peaking over central and posterior locations. VTS increased the amplitude of slow waves, especially during the first 3-4 s of stimulation. Noticeably, we did not observe local-hemispheric effects, that is, VTS resulted in a global cortical response regardless of stimulation laterality. VTS moderately increased slow and fast frequency activities in resting wakefulness, to a much lower extent compared to NREM sleep. The concomitant increase in slow and fast frequency activities in response to VTS indicates an instant homeostatic response coupled with wake-like, high-frequency activity potentially reflecting transient periods of increased environmental processing.
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Affiliation(s)
- Péter Simor
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN-Center for Research in Cognition and Neurosciences, Brussels, Belgium.,UNI-ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Tamás Bogdány
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN-Center for Research in Cognition and Neurosciences, Brussels, Belgium.,Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Rebeca Sifuentes-Ortega
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN-Center for Research in Cognition and Neurosciences, Brussels, Belgium.,UNI-ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Antonin Rovai
- UNI-ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), ULB Neuroscience Institute (UNI), CUB-Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB-Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Peigneux
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN-Center for Research in Cognition and Neurosciences, Brussels, Belgium.,UNI-ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Chen S, Li Q, Zou X, Zhong Z, Ouyang Q, Wang M, Luo Y, Yao D. Effects of CPAP Treatment on Electroencephalographic Activity in Patients with Obstructive Sleep Apnea Syndrome During Deep Sleep with Consideration of Cyclic Alternating Pattern. Nat Sci Sleep 2022; 14:2075-2089. [PMID: 36440180 PMCID: PMC9697441 DOI: 10.2147/nss.s382305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate whether continuous positive airway pressure (CPAP) treatment would change EEG activities associated with cyclic alternating pattern (CAP subtype A1, A2, and A3) and non-CAP (NCAP) during non-rapid eye movement sleep stage 3 (N3) in patients with obstructive sleep apnea (OSA). Methods The effects of CPAP treatment on the percentages of sleep stage N3 occupied by the CAP and NCAP, power of EEG waves in the CAP and NCAP were examined in 18 patients with moderate-to-severe OSA undergoing polysomnographic recordings. Results Apnea and hypopnea index during sleep stage N3 was positively correlated with ratios of phases A2 and A3 duration to total phase A duration [Phase (A2+A3) /Phase A] and negatively correlated with phase A1/phase A. With CPAP treatment, percentages of sleep stage N3 occupied by total CAPs and subtypes A2 and A3, as well as CAP A2 and CAP A3 indexes were significantly decreased while percentages of sleep stage N3 occupied by NCAP (NCAP/N3) and CAP A1 index were significantly increased. In addition, CPAP treatment significantly decreased percentage of respiratory events associated CAPs and increased percentage of non-respiratory related CAPs. Moreover, absolute and relative delta power was significantly increased during phase A1, unchanged during phase A2 and phase B2, and significantly decreased during phases B1, A3 and B3. The absolute power of faster frequency EEG waves in CAPs showed a general trend of decrease. The absolute and relative power of delta waves with amplitudes ≥75 μV, but not <75 μV, was significantly increased. Conclusion CPAP treatment improves the sleep quality in OSA patients mainly by increasing delta power and decreasing power of higher frequency waves during phase A1, and decreasing CAP A2 and A3 indexes as well as increasing NCAP/N3 and power of delta waves with amplitudes ≥75 μV during NCAP.
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Affiliation(s)
- Shuliang Chen
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
- Queen Mary College, Nanchang University, Jiangxi, People’s Republic of China
| | - Qi Li
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Xueliang Zou
- Jiangxi Mental Hospital, Nanchang University, Jiangxi, People’s Republic of China
| | - Zhijun Zhong
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Qian Ouyang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Mengmeng Wang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Yaxing Luo
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Dongyuan Yao
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
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3
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Automatic detection of A-phase onsets based on convolutional neural networks. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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4
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Qian X, Qiu Y, He Q, Lu Y, Lin H, Xu F, Zhu F, Liu Z, Li X, Cao Y, Shuai J. A Review of Methods for Sleep Arousal Detection Using Polysomnographic Signals. Brain Sci 2021; 11:1274. [PMID: 34679339 PMCID: PMC8533904 DOI: 10.3390/brainsci11101274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
Multiple types of sleep arousal account for a large proportion of the causes of sleep disorders. The detection of sleep arousals is very important for diagnosing sleep disorders and reducing the risk of further complications including heart disease and cognitive impairment. Sleep arousal scoring is manually completed by sleep experts by checking the recordings of several periods of sleep polysomnography (PSG), which is a time-consuming and tedious work. Therefore, the development of efficient, fast, and reliable automatic sleep arousal detection system from PSG may provide powerful help for clinicians. This paper reviews the automatic arousal detection methods in recent years, which are based on statistical rules and deep learning methods. For statistical detection methods, three important processes are typically involved, including preprocessing, feature extraction and classifier selection. For deep learning methods, different models are discussed by now, including convolution neural network (CNN), recurrent neural network (RNN), long-term and short-term memory neural network (LSTM), residual neural network (ResNet), and the combinations of these neural networks. The prediction results of these neural network models are close to the judgments of human experts, and these methods have shown robust generalization capabilities on different data sets. Therefore, we conclude that the deep neural network will be the main research method of automatic arousal detection in the future.
