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Moguilner SG, Berezuk C, Bender AC, Pellerin KR, Gomperts SN, Cash SS, Sarkis RA, Lam AD. Sleep functional connectivity, hyperexcitability, and cognition in Alzheimer's disease. Alzheimers Dement 2024; 20:4234-4249. [PMID: 38764252 PMCID: PMC11180941 DOI: 10.1002/alz.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Sleep disturbances are common in Alzheimer's disease (AD) and may reflect pathologic changes in brain networks. To date, no studies have examined changes in sleep functional connectivity (FC) in AD or their relationship with network hyperexcitability and cognition. METHODS We assessed electroencephalogram (EEG) sleep FC in 33 healthy controls, 36 individuals with AD without epilepsy, and 14 individuals with AD and epilepsy. RESULTS AD participants showed increased gamma connectivity in stage 2 sleep (N2), which was associated with longitudinal cognitive decline. Network hyperexcitability in AD was associated with a distinct sleep connectivity signature, characterized by decreased N2 delta connectivity and reversal of several connectivity changes associated with AD. Machine learning algorithms using sleep connectivity features accurately distinguished diagnostic groups and identified "fast cognitive decliners" among study participants who had AD. DISCUSSION Our findings reveal changes in sleep functional networks associated with cognitive decline in AD and may have implications for disease monitoring and therapeutic development. HIGHLIGHTS Brain functional connectivity (FC) in Alzheimer's disease is altered during sleep. Sleep FC measures correlate with cognitive decline in AD. Network hyperexcitability in AD has a distinct sleep connectivity signature.
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Affiliation(s)
- Sebastian G. Moguilner
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Courtney Berezuk
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Alex C. Bender
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Kyle R. Pellerin
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Stephen N. Gomperts
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Sydney S. Cash
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Rani A. Sarkis
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyBrigham and Women's HospitalBostonMassachusettsUSA
| | - Alice D. Lam
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
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Zeller CJ, Wunderlin M, Wicki K, Teunissen CE, Nissen C, Züst MA, Klöppel S. Multi-night acoustic stimulation is associated with better sleep, amyloid dynamics, and memory in older adults with cognitive impairment. GeroScience 2024:10.1007/s11357-024-01195-z. [PMID: 38744792 DOI: 10.1007/s11357-024-01195-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
Sleep is a potential early, modifiable risk factor for cognitive decline and dementia. Impaired slow wave sleep (SWS) is pronounced in individuals with cognitive impairment (CI). Cognitive decline and impairments of SWS are bi-directionally linked in a vicious cycle. SWS can be enhanced non-invasively using phase-locked acoustic stimulation (PLAS), potentially breaking this vicious cycle. Eighteen healthy older adults (HC, agemean±sd, 68.3 ± 5.1) and 16 older adults (agemean±sd, 71.9 ± 3.9) with CI (Montreal Cognitive Assessment ≤ 25) underwent one baseline (sham-PLAS) night and three consecutive stimulation nights (real-PLAS). EEG responses and blood-plasma amyloid beta Aβ42/Aβ40 ratio were measured pre- and post-intervention, as was episodic memory. The latter was again evaluated 1 week and 3 months after the intervention. In both groups, PLAS induced a significant electrophysiological response in both voltage- and time-frequency analyses, and memory performance improved in association with the magnitude of this response. In the CI group, both electrophysiological and associated memory effects were delayed compared to the healthy group. After 3 intervention nights, electrophysiological response to PLAS was no longer different between CI and HC groups. Only in the CI sample, stronger electrophysiological responses were significantly associated with improving post-intervention Aβ42/Aβ40 ratios. PLAS seems to improve SWS electrophysiology, memory, and amyloid dynamics in older adults with CI. However, effects on memory require more time to unfold compared to healthy older adults. This indicates that PLAS may become a potential tool to ameliorate cognitive decline, but longer interventions are necessary to compensate for declining brain integrity. This study was pre-registered (clinicaltrials.gov: NCT04277104).
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Affiliation(s)
- Céline J Zeller
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland
| | - Korian Wicki
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, Netherlands
| | - Christoph Nissen
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), 1201, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, 1201, Geneva, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland.
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland
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Herberger S, Penzel T, Fietze I, Glos M, Cicolin A, Fattori E, Grimaldi D, Reid K, Zee P, Mason M, Kräuchi K. Enhanced conductive body heat loss during sleep increases slow-wave sleep and calms the heart. Sci Rep 2024; 14:4669. [PMID: 38409133 PMCID: PMC10897321 DOI: 10.1038/s41598-024-53839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/06/2024] [Indexed: 02/28/2024] Open
Abstract
Substantial evidence suggests that the circadian decline of core body temperature (CBT) triggers the initiation of human sleep, with CBT continuing to decrease during sleep. Although the connection between habitual sleep and CBT patterns is established, the impact of external body cooling on sleep remains poorly understood. The main aim of the present study is to show whether a decline in body temperatures during sleep can be related to an increase in slow wave sleep (N3). This three-center study on 72 individuals of varying age, sex, and BMI used an identical type of a high-heat capacity mattress as a reproducible, non-disturbing way of body cooling, accompanied by measurements of CBT and proximal back skin temperatures, heart rate and sleep (polysomnography). The main findings were an increase in nocturnal sleep stage N3 (7.5 ± 21.6 min/7.5 h, mean ± SD; p = 0.0038) and a decrease in heart rate (- 2.36 ± 1.08 bpm, mean ± SD; p < 0.0001); sleep stage REM did not change (p = 0.3564). Subjects with a greater degree of body cooling exhibited a significant increase in nocturnal N3 and a decrease in REM sleep, mainly in the second part of the night. In addition, these subjects showed a phase advance in the NREM-REM sleep cycle distribution of N3 and REM. Both effects were significantly associated with increased conductive inner heat transfer, indicated by an increased CBT- proximal back skin temperature -gradient, rather than with changes in CBT itself. Our findings reveal a previously far disregarded mechanism in sleep research that has potential therapeutic implications: Conductive body cooling during sleep is a reliable method for promoting N3 and reducing heart rate.
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Affiliation(s)
- Sebastian Herberger
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alessandro Cicolin
- Sleep Disorder Center, Department of Neurosciences, University of Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Elisa Fattori
- Sleep Disorder Center, Department of Neurosciences, University of Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Daniela Grimaldi
- Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Reid
- Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Phyllis Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Kurt Kräuchi
- Psychiatric University Clinics, University of Basel, Basel, Switzerland.
