Manipulating REM sleep in older adults by selective REM sleep deprivation and physiological as well as pharmacological REM sleep augmentation methods

Quantitative Data Integration Analysis Method for Cross-Studies: Obstructive Sleep Apnea as an Example

Objective

In recent years, the prevalence of obstructive sleep apnea (OSA) has gradually increased. The diagnosis of this multiphenotypic disorder requires a combination of several indicators. The objective of this study was to find significant apnea monitor indicators of OSA by developing a strategy for cross-study screening and integration of quantitative data.

Methods

Articles related to sleep disorders were obtained from the PubMed database. A sleep disorder dataset and an OSA dataset were manually curated from these articles. Two evaluation indexes, the indicator coverage ratio (ICR) and the study integrity ratio (SIR), were used to filter out OSA indicators from the OSA dataset and create profiles including different numbers of indicators and studies for analysis. Data were analyzed by the meta 4.18-0 package of R, and the p value and standard mean difference (SMD) values were calculated to evaluate the change of each indicator.

Results

The sleep disorder dataset was constructed based on 178 studies from 119 publications, the OSA dataset was extracted from 89 studies, 284 sleep-related indicators were filtered out, and 22 profiles were constructed. Apnea hypopnea index was significantly decreased in all 22 profiles. Total sleep time (TST) (min) showed no significant differences in 21 profiles. There were significant increases in rapid eye movement (REM) (%TST) in 18 profiles, minimum arterial oxygen saturation (SaO₂) in 9 profiles, REM duration in 3 profiles, and slow wave sleep duration (%TST) and pulse oximetry lowest point in 2 profiles. There were significant decreases in apnea index (AI) in 14 profiles; arousal index and SaO₂ < 90 (%TST) in 8 profiles; N1 stage (%TST) in 7 profiles; and hypopnea index, N1 stage (% sleep period time (%SPT)), N2 stage (%SPT), respiratory arousal index, and respiratory disorder index in 2 profiles.

Conclusion

The proposed data integration strategy successfully identified multiple significant OSA indicators.

The association of changes of sleep architecture related to donepezil: A systematic review and meta-analysis

BACKGROUND

Donepezil had been recognized to have impact on sleep quality in demented patients. However, there was insufficient evidences about the actual effect of donepezil in the sleep architectures. Our meta-analysis aimed to evaluate the changes of sleep architectures related to donepezil use.

METHODS

Followed the PRISMA2020 and AMSTAR2 guidelines, electronic search had been performed on the databases of PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane CENTRAL, ProQuest, Web of Science, and ClinicalTrials.gov. The outcome measurement was changes of sleep parameters detected by polysomnography. A random-effects meta-analysis was conducted.

RESULTS

Total twelve studies had been involved. The percentage of REM sleep would significantly increase after donepezil treatment (Hedges' g = 0.694, p < 0.001). Compared to placebo/controls, subjects with donepezil would had significantly increased percentage of REM sleep stage (Hedges' g = 0.556, p = 0.018). Furthermore, donepezil was also associated with the decreased stage 2 sleep percentage, sleep efficiency, or total sleep time in different analysis conditions.

CONCLUSION

Our meta-analysis provided detailed changes of sleep architectures related to donepezil treatment. Further larger sample size studies with stricter control of potential moderators are needed to clarify these issues.

Unexpected REM sleep excess associated with a pontine lesion in multiple sclerosis

NONE

Sleep disorders are prevalent in patients with multiple sclerosis. In contrast, a frank increase of rapid eye movement (REM) sleep time is a rare phenomenon, mostly described in the context of REM sleep rebound (after sleep deprivation, abrupt withdrawal of antidepressants or neuroleptics, and during the first night of ventilation for severe sleep apnea), but not in link with specific brain lesions. We incidentally found an isolated, marked increase in REM sleep time (200 min, 40% of total sleep time, normative values: 18.2-20.3%) and in rapid eye movements density during REM sleep in a patient with a secondary progressive multiple sclerosis, associated with an anterior pontine demyelinating lesion on magnetic resonance imaging. This result suggests that a network blocking REM sleep in the pons has been damaged.

Sleep-dependent memory consolidation in healthy aging and mild cognitive impairment