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Affiliation(s)
- Xiangyu Qian
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
| | - Ye Qiu
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
| | - Qingzu He
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
| | - Yuer Lu
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
| | - Hai Lin
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
| | - Fei Xu
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
| | - Fangfang Zhu
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
| | - Zhilong Liu
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
| | - Xiang Li
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
| | - Yuping Cao
- Department of Psychiatry of Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Jianwei Shuai
- Department of Physics, and Fujian Provincial Key Laboratory for Soft Functional Materials Research, Xiamen University, Xiamen 361005, China; (X.Q.); (Y.Q.); (Q.H.); (Y.L.); (H.L.); (F.X.); (F.Z.); (Z.L.); (X.L.)
- National Institute for Data Science in Health and Medicine, and State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, Xiamen University, Xiamen 361102, China
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325001, China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou 325001, China
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5
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Migueis DP, Lopes MC, Ignacio PSD, Thuler LCS, Araujo-Melo MH, Spruyt K, Lacerda GCB. A systematic review and meta-analysis of the cyclic alternating pattern across the lifespan. Sleep Med 2021; 85:25-37. [PMID: 34271180 DOI: 10.1016/j.sleep.2021.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters according to the aging process in healthy subjects through a systematic review and meta-analysis. METHODS Two authors independently searched databases using PRISMA guidelines. Discrepancies were reconciled by a third reviewer. Subgroup analysis and tests for heterogeneity were conducted. RESULTS Of 286 studies, 10 submitted a total of 168 healthy individuals to CAP analysis. Scoring of CAP can begin at 3 months of life, when K-complexes, delta bursts, or spindles can be recognized. Rate of CAP increased with age, mainly during the first 2 years of life, then decreased in adolescence, and increased in the elderly. The A1 CAP subtype and CAP rate were high in school-aged children during slow-wave sleep (SWS). A1 CAP subtypes were significantly more numerous in adolescents compared with other groups, while the elderly showed the highest amounts of A2 and A3 CAP subtypes. Our meta-analysis registered the lowest CAP rate in infants younger than 2 years old and the highest in the elderly. CONCLUSIONS This review summarized the normative data of CAP in NREM sleep during the aging process. The CAP rate increased with age and sleep depth, especially during SWS. Parameters of CAP may reflect gender hormonal effects and neuroplasticity. More reports on CAP subtypes are needed for their reference values establishment.
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Affiliation(s)
- D P Migueis
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Antonio Pedro University Hospital / Fluminense Federal University, Niterói, Brazil.
| | - M C Lopes
- Child and Adolescent Affective Disorder Program (PRATA), Department and Institute of Psychiatry at University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - P S D Ignacio
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L C S Thuler
- National Cancer Institute, Rio de Janeiro, Brazil
| | - M H Araujo-Melo
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - K Spruyt
- INSERM, Université de Paris, NeuroDiderot, France
| | - G C B Lacerda
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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6
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Arce-Santana ER, Alba A, Mendez MO, Arce-Guevara V. A-phase classification using convolutional neural networks. Med Biol Eng Comput 2020; 58:1003-1014. [DOI: 10.1007/s11517-020-02144-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/12/2020] [Indexed: 12/27/2022]
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7
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Largo R, Lopes M, Spruyt K, Guilleminault C, Wang Y, Rosa A. Visual and automatic classification of the cyclic alternating pattern in electroencephalography during sleep. Braz J Med Biol Res 2019; 52:e8059. [PMID: 30810623 PMCID: PMC6393849 DOI: 10.1590/1414-431x20188059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022] Open
Abstract
Cyclic alternating pattern (CAP) is a neurophysiological pattern that can be visually scored by international criteria. The aim of this study was to verify the feasibility of visual CAP scoring using only one channel of sleep electroencephalogram (EEG) to evaluate the inter-scorer agreement in a variety of recordings, and to compare agreement between visual scoring and automatic scoring systems. Sixteen hours of single-channel European data format recordings from four different sleep laboratories with either C4-A1 or C3-A2 channels and with different sampling frequencies were used in this study. Seven independent scorers applied visual scoring according to international criteria. Two automatic blind scorings were also evaluated. Event-based inter-scorer agreement analysis was performed. The pairwise inter-scorer agreement (PWISA) was between 55.5 and 84.3%. The average PWISA was above 60% for all scorers and the global average was 69.9%. Automatic scoring systems showed similar results to those of visual scoring. The study showed that CAP could be scored using only one EEG channel. Therefore, CAP scoring might also be integrated in sleep scoring features and automatic scoring systems having similar performances to visual sleep scoring systems.