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Wortha SM, Schulz J, Hanna J, Schwarz C, Stubbe B, Frenzel S, Bülow R, Friedrich N, Nauck M, Völzke H, Ewert R, Vogelgesang A, Grabe HJ, Ladenbauer J, Flöel A. Association of spermidine blood levels with microstructure of sleep-implications from a population-based study. GeroScience 2024; 46:1319-1330. [PMID: 37548882 PMCID: PMC10828152 DOI: 10.1007/s11357-023-00886-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Deteriorations in slow wave sleep (SWS) have been linked to brain aging and Alzheimer's disease (AD), possibly due to its key role in clearance of amyloid-beta and tau (Aß/tau), two pathogenic hallmarks of AD. Spermidine administration has been shown to improve sleep quality in animal models. So far, the association between spermidine levels in humans and parameters of SWS physiology are unknown but may be valuable for therapeutic strategies. Data from 216 participants (age range 50-81 years) of the population-based Study of Health in Pomerania TREND were included in our analysis. We investigated associations between spermidine plasma levels, key parameters of sleep macroarchitecture and microarchitecture that were previously associated with AD pathology, and brain health measured via a marker of structural brain atrophy (AD score). Higher spermidine levels were significantly associated with lower coupling between slow oscillations and spindle activity. No association was evident for SWS, slow oscillatory, and spindle activity throughout non-rapid eye movement sleep. Furthermore, elevated spermidine blood levels were significantly associated with a higher AD score, while sleep markers revealed no association with AD score. The association between higher spermidine levels and brain health was not mediated by coupling between slow oscillations and spindle activity. We report that higher spermidine blood levels are associated not only with deteriorated brain health but also with less advantageous markers of sleep quality in older adults. Future studies need to evaluate whether sleep, spermidine, and Aß/tau deposition are interrelated and whether sleep may play a mediating role.
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Affiliation(s)
- Silke M Wortha
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
- Centre for Mathematical Cognition, School of Science, Loughborough University, Loughborough, UK.
| | - Juliane Schulz
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Jevri Hanna
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Claudia Schwarz
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Beate Stubbe
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Antje Vogelgesang
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Julia Ladenbauer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
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Simor P, Polner B, Báthori N, Bogdány T, Sifuentes Ortega R, Peigneux P. Reduced REM and N2 sleep, and lower dream intensity predict increased mind-wandering. Sleep 2024; 47:zsad297. [PMID: 37976037 DOI: 10.1093/sleep/zsad297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
Mind-wandering is a mental state in which attention shifts from the present environment or current task to internally driven, self-referent mental content. Homeostatic sleep pressure seems to facilitate mind-wandering as indicated by studies observing links between increased mind-wandering and impaired sleep. Nevertheless, previous studies mostly relied on cross-sectional measurements and self-reports. We aimed to combine the accuracy of objective sleep measures with the use of self-reports in a naturalistic setting in order to examine if objective sleep parameters predict the tendency for increased mind-wandering on the following day. We used mobile sleep electroencephalographic (EEG) headbands and self-report scales over 7 consecutive nights in a group of 67 healthy participants yielding ~400 analyzable nights. Nights with more wakefulness and shorter REM and slow wave sleep were associated with poorer subjective sleep quality at the intraindividual level. Reduced REM and N2 sleep, as well as less intense dream experiences, predicted more mind-wandering the following day. Our micro-longitudinal study indicates that intraindividual fluctuations in the duration of specific sleep stages predict the perception of sleep quality as assessed in the morning, as well as the intensity of daytime mind-wandering the following hours. The combined application of sleep EEG assessments and self-reports over repeated assessments provides new insights into the subtle intraindividual, night-to-day associations between nighttime sleep and the next day's subjective experiences.
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Affiliation(s)
- Péter Simor
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
| | - Bertalan Polner
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
- Donders Centre for Cognition, Radboud University, Nijmegen, The Netherlands
| | - Noémi Báthori
- Department of Cognitive Science, Faculty of Natural Sciences, Budapest University of Technology and Economics
| | - Tamás Bogdány
- Doctoral School of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
| | - Rebeca Sifuentes Ortega
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN affiliated at Center for Research in Cognition and Neurosciences and UNI - ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Belgium
| | - Philippe Peigneux
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN affiliated at Center for Research in Cognition and Neurosciences and UNI - ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Belgium
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Wei J, Wang M, Guo Y, Liu Y, Dong X. Sleep structure assessed by objective measurement in patients with mild cognitive impairment: A meta-analysis. Sleep Med 2024; 113:397-405. [PMID: 38134714 DOI: 10.1016/j.sleep.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES A meta-analysis was used to explore the characteristic changes in objective sleep structure of patients with mild cognitive impairment (MCI) compared with cognitively healthy older adults. MATERIALS AND METHODS PubMed, EMBAS, Cochrane Library, Scopus, and Web of Science were searched until November 2023. A literature quality evaluation was performed according to the Newcastle-Ottawa Scale, and a meta-analysis was performed by RevMan 5.3 software. RESULTS Fifteen studies with 771 participants were finally included. Compared with normal control groups, patients with MCI had a decreased total sleep time by 34.44 min, reduction in sleep efficiency by 7.96 %, increased waking after sleep onset by 19.61 min, and increased sleep latency by 6.97 min. Ten included studies showed that the patients with MCI had increased N1 sleep by 2.72 % and decreased N3 sleep by 0.78 %; however, there was no significant difference between the MCI and control groups in percentage of N2 sleep. Moreover, Twelve included studies reported the MCI groups had shorter REM sleep of 2.69 %. CONCLUSION Our results provide evidence of abnormal sleep architecture in patients with MCI. As a "plastic state," abnormal sleep architecture may be a promising therapeutic target for slowing cognitive decline and dementia prevention.
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Affiliation(s)
- Jianing Wei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Min Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuanli Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yanjin Liu
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiaofang Dong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
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Wunderlin M, Zeller CJ, Senti SR, Fehér KD, Suppiger D, Wyss P, Koenig T, Teunissen CE, Nissen C, Klöppel S, Züst MA. Acoustic stimulation during sleep predicts long-lasting increases in memory performance and beneficial amyloid response in older adults. Age Ageing 2023; 52:afad228. [PMID: 38163288 PMCID: PMC10758173 DOI: 10.1093/ageing/afad228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Sleep and neurodegeneration are assumed to be locked in a bi-directional vicious cycle. Improving sleep could break this cycle and help to prevent neurodegeneration. We tested multi-night phase-locked acoustic stimulation (PLAS) during slow wave sleep (SWS) as a non-invasive method to improve SWS, memory performance and plasma amyloid levels. METHODS 32 healthy older adults (agemean: 68.9) completed a between-subject sham-controlled three-night intervention, preceded by a sham-PLAS baseline night. RESULTS PLAS induced increases in sleep-associated spectral-power bands as well as a 24% increase in slow wave-coupled spindles, known to support memory consolidation. There was no significant group-difference in memory performance or amyloid-beta between the intervention and control group. However, the magnitude of PLAS-induced physiological responses were associated with memory performance up to 3 months post intervention and beneficial changes in plasma amyloid. Results were exclusive to the intervention group. DISCUSSION Multi-night PLAS is associated with long-lasting benefits in memory and metabolite clearance in older adults, rendering PLAS a promising tool to build upon and develop long-term protocols for the prevention of cognitive decline.
