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Ouyang A, Zhang C, Adra N, Tesh RA, Sun H, Lei D, Jing J, Fan P, Paixao L, Ganglberger W, Briggs L, Salinas J, Bevers MB, Wrann CD, Chemali Z, Fricchione G, Thomas RJ, Rosand J, Tanzi RE, Westover MB. Effects of Aerobic Exercise on Brain Age and Health in Middle-Aged and Older Adults: A Single-Arm Pilot Clinical Trial. Life (Basel) 2024; 14:855. [PMID: 39063609 PMCID: PMC11278044 DOI: 10.3390/life14070855] [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: 02/11/2024] [Revised: 05/26/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUNDS Sleep disturbances are prevalent among elderly individuals. While polysomnography (PSG) serves as the gold standard for sleep monitoring, its extensive setup and data analysis procedures impose significant costs and time constraints, thereby restricting the long-term application within the general public. Our laboratory introduced an innovative biomarker, utilizing artificial intelligence algorithms applied to PSG data to estimate brain age (BA), a metric validated in cohorts with cognitive impairments. Nevertheless, the potential of exercise, which has been a recognized means of enhancing sleep quality in middle-aged and older adults to reduce BA, remains undetermined. METHODS We conducted an exploratory study to evaluate whether 12 weeks of moderate-intensity exercise can improve cognitive function, sleep quality, and the brain age index (BAI), a biomarker computed from overnight sleep electroencephalogram (EEG), in physically inactive middle-aged and older adults. Home wearable devices were used to monitor heart rate and overnight sleep EEG over this period. The NIH Toolbox Cognition Battery, in-lab overnight polysomnography, cardiopulmonary exercise testing, and a multiplex cytokines assay were employed to compare pre- and post-exercise brain health, exercise capacity, and plasma proteins. RESULTS In total, 26 participants completed the initial assessment and exercise program, and 24 completed all procedures. Data are presented as mean [lower 95% CI of mean, upper 95% CI of mean]. Participants significantly increased maximal oxygen consumption (Pre: 21.11 [18.98, 23.23], Post 22.39 [20.09, 24.68], mL/kg/min; effect size: -0.33) and decreased resting heart rate (Pre: 66.66 [63.62, 67.38], Post: 65.13 [64.25, 66.93], bpm; effect size: -0.02) and sleeping heart rate (Pre: 64.55 [61.87, 667.23], Post: 62.93 [60.78, 65.09], bpm; effect size: -0.15). Total cognitive performance (Pre: 111.1 [107.6, 114.6], Post: 115.2 [111.9, 118.5]; effect size: 0.49) was significantly improved. No significant differences were seen in BAI or measures of sleep macro- and micro-architecture. Plasma IL-4 (Pre: 0.24 [0.18, 0.3], Post: 0.33 [0.24, 0.42], pg/mL; effect size: 0.49) was elevated, while IL-8 (Pre: 5.5 [4.45, 6.55], Post: 4.3 [3.66, 5], pg/mL; effect size: -0.57) was reduced. CONCLUSIONS Cognitive function was improved by a 12-week moderate-intensity exercise program in physically inactive middle-aged and older adults, as were aerobic fitness (VO2max) and plasma cytokine profiles. However, we found no measurable effects on sleep architecture or BAI. It remains to be seen whether a study with a larger sample size and more intensive or more prolonged exercise exposure can demonstrate a beneficial effect on sleep quality and brain age.
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Affiliation(s)
- An Ouyang
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA 02131, USA
| | - Can Zhang
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Noor Adra
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Ryan A. Tesh
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Haoqi Sun
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Dan Lei
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Jin Jing
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Peng Fan
- Department of Physical Therapy & Human Movement Science, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Wolfgang Ganglberger
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Logan Briggs
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Joel Salinas
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Matthew B. Bevers
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Christiane Dorothea Wrann
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Zeina Chemali
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gregory Fricchione
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Robert J. Thomas
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Rudolph E. Tanzi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Michael Brandon Westover
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
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Li L, Long T, Liu Y, Ayoub M, Song Y, Shu Y, Liu X, Zeng L, Huang L, Liu Y, Deng Y, Li H, Peng D. Abnormal dynamic functional connectivity and topological properties of cerebellar network in male obstructive sleep apnea. CNS Neurosci Ther 2024; 30:e14786. [PMID: 38828694 PMCID: PMC11145370 DOI: 10.1111/cns.14786] [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: 01/04/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE To investigate dynamic functional connectivity (dFC) within the cerebellar-whole brain network and dynamic topological properties of the cerebellar network in obstructive sleep apnea (OSA) patients. METHODS Sixty male patients and 60 male healthy controls were included. The sliding window method examined the fluctuations in cerebellum-whole brain dFC and connection strength in OSA. Furthermore, graph theory metrics evaluated the dynamic topological properties of the cerebellar network. Additionally, hidden Markov modeling validated the robustness of the dFC. The correlations between the abovementioned measures and clinical assessments were assessed. RESULTS Two dynamic network states were characterized. State 2 exhibited a heightened frequency, longer fractional occupancy, and greater mean dwell time in OSA. The cerebellar networks and cerebrocerebellar dFC alterations were mainly located in the default mode network, frontoparietal network, somatomotor network, right cerebellar CrusI/II, and other networks. Global properties indicated aberrant cerebellar topology in OSA. Dynamic properties were correlated with clinical indicators primarily on emotion, cognition, and sleep. CONCLUSION Abnormal dFC in male OSA may indicate an imbalance between the integration and segregation of brain networks, concurrent with global topological alterations. Abnormal default mode network interactions with high-order and low-level cognitive networks, disrupting their coordination, may impair the regulation of cognitive, emotional, and sleep functions in OSA.
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Affiliation(s)
- Lifeng Li
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
- Department of Radiology, The Affiliated Changsha Central Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangHunan ProvinceChina
| | - Ting Long
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
| | - Yuting Liu
- Department of OphthalmologyHunan Children's HospitalChangshaHunan ProvinceChina
| | - Muhammad Ayoub
- School of Computer Science and Engineering, Central South UniversityChangshaHunan ProvinceChina
| | - Yucheng Song
- School of Computer Science and Engineering, Central South UniversityChangshaHunan ProvinceChina
| | - Yongqiang Shu
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
| | - Xiang Liu
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
| | - Li Zeng
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
| | - Ling Huang
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
| | - Yumeng Liu
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
| | - Yingke Deng
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
| | - Haijun Li
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
- PET Center, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
| | - Dechang Peng
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
- PET Center, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJiangxi ProvinceChina
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Mu FZ, Liu J, Lou H, Zhu WD, Wang ZC, Li B. Influence of physical exercise on negative emotions in college students: chain mediating role of sleep quality and self-rated health. Front Public Health 2024; 12:1402801. [PMID: 38765486 PMCID: PMC11100322 DOI: 10.3389/fpubh.2024.1402801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Background Negative emotions in college students are a significant factor affecting mental health, with suicide behaviors caused by negative emotions showing an annual increasing trend. Existing studies suggest that physical exercise is essential to alleviate negative feelings, yet the intrinsic mechanisms by which it affects negative emotions have not been fully revealed. Objective Negative emotions in college students represent a significant issue affecting mental health. This study investigates the relationship between physical exercise and negative emotions among college students, incorporating sleep quality and self-rated health (SRH) as mediators to analyze the pathway mechanism of how physical exercise affects students' negative emotions. Methods A cross-sectional study design was utilized, employing online questionnaires for investigation. The scales included the Physical Activity Rating Scale-3 (PARS-3), the Depression Anxiety Stress Scales-21 (DASS-21), the Pittsburgh Sleep Quality Index (PSQI), and the 12-Item Short Form Health Survey (SF-12), resulting in the collection of 30,475 valid questionnaires, with a validity rate of 91%. Chain mediation tests and Bootstrap methods were applied for effect analysis. Results The proportions of university students engaged in low, medium, and high levels of physical exercise were 77.6, 13.1, and 9.3%, respectively. The proportions of students experiencing "very severe" levels of stress, anxiety, and depression were 4.5, 10.9, and 3.6%, respectively. Physical exercise was significantly positively correlated with self-rated health (r = 0.194, p < 0.01), significantly negatively correlated with sleep quality (r = -0.035, p < 0.01), and significantly negatively correlated with stress, anxiety, and depression (r = -0.03, p < 0.01; r = -0.058, p < 0.01; r = -0.055, p < 0.01). Sleep quality was significantly negatively correlated with self-rated health (r = -0.242, p < 0.01). Mediation effect testing indicated that sleep quality and self-rated health partially mediated the relationship between physical exercise and negative emotions, with total effect, total direct effect, and total indirect effect values of -1.702, -0.426, and - 1.277, respectively. Conclusion College students primarily engage in low-intensity physical activity. Sleep quality and self-rated health mediate the impact of physical exercise on students' negative emotions. A certain level of physical activity can directly affect students' emotional states and indirectly influence their negative emotions via sleep and self-rated health. Regular engagement in physical activities primarily positively impacts emotional states by enhancing mood stability and overall emotional resilience.
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Affiliation(s)
- Fan-zheng Mu
- Institute of Sports Science, Nantong University, Nantong, China
| | - Jun Liu
- Institute of Sports Science, Nantong University, Nantong, China
| | - Hu Lou
- Institute of Sports Science, Nantong University, Nantong, China
| | - Wei-dong Zhu
- Institute of Sports Science, Nantong University, Nantong, China
| | - Zhen-cheng Wang
- School of Basic Medicine, Nanjing Medical University, Nanjing, China
| | - Bo Li
- Institute of Sports Science, Nantong University, Nantong, China
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Patel M, Braun J, Lambert G, Kameneva T, Keatch C, Lambert E. Central mechanisms in sympathetic nervous dysregulation in obesity. J Neurophysiol 2023; 130:1414-1424. [PMID: 37910522 DOI: 10.1152/jn.00254.2023] [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: 06/28/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
Cardiovascular and metabolic complications associated with excess adiposity are linked to chronic activation of the sympathetic nervous system, resulting in a high risk of mortality among obese individuals. Obesity-related positive energy balance underlies the progression of hypertension, end-organ damage, and insulin resistance, driven by increased sympathetic tone throughout the body. It is, therefore, important to understand the central network that drives and maintains sustained activation of the sympathetic nervous system in the obese state. Experimental and clinical studies have identified structural changes and altered dynamics in both grey and white matter regions in obesity. Aberrant activation in certain brain regions has been associated with altered reward circuitry and metabolic pathways including leptin and insulin signaling along with adiposity-driven systemic and central inflammation. The impact of these pathways on the brain via overactivity of the sympathetic nervous system has gained interest in the past decade. Primarily, the brainstem, hypothalamus, amygdala, hippocampus, and cortical structures including the insular, orbitofrontal, temporal, cingulate, and prefrontal cortices have been identified in this context. Although the central network involving these structures is much more intricate, this review highlights recent evidence identifying these regions in sympathetic overactivity in obesity.