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Affiliation(s)
- R. Largo
- LaSEEB - Evolutionary Systems and Biomedical Engineering Laboratory, Institute for Systems and Robotics (ISR-Lisboa), Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal
- Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - M.C. Lopes
- LaSEEB - Evolutionary Systems and Biomedical Engineering Laboratory, Institute for Systems and Robotics (ISR-Lisboa), Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal
- Instituto de Psiquiatria (PRATA), Hospital das Cl�nicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - K. Spruyt
- Lyon Neuroscience Research Center, INSERM U1028-CNRS UMR 5292 Waking Team, School of Medicine, University Claude Bernard, Lyon, France
| | - C. Guilleminault
- Sleep Disorders Clinic, Stanford University Medical Center, Stanford, CA, USA
| | - Y.P. Wang
- Instituto de Psiquiatria (LIM-23), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A.C. Rosa
- LaSEEB - Evolutionary Systems and Biomedical Engineering Laboratory, Institute for Systems and Robotics (ISR-Lisboa), Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal
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Ujma PP, Halász P, Simor P, Fabó D, Ferri R. Increased cortical involvement and synchronization during CAP A1 slow waves. Brain Struct Funct 2018; 223:3531-3542. [PMID: 29951916 DOI: 10.1007/s00429-018-1703-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/20/2018] [Indexed: 12/25/2022]
Abstract
Slow waves recorded with EEG in NREM sleep are indicative of the strength and spatial extent of synchronized firing in neuronal assemblies of the cerebral cortex. Slow waves often appear in the A1 part of the cyclic alternating patterns (CAP), which correlate with a number of behavioral and biological parameters, but their physiological significance is not adequately known. We automatically detected slow waves from the scalp recordings of 37 healthy patients, visually identified CAP A1 events and compared slow waves during CAP A1 with those during NCAP. For each slow wave, we computed the amplitude, slopes, frequency, synchronization (synchronization likelihood) between specific cortical areas, as well as the location of origin and scalp propagation of individual waves. CAP A1 slow waves were characterized by greater spatial extent and amplitude, steeper slopes and greater cortical synchronization, but a similar prominence in frontal areas and similar propagation patterns to other areas on the scalp. Our results indicate that CAP A1 represents a period of highly synchronous neuronal firing over large areas of the cortical mantle. This feature may contribute to the role CAP A1 plays in both normal synaptic homeostasis and in the generation of epileptiform phenomena in epileptic patients.
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Affiliation(s)
- Péter Przemyslaw Ujma
- Institute of Clinical Neuroscience, "Juhász Pál" Epilepsy Centrum, Amerikai út 57, Budapest, 1145, Hungary.
- Institute of Behavioural Sciences, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary.
| | - Péter Halász
- Institute of Clinical Neuroscience, "Juhász Pál" Epilepsy Centrum, Amerikai út 57, Budapest, 1145, Hungary
| | - Péter Simor
- Institute of Psychology, ELTE, Eötvos Loránd University, Kazinczy utca 23-27, Budapest, 1075, Hungary
| | - Dániel Fabó
- Institute of Clinical Neuroscience, "Juhász Pál" Epilepsy Centrum, Amerikai út 57, Budapest, 1145, Hungary
| | - Raffaele Ferri
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 91018, Troina, Italy
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Manconi M, Silvani A, Ferri R. Commentary: Coordinated infraslow neural and cardiac oscillations mark fragility and offline periods in mammalian sleep. Front Physiol 2017; 8:847. [PMID: 29176949 PMCID: PMC5686119 DOI: 10.3389/fphys.2017.00847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/11/2017] [Indexed: 12/03/2022] Open
Affiliation(s)
- Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland.,Department of Neurology, Bern University Hospital, Bern, Switzerland
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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10
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Analysis of A-phase transitions during the cyclic alternating pattern under normal sleep. Med Biol Eng Comput 2015; 54:133-48. [DOI: 10.1007/s11517-015-1349-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/07/2015] [Indexed: 11/26/2022]
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11
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Ujma PP, Simor P, Ferri R, Fabó D, Kelemen A, Erőss L, Bódizs R, Halász P. Increased interictal spike activity associated with transient slow wave trains during non-rapid eye movement sleep. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Péter Przemyslaw Ujma
- Institute of Behavioural Sciences; Semmelweis University; Budapest Hungary
- Department of Functional Neurosurgery; National Institute of Clinical Neuroscience; Budapest Hungary
| | - Péter Simor
- Department of Cognitive Sciences; Budapest University of Technology and Economics; Budapest Hungary
- Nyírő Gyula Hospital; National Institute of Psychiatry and Addictions; Budapest Hungary
| | - Raffaele Ferri
- Sleep Research Centre; Department of Neurology I.C.; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina Italy
| | - Dániel Fabó
- Department of Neurology; National Institute of Clinical Neuroscience, Epilepsy Centrum; Budapest Hungary
| | - Anna Kelemen
- Department of Neurology; National Institute of Clinical Neuroscience, Epilepsy Centrum; Budapest Hungary
| | - Loránd Erőss
- Department of Functional Neurosurgery; National Institute of Clinical Neuroscience; Budapest Hungary
| | - Róbert Bódizs
- Institute of Behavioural Sciences; Semmelweis University; Budapest Hungary
- Department of General Psychology; Pázmány Péter Catholic University; Piliscsaba Hungary
| | - Péter Halász
- Department of Neurology; National Institute of Clinical Neuroscience, Epilepsy Centrum; Budapest Hungary
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12
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A Recurrent Increase of Synchronization in the EEG Continues from Waking throughout NREM and REM Sleep. ISRN NEUROSCIENCE 2014; 2014:756952. [PMID: 24967318 PMCID: PMC4045569 DOI: 10.1155/2014/756952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/19/2013] [Indexed: 11/18/2022]
Abstract
Pointwise transinformation (PTI) provides a quantitative nonlinear approach to spatiotemporal synchronization patterns of the rhythms of coupled cortical oscillators. We applied PTI to the waking and sleep EEGs of 21 healthy sleepers; we calculated the mean levels and distances of synchronized episodes and estimated the dominant frequency shift from unsynchronized to synchronized EEG segments by spectral analysis. Recurrent EEG synchronization appeared and ceased abruptly in the anterior, central, and temporal derivations; in the posterior derivations it appeared more fluctuating. This temporal dynamics of synchronization remained stable throughout all states of vigilance, while the dominant frequencies of synchronized phases changed markedly. Mean synchronization had high frontal and occipital levels and low central and midtemporal levels. Thus, a fundamental coupling pattern with recurrent increases of synchronization in the EEG (“RISE”) seems to exist during the brain's resting state. The generators of RISE could be coupled corticocortical neuronal assemblies which might be modulated by subcortical structures. RISE designates the recurrence of transiently synchronized cortical microstates that are independent of specific EEG waves, the spectral content of the EEG, and especially the current state of vigilance. Therefore, it might be suited for EEG analysis in clinical situations without stable vigilance.