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Affiliation(s)
- Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
| | - Céline Jacqueline Zeller
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
| | - Samira Rafaela Senti
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Kristoffer Daniel Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Debora Suppiger
- Department of Neonatology, University Hospital Zurich and University of Zurich, 8006 Zürich, Switzerland
| | - Patric Wyss
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Thomas Koenig
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Charlotte Elisabeth Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Division of Psychiatric Specialties, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Marc Alain Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
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O CK, Siu BWH, Leung VWS, Lin YY, Ding CZ, Lau ESH, Luk AOY, Chow EYK, Ma RCW, Chan JCN, Chan RNY, Wing YK, Kong APS. Association of insomnia with incident chronic cognitive impairment in older adults with type 2 diabetes mellitus: A prospective study of the Hong Kong Diabetes Register. J Diabetes Complications 2023; 37:108598. [PMID: 37716256 DOI: 10.1016/j.jdiacomp.2023.108598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
AIMS To examine the risk association of insomnia with incident chronic cognitive impairment in older adults with type 2 diabetes mellitus (T2D). METHODS Between July 2010 and June 2015, patients with T2D aged ≥60 years enrolled in the Hong Kong Diabetes Register completed the Insomnia Severity Index (ISI) questionnaire. Patients were considered having insomnia if they had ISI score > 14. We prospectively followed up the cohort and censored outcome through reviewing diagnoses and clinical notes entered by attending physicians in electronic medical record to identify incident cases of mild cognitive impairment and dementia. RESULTS After excluding shift workers and those with established chronic cognitive impairment at baseline, we included 986 patients with T2D in this study (58.3 % men, mean age ± standard deviation: 62.5 ± 2.6 years, disease duration of diabetes: 10.7 ± 8.2 years, HbA1c: 7.4 ± 1.3 %, insulin users: 28.7 %, insomnia: 9.1 %). After a median follow-up of 7.6 (interquartile range = 2.0) years, 41 (4.2 %) developed chronic cognitive impairment. Using Cox regression analysis, insomnia (hazard ratio, HR 2.909, p = 0.012) and HbA1c ≥ 7 % (HR 2.300, p = 0.038) were positively associated with incident chronic cognitive impairment while insulin use (HR 0.309, p = 0.028) showed negative association. CONCLUSIONS Insomnia, suboptimal glycemic control and non-insulin use are independent risk factors for incident chronic cognitive impairment in older adults with T2D.
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Affiliation(s)
- Chun-Kwan O
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Brian Wai-Hei Siu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Vanessa Wai-Shan Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Yuan-Yuan Lin
- Department of Statistics, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Chen-Zhao Ding
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eric Siu-Him Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Andrea On-Yan Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Elaine Yee-Kwan Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Ronald Ching-Wan Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Juliana Chung-Ngor Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Rachel Ngan-Yin Chan
- Department of Psychiatry, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Yun Kwok Wing
- Department of Psychiatry, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Alice Pik-Shan Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Züst MA, Mikutta C, Omlin X, DeStefani T, Wunderlin M, Zeller CJ, Fehér KD, Hertenstein E, Schneider CL, Teunissen CE, Tarokh L, Klöppel S, Feige B, Riemann D, Nissen C. The Hierarchy of Coupled Sleep Oscillations Reverses with Aging in Humans. J Neurosci 2023; 43:6268-6279. [PMID: 37586871 PMCID: PMC10490476 DOI: 10.1523/jneurosci.0586-23.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023] Open
Abstract
A well orchestrated coupling hierarchy of slow waves and spindles during slow-wave sleep supports memory consolidation. In old age, the duration of slow-wave sleep and the number of coupling events decrease. The coupling hierarchy deteriorates, predicting memory loss and brain atrophy. Here, we investigate the dynamics of this physiological change in slow wave-spindle coupling in a frontocentral electroencephalography position in a large sample (N = 340; 237 females, 103 males) spanning most of the human life span (age range, 15-83 years). We find that, instead of changing abruptly, spindles gradually shift from being driven by slow waves to driving slow waves with age, reversing the coupling hierarchy typically seen in younger brains. Reversal was stronger the lower the slow-wave frequency, and starts around midlife (age range, ∼40-48 years), with an established reversed hierarchy between 56 and 83 years of age. Notably, coupling strength remains unaffected by age. In older adults, deteriorating slow wave-spindle coupling, measured using the phase slope index (PSI) and the number of coupling events, is associated with blood plasma glial fibrillary acidic protein levels, a marker for astrocyte activation. Data-driven models suggest that decreased sleep time and higher age lead to fewer coupling events, paralleled by increased astrocyte activation. Counterintuitively, astrocyte activation is associated with a backshift of the coupling hierarchy (PSI) toward a "younger" status along with increased coupling occurrence and strength, potentially suggesting compensatory processes. As the changes in coupling hierarchy occur gradually starting at midlife, we suggest there exists a sizable window of opportunity for early interventions to counteract undesirable trajectories associated with neurodegeneration.SIGNIFICANCE STATEMENT Evidence accumulates that sleep disturbances and cognitive decline are bidirectionally and causally linked, forming a vicious cycle. Improving sleep quality could break this cycle. One marker for sleep quality is a clear hierarchical structure of sleep oscillations. Previous studies showed that sleep oscillations decouple in old age. Here, we show that, rather, the hierarchical structure gradually shifts across the human life span and reverses in old age, while coupling strength remains unchanged. This shift is associated with markers for astrocyte activation in old age. The shifting hierarchy resembles brain maturation, plateau, and wear processes. This study furthers our comprehension of this important neurophysiological process and its dynamic evolution across the human life span.