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Affiliation(s)
- Mariya Patel
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Joe Braun
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Gavin Lambert
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Tatiana Kameneva
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Charlotte Keatch
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Elisabeth Lambert
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
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Qin Y, Sun C, Sun H, Li M, Leng B, Yao R, Li Z, Zhang J. Electroencephalographic slowdowns during sleep are associated with cognitive impairment in patients who have obstructive sleep apnea but no dementia. Sleep Breath 2023; 27:2315-2324. [PMID: 37155126 DOI: 10.1007/s11325-023-02843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/27/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To research the relationship between quantitative electroencephalogram (qEEG) and impaired cognitive function patients who have obstructive sleep apnea (OSA) but no dementia. METHODS Subjects who complained of snoring between March 2020 and April 2021 in the Sleep Medicine Center of Weihai Municipal Hospital were included. All subjects underwent overnight in-laboratory polysomnography (PSG) and were assessed using a neuropsychological scale. Standard fast fourier transform (FFT) was used to obtain the electroencephalogram (EEG) power spectral density curve, and to calculate the delta, theta, alpha, and beta relative power and the ratio between slow and fast frequencies. Binary logistic regression was used to assess the risk factors for cognitive impairment in patients who had OSA but no dementia. Correlation analysis was performed to determine the relationship between qEEG and cognitive impairment. RESULTS A total of 175 participants without dementia who met the inclusion criteria were included in this study. There were 137 patients with OSA, including 76 with mild cognitive impairment (OSA + MCI), 61 without mild cognitive impairment (OSA-MCI), and 38 participants without OSA (non-OSA). The relative theta power in the frontal lobe in stage 2 of non-rapid eye movement sleep (NREM 2) in OSA + MCI was higher than that in OSA-MCI (P = 0.038) and non-OSA (P = 0.018). Pearson correlation analysis showed that the relative theta power in the frontal lobe in NREM 2 was negatively correlated with Mini-Mental State Examination (MMSE) scores, Montreal Cognitive Assessment (MoCA) Beijing version scores, and MoCA subdomains scores (visual executive function, naming, attention, language, abstraction, delayed recall and orientation) outside language. CONCLUSIONS In patients who had OSA but no dementia, the EEG slower frequency power increased. The relative theta power in the frontal lobe in NREM 2 was associated with MCI of patients with OSA. These results suggest that the slowing of theta activity may be one of the neurophysiological changes in the early stage of cognitive impairment in patients with OSA.
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Affiliation(s)
- Yibing Qin
- The Second Clinical Medical College, Binzhou Medical University, Yantai, 264000, Shandong, China
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, Shandong, China
| | - Chao Sun
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, Shandong, China
| | - Hairong Sun
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, Shandong, China
| | - Mengfan Li
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, Shandong, China
- Liaocheng People's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Bing Leng
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, Shandong, China
| | - Ran Yao
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, Shandong, China
| | - Zhenguang Li
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, Shandong, China
| | - Jinbiao Zhang
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, Shandong, China.
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Zhang C, Wang Y, Li D, Li M, Zhang X, Rong W, Wang P, Li L, He S, Xu Y, Li Y. EEG Power Spectral Density in NREM Sleep is Associated with the Degree of Hypoxia in Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2023; 15:979-992. [PMID: 38046177 PMCID: PMC10691959 DOI: 10.2147/nss.s433820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder. Research conducted on patients with OSA using electroencephalography (EEG) has revealed a noticeable shift in the overnight polysomnography (PSG) power spectrum. To better quantify the effects of OSA on brain function and to identify the most reliable predictors of pathological cortical activation, this study quantified the PSG power and its association with the degree of hypoxia in OSA patients. Patients and Methods This retrospective study recruited 93 patients with OSA. OSA patients were divided into three groups based on their apnea-hypopnea index (AHI) scores. The clinical characteristics and sleep macrostructure of these patients were examined, followed by an analysis of PSG signals. Power spectral density (PSD) in five frequency bands was analyzed during nonrapid eye movement (NREM) sleep, rapid eye movement (REM) sleep, and wakefulness. Finally, correlation analysis was conducted to assess the relationships among PSD, PSG parameters, and serum levels of S100β and uric acid. Results Obstructive sleep apnea occurred during both the NREM and REM sleep phases. Except for a decrease in the duration of N2 sleep and an increase in the microarousal index, there were no significant differences in sleep architecture based on disease severity. Compared to the mild OSA group, the theta and alpha band PSD in the frontal and occipital regions during NREM sleep and wakefulness were significantly decreased in the moderate and severe OSA groups. Correlation analysis revealed that theta PSD in N1 and N3 stages were negatively correlated the AHI, oxygen desaturation index, SaO2<90% and microarousal index. Conclusion These findings imply that patients with more severe OSA exhibited considerable NREM hypoxia and abnormal brain activity in the frontal and occipital regions. Therefore, sleep EEG oscillation may be a useful neurophysiological indicator for assessing brain function and disease severity in patients with OSA.
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Affiliation(s)
- Chan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, People’s Republic of China
| | - Yanhui Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
- The Academy of Medical Sciences of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Dongxiao Li
- Henan Neurodevelopment Engineering Research Center for Children, Henan Key Laboratory of Children’s Genetics and Metabolic Diseases, Children’s Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, 450018, People’s Republic of China
| | - Mengjie Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
- The Academy of Medical Sciences of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Xiaofeng Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, People’s Republic of China
| | - Wenzheng Rong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, People’s Republic of China
| | - Pu Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Lanjun Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, People’s Republic of China
| | - Shujing He
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, People’s Republic of China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, People’s Republic of China
| | - Yusheng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, People’s Republic of China
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Harper RM. Exploring the brain with sleep-related injuries, and fixing it. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad007. [PMID: 37193272 PMCID: PMC10148654 DOI: 10.1093/sleepadvances/zpad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Indexed: 05/18/2023]
Abstract
The focus of my research efforts rests with determining dysfunctional neural systems underlying disorders of sleep, and identifying interventions to overcome those disorders. Aberrant central and physiological control during sleep exerts serious consequences, including disruptions in breathing, motor control, blood pressure, mood, and cognition, and plays a major role in sudden infant death syndrome, congenital central hypoventilation, and sudden unexpected death in epilepsy, among other concerns. The disruptions can be traced to brain structural injury, leading to inappropriate outcomes. Identification of failing systems arose from the assessment of single neuron discharge in intact, freely moving and state-changing human and animal preparations within multiple systems, including serotonergic action and motor control sites. Optical imaging of chemosensitive, blood pressure and other breathing regulatory areas, especially during development, were useful to show integration of regional cellular action in modifying neural output. Identification of damaged neural sites in control and afflicted humans through structural and functional magnetic resonance imaging procedures helped to identify the sources of injury, and the nature of interactions between brain sites that compromise physiological systems and lead to failure. Interventions to overcome flawed regulatory processes were developed, and incorporate noninvasive neuromodulatory means to recruit ancient reflexes or provide peripheral sensory stimulation to assist breathing drive to overcome apnea, reduce the frequency of seizures, and support blood pressure in conditions where a failure to perfuse can lead to death.
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Affiliation(s)
- Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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8
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Fauria K, Minguillon C, Knezevic I, Tort-Colet N, Stankeviciute L, Hernández L, Rădoi A, Deulofeu C, Fuentes-Julián S, Turull I, Fusté D, Sánchez-Benavides G, Arenaza-Urquijo EM, Suárez-Calvet M, Holst SC, Garcés P, Mueggler T, Zetterberg H, Blennow K, Arqueros A, Iranzo Á, Domingo Gispert J, Molinuevo JL, Grau-Rivera O. Exploring cognitive and biological correlates of sleep quality and their potential links with Alzheimer's disease (ALFASleep project): protocol for an observational study. BMJ Open 2022; 12:e067159. [PMID: 36585141 PMCID: PMC9809234 DOI: 10.1136/bmjopen-2022-067159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/21/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The growing worldwide prevalence of Alzheimer's disease (AD) and the lack of effective treatments pose a dire medical challenge. Sleep disruption is also prevalent in the ageing population and is increasingly recognised as a risk factor and an early sign of AD. The ALFASleep project aims to characterise sleep with subjective and objective measurements in cognitively unimpaired middle/late middle-aged adults at increased risk of AD who are phenotyped with fluid and neuroimaging AD biomarkers. This will contribute to a better understanding of the pathophysiological mechanisms linking sleep with AD, thereby paving the way for the development of non-invasive biomarkers and preventive strategies targeting sleep. METHODS AND ANALYSIS We will invite 200 participants enrolled in the ALFA+ (for ALzheimer and FAmilies) prospective observational study to join the ALFASleep study. ALFA+ participants are cognitively unimpaired middle-aged/late middle-aged adults who are followed up every 3 years with a comprehensive set of evaluations including neuropsychological tests, blood and cerebrospinal fluid (CSF) sampling, and MRI and positron emission tomography acquisition. ALFASleep participants will be additionally characterised with actigraphy and CSF-orexin-A measurements, and a subset (n=90) will undergo overnight polysomnography. We will test associations of sleep measurements and CSF-orexin-A with fluid biomarkers of AD and glial activation, neuroimaging outcomes and cognitive performance. In case we found any associations, we will test whether changes in AD and/or glial activation markers mediate the association between sleep and neuroimaging or cognitive outcomes and whether sleep mediates associations between CSF-orexin-A and AD biomarkers. ETHICS AND DISSEMINATION The ALFASleep study protocol has been approved by the independent Ethics Committee Parc de Salut Mar, Barcelona (2018/8207/I). All participants have signed a written informed consent before their inclusion (approved by the same ethics committee). Study findings will be presented at national and international conferences and submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04932473.
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Affiliation(s)
- Karine Fauria
- Barcelonaβeta Brain Research Center, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
| | - Carolina Minguillon
- Barcelonaβeta Brain Research Center, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Iva Knezevic
- Barcelonaβeta Brain Research Center, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Andreea Rădoi
- Barcelonaβeta Brain Research Center, Barcelona, Spain
| | | | | | - Israel Turull
- Barcelonaβeta Brain Research Center, Barcelona, Spain
| | - David Fusté
- Barcelonaβeta Brain Research Center, Barcelona, Spain
- Pasqual Maragall Foundation, Barcelona, Spain
| | - Gonzalo Sánchez-Benavides
- Barcelonaβeta Brain Research Center, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Eider M Arenaza-Urquijo
- Barcelonaβeta Brain Research Center, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Marc Suárez-Calvet
- Barcelonaβeta Brain Research Center, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Servei de Neurologia, Hospital del Mar, Barcelona, Spain
| | | | | | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, People's Republic of China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Aurora Arqueros
- Neurology Service, Hospital Clínic de Barcelona and Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Álex Iranzo
- Neurology Service, Hospital Clínic de Barcelona and Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Oriol Grau-Rivera
- Barcelonaβeta Brain Research Center, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Servei de Neurologia, Hospital del Mar, Barcelona, Spain
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9
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Singh K, García-Gomar MG, Cauzzo S, Staab JP, Indovina I, Bianciardi M. Structural connectivity of autonomic, pain, limbic, and sensory brainstem nuclei in living humans based on 7 Tesla and 3 Tesla MRI. Hum Brain Mapp 2022; 43:3086-3112. [PMID: 35305272 PMCID: PMC9188976 DOI: 10.1002/hbm.25836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/09/2022] [Accepted: 03/06/2022] [Indexed: 11/18/2022] Open
Abstract
Autonomic, pain, limbic, and sensory processes are mainly governed by the central nervous system, with brainstem nuclei as relay centers for these crucial functions. Yet, the structural connectivity of brainstem nuclei in living humans remains understudied. These tiny structures are difficult to locate using conventional in vivo MRI, and ex vivo brainstem nuclei atlases lack precise and automatic transformability to in vivo images. To fill this gap, we mapped our recently developed probabilistic brainstem nuclei atlas developed in living humans to high‐spatial resolution (1.7 mm isotropic) and diffusion weighted imaging (DWI) at 7 Tesla in 20 healthy participants. To demonstrate clinical translatability, we also acquired 3 Tesla DWI with conventional resolution (2.5 mm isotropic) in the same participants. Results showed the structural connectome of 15 autonomic, pain, limbic, and sensory (including vestibular) brainstem nuclei/nuclei complex (superior/inferior colliculi, ventral tegmental area‐parabrachial pigmented, microcellular tegmental–parabigeminal, lateral/medial parabrachial, vestibular, superior olivary, superior/inferior medullary reticular formation, viscerosensory motor, raphe magnus/pallidus/obscurus, parvicellular reticular nucleus‐alpha part), derived from probabilistic tractography computation. Through graph measure analysis, we identified network hubs and demonstrated high intercommunity communication in these nuclei. We found good (r = .5) translational capability of the 7 Tesla connectome to clinical (i.e., 3 Tesla) datasets. Furthermore, we validated the structural connectome by building diagrams of autonomic/pain/limbic connectivity, vestibular connectivity, and their interactions, and by inspecting the presence of specific links based on human and animal literature. These findings offer a baseline for studies of these brainstem nuclei and their functions in health and disease, including autonomic dysfunction, chronic pain, psychiatric, and vestibular disorders.