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13
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Chouvarda I, Mendez MO, Alba A, Bianchi AM, Grassi A, Arce-Santana E, Rosso V, Terzano MG, Parrino L. Nonlinear analysis of the change points between A and B phases during the Cyclic Alternating Pattern under normal sleep. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:1049-52. [PMID: 23366075 DOI: 10.1109/embc.2012.6346114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study analyzes the nonlinear properties of the EEG at transition points of the sequences that build the Cyclic Alternating Pattern (CAP). CAP is a sleep phenomenon built up by consecutive sequences of activations and non-activations observed during the sleep time. The sleep condition can be evaluated from the patterns formed by these sequences. Eleven recordings from healthy and good sleepers were included in this study. We investigated the complexity properties of the signal at the onset and offset of the activations. The results show that EEG signals present significant differences (p<0.05) between activations and non-activations in the Sample Entropy and Tsallis Entropy indices. These indices could be useful in the development of automatic methods for detecting the onset and offset of the activations, leading to significant savings of the physician's time by simplifying the manual inspection task.
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Affiliation(s)
- I Chouvarda
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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14
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Pizza F, Ferri R, Poli F, Vandi S, Cosentino FII, Plazzi G. Polysomnographic study of nocturnal sleep in idiopathic hypersomnia without long sleep time. J Sleep Res 2012; 22:185-96. [DOI: 10.1111/j.1365-2869.2012.01061.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/12/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Fabio Pizza
- Department of Neurological Sciences; University of Bologna/IRCCS Istituto delle Scienze Neurologiche; Bologna; Italy
| | - Raffaele Ferri
- Department of Neurology; Oasi Institute IRCCS; Troina; Italy
| | - Francesca Poli
- Department of Neurological Sciences; University of Bologna/IRCCS Istituto delle Scienze Neurologiche; Bologna; Italy
| | - Stefano Vandi
- Department of Neurological Sciences; University of Bologna/IRCCS Istituto delle Scienze Neurologiche; Bologna; Italy
| | | | - Giuseppe Plazzi
- Department of Neurological Sciences; University of Bologna/IRCCS Istituto delle Scienze Neurologiche; Bologna; Italy
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Guilleminault C, da Rosa A, Hagen CC, Prilipko O. Cyclic Alternating Pattern (CAP) and Sleep-Disordered Breathing in Young Women. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Bruni O, Novelli L, Mallucci A, Corte MD, Romeo A, Ferri R. Benign Rolandic and Occipital Epilepsies of Childhood. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2011.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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17
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Chouvarda I, Rosso V, Mendez MO, Bianchi AM, Parrino L, Grassi A, Terzano M, Cerutti S. Assessment of the EEG complexity during activations from sleep. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2011; 104:e16-e28. [PMID: 21156327 DOI: 10.1016/j.cmpb.2010.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 10/30/2010] [Accepted: 11/09/2010] [Indexed: 05/30/2023]
Abstract
The present study quantitatively analyzes the EEG characteristics during activations (Act) that occur during NREM sleep, and constitute elements of sleep microstructure (i.e. the Cyclic Alternating Pattern). The fractal dimension (FD) and the sample entropy (SampEn) measures were used to study the different sleep stages and the Act that build up the sleep structure. Polysomnographic recordings from 10 good sleepers were analyzed. The complexity indexes of the Act were compared with the non-activation (NAct) periods during non-REM sleep. In addition, complexity measures among the different Act subtypes (A1, A2 and A3) were analyzed. A3 presented a quite similar complexity independently of the sleep stage, while A1 and A2 showed higher complexity in light sleep than during deep sleep. The current results suggest that Act present a hierarchic complexity between subtypes A3 (higher), A2 (intermediate) and A1 (lower) in all sleep stages.
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Affiliation(s)
- I Chouvarda
- Lab of Medical Informatics, The Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Poryazova R, Werth E, Parrino L, Terzano MG, Bassetti CL. Cyclic alternating pattern in narcolepsy patients and healthy controls after partial and total sleep deprivation. Clin Neurophysiol 2011; 122:1788-93. [PMID: 21458370 DOI: 10.1016/j.clinph.2011.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 02/21/2011] [Accepted: 02/24/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the regulation NREM sleep at baseline and in morning recovery sleep after partial and total sleep deprivation (SD) in narcolepsy-cataplexy (NC) using cyclic alternating pattern (CAP). METHODS Daytime sleep under either increased (no sleep in the previous night) or decreased sleep pressure (allowing 4h of sleep, 23:00-3:00 h) was recorded in ten drug-free, HLA-positive, hypocretin deficient NC patients and ten age, gender and body mass index matched healthy controls. Baseline sleep was also recorded and used for comparison purposes. CAP parameters were scored and analyzed for each subject. RESULTS Narcolepsy patients had significantly lower CAP rate, CAP index, CAP time, number of CAP cycles, A1 index and number of A1 cycles in comparison to healthy controls at baseline as well as after partial and total SD. In both narcolepsy patients and healthy control subjects there was a significant decrease in these parameters after partial and total SD but the changes followed a similar pattern. CONCLUSION The persistence of baseline differences in CAP parameters between narcolepsy patients and healthy controls and their similar behavior after partial and total SD suggests similar homeostatic NREM sleep regulation but on a different level. SIGNIFICANCE CAP analysis demonstrates that NREM sleep homeostasis although altered, is functional in narcolepsy patients.