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Affiliation(s)
- Marc Alain Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- Private Clinic Meiringen, 3860 Meiringen, Switzerland
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, United Kingdom
| | - Ximena Omlin
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Tatjana DeStefani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Céline Jacqueline Zeller
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Kristoffer Daniel Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- Division of Psychiatric Specialties, Geneva University Hospitals (HUG), 1201 Geneva, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Charlotte Elisabeth Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Leila Tarokh
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, 79104 Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, 79104 Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- Division of Psychiatric Specialties, Geneva University Hospitals (HUG), 1201 Geneva, Switzerland
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10
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Pase MP, Harrison S, Misialek JR, Kline CE, Cavuoto M, Baril AA, Yiallourou S, Bisson A, Himali D, Leng Y, Yang Q, Seshadri S, Beiser A, Gottesman RF, Redline S, Lopez O, Lutsey PL, Yaffe K, Stone KL, Purcell SM, Himali JJ. Sleep Architecture, Obstructive Sleep Apnea, and Cognitive Function in Adults. JAMA Netw Open 2023; 6:e2325152. [PMID: 37462968 PMCID: PMC10354680 DOI: 10.1001/jamanetworkopen.2023.25152] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
Importance Good sleep is essential for health, yet associations between sleep and dementia risk remain incompletely understood. The Sleep and Dementia Consortium was established to study associations between polysomnography (PSG)-derived sleep and the risk of dementia and related cognitive and brain magnetic resonance imaging endophenotypes. Objective To investigate association of sleep architecture and obstructive sleep apnea (OSA) with cognitive function in the Sleep and Dementia Consortium. Design, Setting, and Participants The Sleep and Dementia Consortium curated data from 5 population-based cohorts across the US with methodologically consistent, overnight, home-based type II PSG and neuropsychological assessments over 5 years of follow-up: the Atherosclerosis Risk in Communities study, Cardiovascular Health Study, Framingham Heart Study (FHS), Osteoporotic Fractures in Men Study, and Study of Osteoporotic Fractures. Sleep metrics were harmonized centrally and then distributed to participating cohorts for cohort-specific analysis using linear regression; study-level estimates were pooled in random effects meta-analyses. Results were adjusted for demographic variables, the time between PSG and neuropsychological assessment (0-5 years), body mass index, antidepressant use, and sedative use. There were 5946 participants included in the pooled analyses without stroke or dementia. Data were analyzed from March 2020 to June 2023. Exposures Measures of sleep architecture and OSA derived from in-home PSG. Main Outcomes and Measures The main outcomes were global cognitive composite z scores derived from principal component analysis, with cognitive domains investigated as secondary outcomes. Higher scores indicated better performance. Results Across cohorts, 5946 adults (1875 females [31.5%]; mean age range, 58-89 years) were included. The median (IQR) wake after sleep onset time ranged from 44 (27-73) to 101 (66-147) minutes, and the prevalence of moderate to severe OSA ranged from 16.9% to 28.9%. Across cohorts, higher sleep maintenance efficiency (pooled β per 1% increase, 0.08; 95% CI, 0.03 to 0.14; P < .01) and lower wake after sleep onset (pooled β per 1-min increase, -0.07; 95% CI, -0.13 to -0.01 per 1-min increase; P = .02) were associated with better global cognition. Mild to severe OSA (apnea-hypopnea index [AHI] ≥5) was associated with poorer global cognition (pooled β, -0.06; 95% CI, -0.11 to -0.01; P = .01) vs AHI less than 5; comparable results were found for moderate to severe OSA (pooled β, -0.06; 95% CI, -0.11 to -0.01; P = .02) vs AHI less than 5. Differences in sleep stages were not associated with cognition. Conclusions and Relevance This study found that better sleep consolidation and the absence of OSA were associated with better global cognition over 5 years of follow-up. These findings suggest that the role of interventions to improve sleep for maintaining cognitive function requires investigation.
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Affiliation(s)
- Matthew P. Pase
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Harvard T.H. Chan School of Public Health, Massachusetts
- Framingham Heart Study, Framingham, Massachusetts
| | | | - Jeffrey R. Misialek
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Christopher E. Kline
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marina Cavuoto
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Andree-Ann Baril
- Framingham Heart Study, Framingham, Massachusetts
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Stephanie Yiallourou
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Alycia Bisson
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Dibya Himali
- Framingham Heart Study, Framingham, Massachusetts
| | - Yue Leng
- Department of Psychiatry and Behavioral Sciences, University of California
| | - Qiong Yang
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center San Antonio
| | - Alexa Beiser
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Oscar Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
- Department of Epidemiology, University of California, San Francisco
| | - Katie L. Stone
- California Pacific Medical Center, Research Institute, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Shaun M. Purcell
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jayandra J. Himali
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center San Antonio
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio
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11
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Kong SDX, Gordon CJ, Hoyos CM, Wassing R, D’Rozario A, Mowszowski L, Ireland C, Palmer JR, Grunstein RR, Shine JM, McKinnon AC, Naismith SL. Heart rate variability during slow wave sleep is linked to functional connectivity in the central autonomic network. Brain Commun 2023; 5:fcad129. [PMID: 37234683 PMCID: PMC10208252 DOI: 10.1093/braincomms/fcad129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/20/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Reduced heart rate variability can be an early sign of autonomic dysfunction in neurodegenerative diseases and may be related to brain dysfunction in the central autonomic network. As yet, such autonomic dysfunction has not been examined during sleep-which is an ideal physiological state to study brain-heart interaction as both the central and peripheral nervous systems behave differently compared to during wakefulness. Therefore, the primary aim of the current study was to examine whether heart rate variability during nocturnal sleep, specifically slow wave (deep) sleep, is associated with central autonomic network functional connectivity in older adults 'at-risk' of dementia. Older adults (n = 78; age range = 50-88 years; 64% female) attending a memory clinic for cognitive concerns underwent resting-state functional magnetic resonance imaging and an overnight polysomnography. From these, central autonomic network functional connectivity strength and heart rate variability data during sleep were derived, respectively. High-frequency heart rate variability was extracted to index parasympathetic activity during distinct periods of sleep, including slow wave sleep as well as secondary outcomes of non-rapid eye movement sleep, wake after sleep onset, and rapid eye movement sleep. General linear models were used to examine associations between central autonomic network functional connectivity and high-frequency heart rate variability. Analyses revealed that increased high-frequency heart rate variability during slow wave sleep was associated with stronger functional connectivity (F = 3.98, P = 0.022) in two core brain regions within the central autonomic network, the right anterior insular and posterior midcingulate cortex, as well as stronger functional connectivity (F = 6.21, P = 0.005) between broader central autonomic network brain regions-the right amygdala with three sub-nuclei of the thalamus. There were no significant associations between high-frequency heart rate variability and central autonomic network connectivity during wake after sleep onset or rapid eye movement sleep. These findings show that in older adults 'at-risk' of dementia, parasympathetic regulation during slow wave sleep is uniquely linked to differential functional connectivity within both core and broader central autonomic network brain regions. It is possible that dysfunctional brain-heart interactions manifest primarily during this specific period of sleep known for its role in memory and metabolic clearance. Further studies elucidating the pathophysiology and directionality of this relationship should be conducted to determine if heart rate variability drives neurodegeneration, or if brain degeneration within the central autonomic network promotes aberrant heart rate variability.
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Affiliation(s)
- Shawn D X Kong
- Correspondence to: Shawn Dexiao KongHealthy Brain Ageing ProgramBrain and Mind Centre, University of Sydney100 Mallett St, Camperdown, NSW 2050, Australia E-mail:
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Camilla M Hoyos
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Rick Wassing
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Angela D’Rozario
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
| | - Catriona Ireland
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Jake R Palmer
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW 2050, Australia
| | - James M Shine
- Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW 2050, Australia
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12
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Zaheed AB, Chervin RD, Spira AP, Zahodne LB. Mental and physical health pathways linking insomnia symptoms to cognitive performance 14 years later. Sleep 2023; 46:zsac262. [PMID: 36309871 PMCID: PMC9995792 DOI: 10.1093/sleep/zsac262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/27/2022] [Indexed: 12/04/2022] Open
Abstract
STUDY OBJECTIVES Insomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive functioning across domains; (2) whether insomnia-cognition associations are mediated by mental and physical health; and (3) whether these associations are modified by gender. METHODS Participants included 2595 adults ages 51-88 at baseline (Mage=64.00 ± 6.66, 64.5% women) in the Health and Retirement Study. The frequency of insomnia symptoms (difficulty initiating sleep, night time awakenings, early awakenings, and feeling unrested upon awakening) at baseline (2002) were quantified using a modified Jenkins Sleep Questionnaire. Cognition was assessed in 2016 via the Harmonized Cognitive Assessment Protocol and operationalized with factor scores corresponding to five domains. Depressive symptoms and vascular conditions in 2014 were assessed via self-report. Structural equation models estimated total, indirect, and direct effects of insomnia symptoms on subsequent cognition through depressive symptoms and vascular diseases, controlling for baseline sociodemographic and global cognition. RESULTS Frequent difficulty initiating sleep was associated with poorer episodic memory, executive function, language, visuoconstruction, and processing speed 14 years later (-0.06 ≤ β ≤ -0.04; equivalent to 2.2-3.4 years of aging). Depressive symptoms explained 12.3%-19.5% of these associations and vascular disease explained 6.3%-14.6% of non-memory associations. No other insomnia symptoms were associated with cognition, and no associations were modified by gender. CONCLUSIONS Difficulty initiating sleep in later life may predict future cognitive impairment through multiple pathways. Future research with longitudinal assessments of insomnia, insomnia treatments, and cognition is needed to evaluate insomnia as a potential intervention target to optimize cognitive aging.