Sleep quality and architecture as well as sleep's homeostatic and circadian controls change with healthy aging. Changes include reductions in slow-wave sleep's (SWS) percent and spectral power in the sleep electroencephalogram (EEG), number and amplitude of sleep spindles, rapid eye movement (REM) density and the amplitude of circadian rhythms, as well as a phase advance (moved earlier in time) of the brain's circadian clock. With mild cognitive impairment (MCI) there are further reductions of sleep quality, SWS, spindles, and percent REM, all of which further diminish, along with a profound disruption of circadian rhythmicity, with the conversion to Alzheimer's disease (AD). Sleep disorders may represent risk factors for dementias (e.g., REM Behavior Disorder presages Parkinson's disease) and sleep disorders are themselves extremely prevalent in neurodegenerative diseases. Working memory , formation of new episodic memories, and processing speed all decline with healthy aging whereas semantic, recognition, and emotional declarative memory are spared. In MCI, episodic and working memory further decline along with declines in semantic memory. In young adults, sleep-dependent memory consolidation (SDC) is widely observed for both declarative and procedural memory tasks. However, with healthy aging, although SDC for declarative memory is preserved, certain procedural tasks, such as motor-sequence learning, do not show SDC. In younger adults, fragmentation of sleep can reduce SDC, and a normative increase in sleep fragmentation may account for reduced SDC with healthy aging. Whereas sleep disorders such as insomnia, obstructive sleep apnea, and narcolepsy can impair SDC in the absence of neurodegenerative changes, the incidence of sleep disorders increases both with normal aging and, further, with neurodegenerative disease. Specific features of sleep architecture, such as sleep spindles and SWS are strongly linked to SDC. Diminution of these features with healthy aging and their further decline with MCI may account for concomitant declines in SDC. Notably these same sleep features further markedly decline, in concert with declining cognitive function, with the progression to AD. Therefore, progressive changes in sleep quality, architecture, and neural regulation may constitute a contributing factor to cognitive decline that is seen both with healthy aging and, to a much greater extent, with neurodegenerative disease.

The relationship of sleep with temperature and metabolic rate in a hibernating primate

STUDY OBJECTIVES

It has long been suspected that sleep is important for regulating body temperature and metabolic-rate. Hibernation, a state of acute hypothermia and reduced metabolic-rate, offers a promising system for investigating those relationships. Prior studies in hibernating ground squirrels report that, although sleep occurs during hibernation, it manifests only as non-REM sleep, and only at relatively high temperatures. In our study, we report data on sleep during hibernation in a lemuriform primate, Cheirogaleus medius. As the only primate known to experience prolonged periods of hibernation and as an inhabitant of more temperate climates than ground squirrels, this animal serves as an alternative model for exploring sleep temperature/metabolism relationships that may be uniquely relevant to understanding human physiology.

MEASUREMENTS AND RESULTS

We find that during hibernation, non-REM sleep is absent in Cheirogaleus. Rather, periods of REM sleep occur during periods of relatively high ambient temperature, a pattern opposite of that observed in ground squirrels. Like ground squirrels, however, EEG is marked by ultra-low voltage activity at relatively low metabolic-rates.

CONCLUSIONS

These findings confirm a sleep-temperature/metabolism link, though they also suggest that the relationship of sleep stage with temperature/metabolism is flexible and may differ across species or mammalian orders. The absence of non-REM sleep suggests that during hibernation in Cheirogaleus, like in the ground squirrel, the otherwise universal non-REM sleep homeostatic response is greatly curtailed or absent. Lastly, ultra-low voltage EEG appears to be a cross-species marker for extremely low metabolic-rate, and, as such, may be an attractive target for research on hibernation induction.

The orexin antagonist SB-649868 promotes and maintains sleep in men with primary insomnia

STUDY OBJECTIVES

To assess the acute effects of SB-649868 in male subjects with Primary Insomnia with regard to (1) objective and subjective sleep parameters, (2) safety and tolerability, (3) next-day residual effects.

DESIGN

Multicenter, randomized, double-blind, placebo-controlled crossover study using a complete set of Williams orthogonal Latin Squares

SETTING

9 sleep centers in Germany

PATIENTS

52 male subjects with a diagnosis of primary insomnia (difficulty in sleep initiation and maintenance) confirmed by polysomnography

INTERVENTIONS

SB-649868 (10, 30, 60 mg) and placebo administered after dinner 90 minutes before bedtime

MEASUREMENTS AND RESULTS

Sleep effects assessed by polysomnography during 2 consecutive nights and by sleep questionnaires completed by subjects after each night at the sleep laboratory. Safety and tolerability were assessed by adverse events collection, electrocardiogram (ECG), vital signs, laboratory tests. Next-day residual effects were assessed by Digit Symbol Substitution Test, and modified Verbal Learning Memory Test administered at "lights on" after night 2. SB-649868 significantly reduced latency to persistent sleep, wake after sleep onset (WASO), and increased total sleep time (TST) compared to placebo. A dose-dependent effect was observed. A dose-dependent increase in absolute and percent REM sleep and reduction in REM sleep latency was observed mainly at the 60-mg dose. SB-649868 was well tolerated with inconsistent next day residual effects. SB-649868 sleep effects were correlated with SB-649868 circulating levels.

CONCLUSION

The data demonstrate the sleep-promoting properties of the orexin antagonist SB-649868 in male patients with insomnia.