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Insomnia: Neurophysiological and NeuropsychologicalApproaches. Neuropsychol Rev 2011; 21:22-40. [DOI: 10.1007/s11065-011-9160-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/06/2011] [Indexed: 01/08/2023]
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20
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Aricò D, Drago V, Foster PS, Heilman KM, Williamson J, Ferri R. Effects of NREM sleep instability on cognitive processing. Sleep Med 2010; 11:791-8. [DOI: 10.1016/j.sleep.2010.02.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 02/13/2010] [Accepted: 02/23/2010] [Indexed: 11/16/2022]
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21
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Halász P. The carrier of the CAP concept and practice in sleep medicine. Sleep Med 2010; 11:601-2. [DOI: 10.1016/j.sleep.2009.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 12/08/2009] [Indexed: 11/26/2022]
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22
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Bruni O, Novelli L, Miano S, Parrino L, Terzano MG, Ferri R. Cyclic alternating pattern: A window into pediatric sleep. Sleep Med 2010; 11:628-36. [PMID: 20427233 DOI: 10.1016/j.sleep.2009.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 10/12/2009] [Accepted: 10/16/2009] [Indexed: 10/19/2022]
Abstract
Cyclic alternating pattern (CAP) has now been studied in different age groups of normal infants and children, and it is clear that it shows dramatic changes with age. In this review we first focus on the important age-related changes of CAP from birth to peripubertal age and, subsequently, we describe the numerous studies on CAP in developmental clinical conditions such as pediatric sleep disordered breathing, disorders of arousal (sleep walking and sleep terror), pediatric narcolepsy, learning disabilities with mental retardation (fragile-X syndrome, Down syndrome, autistic spectrum disorder, Prader-Willi syndrome) or without (dyslexia, Asperger syndrome, attention-deficit/hyperactivity disorder). CAP rate is almost always decreased in these conditions with the exception of the disorders of arousal and some cases of sleep apnea. Another constant result is the reduction of A1 subtypes, probably in relationship with the degree of cognitive impairment. The analysis of CAP in pediatric sleep allows a better understanding of the underlying neurophysiological mechanisms of sleep disturbance. CAP can be considered as a window into pediatric sleep, allowing a new vision on how the sleeping brain is influenced by a specific pathology or how sleep protecting mechanisms try to counteract internal or external disturbing events.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental Neurology and Psychiatry, Centre for Pediatric Sleep Disorders, Sapienza University, Rome, Italy.
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Ferri R, Drago V, Aricò D, Bruni O, Remington RW, Stamatakis K, Punjabi NM. The effects of experimental sleep fragmentation on cognitive processing. Sleep Med 2010; 11:378-85. [PMID: 20226732 PMCID: PMC2851141 DOI: 10.1016/j.sleep.2010.01.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 12/24/2009] [Accepted: 01/10/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The primary objective of this study was to characterize the association between cyclic alternating pattern (CAP) and neurocognitive performance in a group of normal subjects before and after two nights of experimentally-induced sleep fragmentation. SUBJECTS AND METHODS Fifteen healthy subjects underwent one night of uninterrupted and two sequential nights of experimental sleep fragmentation achieved by auditory and mechanical stimuli. Eight subjects were re-examined using a similar paradigm with three nights of uninterrupted sleep. Sleep was polygraphically recorded and CAP analysis was performed for all recordings. A battery of neurocognitive tests was performed for spatial attention, inhibition of return, mental rotation, and Stroop color word test in the afternoon following the first and third night of sleep under fragmented and non-fragmented conditions. RESULTS With sleep fragmentation, the percentage of slow-wave sleep was dramatically reduced and there was a twofold increase in total CAP rate across all NREM sleep stages. Moreover, the number of all CAP A subtypes/hour of sleep (index) was significantly increased. Total CAP rate during the non-fragmented night correlated with reaction times. Similarly, the percentages of A1 and A3 subtypes were negatively and positively correlated with reaction times, respectively. Of the neurocognitive test battery, however, only values obtained from some subtests of the mental rotation test showed a significant improvement after sleep fragmentation. CONCLUSIONS The results of this study suggest that CAP A1 subtypes are associated with higher cognitive functioning, whereas CAP A3 subtypes are associated with lower cognitive functioning in young healthy subjects. The lack of cognitive functioning impairment after sleep fragmentation may be due to persistence and even enhancement of transient slow-wave activity contained in CAP A1 subtypes which also caused a significant enhancement of the EEG power spectrum in the lower frequencies.
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Affiliation(s)
- Raffaele Ferri
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy.