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Affiliation(s)
- Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD 21205, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
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13
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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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14
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Zeller CJ, Züst MA, Wunderlin M, Nissen C, Klöppel S. The promise of portable remote auditory stimulation tools to enhance slow-wave sleep and prevent cognitive decline. J Sleep Res 2023:e13818. [PMID: 36631001 DOI: 10.1111/jsr.13818] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
Dementia is the seventh leading cause of mortality, and a major source of disability and dependency in older individuals globally. Cognitive decline (and, to a lesser extent, normal ageing) are associated with sleep fragmentation and loss of slow-wave sleep. Evidence suggests a bidirectional causal link between these losses. Phase-locked auditory stimulation has emerged as a promising non-invasive tool to enhance slow-wave sleep, potentially ameliorating cognitive decline. In laboratory settings, auditory stimulation is usually supervised by trained experts. Different algorithms (simple amplitude thresholds, topographic correlation, sine-wave fitting, phase-locked loop, and phase vocoder) are used to precisely target auditory stimulation to a desired phase of the slow wave. While all algorithms work well in younger adults, the altered sleep physiology of older adults and particularly those with neurodegenerative disorders requires a tailored approach that can adapt to older adults' fragmented sleep and reduced amplitudes of slow waves. Moreover, older adults might require a continuous intervention that is not feasible in laboratory settings. Recently, several auditory stimulation-capable portable devices ('Dreem®', 'SmartSleep®' and 'SleepLoop®') have been developed. We discuss these three devices regarding their potential as tools for science, and as clinical remote-intervention tools to combat cognitive decline. Currently, SleepLoop® shows the most promise for scientific research in older adults due to high transparency and customizability but is not commercially available. Studies evaluating down-stream effects on cognitive abilities, especially in patient populations, are required before a portable auditory stimulation device can be recommended as a clinical preventative remote-intervention tool.
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Affiliation(s)
- Céline J Zeller
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Division of Psychiatric Specialties, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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15
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Li Y, Li Q, Zou X, Zhong Z, Ouyang Q, Zeng Q, Hu Y, Wang M, Luo Y, Yao D. Effects of CPAP treatment on electroencephalographic activity in patients with obstructive sleep apnea syndrome during deep sleep: Preliminary findings of a cross-sectional study. Chron Respir Dis 2023; 20:14799731231215094. [PMID: 37967573 PMCID: PMC10655652 DOI: 10.1177/14799731231215094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
Study objectives: To investigate whether electroencephalographic (EEG) activities during non-rapid eye movement sleep stage 3 (N3) in obstructive sleep apnea syndrome (OSAS) patients were changed with continuous positive airway pressure (CPAP) treatment.Methods: A cross-sectional study of EEG activity during N3 sleep was conducted in 15 patients with moderate to severe OSAS without and with CPAP treatment compared to 15 normal controls. The amplitude, and absolute and relative power of delta, theta, alpha and beta waves as well as the absolute power ratio of slow to fast EEG waves (i.e., absolute power of delta and theta waves/absolute power of alpha and beta waves) and the spectral power density of 0-30 Hz EEG activities were analyzed.Results: CPAP significantly increased N3 sleep, the absolute and relative powers, amplitudes of delta and theta waves, and absolute power ratio of slow to fast EEG waves, but decreased relative alpha and beta powers during N3 sleep. However, there were no significant differences in those parameters between the OSAS patients with CPAP treatment and normal controls.Conclusions: CPAP prolongs N3 sleep and increases the power and amplitude of slow EEG waves during N3 sleep, which indicates an improvement in sleep quality and further provides evidence for recommendation of CPAP treatment for OSAS patients.
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Affiliation(s)
- Yiran Li
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, 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, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Xueliang Zou
- Jiangxi Mental Hospital, Nanchang University, Nanchang, 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, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, 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, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Qinghong Zeng
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Yinyin Hu
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, 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, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, 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, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, 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, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
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16
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Owens AP, Krebs C, Kuruppu S, Brem AK, Kowatsch T, Aarsland D, Klöppel S. Broadened assessments, health education and cognitive aids in the remote memory clinic. Front Public Health 2022; 10:1033515. [PMID: 36568790 PMCID: PMC9768191 DOI: 10.3389/fpubh.2022.1033515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022] Open
Abstract
The prevalence of dementia is increasing and poses a health challenge for individuals and society. Despite the desire to know their risks and the importance of initiating early therapeutic options, large parts of the population do not get access to memory clinic-based assessments. Remote memory clinics facilitate low-level access to cognitive assessments by eschewing the need for face-to-face meetings. At the same time, patients with detected impairment or increased risk can receive non-pharmacological treatment remotely. Sensor technology can evaluate the efficiency of this remote treatment and identify cognitive decline. With remote and (partly) automatized technology the process of cognitive decline can be monitored but more importantly also modified by guiding early interventions and a dementia preventative lifestyle. We highlight how sensor technology aids the expansion of assessments beyond cognition and to other domains, e.g., depression. We also illustrate applications for aiding remote treatment and describe how remote tools can facilitate health education which is the cornerstone for long-lasting lifestyle changes. Tools such as transcranial electric stimulation or sleep-based interventions have currently mostly been used in a face-to-face context but have the potential of remote deployment-a step already taken with memory training apps. Many of the presented methods are readily scalable and of low costs and there is a range of target populations, from the worried well to late-stage dementia.