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Affiliation(s)
- Kavita Singh
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - María Guadalupe García-Gomar
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Escuela Nacional de Estudios Superiores, Juriquilla, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Simone Cauzzo
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Life Sciences Institute, Sant'Anna School of Advanced Studies, Pisa, Italy.,Research Center E. Piaggio, University of Pisa, Pisa, Italy
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Iole Indovina
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy.,Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marta Bianciardi
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Sleep Medicine, Harvard University, Boston, Massachusetts, USA
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10
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Abstract
Brain PCO2 is sensed primarily via changes in [H+]. Small pH changes are detected in the medulla oblongata and trigger breathing adjustments that help maintain arterial PCO2 constant. Larger perturbations of brain CO2/H+, possibly also sensed elsewhere in the CNS, elicit arousal, dyspnea, and stress, and cause additional breathing modifications. The retrotrapezoid nucleus (RTN), a rostral medullary cluster of glutamatergic neurons identified by coexpression of Phoxb and Nmb transcripts, is the lynchpin of the central respiratory chemoreflex. RTN regulates breathing frequency, inspiratory amplitude, and active expiration. It is exquisitely responsive to acidosis in vivo and maintains breathing autorhythmicity during quiet waking, slow-wave sleep, and anesthesia. The RTN response to [H+] is partly an intrinsic neuronal property mediated by proton sensors TASK-2 and GPR4 and partly a paracrine effect mediated by astrocytes and the vasculature. The RTN also receives myriad excitatory or inhibitory synaptic inputs including from [H+]-responsive neurons (e.g., serotonergic). RTN is silenced by moderate hypoxia. RTN inactivity (periodic or sustained) contributes to periodic breathing and, likely, to central sleep apnea. RTN development relies on transcription factors Egr2, Phox2b, Lbx1, and Atoh1. PHOX2B mutations cause congenital central hypoventilation syndrome; they impair RTN development and consequently the central respiratory chemoreflex.
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Affiliation(s)
- Patrice G Guyenet
- Department of Pharmacology, University of Virginia, Charlottesville, VA, United States.
| | - Douglas A Bayliss
- Department of Pharmacology, University of Virginia, Charlottesville, VA, United States
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11
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Brooks SJ, Katz ES, Stamoulis C. Shorter Duration and Lower Quality Sleep Have Widespread Detrimental Effects on Developing Functional Brain Networks in Early Adolescence. Cereb Cortex Commun 2021; 3:tgab062. [PMID: 35047823 PMCID: PMC8759437 DOI: 10.1093/texcom/tgab062] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 08/26/2021] [Accepted: 10/15/2021] [Indexed: 11/12/2022] Open
Abstract
Sleep is critical for cognitive health, especially during complex developmental periods such as adolescence. However, its effects on maturating brain networks that support cognitive function are only partially understood. We investigated the impact of shorter duration and reduced quality sleep, common stressors during development, on functional network properties in early adolescence-a period of significant neural maturation, using resting-state functional magnetic resonance imaging from 5566 children (median age = 120.0 months; 52.1% females) in the Adolescent Brain Cognitive Development cohort. Decreased sleep duration, increased sleep latency, frequent waking up at night, and sleep-disordered breathing symptoms were associated with lower topological efficiency, flexibility, and robustness of visual, sensorimotor, attention, fronto-parietal control, default-mode and/or limbic networks, and with aberrant changes in the thalamus, basal ganglia, hippocampus, and cerebellum (P < 0.05). These widespread effects, many of which were body mass index-independent, suggest that unhealthy sleep in early adolescence may impair neural information processing and integration across incompletely developed networks, potentially leading to deficits in their cognitive correlates, including attention, reward, emotion processing and regulation, memory, and executive control. Shorter sleep duration, frequent snoring, difficulty waking up, and daytime sleepiness had additional detrimental network effects in nonwhite participants, indicating racial disparities in the influence of sleep metrics.
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12
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Lydic R, Baghdoyan HA. Prefrontal Cortex Metabolome Is Modified by Opioids, Anesthesia, and Sleep. Physiology (Bethesda) 2021; 36:203-219. [PMID: 34159803 DOI: 10.1152/physiol.00043.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Obtundation of wakefulness caused by opioids and loss of wakefulness caused by anesthetics and sleep significantly alter concentrations of molecules comprising the prefrontal cortex (PFC) metabolome. Quantifying state-selective changes in the PFC metabolome is essential for advancing functional metabolomics. Diverse functions of the PFC suggest the PFC metabolome as a potential therapeutic entry point for countermeasures to state-selective autonomic dysfunction.
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Affiliation(s)
- Ralph Lydic
- Psychology, University of Tennessee, Knoxville, Tennessee.,Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | - Helen A Baghdoyan
- Psychology, University of Tennessee, Knoxville, Tennessee.,Oak Ridge National Laboratory, Oak Ridge, Tennessee
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13
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Snyder BD, Simone SM, Giovannetti T, Floyd TF. Cerebral Hypoxia: Its Role in Age-Related Chronic and Acute Cognitive Dysfunction. Anesth Analg 2021; 132:1502-1513. [PMID: 33780389 PMCID: PMC8154662 DOI: 10.1213/ane.0000000000005525] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Postoperative cognitive dysfunction (POCD) has been reported with widely varying frequency but appears to be strongly associated with aging. Outside of the surgical arena, chronic and acute cerebral hypoxia may exist as a result of respiratory, cardiovascular, or anemic conditions. Hypoxia has been extensively implicated in cognitive impairment. Furthermore, disease states associated with hypoxia both accompany and progress with aging. Perioperative cerebral hypoxia is likely underdiagnosed, and its contribution to POCD is underappreciated. Herein, we discuss the various disease processes and forms in which hypoxia may contribute to POCD. Furthermore, we outline hypoxia-related mechanisms, such as hypoxia-inducible factor activation, cerebral ischemia, cerebrovascular reserve, excitotoxicity, and neuroinflammation, which may contribute to cognitive impairment and how these mechanisms interact with aging. Finally, we discuss opportunities to prevent and manage POCD related to hypoxia.
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Affiliation(s)
- Brina D. Snyder
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Thomas F. Floyd
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
- Department of Cardiothoracic Surgery, UT Southwestern Medical Center, Dallas, TX
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14
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Broström A, Ulander M, Nilsen P, Lin CY, Pakpour AH. Development and psychometric evaluation of the Motivation to Use CPAP Scale (MUC-S) using factorial structure and Rasch analysis among patients with obstructive sleep apnea before CPAP treatment is initiated. Sleep Breath 2021; 25:627-637. [PMID: 32705529 PMCID: PMC8195890 DOI: 10.1007/s11325-020-02143-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Continuous positive airway treatment (CPAP) is first-line treatment for obstructive sleep apnea (OSA), but adherence tends to be low. A clinical tool focusing on motivation to use CPAP is missing. The purpose was to develop a brief questionnaire to assess motivation to use CPAP that is psychometrically robust and suitable for use in clinical practice. METHODS A convenience sample including 193 treatment naive patients with OSA (67% men; mean age = 59.7 years, SD 11.5) from two CPAP clinics was used. Clinical assessments and full night polygraphy were performed. Questionnaires administered before CPAP treatment included the newly developed Motivation to Use CPAP Scale (MUC-S), Minimal Insomnia Symptoms Scale (MISS), Epworth Sleepiness Scale (ESS), and Attitude towards CPAP treatment Inventory (ACTI). The validity and reliability of the MUC-S were investigated using Rasch and exploratory factor analysis models. Measurement invariance, dimensionality and differential item functioning (i.e., across gender groups, excessive daytime sleepiness (ESS), insomnia (MISS) and attitude towards CPAP (ACTI) groups) were assessed. RESULTS The results supported a two-factor solution (autonomous motivation, 6 items, factor loadings between 0.61 and 0.85 and controlled motivation, 3 items, factor loadings between 0.79 and 0.88) explaining 60% of the total variance. The internal consistency was good with Cronbach's alpha of 0.88 and 0.86 for the two factors. No differential item functioning was found. A latent class analysis yielded three profiles of patients with high (n = 111), moderate (n = 60) and low (n = 22) motivation. Patients with high motivation were older, had higher daytime sleepiness scores, more insomnia symptoms and a more positive attitude towards CPAP. CONCLUSIONS The MUC-S seems to be a valid tool with robust psychometric properties suitable for use at CPAP clinics. Future studies should focus on how motivation changes over time and if MUC-S can predict objective long-term CPAP adherence.
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Affiliation(s)
- Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
- Department of Clinical Neurophysiology, Linköping University Hospital, S-581 85, Linköping, Sweden.
| | - M Ulander
- Department of Clinical Neurophysiology, Linköping University Hospital, S-581 85, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Division of Clinical Neurophysiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - P Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - A H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahounar BLV, Qazvin, 3419759811, Iran
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15
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Isaiah A, Ernst T, Cloak CC, Clark DB, Chang L. Associations between frontal lobe structure, parent-reported obstructive sleep disordered breathing and childhood behavior in the ABCD dataset. Nat Commun 2021; 12:2205. [PMID: 33850154 PMCID: PMC8044120 DOI: 10.1038/s41467-021-22534-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/16/2021] [Indexed: 02/03/2023] Open
Abstract
Parents frequently report behavioral problems among children who snore. Our understanding of the relationship between symptoms of obstructive sleep disordered breathing (oSDB) and childhood behavioral problems associated with brain structural alterations is limited. Here, we examine the associations between oSDB symptoms, behavioral measures such as inattention, and brain morphometry in the Adolescent Brain Cognitive Development (ABCD) study comprising 10,140 preadolescents. We observe that parent-reported symptoms of oSDB are associated with composite and domain-specific problem behaviors measured by parent responses to the Child Behavior Checklist. Alterations of brain structure demonstrating the strongest negative associations with oSDB symptoms are within the frontal lobe. The relationships between oSDB symptoms and behavioral measures are mediated by significantly smaller volumes of multiple frontal lobe regions. These results provide population-level evidence for an association between regional structural alterations in cortical gray matter and problem behaviors reported in children with oSDB.
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Grants
- U01 DA041174 NIDA NIH HHS
- U01 DA041048 NIDA NIH HHS
- U01 DA041156 NIDA NIH HHS
- U01 DA041093 NIDA NIH HHS
- U01 DA041106 NIDA NIH HHS
- U01 DA050989 NIDA NIH HHS
- U01 DA041089 NIDA NIH HHS
- U01 DA050988 NIDA NIH HHS
- U01 DA041028 NIDA NIH HHS
- U01 DA041134 NIDA NIH HHS
- U24 DA041147 NIDA NIH HHS
- U01 DA050987 NIDA NIH HHS
- P50 DA046346 NIDA NIH HHS
- U01 DA041022 NIDA NIH HHS
- U01 DA041025 NIDA NIH HHS
- U01 DA051037 NIDA NIH HHS
- U01 DA051016 NIDA NIH HHS
- U01 DA041148 NIDA NIH HHS
- U24 DA041123 NIDA NIH HHS
- U01 DA041120 NIDA NIH HHS
- U01 DA051039 NIDA NIH HHS
- U01 DA051018 NIDA NIH HHS
- U01 DA051038 NIDA NIH HHS
- U.S. Department of Health & Human Services | National Institutes of Health (NIH)
- The ABCD Study is supported by the National Institutes of Health (NIH) and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, U24DA041147, U01DA041093, and U01DA041025. A full list of supporters is available at https://abcdstudy.org/federal-partners.html. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/Consortium_Members.pdf.