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Bruni O, Novelli L, Luchetti A, Zarowski M, Meloni M, Cecili M, Villa M, Ferri R. Reduced NREM sleep instability in benign childhood epilepsy with centro-temporal spikes. Clin Neurophysiol 2010; 121:665-71. [PMID: 20097604 DOI: 10.1016/j.clinph.2009.12.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Revised: 12/17/2009] [Accepted: 12/20/2009] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To analyze sleep architecture and NREM sleep instability by means of the cyclic alternating pattern (CAP) in children with benign epilepsy with rolandic spikes (BERS). METHODS Ten children with BERS, drug free at the time of the study and 10 age-matched normal controls were included in this study. Sleep was visually scored for sleep architecture and CAP using standard criteria. RESULTS Sleep architecture in BERS showed only few significant differences vs. controls with a reduction of total sleep time, sleep efficiency, and REM sleep percentage. CAP analysis revealed several significant differences: reduced total CAP rate, mainly in sleep stage 2, and reduced EEG slow oscillations and arousals during stages N1 and N2. CONCLUSIONS Sleep architecture is not importantly affected in BERS but CAP analysis reveals a decrease of NREM instability, mainly in sleep stage 2. Since there is a spindle-related spike activation in BERS, we speculate that the decrease of CAP and of EEG slow oscillations and arousals might be linked with the inhibitory action of spindling activity and spikes on arousals. SIGNIFICANCE CAP analysis discloses sleep structure abnormalities in children with BERS not shown by the classical sleep scoring. Spike activity and CAP A1 subtypes seem to be mutually exclusive probably because centro-temporal spikes disturb the physiological synchronization mechanisms needed for the generation of slow-wave components of CAP.
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Affiliation(s)
- Oliviero Bruni
- Pediatric Sleep Center, Department Developmental Neurology and Psychiatry, Sapienza University, Rome, Italy.
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25
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Smith AKA, Togeiro SMG, Tufik S, Roizenblatt S. Disturbed sleep and musculoskeletal pain in the bed partner of patients with obstructive sleep apnea. Sleep Med 2009; 10:904-12. [DOI: 10.1016/j.sleep.2008.08.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 07/16/2008] [Accepted: 08/28/2008] [Indexed: 11/24/2022]
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26
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Manousakis E. Quantum formalism to describe binocular rivalry. Biosystems 2009; 98:57-66. [PMID: 19520143 DOI: 10.1016/j.biosystems.2009.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 05/25/2009] [Accepted: 05/29/2009] [Indexed: 12/01/2022]
Abstract
On the basis of the general character and operation of the process of perception, a formalism is sought to mathematically describe the subjective or abstract/mental process of perception. It is shown that the formalism of orthodox quantum theory of measurement, where the observer plays a key role, is a broader mathematical foundation which can be adopted to describe the dynamics of the subjective experience. The mathematical formalism describes the psychophysical dynamics of the subjective or cognitive experience as communicated to us by the subject. Subsequently, the formalism is used to describe simple perception processes and, in particular, to describe the probability distribution of dominance duration obtained from the testimony of subjects experiencing binocular rivalry. Using this theory and parameters based on known values of neuronal oscillation frequencies and firing rates, the calculated probability distribution of dominance duration of rival states in binocular rivalry under various conditions is found to be in good agreement with available experimental data. This theory naturally explains an observed marked increase in dominance duration in binocular rivalry upon periodic interruption of stimulus and yields testable predictions for the distribution of perceptual alteration in time.
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27
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NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome. Sleep Med 2009; 10:471-8. [DOI: 10.1016/j.sleep.2008.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 04/29/2008] [Accepted: 04/30/2008] [Indexed: 11/23/2022]
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28
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Bruni O, Novelli L, Finotti E, Luchetti A, Uggeri G, Aricò D, Ferri R. All-night EEG power spectral analysis of the cyclic alternating pattern at different ages. Clin Neurophysiol 2009; 120:248-56. [DOI: 10.1016/j.clinph.2008.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Revised: 09/28/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
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29
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Cosentino FI, Bosco P, Drago V, Prestianni G, Lanuzza B, Iero I, Tripodi M, Spada RS, Toscano G, Caraci F, Ferri R. The APOE ε4 allele increases the risk of impaired spatial working memory in obstructive sleep apnea. Sleep Med 2008; 9:831-9. [DOI: 10.1016/j.sleep.2007.10.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 10/04/2007] [Accepted: 10/31/2007] [Indexed: 10/22/2022]
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Abstract
Even though the most impressive manifestation of narcolepsy is excessive sleepiness, paradoxically a significant number of patients have trouble sleeping at night. A wide array of alterations can affect the night-time sleep of a narcoleptic patient, and the aim of this review is to increase awareness on this issue, thereby enhancing the care of narcoleptic patients by more specific approaches to their disturbed night sleep. This review covers a broad variety of nocturnal sleep features in narcolepsy. Starting from animal models and the clinical features of patients, the paper then discusses the many comorbid conditions found in narcolepsy at night, the most advanced methods of analysis and the few recent advances in the specific treatment of night sleep in narcoleptic patients.
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Affiliation(s)
- Giuseppe Plazzi
- Department of Neurological Sciences, University of Bologna, Bologna, Italy.