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Affiliation(s)
- Andrew P. Owens
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Christine Krebs
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sajini Kuruppu
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Anna-Katharine Brem
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom,University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland,School of Medicine, University of St. Gallen, St. Gallen, Switzerland,Centre for Digital Health Interventions, Department Management, Technology, and Economics at ETH Zurich, Zurich, Switzerland
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,*Correspondence: Stefan Klöppel
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17
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Wunderlin M, Koenig T, Zeller C, Nissen C, Züst MA. Automatized online prediction of slow-wave peaks during non-rapid eye movement sleep in young and old individuals: Why we should not always rely on amplitude thresholds. J Sleep Res 2022; 31:e13584. [PMID: 35274389 PMCID: PMC9787564 DOI: 10.1111/jsr.13584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/02/2022] [Accepted: 02/25/2022] [Indexed: 12/30/2022]
Abstract
Brain-state-dependent stimulation during slow-wave sleep is a promising tool for the treatment of psychiatric and neurodegenerative diseases. A widely used slow-wave prediction algorithm required for brain-state-dependent stimulation is based on a specific amplitude threshold in the electroencephalogram. However, due to decreased slow-wave amplitudes in aging and psychiatric conditions, this approach might miss many slow-waves because they do not fulfill the amplitude criterion. Here, we compared slow-wave peaks predicted via an amplitude-based versus a multidimensional approach using a topographical template of slow-wave peaks in 21 young and 21 older healthy adults. We validate predictions against the gold-standard of offline detected peaks. Multidimensionally predicted peaks resemble the gold-standard regarding spatiotemporal dynamics but exhibit lower peak amplitudes. Amplitude-based prediction, by contrast, is less sensitive, less precise and - especially in the older group - predicts peaks that differ from the gold-standard regarding spatiotemporal dynamics. Our results suggest that amplitude-based slow-wave peak prediction might not always be the ideal choice. This is particularly the case in populations with reduced slow-wave amplitudes, like older adults or psychiatric patients. We recommend the use of multidimensional prediction, especially in studies targeted at populations other than young and healthy individuals.
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Affiliation(s)
- Marina Wunderlin
- University Hospital of Old Age Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
| | - Thomas Koenig
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland,Interfaculty Research Cooperation ‐ Decoding SleepUniversity of BernBernSwitzerland
| | - Céline Zeller
- University Hospital of Old Age Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland,Interfaculty Research Cooperation ‐ Decoding SleepUniversity of BernBernSwitzerland
| | - Marc Alain Züst
- University Hospital of Old Age Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
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18
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Damsgaard L, Janbek J, Laursen TM, Erlangsen A, Spira AP, Waldemar G. Hospital-diagnosed sleep disorders and incident dementia: a nationwide observational cohort study. Eur J Neurol 2022; 29:3528-3536. [PMID: 35916072 PMCID: PMC9805192 DOI: 10.1111/ene.15517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Several smaller, community-based studies have suggested a link between sleep disorders and dementia with a focus on sleep as a modifiable risk factor for dementia. Studies on neurodegenerative diseases are prone to reverse causation, and few studies have examined the association with long follow-up time. Our aim was to explore the possible association between sleep disorders and late-onset dementia in an entire population. METHODS In a nationwide cohort with 40-year follow-up, associations between hospital-based sleep disorder diagnoses and late-onset dementia were assessed. Incidence rate ratios (IRR) were calculated using Poisson regression. RESULTS The cohort consisted of 1,491,276 people. Those with any sleep disorder had a 17% higher risk of dementia (IRR 1.17, 95% confidence interval [CI] 1.11-1.24) compared to people with no sleep disorder, adjusted for age, sex, calendar year, highest attained educational level at age 50, and somatic and psychiatric comorbidity. The risk of dementia was significantly increased 0-5 years after sleep disorder diagnosis (IRR 1.35, 95% CI 1.25-1.47), whilst the association after 5 years or more was non-significant (1.05, 95% CI 0.97-1.13). CONCLUSIONS Our findings show an increased short-term risk of dementia following a hospital-based sleep disorder diagnosis, whilst weaker evidence of a long-term risk was found. This could potentially point towards sleep disorders as an early symptom of dementia. Further research is needed to distinguish sleep disorders as an early symptom of dementia, a risk factor, or both.
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Affiliation(s)
- Line Damsgaard
- Danish Dementia Research Centre, Section 8008, Department of NeurologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Janet Janbek
- Danish Dementia Research Centre, Section 8008, Department of NeurologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Thomas Munk Laursen
- Department of Economics and Business EconomicsNational Centre for Register‐based Research, Aarhus BSS, Aarhus UniversityAarhus VDenmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre CopenhagenHellerupDenmark,Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA,Copenhagen Research Centre for Mental HealthHellerupDenmark,Center of Mental Health ResearchAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Adam P. Spira
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA,Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA,Johns Hopkins Center on Aging and HealthBaltimoreMarylandUSA
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Section 8008, Department of NeurologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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19
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A systematic review of the validity of non-invasive sleep-measuring devices in mid-to-late life adults: Future utility for Alzheimer's disease research. Sleep Med Rev 2022; 65:101665. [DOI: 10.1016/j.smrv.2022.101665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
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20
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McConnell BV, Kronberg E, Medenblik LM, Kheyfets VO, Ramos AR, Sillau SH, Pulver RL, Bettcher BM. The Rise and Fall of Slow Wave Tides: Vacillations in Coupled Slow Wave/Spindle Pairing Shift the Composition of Slow Wave Activity in Accordance With Depth of Sleep. Front Neurosci 2022; 16:915934. [PMID: 35812239 PMCID: PMC9260314 DOI: 10.3389/fnins.2022.915934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
Slow wave activity (SWA) during sleep is associated with synaptic regulation and memory processing functions. Each cycle of non-rapid-eye-movement (NREM) sleep demonstrates a waxing and waning amount of SWA during the transitions between stages N2 and N3 sleep, and the deeper N3 sleep is associated with an increased density of SWA. Further, SWA is an amalgam of different types of slow waves, each identifiable by their temporal coupling to spindle subtypes with distinct physiological features. The objectives of this study were to better understand the neurobiological properties that distinguish different slow wave and spindle subtypes, and to examine the composition of SWA across cycles of NREM sleep. We further sought to explore changes in the composition of NREM cycles that occur among aging adults. To address these goals, we analyzed subsets of data from two well-characterized cohorts of healthy adults: (1) The DREAMS Subjects Database (n = 20), and (2) The Cleveland Family Study (n = 60). Our analyses indicate that slow wave/spindle coupled events can be characterized as frontal vs. central in their relative distribution between electroencephalography (EEG) channels. The frontal predominant slow waves are identifiable by their coupling to late-fast spindles and occur more frequently during stage N3 sleep. Conversely, the central-associated slow waves are identified by coupling to early-fast spindles and favor occurrence during stage N2 sleep. Together, both types of slow wave/spindle coupled events form the composite of SWA, and their relative contribution to the SWA rises and falls across cycles of NREM sleep in accordance with depth of sleep. Exploratory analyses indicated that older adults produce a different composition of SWA, with a shift toward the N3, frontal subtype, which becomes increasingly predominant during cycles of NREM sleep. Overall, these data demonstrate that subtypes of slow wave/spindle events have distinct cortical propagation patterns and differ in their distribution across lighter vs. deeper NREM sleep. Future efforts to understand how slow wave sleep and slow wave/spindle coupling impact memory performance and neurological disease may benefit from examining the composition of SWA to avoid potential confounds that may occur when comparing dissimilar neurophysiological events.