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Affiliation(s)
- Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Thomas Ernst
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine C Cloak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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16
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Liu S, Shen J, Li Y, Wang J, Wang J, Xu J, Wang Q, Chen R. EEG Power Spectral Analysis of Abnormal Cortical Activations During REM/NREM Sleep in Obstructive Sleep Apnea. Front Neurol 2021; 12:643855. [PMID: 33716946 PMCID: PMC7953149 DOI: 10.3389/fneur.2021.643855] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/27/2021] [Indexed: 01/29/2023] Open
Abstract
Objective: To characterize electroencephalogram (EEG) power in different frequency bands during rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep in patients with obstructive sleep apnea (OSA). Methods: Retrospective data on 151 patients were collected and divided into three groups: primary snoring group (AHI < 5/h), mild-moderate OSA group (6 ≤ AHI < 30/h), and severe OSA group (AHI ≥ 30/h). EEG recordings in the frontal, central, and occipital regions were extracted from both REM and NREM sleep, to compute the normalized spectral power densities in the delta, theta, alpha, sigma, beta, and gamma frequency bands, using Fast Fourier Transform. Correlations between the computed EEG power and PSG parameters were analyzed. Results: In NREM sleep, elevated normalized power spectral density (PSD) in the delta band was observed in the severe OSA group compared to the other two groups. In contrast, the PSD of the other frequency bands showed a corresponding decrease in the severe OSA group. In REM sleep, similar changes were observed in the frontal region. Delta band PSD was positively correlated with Apnea Hypopnea Index (AHI) (r = 0.33), longest time of apnea, oxygen desaturation index (ODI) (r = 0.34), percent sleep time below 90% SaO2 (T90%) (r = 0.30), Arousal Index (ArI) (r = 0.29), and negatively correlated with N3%, minimum oxygen saturation (minSaO2). Conclusion: Our findings provide neurophysiological evidence for pathological cortical activation during REM/NREM sleep, which may be associated with the arousals and cognitive impairments in OSA. The technique of power spectral analysis could prove a potentially useful tool in complementing traditional PSG parameters in assessing disease burden to guide therapeutic decisions.
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Affiliation(s)
- Shuling Liu
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Jiucheng Shen
- Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yezhou Li
- School of Medicine, The University of Manchester, Manchester, United Kingdom
| | - Jing Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhua Wang
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Juan Xu
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Qiaojun Wang
- Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Chen
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
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17
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van den Heuvel MI, Hect JL, Smarr BL, Qawasmeh T, Kriegsfeld LJ, Barcelona J, Hijazi KE, Thomason ME. Maternal stress during pregnancy alters fetal cortico-cerebellar connectivity in utero and increases child sleep problems after birth. Sci Rep 2021; 11:2228. [PMID: 33500446 PMCID: PMC7838320 DOI: 10.1038/s41598-021-81681-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/16/2020] [Indexed: 01/07/2023] Open
Abstract
Child sleep disorders are increasingly prevalent and understanding early predictors of sleep problems, starting in utero, may meaningfully guide future prevention efforts. Here, we investigated whether prenatal exposure to maternal psychological stress is associated with increased sleep problems in toddlers. We also examined whether fetal brain connectivity has direct or indirect influence on this putative association. Pregnant women underwent fetal resting-state functional connectivity MRI and completed questionnaires on stress, worry, and negative affect. At 3-year follow-up, 64 mothers reported on child sleep problems, and in the subset that have reached 5-year follow-up, actigraphy data (N = 25) has also been obtained. We observe that higher maternal prenatal stress is associated with increased toddler sleep concerns, with actigraphy sleep metrics, and with decreased fetal cerebellar-insular connectivity. Specific mediating effects were not identified for the fetal brain regions examined. The search for underlying mechanisms of the link between maternal prenatal stress and child sleep problems should be continued and extended to other brain areas.
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Affiliation(s)
| | - Jasmine L Hect
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Benjamin L Smarr
- Department of Bioengineering and Halicioglu Data Science Institute, UCSD, San Diego, CA, USA
| | - Tamara Qawasmeh
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Lance J Kriegsfeld
- Department of Psychology, University of California Berkeley, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - Jeanne Barcelona
- Department of Kinesiology, Health, and Sport Studies, Wayne State University, Detroit, MI, USA
| | - Kowsar E Hijazi
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Moriah E Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, NYU Langone Medical Center, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, NYU Langone Medical Center, New York, USA
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18
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Ramage AE. Potential for Cognitive Communication Impairment in COVID-19 Survivors: A Call to Action for Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1821-1832. [PMID: 32946270 DOI: 10.1044/2020_ajslp-20-00147] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Severe acute respiratory syndrome coronavirus 2 is the virus resulting in COVID-19 infections in nearly 4.3 million Americans with COVID-19 in the United States as of July 29, 2020, with nearly 150,000 deaths and hundreds of thousands of survivors (https://www.coronavirus.jhu.edu/map.html). This tutorial reviews (a) what has been reported about neurological insults in cases of COVID-19 infection, (b) what is known from similar conditions in other disorders, and (c) how that combined information can inform clinical decision making. Method PubMed and the Cochrane Central Register of Controlled Trials were searched for COVID-19 or other coronavirus infections, cognitive impairment observed following critical care, and disorders for which intermittent or chronic hypoxia is characteristic. These were combined with searches relating to cognition, brain, and communication. All searches were conducted between April 8 and May 23, 2020. Meta-analyses and randomized clinical trials addressing other critical illnesses were also included to extend findings to potential cognitive communication outcomes following COVID-19. Results COVID-19 infection results in a combination of (a) respiratory infection with mechanical ventilation secondary to inadequate oxygenation, (b) inflammatory system reactivity, and (c) increased blood clotting factors. These affect central nervous system function incurring long-term cognitive communication impairment in a proportion of survivors. Diagnostic and intervention approaches for such impairments are discussed. Conclusions The existing literature on cognitive sequela of COVID-19 infection is small to date, but much can be learned from similar viral infections and disorders. Although COVID-19 is novel, the speech-language pathology approaches to evaluation and intervention of other populations of critical care patients are applicable. However, speech-language pathologists have not routinely been involved in these patients' acute care. As such, this is a call to action to speech-language pathologists to address the unprecedented numbers of patients who will need their services early in the disease process and throughout recovery.
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Affiliation(s)
- Amy E Ramage
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham
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19
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Zou F, Su X, Pan P. Toll-Like Receptor-4-Mediated Inflammation is Involved in Intermittent Hypoxia-Induced Lung Injury. Lung 2020; 198:855-862. [PMID: 32785858 DOI: 10.1007/s00408-020-00384-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/31/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE Intermittent hypoxia (IH) is a recognized risk factor for multiple organs damage, resulting in lung injury. Its pathophysiology is still poorly understood. Toll-like receptor 4 (TLR4) signaling plays a critical role in host immune response to invading pathogen and non-infectious tissue injury. The role of TLR4-mediated inflammation in IH-induced lung injury was investigated in this study. METHODS Lean adult male TLR4-deficient (TLR4-/-) mice and their controls (C57BL/6 mice) were exposed to either IH (FiO2 6-8% for 25 s, 150 s/cycle, 8 h/day) or air (normoxic mice) for 6 weeks. Animals were sacrificed after 6-week exposure, and the lung tissues were harvested for morphological and inflammatory analyses. The expression of TLR4 and nuclear factor kappa-B (NF-κB) P65 were examined by real-time quantitative polymerase chain reaction and immunohistochemical method. Serum cytokine levels of interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) were analyzed by enzyme-linked immunosorbent assay. RESULTS IH induced morphological and inflammation changes in the lung. IH for 6 weeks induced higher expression of TLR4 (C57BL/6-N vs C57BL/6-IH, P < 0.05) and resulted in higher release of TNF-α, IL-6 (P < 0.05), and NF-κB P65 (P < 0.05). These alterations were remitted by TLR4 deletion. CONCLUSIONS TLR4-mediated inflammation plays an important role in the development of IH-induced lung injury in mice, possibly through mechanisms involving nuclear factor-κB. Targeting TLR4/NF-κB pathway could represent a further therapeutic option for sleep apnea patients.
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Affiliation(s)
- Fangfang Zou
- Department of Internal Medicine, Hunan Chest Hospital, Changsha, 410013, Hunan, People's Republic of China
| | - Xiaoli Su
- Department of Respiratory Medicine, Xiangya Hospital, Key Cite of National Clinical Research Center for Respiratory Disease, Central South University, Changsha, 410008, Hunan, People's Republic of China.
| | - Pinhua Pan
- Department of Respiratory Medicine, Xiangya Hospital, Key Cite of National Clinical Research Center for Respiratory Disease, Central South University, Changsha, 410008, Hunan, People's Republic of China
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20
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Vyas S, Singh P, Khandelwal N, Govind V, Aggarwal AN, Mohanty M. Evaluation of cerebral microstructural changes in adult patients with obstructive sleep apnea by MR diffusion kurtosis imaging using a whole-brain atlas. Indian J Radiol Imaging 2019; 29:356-363. [PMID: 31949336 PMCID: PMC6958883 DOI: 10.4103/ijri.ijri_326_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/26/2019] [Accepted: 10/23/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: The association between obstructive sleep apnea (OSA) and cognitive impairment is well-recognized, but little is known about neural derangements that underlie this phenomenon. The purpose of this study was to evaluate the utility of diffusion kurtosis imaging (DKI) using a whole-brain atlas to comprehensively assess microstructural tissue changes in the brain of patients with OSA. Methods: This prospective study was conducted in 20 patients with moderate-to-severe OSA and 20 age- and gender-matched controls. MRI data acquisition was performed with 3 Tesla and data was analyzed using a whole-brain atlas. DKI data were processed and transformed into a brain template space to obtain various kurtosis parameters including axial kurtosis (AK), radial kurtosis (RK), mean kurtosis (MK), and kurtosis fractional anisotropy (KFA) using a 189-region brain atlas in the same template space. These kurtosis measurements were further analyzed using a student t-test in order to determine kurtosis measurements that present significant differences between the OSA patient set and the control set. Results: Significant differences (P < 0.05) were found in AK (54 regions), RK (10 regions), MK (6 regions) and KFA (41 regions) values in patients with OSA as compared to controls. DKI indices, using an atlas-based whole-brain analysis approach used in our study, showed widespread involvement of the anatomical regions in patients with OSA. Conclusion: The kurtosis parameters are more sensitive in demonstrating abnormalities in brain tissue structural organization at the microstructural level before any detectable changes appear in conventional MRI or other imaging modalities.