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31
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Ferri R, Huber R, Aricò D, Drago V, Rundo F, Ghilardi MF, Massimini M, Tononi G. The slow-wave components of the cyclic alternating pattern (CAP) have a role in sleep-related learning processes. Neurosci Lett 2008; 432:228-31. [DOI: 10.1016/j.neulet.2007.12.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2007] [Revised: 10/26/2007] [Accepted: 12/13/2007] [Indexed: 11/24/2022]
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32
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Bruni O, Ferri R, Vittori E, Novelli L, Vignati M, Porfirio MC, Aricò D, Bernabei P, Curatolo P. Sleep architecture and NREM alterations in children and adolescents with Asperger syndrome. Sleep 2007; 30:1577-85. [PMID: 18041490 PMCID: PMC2082103 DOI: 10.1093/sleep/30.11.1577] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVES To analyze sleep in children with Asperger syndrome (AS) by means of standard sleep questionnaires, to evaluate sleep architecture and NREM sleep alterations by means of cyclic alternating pattern (CAP) and to correlate objective sleep parameters with cognitive behavioral measures. DESIGN Cross-sectional study involving validated sleep questionnaires, neuropsychological scales, and PSG recording. SETTING Sleep medicine center. PARTICIPANTS Eight children with AS, 10 children with autism, and 12 healthy control children. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Children with AS had a higher prevalence of problems of initiating sleep and daytime sleepiness. Sleep architecture parameters showed minor differences between the 3 groups. CAP parameters showed an increased percentage of A1 and a decreased percentage of A2 subtypes in subjects with AS vs. controls. All A subtype indexes (number per hour of NREM sleep) were decreased, mostly in sleep stage 2 but not in SWS. With respect to children with autism, subjects with AS showed increased CAP rate in SWS and A1 percentage. In subjects with AS, verbal IQ had a significant positive correlation with total CAP rate and CAP rate in SWS and with global and SWS A1 index. The percentage of A2 negatively correlated with full scale IQ, verbal and performance IQ. CBCL total score correlated positively with CAP rate and A1 index while externalizing score correlated negatively with A3%. CONCLUSIONS This study shows peculiar CAP modifications in children with AS and represents an attempt to correlate the quantification of sleep EEG oscillations with the degree of mental ability/disability.
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Affiliation(s)
- Oliviero Bruni
- Center for Pediatric Sleep Disorders, Department of Developmental Neurology and Psychiatry, University La Sapienza, 00185 Rome, Italy.
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Smerieri A, Parrino L, Agosti M, Ferri R, Terzano MG. Cyclic alternating pattern sequences and non-cyclic alternating pattern periods in human sleep. Clin Neurophysiol 2007; 118:2305-13. [PMID: 17709292 DOI: 10.1016/j.clinph.2007.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 06/27/2007] [Accepted: 07/02/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The CAP cycle is a module of activation (phase A) and inhibition (phase B) which repeats itself in sequences. The study aims at testing the hypothesis that the duration of CAP sequences is determined primarily by the number and not by the length of CAP cycles. METHODS The polysomnographic recordings of 24 normal subjects, 12 males and 12 females, ranging in age from 20 to 35 years (mean 27.8+/-7.2), were examined. RESULTS A total of 1053 CAP sequences were counted with an average of 43.9 sequences per night. The mean duration of CAP sequences was 2 min and 33 s. Each CAP sequence was composed of an average of 5.6 CAP cycles. All subjects presented CAP sequences lasting at least 5 min and 30s. The mean duration of CAP cycles was 26.9+/-4.1s. CAP cycles including subtypes A1 presented the highest correlation with the CAP sequence length (r=0.92; p<0.0001). CONCLUSIONS The progressive increase of CAP sequences length is linked to the progressive accumulation of CAP cycles. SIGNIFICANCE CAP sequences can be considered as strings of time-constant modules, i.e., CAP cycles, which are involved in the dynamic tailoring of sleep structure.
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Affiliation(s)
- Arianna Smerieri
- Sleep Disorders Center, Department of Neuroscience, University of Parma, Italy
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Miano S, Bruni O, Elia M, Trovato A, Smerieri A, Verrillo E, Roccella M, Terzano MG, Ferri R. Sleep in children with autistic spectrum disorder: a questionnaire and polysomnographic study. Sleep Med 2007; 9:64-70. [PMID: 17728182 DOI: 10.1016/j.sleep.2007.01.014] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 01/29/2007] [Accepted: 01/31/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate sleep in children with autistic spectrum disorder (ASD) by means of sleep questionnaires and polysomnography; moreover, to analyze their cyclic alternating pattern (CAP). METHODS Thirty-one patients with ASD (28 males, 3 females, aged 3.7-19 years) and age-matched normal controls were included. ASD children were evaluated by a standard sleep questionnaire that consisted of 45 items in a Likert-type scale covering several areas of sleep disorders and by overnight polysomnography in the sleep laboratory after one adaptation night. RESULTS The questionnaire results showed that parents of ASD children reported a high prevalence of disorders of initiating and maintaining sleep, enuresis, repetitive behavior when falling asleep, and daytime sleepiness. Polysomnographically, ASD children showed reduced time in bed, total sleep time, sleep period time and rapid eye movement (REM) latency. ASD subjects had a CAP rate during slow-wave sleep (SWS) lower than normal controls, together with a lower percentage of A1 subtypes. CONCLUSIONS ASD children questionnaires showed a higher percentage of disorders of initiating and maintaining sleep than normal controls; this was not completely confirmed by sleep staging. CAP measures showed subtle alterations of NREM sleep which could be detected with an appropriate methodology of analysis. The reduction of A1 subtypes during SWS might play a role in the impairment of cognitive functioning in these subjects.