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Affiliation(s)
- Brice V. McConnell
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
- *Correspondence: Brice V. McConnell,
| | - Eugene Kronberg
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
| | - Lindsey M. Medenblik
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
| | - Vitaly O. Kheyfets
- Pediatric Critical Care Medicine, University of Colorado, Denver, Denver, CO, United States
| | - Alberto R. Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stefan H. Sillau
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
| | - Rachelle L. Pulver
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
| | - Brianne M. Bettcher
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
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21
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Kim H, Levine A, Cohen D, Gehrman P, Zhu X, Devanand DP, Lee S, Goldberg TE. The Role of Amyloid, Tau, and APOE Genotype on the Relationship Between Informant-Reported Sleep Disturbance and Alzheimer’s Disease Risks. J Alzheimers Dis 2022; 87:1567-1580. [DOI: 10.3233/jad-215417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The association between sleep and Alzheimer’s disease (AD) biomarkers are well-established, but little is known about how they interact to change the course of AD. Objective: To determine the potential interaction between sleep disturbance and Aβ, tau, and APOE4 on brain atrophy and cognitive decline. Methods: Sample included 351 participants (mean age 72.01 ± 6.67, 50.4%female) who were followed for approximately 5 years as part of the Alzheimer’s Disease Neuroimaging Initiative. Informant-reported sleep disturbance (IRSD) was measured using the Neuropsychiatric Inventory (NPI). Changes in magnetic resonance imaging (MRI)-measured AD signature brain regions and cognitive performance and IRSD’s interaction with cerebrospinal fluid amyloid-β (Aβ42) and p-Tau depositions and APOE4 status were examined using the linear mixed models. Results: Baseline IRSD was not significantly associated with the rate of atrophy after adjusting for covariates (age, sex, education, total NPI severity score, and sleep medications). However, there was a significant interaction between IRSD and AD biomarkers on faster atrophy rates in multiple brain regions, including the cortical and middle temporal volumes. Post-hoc analyses indicated that Aβ and p-Tau/Aβ predicted a faster decline in these regions/domains in IRSD, compared with biomarker-negative individuals with IRSD (ps≤0.001). There was a significant IRSD*APOE4 interaction for brain atrophy rate (ps≤0.02) but not for cognition. Conclusion: IRSD may increase the future risk of AD by contributing to faster brain atrophy and cognitive decline when combined with the presence of AD biomarkers and APOE4. Early intervention for sleep disturbance could help reduce the risk of developing AD.
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Affiliation(s)
- Hyun Kim
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
| | - Alina Levine
- Division of Mental Health DataScience, New York State Psychiatric Institute, New York, NY, USA
| | - Daniel Cohen
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
| | - Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
| | - Davangere P. Devanand
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
- Department ofNeurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Seonjoo Lee
- Division of Mental Health DataScience, New York State Psychiatric Institute, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Terry E. Goldberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA
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22
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Henao D, Navarrete M, Juez JY, Dinh H, Gómez R, Valderrama M, Le Van Quyen M. Auditory closed‐loop stimulation on sleep slow oscillations using in‐ear EEG sensors. J Sleep Res 2022; 31:e13555. [DOI: 10.1111/jsr.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- David Henao
- Department of Biomedical Engineering Universidad de Los Andes Bogotá D.C. Colombia
| | - Miguel Navarrete
- Department of Biomedical Engineering Universidad de Los Andes Bogotá D.C. Colombia
- Cardiff University Brain Research Imaging Centre (CUBRIC) School of Psychology Cardiff University Cardiff UK
| | - José Yesith Juez
- Department of Biomedical Engineering Universidad de Los Andes Bogotá D.C. Colombia
| | | | - Rodrigo Gómez
- Department of Biomedical Engineering Universidad de Los Andes Bogotá D.C. Colombia
| | - Mario Valderrama
- Department of Biomedical Engineering Universidad de Los Andes Bogotá D.C. Colombia
| | - Michel Le Van Quyen
- Laboratoire d’Imagerie Biomédicale (LIB) Inserm U1146/Sorbonne Université UMCR2/UMR7371 CNRS Paris France
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23
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Weihs A, Frenzel S, Garvert L, Kühn L, Wittfeld K, Ewert R, Fietze I, Penzel T, Stubbe B, Szentkirályi A, Wulms N, Völzke H, Grabe HJ. The relationship between Alzheimer's‐related brain atrophy patterns and sleep macro‐architecture. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2022; 14:e12371. [PMID: 36381559 PMCID: PMC9652484 DOI: 10.1002/dad2.12371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/15/2022]
Abstract
Introduction Sleep is increasingly recognized as a major risk factor for neurodegenerative disorders such as Alzheimer's disease (AD). Methods Using an magnetic resonance imaging (MRI)-based AD score based on clinical data from the Alzheimer's Disease Neuroimaging Initiative 1 (ADNI1) case-control cohort, we investigated the associations between polysomnography-based sleep macro-architecture and AD-related brain atrophy patterns in 712 pre-symptomatic, healthy subjects from the population-based Study of Health in Pomerania. Results We identified a robust inverse association between slow-wave sleep and the AD marker (estimate: -0.019; 95% confidence interval: -0.03 to -0.0076; false discovery rate [FDR] = 0.0041), as well as with gray matter (GM) thicknesses in typical individual cortical AD-signature regions. No effects were identified regarding rapid eye movement or non-rapid eye movement (NREM) stage 2 sleep, and NREM stage 1 was positively associated with GM thickness, mainly in the prefrontal cortical regions. Discussion There is a cross-sectional relationship between AD-related neurodegenerative patterns and the proportion of sleep spent in slow-wave sleep.