Effect of oxidative stress induced by paradoxical sleep deprivation on the activities of Na+, K+-ATPase and acetylcholinesterase in the cortex and hippocampus of rat

Several studies revealed the importance of paradoxical sleep as a homeostatic mechanism by which the brain can control oxidative stress. The aim of the present study is to investigate the effect of 72 h of paradoxical sleep deprivation on the oxidative stress markers and its insults on the activities of Na(+), K(+)-ATPase and acetylcholinesterase in the cortex and hippocampus of albino rat. Animals were subjected to paradoxical sleep deprivation for 72 h. At the end of the experiment, the rats were sacrificed, and catalase activity, levels of reduced glutathione, lipid peroxidation, and nitric oxide were assayed together with the activities of Na(+), K(+)-ATPase and acetylcholinesterase in the cortex and hippocampus. The present study revealed a significant increase in lipid peroxidation accompanied by a significant decrease in reduced glutathione in the cortex and hippocampus. Na(+), K(+)-ATPase decreased significantly in both areas. However, acetylcholinesterase showed a significant increase in the investigated brain regions. The present data showed that 72 h of paradoxical sleep deprivation induced oxidative stress in the cortex and hippocampus. It could be suggested that the inhibition of Na(+), K(+)-ATPase and the increased acetylcholinesterase activity may underlie memory impairment, increased brain excitability, and anxiety induced by paradoxical sleep deprivation.

REM sleep characteristics of nightmare sufferers before and after REM sleep deprivation

OBJECTIVES

To examine whether disrupted regulation of REM sleep propensity is implicated in nightmare (NM) pathophysiology.

BACKGROUND

Heightened REM propensity induced by REM sleep deprivation is belied by increases in REM %, REM density and the dream-like quality of dream mentation during post-deprivation recovery sleep. Compromised regulation of REM sleep propensity may be a contributing factor in the pathophysiology of frequent NMs.

METHODS

A preliminary study of 14 subjects with frequent NMs (> or = 1 NM/week; 27.6+/-9.9 years) and 11 healthy control subjects (<1 NM/month; 24.3+/-5.3 years) was undertaken. Subjects completed home sleep/dream logs and underwent three nights of polysomnographic recording with REM sleep deprivation on night 2. Group differences were assessed for a battery of REM sleep and dream measures on nights 1 and 3.

RESULTS

Several measures, including #skipped early-night REM periods, REM latency, REM/NREM cycle length, early/late REM density, REM rebound, late-night REM% and dream vividness, suggested that REM sleep propensity was abnormally low for the frequent NM group throughout the 3-day study.

CONCLUSIONS

Findings raise the possibility that REM anomalies recorded from NM sufferers sleeping in the laboratory environment reflect a disruption of one or more endogenous regulators of REM sleep propensity.

Slow wave sleep and REM sleep awakenings do not affect sleep dependent memory consolidation

STUDY OBJECTIVES

The effects of REM sleep and slow wave sleep (SWS) deprivation on sleep-dependent motor and declarative memory consolidation.

DESIGN

Randomized, within-subject, cross-over study.

SETTING

Weekly (women: monthly) sleep laboratory visits, with retest 60 hours later.

PARTICIPANTS

Twelve healthy subjects (6 men) aged between 20 and 30 years.

INTERVENTIONS

REM sleep deprivation, SWS deprivation, or undisturbed sleep.

MEASUREMENTS AND RESULTS

We deprived subjects once each of REM sleep and SWS, and once let them sleep undisturbed through the night. After each night, we tested declarative and procedural memory consolidation. We tested memory performance by a verbal paired associate task and a sequential finger-tapping task at 21:00 on the study night and again 60 hours later. Although REM sleep and SWS awakenings led to a significant reduction of the respective sleep stages, memory consolidation remained unaffected. We also found a significant correlation between the declarative task and sleep spindles in the undisturbed condition, especially the sleep spindles in the first third of the night.

CONCLUSION

We suggest that word-pair learning relies on stage 2 sleep spindles and requires little SWS. Their sleep dependent consolidation is not affected by SWS deprivation. Simple motor tasks may either be consolidated in stage 2 sleep or depend on only small amounts of REM sleep. Their sleep dependent consolidation is not influenced by REM sleep deprivation.

The relationship between REM sleep and memory consolidation in old age and effects of cholinergic medication

BACKGROUND

Recent findings in young adults suggest that rapid eye movement (REM) sleep plays a role in procedural memory consolidation. The significance of REM sleep for memory consolidation in old age has not yet been investigated.

METHODS

Effects of REM sleep manipulation on declarative and procedural memory consolidation were investigated in 107 healthy older adults, ages 60-82 years. Rapid eye movement sleep deprivation was achieved by REM sleep awakenings and compared with non-REM sleep awakenings. Rapid eye movement sleep augmentation was realized physiologically by REM sleep rebound and pharmacologically by administering an acetylcholinesterase inhibitor in a double-blind, placebo-controlled design. Memory performance was tested by a paired associate list and a mirror tracing task at 9:30 pm and 7:30 am with sleep intervening between 11:00 pm and 7:00 am.

RESULTS

Although REM sleep deprivation led to a significant reduction in total and phasic REM sleep, memory consolidation remained unaffected. Both REM sleep augmentation groups showed a significant increase in phasic REM sleep, whereas only pharmacological cholinergic REM sleep manipulation exerted a significant positive effect on procedural memory consolidation.

CONCLUSIONS

Because only after cholinergic stimulation of phasic REM sleep procedural memory consolidation is improved, cholinergic activation seems to be a crucial component of REM sleep-related memory consolidation in old age.