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Affiliation(s)
- Silvia Miano
- Department of Neurology, Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via C. Ruggero 73, 94018 Troina, Italy
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Ferri R, Rundo F, Bruni O, Terzano MG, Stam CJ. Small-world network organization of functional connectivity of EEG slow-wave activity during sleep. Clin Neurophysiol 2007; 118:449-56. [PMID: 17174148 DOI: 10.1016/j.clinph.2006.10.021] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 10/12/2006] [Accepted: 10/29/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the functional connectivity patterns of the EEG slow-wave activity during the different sleep stages and Cyclic Alternating Pattern (CAP) conditions, using concepts derived from Graph Theory. METHODS We evaluated spatial patterns of EEG slow-wave synchronization between all possible pairs of electrodes (19) placed over the scalp of 10 sleeping healthy young normal subjects using two graph theoretical measures: the clustering coefficient (Cp) and the characteristic path length (Lp). The measures were obtained during the different sleep stages and CAP conditions from the real EEG connectivity networks and randomized control (surrogate) networks (Cp-s and Lp-s). RESULTS Cp and Cp/Cp-s increased significantly from wakefulness to sleep while Lp and Lp/Lp-s did not show changes. Cp/Cp-s was higher for A1 phases, compared to B phases of CAP. CONCLUSIONS The network organization of the EEG slow-wave synchronization during sleep shows features characteristic of small-world networks (high Cp combined with low Lp); this type of organization is slightly but significantly more evident during the CAP A1 subtypes. SIGNIFICANCE Our results show feasibility of using graph theoretical measures to characterize the complexity of brain networks during sleep and might indicate sleep, and the A1 phases of CAP in particular, as a period during which slow-wave synchronization shows optimal network organization for information processing.
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Affiliation(s)
- Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute (IRCCS), Via Conte Ruggero 73, 94018 Troina, Italy.
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Ferri R, Zucconi M, Rundo F, Spruyt K, Manconi M, Ferini-Strambi L. Heart rate and spectral EEG changes accompanying periodic and non-periodic leg movements during sleep. Clin Neurophysiol 2007; 118:438-48. [PMID: 17140849 DOI: 10.1016/j.clinph.2006.10.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 09/18/2006] [Accepted: 10/08/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the changes in heart rate (HR) and EEG spectra accompanying periodic (PLM) and non-periodic leg movements (NPLM) during sleep in patients with restless legs syndrome (RLS). METHODS Sixteen patients with RLS underwent one polysomnographic night recording; leg movements (LMs) during sleep were detected and classified as PLM or NPLM; up to 10 PLM and NPLM were chosen from NREM and REM sleep, for each patient and for each type (mono- or bilateral). EEG spectral analysis and HR were evaluated for 20s preceding and 30s following the onset of each LM. RESULTS EEG activation preceded LMs, particularly in the delta band which increased before the other frequency bands, in NREM sleep but not in REM sleep for PLM, and in both stages for NPLM. A similar difference was seen between mono- and bilateral LMs. CONCLUSIONS Sleep EEG, HR, and leg motor activity seems to be modulated by a complex dynamically interacting system of cortical and subcortical mechanisms, which influence each other. SIGNIFICANCE Future studies on the clinical significance of leg motor events during sleep need to take into account events classifiable as "isolated" and to integrate the autonomic and EEG changes accompanying them.
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Affiliation(s)
- Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute (IRCCS), 94018 Troina, Italy.
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37
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Guilleminault C, da Rosa A, Hagen CC, Prilipko O. Cyclic Alternating Pattern (CAP), Sleep Disordered Breathing, and Automatic Analysis. Sleep Med Clin 2006. [DOI: 10.1016/j.jsmc.2006.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Terzano MG, Smerieri A, Del Felice A, Giglia F, Palomba V, Parrino L. Cyclic alternating pattern (CAP) alterations in narcolepsy. Sleep Med 2006; 7:619-26. [PMID: 16740406 DOI: 10.1016/j.sleep.2005.12.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 10/24/2005] [Accepted: 12/02/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Narcolepsy is a sleep disorder with clinical symptoms attributed to a reduced activation of the arousal system. Cyclic alternating pattern (CAP) is the expression of rhythmic arousability during non-rapid eye movement (NREM) sleep. CAP parameters, arousals and conventional sleep measures were studied in narcoleptic patients with cataplexy. PATIENTS AND METHODS Data were collected from all-night polysomnographic (PSG) recordings and the multiple sleep latency test (MSLT) on the intervening day of 25 drug-naive patients (10 males and 15 females; mean age: 34+/-16 years) after adaptation and exclusion of other sleep disorders. A group of 25 age- and gender-matched normal sleepers were selected as controls. Each PSG recording was subdivided into sleep cycles. Analysis of CAP included classification of A phases into subtypes A1, A2, and A3. RESULTS There was an increase in sleep period time mainly due to an increased wake time after sleep onset. REM latency was sharply reduced. The percentage of NREM sleep was slightly reduced and the balance between light sleep (S1+S2) and deep sleep (S3+S4) showed a curtailment of the former, while deep sleep was slightly increased. Excluding sleep cycles with sleep onset REM periods (SOREMPs), the duration of ordered sleep cycles was not different between narcoleptics and controls. The two groups showed similar values of arousal index, while CAP time, CAP rate, number of CAP cycles and of phase A subtypes (in particular subtypes A1) were significantly reduced in narcoleptic patients. CONCLUSIONS The reduced periods of CAP in narcoleptic NREM sleep could be the electroencephalographic (EEG) expression of a generally reduced arousability or an increased strength of sleep-promoting forces in the balance between sleep and arousal systems. This can explain some of the clinical correlates of the disorder, i.e. excessive sleepiness, short sleep latency and impaired attentive performances, even without any sign of arousal-induced sleep fragmentation.
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Affiliation(s)
- Mario Giovanni Terzano
- Department of Neuroscience, Sleep Disorders Center, University of Parma, Via Gramsci, 14, 43100 Parma, Italy.
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