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Affiliation(s)
- Sameer Vyas
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjeet Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varan Govind
- Department of Radiology, University of Miami, Miami, Florida, USA
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manju Mohanty
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Guyenet PG, Stornetta RL, Souza GMPR, Abbott SBG, Shi Y, Bayliss DA. The Retrotrapezoid Nucleus: Central Chemoreceptor and Regulator of Breathing Automaticity. Trends Neurosci 2019; 42:807-824. [PMID: 31635852 DOI: 10.1016/j.tins.2019.09.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
Abstract
The ventral surface of the rostral medulla oblongata has been suspected since the 1960s to harbor central respiratory chemoreceptors [i.e., acid-activated neurons that regulate breathing to maintain a constant arterial PCO2 (PaCO2)]. The key neurons, a.k.a. the retrotrapezoid nucleus (RTN), have now been identified. In this review we describe their transcriptome, developmental lineage, and anatomical projections. We also review their contribution to CO2 homeostasis and to the regulation of breathing automaticity during sleep and wake. Finally, we discuss several mechanisms that contribute to the activation of RTN neurons by CO2in vivo: cell-autonomous effects of protons; paracrine effects of pH mediated by surrounding astrocytes and blood vessels; and excitatory inputs from other CO2-responsive CNS neurons.
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Affiliation(s)
- Patrice G Guyenet
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, USA.
| | - Ruth L Stornetta
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, USA
| | - George M P R Souza
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, USA
| | - Stephen B G Abbott
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, USA
| | - Yingtang Shi
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, USA
| | - Douglas A Bayliss
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, USA
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22
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Interhemispheric Brain Switching Correlates with Severity of Sleep-Disordered Breathing for Obstructive Sleep Apnea Patients. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9081568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
(1) Background: Alternating interhemispheric slow-wave activity during sleep is well-established in birds and cetaceans, but its investigation in humans has been largely neglected. (2) Methods: Fuzzy entropy was used to calculate a laterality index (LI) from C3 and C4 EEG channels. The subjects were grouped according to an apnoea-hypopnoea index (AHI) for statistical analyses: Group A AHI < 15 (mild); Group B 15 ≤ AHI < 30 (moderate); Group C AHI ≥ 30 (severe). The LI distribution was analysed to characterise the brain activity variation in both hemispheres, and the cross-zero switching rate was given statistical tests to find the correlations with the severity of obstructive sleep apnea and sleep states, i.e., wake (W), light sleep (LS), deep sleep (DS), and REM. (3) Results: EEG brain switching activity was observed in all sleep stages, and the LI distribution shows that, for obstructive sleep apnea patients, the interhemispheric asymmetry of brain activity is more obvious than healthy people. A one-way ANOVA revealed a significant difference of switching rate among three groups (F(2,95) = 7.23, p = 0.0012), with Group C shows the least, and also a significant difference among four sleep stages (F(3,94) = 5.09, p = 0.0026), with REM the highest. (4) Conclusions: The alternating interhemispheric activity is confirmed ubiquitous for humans during sleep, and sleep-disordered breathing intends to exacerbate the interhemispheric asymmetry.
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23
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Huang X, Tang S, Lyu X, Yang C, Chen X. Structural and functional brain alterations in obstructive sleep apnea: a multimodal meta-analysis. Sleep Med 2019; 54:195-204. [DOI: 10.1016/j.sleep.2018.09.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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24
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Yang YN, Liu YP, Hsieh MT, Lin YC, Tung CS. Effects of prolonged paradoxical sleep deprivation with or without acute cold stress on hemodynamic perturbations in rats. Stress 2018; 21:520-527. [PMID: 29939104 DOI: 10.1080/10253890.2018.1483328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Prolonged paradoxical sleep deprivation (PSD) and cold stress (CS) are known to cause sympathoexcitation and increase the risk of cardiovascular disease. The present study examined the effect of PSD with CS on hemodynamic perturbations by investigating blood pressure and heart rate variability (BPV and HRV) in conscious rats. Adult male Sprague-Dawley rats were divided into three groups (n = 10, each): normal sleep (NS), PSD of 72 h, and recovery sleep of 7 days after PSD. When compared with NS, PSD increased systolic blood pressure in all three conditions: before CS (PreCS), CS, and after CS (PostCS). The PSD also increased heart rate in both PreCS and PostCS. Furthermore, spectral power changes were observed throughout the experiment. The PSD increased very-low-frequency BPV in PreCS, decreased very-low-frequency HRV in CS, and increased low-frequency BPV in all three conditions. The PSD increased low-frequency HRV in PreCS, increased high-frequency BPV in both CS and PostCS, and also increased high-frequency HRV in both PreCS and CS but decreased that in PostCS. On the other hand, when compared with PSD, recovery sleep has reversed most cardiovascular changes in PSD toward the NS level. However, when compared with NS, spectral powers of very-low-frequency BPV in the recovery phase showed a lower level. These results showed that in the resting condition, PSD might evoke sympathoexcitation with a tendency to increase both very-low-frequency BPV and very-low-frequency HRV, as the intensified myogenic oscillations. However, in the CS condition, PSD evoked the sympathoexcitation yet might attenuate such myogenic oscillations.
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Affiliation(s)
- Yung-Nien Yang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
| | - Yia-Ping Liu
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
- Department of Physiology, Laboratory of Cognitive Neuroscience, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Mong-Ting Hsieh
- Department of Emergency, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
| | - Yu-Chieh Lin
- Division of Medical Research & Education, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
| | - Che-Se Tung
- Division of Medical Research & Education, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
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25
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Wiersema C, Van Zelst W, Oude Voshaar R. When a patient with depression is feeling sleepy, be aware of sleep apnoea. BMJ Case Rep 2018; 2018:bcr-2018-224873. [PMID: 29991545 PMCID: PMC6058169 DOI: 10.1136/bcr-2018-224873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 67-year-old man was referred to an outpatient clinic of geriatric psychiatry because of persistent symptoms of depression and anxiety, accompanied by sleepiness. The latter had been evaluated multiple times in the general practice over several years; each time it was considered to be a symptom of depression. After referral, the patient was diagnosed with severe obstructive sleep apnoea (OSA), comorbid to a depressive and anxiety disorder. Retrospectively, we conclude that affective symptoms accompanying OSA and sleepiness were wrongfully interpreted as depression, but after having led to problems at work, they have triggered psychiatric comorbidity. Treatment of OSA in addition to the psychiatric disorders resulted in a full recovery over time. The delayed diagnosis of OSA has certainly diminished the patient’s quality of life and might have precipitated the depressive disorder. Moreover, OSA poses patients at an increased risk of cardiovascular disease, hypertension, stroke and traffic accidents.
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Affiliation(s)
- Carlijn Wiersema
- University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Willeke Van Zelst
- University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Oude Voshaar
- University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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26
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Anoxia-Hypoxia in Forensic Neuropsychological Assessment: Cognitive Impact of Pulmonary Injuries, Respiratory Distress, Cerebral Blood Hypoperfusion, and Major Surgeries. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9319-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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27
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Aguilar M, González-Candia A, Rodríguez J, Carrasco-Pozo C, Cañas D, García-Herrera C, Herrera EA, Castillo RL. Mechanisms of Cardiovascular Protection Associated with Intermittent Hypobaric Hypoxia Exposure in a Rat Model: Role of Oxidative Stress. Int J Mol Sci 2018; 19:ijms19020366. [PMID: 29373484 PMCID: PMC5855588 DOI: 10.3390/ijms19020366] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/25/2022] Open
Abstract
More than 140 million people live and works (in a chronic or intermittent form) above 2500 m worldwide and 35 million live in the Andean Mountains. Furthermore, in Chile, it is estimated that 55,000 persons work in high altitude shifts, where stays at lowlands and interspersed with working stays at highlands. Acute exposure to high altitude has been shown to induce oxidative stress in healthy human lowlanders, due to an increase in free radical formation and a decrease in antioxidant capacity. However, in animal models, intermittent hypoxia (IH) induce preconditioning, like responses and cardioprotection. Here, we aimed to describe in a rat model the responses on cardiac and vascular function to 4 cycles of intermittent hypobaric hypoxia (IHH). Twelve adult Wistar rats were randomly divided into two equal groups, a four-cycle of IHH, and a normobaric hypoxic control. Intermittent hypoxia was induced in a hypobaric chamber in four continuous cycles (1 cycle = 4 days hypoxia + 4 days normoxia), reaching a barometric pressure equivalent to 4600 m of altitude (428 Torr). At the end of the first and fourth cycle, cardiac structural, and functional variables were determined by echocardiography. Thereafter, ex vivo vascular function and biomechanical properties were determined in femoral arteries by wire myography. We further measured cardiac oxidative stress biomarkers (4-Hydroxy-nonenal, HNE; nytrotirosine, NT), reactive oxygen species (ROS) sources (NADPH and mitochondrial), and antioxidant enzymes activity (catalase, CAT; glutathione peroxidase, GPx, and superoxide dismutase, SOD). Our results show a higher ejection and shortening fraction of the left ventricle function by the end of the 4th cycle. Further, femoral vessels showed an improvement of vasodilator capacity and diminished stiffening. Cardiac tissue presented a higher expression of antioxidant enzymes and mitochondrial ROS formation in IHH, as compared with normobaric hypoxic controls. IHH exposure determines a preconditioning effect on the heart and femoral artery, both at structural and functional levels, associated with the induction of antioxidant defence mechanisms. However, mitochondrial ROS generation was increased in cardiac tissue. These findings suggest that initial states of IHH are beneficial for cardiovascular function and protection.
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Affiliation(s)
- Miguel Aguilar
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 7500922, Chile.
| | - Alejandro González-Candia
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 7500922, Chile.
| | - Jorge Rodríguez
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 7500922, Chile.
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile.
| | - Catalina Carrasco-Pozo
- Discovery Biology, Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4222, Australia.
- Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile.
| | - Daniel Cañas
- Departamento de Ingeniería Mecánica, Facultad de Ingeniería, Universidad de Santiago de Chile, Santiago 9170125, Chile.
| | - Claudio García-Herrera
- Departamento de Ingeniería Mecánica, Facultad de Ingeniería, Universidad de Santiago de Chile, Santiago 9170125, Chile.
| | - Emilio A Herrera
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 7500922, Chile.
- International Center for Andean Studies, Universidad de Chile, Putre, Chile.
| | - Rodrigo L Castillo
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 7500922, Chile.
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28
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Allen LA, Harper RM, Kumar R, Guye M, Ogren JA, Lhatoo SD, Lemieux L, Scott CA, Vos SB, Rani S, Diehl B. Dysfunctional Brain Networking among Autonomic Regulatory Structures in Temporal Lobe Epilepsy Patients at High Risk of Sudden Unexpected Death in Epilepsy. Front Neurol 2017; 8:544. [PMID: 29085330 PMCID: PMC5650686 DOI: 10.3389/fneur.2017.00544] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) is common among young people with epilepsy. Individuals who are at high risk of SUDEP exhibit regional brain structural and functional connectivity (FC) alterations compared with low-risk patients. However, less is known about network-based FC differences among critical cortical and subcortical autonomic regulatory brain structures in temporal lobe epilepsy (TLE) patients at high risk of SUDEP. METHODS 32 TLE patients were risk-stratified according to the following clinical criteria: age of epilepsy onset, duration of epilepsy, frequency of generalized tonic-clonic seizures, and presence of nocturnal seizures, resulting in 14 high-risk and 18 low-risk cases. Resting-state functional magnetic resonance imaging (rs-fMRI) signal time courses were extracted from 11 bilateral cortical and subcortical brain regions involved in autonomic and other regulatory processes. After computing all pairwise correlations, FC matrices were analyzed using the network-based statistic. FC strength among the 11 brain regions was compared between the high- and low-risk patients. Increases and decreases in FC were sought, using high-risk > low-risk and low-risk > high-risk contrasts (with covariates age, gender, lateralization of epilepsy, and presence of hippocampal sclerosis). RESULTS High-risk TLE patients showed a subnetwork with significantly reduced FC (t = 2.5, p = 0.029) involving the thalamus, brain stem, anterior cingulate, putamen and amygdala, and a second subnetwork with significantly elevated FC (t = 2.1, p = 0.031), which extended to medial/orbital frontal cortex, insula, hippocampus, amygdala, subcallosal cortex, brain stem, thalamus, caudate, and putamen. CONCLUSION TLE patients at high risk of SUDEP showed widespread FC differences between key autonomic regulatory brain regions compared to those at low risk. The altered FC revealed here may help to shed light on the functional correlates of autonomic disturbances in epilepsy and mechanisms involved in SUDEP. Furthermore, these findings represent possible objective biomarkers which could help to identify high-risk patients and enhance SUDEP risk stratification via the use of non-invasive neuroimaging, which would require validation in larger cohorts, with extension to patients with other epilepsies and subjects who succumb to SUDEP.