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Affiliation(s)
- Antoine Weihs
- Department of Psychiatry and Psychotherapy University Medicine Greifswald Greifswald Mecklenburg‐Vorpommern Germany
| | - Stefan Frenzel
- Department of Psychiatry and Psychotherapy University Medicine Greifswald Greifswald Mecklenburg‐Vorpommern Germany
| | - Linda Garvert
- Department of Psychiatry and Psychotherapy University Medicine Greifswald Greifswald Mecklenburg‐Vorpommern Germany
| | - Luise Kühn
- Department of Psychiatry and Psychotherapy University Medicine Greifswald Greifswald Mecklenburg‐Vorpommern Germany
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy University Medicine Greifswald Greifswald Mecklenburg‐Vorpommern Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald Greifswald Mecklenburg‐Vorpommern Germany
| | - Ralf Ewert
- Department of Internal Medicine B–Cardiology Pneumology, Infectious Diseases Intensive Care Medicine University Medicine Greifswald Greifswald Mecklenburg‐Vorpommern Germany
| | - Ingo Fietze
- Interdisciplinary Centre of Sleep Medicine CC 12 University Hospital Charité Berlin Berlin Germany
- The Fourth People's hospital of Guangyuan Guangyuan City Sichuan China
| | - Thomas Penzel
- Interdisciplinary Centre of Sleep Medicine CC 12 University Hospital Charité Berlin Berlin Germany
| | - Beate Stubbe
- Department of Internal Medicine B–Cardiology Pneumology, Infectious Diseases Intensive Care Medicine University Medicine Greifswald Greifswald Mecklenburg‐Vorpommern Germany
| | - András Szentkirályi
- Institute of Epidemiology and Social Medicine University of Muenster Muenster Nordrhein‐Westfalen Germany
| | - Niklas Wulms
- Institute of Epidemiology and Social Medicine University of Muenster Muenster Nordrhein‐Westfalen Germany
| | - Henry Völzke
- Institute for Community Medicine Department SHIP/Clinical Epidemiological Research University Medicine Greifswald Greifswald Mecklenburg‐Vorpommern Germany
- German Centre for Cardiovascular Research (DZHK) Partner Site Greifswald Greifswald Mecklenburg‐Vorpommern Germany
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy University Medicine Greifswald Greifswald Mecklenburg‐Vorpommern Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald Greifswald Mecklenburg‐Vorpommern Germany
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Costa MD, Redline S, Hughes TM, Heckbert SR, Goldberger AL. Prediction of Cognitive Decline Using Heart Rate Fragmentation Analysis: The Multi-Ethnic Study of Atherosclerosis. Front Aging Neurosci 2021; 13:708130. [PMID: 34512310 PMCID: PMC8428192 DOI: 10.3389/fnagi.2021.708130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Heart rate fragmentation (HRF), a new non-invasive metric quantifying cardiac neuroautonomic function, is associated with increasing age and cardiovascular disease. Since these are risk factors for cognitive decline and dementia, in the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether disrupted cardiac neuroautonomic function, evidenced by increased HRF, would be associated with worse cognitive function assessed concurrently and at a later examination, and with greater cognitive decline. Methods: HRF was derived from the ECG channel of the polysomnographic recordings obtained in an ancillary study (n = 1,897) conducted in conjunction with MESA exam 5 (2010–2012). Cognitive function was assessed at exam 5 and 6.4 ± 0.5 years later at exam 6 (2016–2018) with tests of global cognitive performance (the Cognitive Abilities Screening Instrument, CASI), processing speed (Digit Symbol Coding, DSC) and working memory (Digit Span). Multivariable regression models were used to quantify the associations between HRF indices and cognitive scores. Results: The participants’ mean age was 68 ± 9 years (54% female). Higher HRF at baseline was independently associated with lower cognitive scores at both exams 5 and 6. Specifically, in cross-sectional analyses, a one-standard deviation (SD) (13.7%) increase in HRF was associated with a 0.51 (95% CI: 0.17–0.86) points reduction in CASI and a 1.12 (0.34–1.90) points reduction in DSC. Quantitatively similar effects were obtained in longitudinal analyses. A one-SD increase in HRF was associated with a 0.44 (0.03–0.86) and a 1.04 (0.28–1.81) points reduction in CASI and DSC from exams 5 to 6, respectively. HRF added predictive value to the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE-APOE-ε4) risk score and to models adjusted for serum concentration of NT-proBNP, an analyte associated with cognitive impairment and dementia. Conclusion: Increased HRF assessed during sleep was independently associated with diminished cognitive performance (concurrent and future) and with greater cognitive decline. These findings lend support to the links between cardiac neuroautonomic regulation and cognitive function. As a non-invasive, repeatable and inexpensive probe, HRF technology may be useful in monitoring cognitive status, predicting risk of dementia and assessing therapeutic interventions.
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Affiliation(s)
- Madalena D Costa
- Margret and H. A. Rey Institute for Non-linear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timothy M Hughes
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Ary L Goldberger
- Margret and H. A. Rey Institute for Non-linear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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25
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Wunderlin M, Züst MA, Hertenstein E, Fehér KD, Schneider CL, Klöppel S, Nissen C. Modulating overnight memory consolidation by acoustic stimulation during slow-wave sleep: a systematic review and meta-analysis. Sleep 2021; 44:6066545. [PMID: 33406249 DOI: 10.1093/sleep/zsaa296] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/12/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES The low-frequency high-amplitude oscillations of slow-wave sleep (SWS) are considered to promote the consolidation of episodic memory. Previous research suggests that sleep slow waves can be entrained and enhanced by presenting short acoustic stimuli to the up-states of endogenous waves. Several studies have investigated the effects of these increases in slow-wave activity on overnight memory consolidation, with inconsistent results. The aim of this meta-analysis was to evaluate the accumulated evidence connecting acoustic stimulation during sleep to episodic memory consolidation. METHODS A systematic literature search was conducted in October 2020 using PubMed, Web of Science, and PsycInfo. The main study inclusion criteria were the application of acoustic slow wave enhancement in healthy participants and an assessment of pre- and post-sleep episodic memory performance. Effect sizes were pooled using a random-effects model. RESULTS A total of 10 primary studies with 11 experiments and 177 participants were included. Results showed a combined effect size (Hedges' g) of 0.25 (p = 0.07). Subgroup models based on young adults (n = 8), phase-locked stimulation approaches (n = 8), and their combination (n = 6) showed combined effect sizes of 0.31 (p = 0.051), 0.36 (p = 0.047), and 0.44 (p = 0.01), respectively. There was no indication of publication bias or bias in individual studies. CONCLUSIONS Acoustic enhancement of SWS tends to increase the overnight consolidation of episodic memory but effects remain small and-with the exception of subgroup models-at trend levels. Currently, the evidence is not sufficient to recommend the use of commercially available devices.
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Affiliation(s)
- Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kristoffer D Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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26
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Fehér KD, Wunderlin M, Maier JG, Hertenstein E, Schneider CL, Mikutta C, Züst MA, Klöppel S, Nissen C. Shaping the slow waves of sleep: A systematic and integrative review of sleep slow wave modulation in humans using non-invasive brain stimulation. Sleep Med Rev 2021; 58:101438. [PMID: 33582581 DOI: 10.1016/j.smrv.2021.101438] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 10/14/2020] [Accepted: 11/10/2020] [Indexed: 01/19/2023]
Abstract
The experimental study of electroencephalographic slow wave sleep (SWS) stretches over more than half a century and has corroborated its importance for basic physiological processes, such as brain plasticity, metabolism and immune system functioning. Alterations of SWS in aging or pathological conditions suggest that modulating SWS might constitute a window for clinically relevant interventions. This work provides a systematic and integrative review of SWS modulation through non-invasive brain stimulation in humans. A literature search using PubMed, conducted in May 2020, identified 3220 studies, of which 82 fulfilled inclusion criteria. Three approaches have been adopted to modulate the macro- and microstructure of SWS, namely auditory, transcranial electrical and transcranial magnetic stimulation. Our current knowledge about the modulatory mechanisms, the space of stimulation parameters and the physiological and behavioral effects are reported and evaluated. The integration of findings suggests that sleep slow wave modulation bears the potential to promote our understanding of the functions of SWS and to develop new treatments for conditions of disrupted SWS.
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Affiliation(s)
- Kristoffer D Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Jonathan G Maier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; Privatklinik Meiringen, Meiringen, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
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27
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Dierks T, Wahlund LO. Editorial. Psychiatry Res Neuroimaging 2020; 306:111175. [PMID: 32919867 DOI: 10.1016/j.pscychresns.2020.111175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Thomas Dierks
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
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