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Affiliation(s)
- Luke A Allen
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Ronald M Harper
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States
| | - Rajesh Kumar
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States.,Department of Anaesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Maxime Guye
- Aix Marseille University, CNRS, CRMBM UMR 7339, Marseille, France
| | - Jennifer A Ogren
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Samden D Lhatoo
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Louis Lemieux
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom
| | - Catherine A Scott
- Institute of Neurology, University College London, London, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Sjoerd B Vos
- Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Translational Imaging Group, University College London, London, United Kingdom
| | - Sandhya Rani
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Beate Diehl
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
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Nadjar A, Wigren HKM, Tremblay ME. Roles of Microglial Phagocytosis and Inflammatory Mediators in the Pathophysiology of Sleep Disorders. Front Cell Neurosci 2017; 11:250. [PMID: 28912686 PMCID: PMC5582207 DOI: 10.3389/fncel.2017.00250] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/07/2017] [Indexed: 11/13/2022] Open
Abstract
Sleep serves crucial learning and memory functions in both nervous and immune systems. Microglia are brain immune cells that actively maintain health through their crucial physiological roles exerted across the lifespan, including phagocytosis of cellular debris and orchestration of neuroinflammation. The past decade has witnessed an explosive growth of microglial research. Considering the recent developments in the field of microglia and sleep, we examine their possible impact on various pathological conditions associated with a gain, disruption, or loss of sleep in this focused mini-review. While there are extensive studies of microglial implication in a variety of neuropsychiatric and neurodegenerative diseases, less is known regarding their roles in sleep disorders. It is timely to stimulate new research in this emergent and rapidly growing field of investigation.
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Affiliation(s)
- Agnes Nadjar
- Nutrition et Neurobiologie Intégrée, UMR 1286, Institut National de la Recherche AgronomiqueBordeaux, France.,Nutrition et Neurobiologie Intégrée, UMR 1286, Bordeaux UniversityBordeaux, France.,OptiNutriBrain International Associated Laboratory (NutriNeuro France-INAF Canada)Québec, QC, Canada
| | | | - Marie-Eve Tremblay
- Axe Neurosciences, CRCHU de Québec-Université LavalQuébec, QC, Canada.,Département de médecine moléculaire, Université LavalQuébec, QC, Canada
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30
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D'Rozario AL, Cross NE, Vakulin A, Bartlett DJ, Wong KKH, Wang D, Grunstein RR. Quantitative electroencephalogram measures in adult obstructive sleep apnea - Potential biomarkers of neurobehavioural functioning. Sleep Med Rev 2016; 36:29-42. [PMID: 28385478 DOI: 10.1016/j.smrv.2016.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/15/2016] [Accepted: 10/08/2016] [Indexed: 10/20/2022]
Abstract
Obstructive sleep apnea (OSA) results in significantly impaired cognitive functioning and increased daytime sleepiness in some patients leading to increased risk of motor vehicle and workplace accidents and reduced productivity. Clinicians often face difficulty in identifying which patients are at risk of neurobehavioural dysfunction due to wide inter-individual variability, and disparity between symptoms and conventional metrics of disease severity such as the apnea hypopnea index. Quantitative electroencephalogram (EEG) measures are determinants of awake neurobehavioural function in healthy subjects. However, the potential value of quantitative EEG (qEEG) measurements as biomarkers of neurobehavioural function in patients with OSA has not been examined. This review summarises the existing literature examining qEEG in OSA patients including changes in brain activity during wake and sleep states, in relation to daytime sleepiness, cognitive impairment and OSA treatment. It will speculate on the mechanisms which may underlie changes in EEG activity and discuss the potential utility of qEEG as a clinically useful predictor of neurobehavioural function in OSA.
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Affiliation(s)
- Angela L D'Rozario
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital & Sydney Local Health District, Sydney, NSW, Australia.
| | - Nathan E Cross
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Vakulin
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Delwyn J Bartlett
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - Keith K H Wong
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital & Sydney Local Health District, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - David Wang
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital & Sydney Local Health District, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - Ronald R Grunstein
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital & Sydney Local Health District, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
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31
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Abstract
Cardiac control is mediated via a series of reflex control networks involving somata in the (i) intrinsic cardiac ganglia (heart), (ii) intrathoracic extracardiac ganglia (stellate, middle cervical), (iii) superior cervical ganglia, (iv) spinal cord, (v) brainstem, and (vi) higher centers. Each of these processing centers contains afferent, efferent, and local circuit neurons, which interact locally and in an interdependent fashion with the other levels to coordinate regional cardiac electrical and mechanical indices on a beat-to-beat basis. This control system is optimized to respond to normal physiological stressors (standing, exercise, and temperature); however, it can be catastrophically disrupted by pathological events such as myocardial ischemia. In fact, it is now recognized that autonomic dysregulation is central to the evolution of heart failure and arrhythmias. Autonomic regulation therapy is an emerging modality in the management of acute and chronic cardiac pathologies. Neuromodulation-based approaches that target select nexus points of this hierarchy for cardiac control offer unique opportunities to positively affect therapeutic outcomes via improved efficacy of cardiovascular reflex control. As such, understanding the anatomical and physiological basis for such control is necessary to implement effectively novel neuromodulation therapies. © 2016 American Physiological Society. Compr Physiol 6:1635-1653, 2016.
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Affiliation(s)
- Jeffrey L Ardell
- Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, California, USA
| | - John Andrew Armour
- Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, California, USA
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32
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Sarma MK, Macey PM, Nagarajan R, Aysola R, Harper RM, Thomas MA. Accelerated Echo Planer J-resolved Spectroscopic Imaging of Putamen and Thalamus in Obstructive Sleep Apnea. Sci Rep 2016; 6:31747. [PMID: 27596614 PMCID: PMC5011642 DOI: 10.1038/srep31747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/26/2016] [Indexed: 12/11/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) leads to neurocognitive and autonomic deficits that are partially mediated by thalamic and putamen pathology. We examined the underlying neurochemistry of those structures using compressed sensing-based 4D echo-planar J-resolved spectroscopic imaging (JRESI), and quantified values with prior knowledge fitting. Bilaterally increased thalamic mI/Cr, putamen Glx/Cr, and Glu/Cr, and bilaterally decreased thalamic and putamen tCho/Cr and GABA/Cr occurred in OSAS vs healthy subjects (p < 0.05). Increased right thalamic Glx/Cr, Glu/Cr, Gln/Cr, Asc/Cr, and decreased GPC/Cr and decreased left thalamic tNAA/Cr, NAA/Cr were detected. The right putamen showed increased mI/Cr and decreased tCho/Cr, and the left, decreased PE/Cr ratio. ROC curve analyses demonstrated 60–100% sensitivity and specificity for the metabolite ratios in differentiating OSAS vs. controls. Positive correlations were found between: left thalamus mI/Cr and baseline oxygen saturation (SaO2); right putamen tCho/Cr and apnea hypopnea index; right putamen GABA/Cr and baseline SaO2; left putamen PE/Cr and baseline SaO2; and left putamen NAA/Cr and SaO2 nadir (all p < 0.05). Negative correlations were found between left putamen PE/Cr and SaO2 nadir. These findings suggest underlying inflammation or glial activation, with greater alterations accompanying lower oxygen saturation. These metabolite levels may provide biomarkers for future neurochemical interventions by pharmacologic or other means.
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Affiliation(s)
- Manoj K Sarma
- Department of Radiological Sciences, UCLA Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Paul M Macey
- UCLA School of Nursing, UCLA Geffen School of Medicine, Los Angeles, CA 90095, USA.,Brain Research Institute, UCLA Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Rajakumar Nagarajan
- Department of Radiological Sciences, UCLA Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Ravi Aysola
- Division of Pulmonary and Critical Care Medicine, UCLA Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Ronald M Harper
- Brain Research Institute, UCLA Geffen School of Medicine, Los Angeles, CA 90095, USA.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - M Albert Thomas
- Department of Radiological Sciences, UCLA Geffen School of Medicine, Los Angeles, CA 90095, USA
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33
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Kalla M, Herring N, Paterson DJ. Cardiac sympatho-vagal balance and ventricular arrhythmia. Auton Neurosci 2016; 199:29-37. [PMID: 27590099 PMCID: PMC5334443 DOI: 10.1016/j.autneu.2016.08.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 12/11/2022]
Abstract
A hallmark of cardiovascular disease is cardiac autonomic dysregulation. The phenotype of impaired parasympathetic responsiveness and sympathetic hyperactivity in experimental animal models is also well documented in large scale human studies in the setting of heart failure and myocardial infarction, and is predictive of morbidity and mortality. Despite advances in emergency revascularisation strategies for myocardial infarction, device therapy for heart failure and secondary prevention pharmacotherapies, mortality from malignant ventricular arrhythmia remains high. Patients at highest risk or those with haemodynamically significant ventricular arrhythmia can be treated with catheter ablation and implantable cardioverter defibrillators, but the morbidity and reduction in quality of life due to the burden of ventricular arrhythmia and shock therapy persists. Therefore, future therapies must aim to target the underlying pathophysiology that contributes to the generation of ventricular arrhythmia. This review explores recent advances in mechanistic research in both limbs of the autonomic nervous system and potential avenues for translation into clinical therapy. In addition, we also discuss the relationship of these findings in the context of the reported efficacy of current neuromodulatory strategies in the management of ventricular arrhythmia. We review advances in mechanistic research in the cardiac autonomic nervous system. This is discussed in relation to neuromodulatory therapy for ventricular arrhythmia. Neuromodulation therapies can influence both neurotransmitters and co-transmitters. This may therefore improve on conventional medical treatment.
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Affiliation(s)
| | - Neil Herring
- Corresponding author at: Burdon Sanderson Cardiac Science Centre, Dept. of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, OX13PT, UK.Burdon Sanderson Cardiac Science CentreDept. of Physiology, Anatomy and GeneticsUniversity of OxfordParks RoadOX13PTUK
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34
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Davies CR, Harrington JJ. Impact of Obstructive Sleep Apnea on Neurocognitive Function and Impact of Continuous Positive Air Pressure. Sleep Med Clin 2016; 11:287-98. [PMID: 27542875 DOI: 10.1016/j.jsmc.2016.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is evidence that obstructive sleep apnea (OSA) can negatively impact attention, memory, learning, executive function, and overall intellectual function in adults and children. Imaging techniques, including MRI, MR diffusion tensor imaging, MR spectroscopy, and fMRI, have provided additional insight into the anatomic and functional underpinnings of OSA-related cognitive impairment. Both animal and human studies have looked to elucidate the separate effects of oxygen desaturation and sleep fragmentation on independent aspects of cognition. Data from animal models point to neuro-inflammation and oxidative stress as driving factors of cognitive impairment.
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Affiliation(s)
- Charles R Davies
- Carle Neuroscience Institute, Carle Foundation Hospital, College of Medicine, University of Illinois at Urbana-Champaign, 602 West University Avenue, Urbana, IL 61801, USA.
| | - John J Harrington
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, 985990 Nebraska Medical Center, Omaha, NE 68159-5990, USA
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35
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Selvadurai S, Al-Saleh S, Amin R, Zweerink A, Drake J, Propst EJ, Narang I. Utility of brain MRI in children with sleep-disordered breathing. Laryngoscope 2016; 127:513-519. [DOI: 10.1002/lary.26042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/08/2016] [Accepted: 03/25/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Sarah Selvadurai
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Reshma Amin
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Allison Zweerink
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
| | - James Drake
- Division of Neurosurgery; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Evan J. Propst
- Department of Otolaryngology-Head & Neck Surgery; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Indra Narang
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
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36
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Edlow BL, McNab JA, Witzel T, Kinney HC. The Structural Connectome of the Human Central Homeostatic Network. Brain Connect 2016; 6:187-200. [PMID: 26530629 PMCID: PMC4827322 DOI: 10.1089/brain.2015.0378] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Homeostatic adaptations to stress are regulated by interactions between the brainstem and regions of the forebrain, including limbic sites related to respiratory, autonomic, affective, and cognitive processing. Neuroanatomic connections between these homeostatic regions, however, have not been thoroughly identified in the human brain. In this study, we perform diffusion spectrum imaging tractography using the MGH-USC Connectome MRI scanner to visualize structural connections in the human brain linking autonomic and cardiorespiratory nuclei in the midbrain, pons, and medulla oblongata with forebrain sites critical to homeostatic control. Probabilistic tractography analyses in six healthy adults revealed connections between six brainstem nuclei and seven forebrain regions, several over long distances between the caudal medulla and cerebral cortex. The strongest evidence for brainstem-homeostatic forebrain connectivity in this study was between the brainstem midline raphe and the medial temporal lobe. The subiculum and amygdala were the sampled forebrain nodes with the most extensive brainstem connections. Within the human brainstem-homeostatic forebrain connectome, we observed that a lateral forebrain bundle, whose connectivity is distinct from that of rodents and nonhuman primates, is the primary conduit for connections between the brainstem and medial temporal lobe. This study supports the concept that interconnected brainstem and forebrain nodes form an integrated central homeostatic network (CHN) in the human brain. Our findings provide an initial foundation for elucidating the neuroanatomic basis of homeostasis in the normal human brain, as well as for mapping CHN disconnections in patients with disorders of homeostasis, including sudden and unexpected death, and epilepsy.
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Affiliation(s)
- Brian L. Edlow
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Jennifer A. McNab
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Department of Radiology, R.M. Lucas Center for Imaging, Stanford University, Stanford, California
| | - Thomas Witzel
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Hannah C. Kinney
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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37
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Wu SQ, Liao QC, Xu XX, Sun L, Wang J, Chen R. Effect of CPAP therapy on C-reactive protein and cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome. Sleep Breath 2016; 20:1185-1192. [PMID: 26993342 DOI: 10.1007/s11325-016-1331-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/17/2016] [Accepted: 03/02/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with neurocognitive impairment. We examined the role of the systemic inflammatory response, measured by high-sensitivity C-reactive protein (hsCRP) assay, and the effect of CPAP treatment on hsCRP and cognitive impairment in patients with OSAHS. METHODS Eligible subjects (n = 178) were categorized into two groups: absent or mild OSAHS, and moderate to severe OSAHS. First, the Montreal Cognitive Assessment (MoCA) and serum hsCRP concentration were measured. Then, the moderate to severe OSAHS group was further divided into a conservative treatment subgroup (n = 68) and a CPAP subgroup (n = 68). After 6 months of treatment, MoCA scores and hsCRP concentrations were re-measured in the moderate to severe group. RESULTS Compared with the absent or mild OSAHS group, hsCRP concentration was higher (1.00 ± 1.28 mg/L versus 2.71 ± 1.8, p < 0.001) and MoCA scores were significantly lower (27.4 ± 1.4 versus 26.3 ± 2.0, p < 0.001) in the moderate to severe group. After adjustment for age, education, body mass index, and neck circumference, hsCRP and MoCA scores correlated with parameters of overnight hypoxia. hsCRP and the proportion of time spent with blood oxygen saturation < 90 % (T90) predicted MoCA score. hsCRP and MoCA score improved, and the subdomains of the MoCA were partially improved, in the CPAP treatment subgroup. In conservatively managed patients, hsCRP concentration increased, and there was no improvement in neurocognitive dysfunction, with the memory subdomain significantly worse. CONCLUSIONS hsCRP may play a role in neurocognitive dysfunction in OSAHS. Long-term CPAP treatment could normalize the serum hsCRP concentration and partially reverse cognitive dysfunction in OSAHS.
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Affiliation(s)
- Shu Qing Wu
- Department of Respiratory Medicine, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Qing Chi Liao
- Hypertension Department, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Xing Xiang Xu
- Department of Respiratory Medicine, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Li Sun
- Sleeping Center, Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, China
| | - Jing Wang
- Sleeping Center, Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, China
| | - Rui Chen
- Department of Respiratory Medicine, Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, China.
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38
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Yamakawa K, Howard-Quijano K, Zhou W, Rajendran P, Yagishita D, Vaseghi M, Ajijola OA, Armour JA, Shivkumar K, Ardell JL, Mahajan A. Central vs. peripheral neuraxial sympathetic control of porcine ventricular electrophysiology. Am J Physiol Regul Integr Comp Physiol 2015; 310:R414-21. [PMID: 26661096 DOI: 10.1152/ajpregu.00252.2015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 12/06/2015] [Indexed: 12/12/2022]
Abstract
Sympathoexcitation is associated with ventricular arrhythmogenesis. The aim of this study was to determine the role of thoracic dorsal root afferent neural inputs to the spinal cord in modulating ventricular sympathetic control of normal heart electrophysiology. We hypothesize that dorsal root afferent input tonically modulates basal and evoked efferent sympathetic control of the heart. A 56-electrode sock placed on the epicardial ventricle in anesthetized Yorkshire pigs (n = 17) recorded electrophysiological function, as well as activation recovery interval (ARI) and dispersion in ARI, at baseline conditions and during stellate ganglion electrical stimulation. Measures were compared between intact states and sequential unilateral T1-T4 dorsal root transection (DRTx), ipsilateral ventral root transection (VRTx), and contralateral dorsal and ventral root transections (DVRTx). Left or right DRTx decreased global basal ARI [Lt.DRTx: 369 ± 12 to 319 ± 13 ms (P < 0.01) and Rt.DRTx: 388 ± 19 to 356 ± 15 ms (P < 0.01)]. Subsequent unilateral VRTx followed by contralateral DRx+VRTx induced no further change. In intact states, left and right stellate ganglion stimulation shortened ARIs (6 ± 2% vs. 17 ± 3%), while increasing dispersion (+139% vs. +88%). There was no difference in magnitude of ARI or dispersion change with stellate stimulation following spinal root transections. Interruption of thoracic spinal afferent signaling results in enhanced basal cardiac sympathoexcitability without diminishing the sympathetic response to stellate ganglion stimulation. This suggests spinal dorsal root transection releases spinal cord-mediated tonic inhibitory control of efferent sympathetic tone, while maintaining intrathoracic cardiocentric neural networks.
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Affiliation(s)
- Kentaro Yamakawa
- Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles (UCLA) Health System, Los Angeles, California
| | - Kimberly Howard-Quijano
- Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles (UCLA) Health System, Los Angeles, California; Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Wei Zhou
- Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles (UCLA) Health System, Los Angeles, California
| | - Pradeep Rajendran
- Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA Health System, Los Angeles, California; and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Daigo Yagishita
- Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA Health System, Los Angeles, California; and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Marmar Vaseghi
- Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA Health System, Los Angeles, California; and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Olujimi A Ajijola
- Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA Health System, Los Angeles, California; and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - J Andrew Armour
- Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA Health System, Los Angeles, California; and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Kalyanam Shivkumar
- Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA Health System, Los Angeles, California; and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Jeffrey L Ardell
- Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA Health System, Los Angeles, California; and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Aman Mahajan
- Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles (UCLA) Health System, Los Angeles, California; Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA Health System, Los Angeles, California; and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
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39
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Farías JG, Herrera EA, Carrasco-Pozo C, Sotomayor-Zárate R, Cruz G, Morales P, Castillo RL. Pharmacological models and approaches for pathophysiological conditions associated with hypoxia and oxidative stress. Pharmacol Ther 2015; 158:1-23. [PMID: 26617218 DOI: 10.1016/j.pharmthera.2015.11.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypoxia is the failure of oxygenation at the tissue level, where the reduced oxygen delivered is not enough to satisfy tissue demands. Metabolic depression is the physiological adaptation associated with reduced oxygen consumption, which evidently does not cause any harm to organs that are exposed to acute and short hypoxic insults. Oxidative stress (OS) refers to the imbalance between the generation of reactive oxygen species (ROS) and the ability of endogenous antioxidant systems to scavenge ROS, where ROS overwhelms the antioxidant capacity. Oxidative stress plays a crucial role in the pathogenesis of diseases related to hypoxia during intrauterine development and postnatal life. Thus, excessive ROS are implicated in the irreversible damage to cell membranes, DNA, and other cellular structures by oxidizing lipids, proteins, and nucleic acids. Here, we describe several pathophysiological conditions and in vivo and ex vivo models developed for the study of hypoxic and oxidative stress injury. We reviewed existing literature on the responses to hypoxia and oxidative stress of the cardiovascular, renal, reproductive, and central nervous systems, and discussed paradigms of chronic and intermittent hypobaric hypoxia. This systematic review is a critical analysis of the advantages in the application of some experimental strategies and their contributions leading to novel pharmacological therapies.
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Affiliation(s)
- Jorge G Farías
- Facultad de Ingeniería y Ciencias, Departamento de Ingeniería Química, Universidad de la Frontera, Casilla 54-D, Temuco, Chile
| | - Emilio A Herrera
- Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, Chile; International Center for Andean Studies (INCAS), Universidad de Chile, Chile
| | | | - Ramón Sotomayor-Zárate
- Centro de Neurobiología y Plasticidad Cerebral (CNPC), Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Chile
| | - Gonzalo Cruz
- Centro de Neurobiología y Plasticidad Cerebral (CNPC), Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Chile
| | - Paola Morales
- Programa de Farmacología Molecular y Clínica, ICBM, Facultad de Medicina, Universidad de Chile, Chile
| | - Rodrigo L Castillo
- Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, Chile.
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40
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Nuding SC, Segers LS, Iceman KE, O'Connor R, Dean JB, Bolser DC, Baekey DM, Dick TE, Shannon R, Morris KF, Lindsey BG. Functional connectivity in raphé-pontomedullary circuits supports active suppression of breathing during hypocapnic apnea. J Neurophysiol 2015; 114:2162-86. [PMID: 26203111 PMCID: PMC4600964 DOI: 10.1152/jn.00608.2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/18/2015] [Indexed: 01/17/2023] Open
Abstract
Hyperventilation is a common feature of disordered breathing. Apnea ensues if CO2 drive is sufficiently reduced. We tested the hypothesis that medullary raphé, ventral respiratory column (VRC), and pontine neurons have functional connectivity and persistent or evoked activities appropriate for roles in the suppression of drive and rhythm during hyperventilation and apnea. Phrenic nerve activity, arterial blood pressure, end-tidal CO2, and other parameters were monitored in 10 decerebrate, vagotomized, neuromuscularly-blocked, and artificially ventilated cats. Multielectrode arrays recorded spiking activity of 649 neurons. Loss and return of rhythmic activity during passive hyperventilation to apnea were identified with the S-transform. Diverse fluctuating activity patterns were recorded in the raphé-pontomedullary respiratory network during the transition to hypocapnic apnea. The firing rates of 160 neurons increased during apnea; the rates of 241 others decreased or stopped. VRC inspiratory neurons were usually the last to cease firing or lose rhythmic activity during the transition to apnea. Mayer wave-related oscillations (0.04-0.1 Hz) in firing rate were also disrupted during apnea. Four-hundred neurons (62%) were elements of pairs with at least one hyperventilation-responsive neuron and a correlational signature of interaction identified by cross-correlation or gravitational clustering. Our results support a model with distinct groups of chemoresponsive raphé neurons contributing to hypocapnic apnea through parallel processes that incorporate disfacilitation and active inhibition of inspiratory motor drive by expiratory neurons. During apnea, carotid chemoreceptors can evoke rhythm reemergence and an inspiratory shift in the balance of reciprocal inhibition via suppression of ongoing tonic expiratory neuron activity.
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Affiliation(s)
- Sarah C Nuding
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Lauren S Segers
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Kimberly E Iceman
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Russell O'Connor
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay B Dean
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Donald C Bolser
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida; and
| | - David M Baekey
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida; and
| | - Thomas E Dick
- Departments of Medicine and Neurosciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Roger Shannon
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Kendall F Morris
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Bruce G Lindsey
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida;
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Ardell JL, Rajendran PS, Nier HA, KenKnight BH, Armour JA. Central-peripheral neural network interactions evoked by vagus nerve stimulation: functional consequences on control of cardiac function. Am J Physiol Heart Circ Physiol 2015; 309:H1740-52. [PMID: 26371171 DOI: 10.1152/ajpheart.00557.2015] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/10/2015] [Indexed: 12/19/2022]
Abstract
Using vagus nerve stimulation (VNS), we sought to determine the contribution of vagal afferents to efferent control of cardiac function. In anesthetized dogs, the right and left cervical vagosympathetic trunks were stimulated in the intact state, following ipsilateral or contralateral vagus nerve transection (VNTx), and then following bilateral VNTx. Stimulations were performed at currents from 0.25 to 4.0 mA, frequencies from 2 to 30 Hz, and a 500-μs pulse width. Right or left VNS evoked significantly greater current- and frequency-dependent suppression of chronotropic, inotropic, and lusitropic function subsequent to sequential VNTx. Bradycardia threshold was defined as the current first required for a 5% decrease in heart rate. The threshold for the right vs. left vagus-induced bradycardia in the intact state (2.91 ± 0.18 and 3.47 ± 0.20 mA, respectively) decreased significantly with right VNTx (1.69 ± 0.17 mA for right and 3.04 ± 0.27 mA for left) and decreased further following bilateral VNTx (1.29 ± 0.16 mA for right and 1.74 ± 0.19 mA for left). Similar effects were observed following left VNTx. The thresholds for afferent-mediated effects on cardiac parameters were 0.62 ± 0.04 and 0.65 ± 0.06 mA with right and left VNS, respectively, and were reflected primarily as augmentation. Afferent-mediated tachycardias were maintained following β-blockade but were eliminated by VNTx. The increased effectiveness and decrease in bradycardia threshold with sequential VNTx suggest that 1) vagal afferents inhibit centrally mediated parasympathetic efferent outflow and 2) the ipsilateral and contralateral vagi exert a substantial buffering capacity. The intact threshold reflects the interaction between multiple levels of the cardiac neural hierarchy.
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Affiliation(s)
- Jeffrey L Ardell
- Neurocardiology Research Center of Excellence, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Molecular, Cellular, and Integrative Physiology Program, University of California-Los Angeles, Los Angeles, California;
| | - Pradeep S Rajendran
- Neurocardiology Research Center of Excellence, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Molecular, Cellular, and Integrative Physiology Program, University of California-Los Angeles, Los Angeles, California
| | - Heath A Nier
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; and
| | | | - J Andrew Armour
- Neurocardiology Research Center of Excellence, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
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Baril AA, Gagnon K, Arbour C, Soucy JP, Montplaisir J, Gagnon JF, Gosselin N. Regional Cerebral Blood Flow during Wakeful Rest in Older Subjects with Mild to Severe Obstructive Sleep Apnea. Sleep 2015; 38:1439-49. [PMID: 25761981 DOI: 10.5665/sleep.4986] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/31/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate changes in regional cerebral blood flow (rCBF) during wakeful rest in older subjects with mild to severe obstructive sleep apnea (OSA) and healthy controls, and to identify markers of OSA severity that predict altered rCBF. DESIGN High-resolution (99m)Tc-HMPAO SPECT imaging during wakeful rest. SETTING Research sleep laboratory affiliated with a University hospital. PARTICIPANTS Fifty untreated OSA patients aged between 55 and 85 years, divided into mild, moderate, and severe OSA, and 20 age-matched healthy controls. INTERVENTIONS N/A. MEASUREMENTS Using statistical parametric mapping, rCBF was compared between groups and correlated with clinical, respiratory, and sleep variables. RESULTS Whereas no rCBF change was observed in mild and moderate groups, participants with severe OSA had reduced rCBF compared to controls in the left parietal lobules, left precentral gyrus, bilateral postcentral gyri, and right precuneus. Reduced rCBF in these regions and in areas of the bilateral frontal and left temporal cortex was associated with more hypopneas, snoring, hypoxemia, and sleepiness. Higher apnea, microarousal, and body mass indexes were correlated to increased rCBF in the basal ganglia, insula, and limbic system. CONCLUSIONS While older individuals with severe obstructive sleep apnea (OSA) had hypoperfusion in the sensorimotor and parietal areas, respiratory variables and subjective sleepiness were correlated with extended regions of hypoperfusion in the lateral cortex. Interestingly, OSA severity, sleep fragmentation, and obesity correlated with increased perfusion in subcortical and medial cortical regions. Anomalies with such a distribution could result in cognitive deficits and reflect impaired vascular regulation, altered neuronal integrity, and/or undergoing neurodegenerative processes.
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Affiliation(s)
- Andrée-Ann Baril
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychiatry, Montreal, Quebec, Canada
| | - Katia Gagnon
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université du Québec à Montréal, Department of Psychology, Montreal, Quebec, Canada
| | - Caroline Arbour
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychology, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- McGill University, McConnell Brain Imaging Centre, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychiatry, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université du Québec à Montréal, Department of Psychology, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychology, Montreal, Quebec, Canada
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Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: Relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res 2015; 93:1778-94. [DOI: 10.1002/jnr.23634] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/02/2015] [Accepted: 08/04/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE/Melbourne School of Engineering, The University of Melbourne; Parkville Victoria Australia
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Mateika JH, El-Chami M, Shaheen D, Ivers B. Intermittent hypoxia: a low-risk research tool with therapeutic value in humans. J Appl Physiol (1985) 2014; 118:520-32. [PMID: 25549763 DOI: 10.1152/japplphysiol.00564.2014] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Intermittent hypoxia has generally been perceived as a high-risk stimulus, particularly in the field of sleep medicine, because it is thought to initiate detrimental cardiovascular, respiratory, cognitive, and metabolic outcomes. In contrast, the link between intermittent hypoxia and beneficial outcomes has received less attention, perhaps because it is not universally understood that outcome measures following exposure to intermittent hypoxia may be linked to the administered dose. The present review is designed to emphasize the less recognized beneficial outcomes associated with intermittent hypoxia. The review will consider the role intermittent hypoxia has in cardiovascular and autonomic adaptations, respiratory motor plasticity, and cognitive function. Each section will highlight the literature that contributed to the belief that intermittent hypoxia leads primarily to detrimental outcomes. The second segment of each section will consider the possible risks associated with experimentally rather than naturally induced intermittent hypoxia. Finally, the body of literature indicating that intermittent hypoxia initiates primarily beneficial outcomes will be considered. The overarching theme of the review is that the use of intermittent hypoxia in research investigations, coupled with reasonable safeguards, should be encouraged because of the potential benefits linked to the administration of a variety of low-risk intermittent hypoxia protocols.
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Affiliation(s)
- Jason H Mateika
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan; and Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Mohamad El-Chami
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan; and
| | - David Shaheen
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan; and
| | - Blake Ivers
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan; and
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Idiaquez J, Santos I, Santin J, Del Rio R, Iturriaga R. Neurobehavioral and autonomic alterations in adults with obstructive sleep apnea. Sleep Med 2014; 15:1319-23. [DOI: 10.1016/j.sleep.2014.05.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 12/31/2022]
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Fatouleh RH, Hammam E, Lundblad LC, Macey PM, McKenzie DK, Henderson LA, Macefield VG. Functional and structural changes in the brain associated with the increase in muscle sympathetic nerve activity in obstructive sleep apnoea. NEUROIMAGE-CLINICAL 2014; 6:275-83. [PMID: 25379440 PMCID: PMC4215471 DOI: 10.1016/j.nicl.2014.08.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/13/2014] [Accepted: 08/22/2014] [Indexed: 12/30/2022]
Abstract
Muscle sympathetic nerve activity (MSNA) is greatly elevated in patients with obstructive sleep apnoea (OSA) during daytime wakefulness, leading to hypertension, but the underlying mechanisms are poorly understood. By recording MSNA concurrently with functional Magnetic Resonance Imaging (fMRI) of the brain we aimed to identify the central processes responsible for the sympathoexcitation. Spontaneous fluctuations in MSNA were recorded via tungsten microelectrodes inserted percutaneously into the common peroneal nerve in 17 OSA patients and 15 healthy controls lying in a 3 T MRI scanner. Blood Oxygen Level Dependent (BOLD) contrast gradient echo, echo-planar images were continuously collected in a 4 s ON, 4 s OFF (200 volumes) sampling protocol. Fluctuations in BOLD signal intensity covaried with the intensity of the concurrently recorded bursts of MSNA. In both groups there was a positive correlation between MSNA and signal intensity in the left and right insulae, dorsolateral prefrontal cortex (dlPFC), dorsal precuneus, sensorimotor cortex and posterior temporal cortex, and the right mid-cingulate cortex and hypothalamus. In OSA the left and right dlPFC, medial PFC (mPFC), dorsal precuneus, anterior cingulate cortex, retrosplenial cortex and caudate nucleus showed augmented signal changes compared with controls, while the right hippocampus/parahippocampus signal intensity decreased in controls but did not change in the OSA subjects. In addition, there were significant increases in grey matter volume in the left mid-insula, the right insula, left and right primary motor cortices, left premotor cortex, left hippocampus and within the brainstem and cerebellum, and significant decreases in the mPFC, occipital lobe, right posterior cingulate cortex, left cerebellar cortex and the left and right amygdala in OSA, but there was no overlap between these structural changes and the functional changes in OSA. These data suggest that the elevated muscle vasoconstrictor drive in OSA may result from functional changes within these brain regions, which are known to be directly or indirectly involved in the modulation of sympathetic outflow via the brainstem. That there was no overlap in the structural and functional changes suggests that asphyxic damage due to repeated episodes of nocturnal obstructive apnoea is not the main cause of the sympathoexcitation. Obstructive sleep apnea increases muscle sympathetic nerve activity (MSNA). fMRI was used to identify brain sites temporally coupled to the increase in MSNA. Augmented BOLD signal intensity occurred in several cortical and subcortical sites. The elevated MSNA in OSA may result from functional changes within these sites.
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Affiliation(s)
- Rania H Fatouleh
- University of Western Sydney, School of Medicine, Sydney, Australia
| | - Elie Hammam
- University of Western Sydney, School of Medicine, Sydney, Australia
| | - Linda C Lundblad
- University of Western Sydney, School of Medicine, Sydney, Australia
| | - Paul M Macey
- UCLA School of Nursing and Brain Research Institute, Los Angeles, CA, USA
| | - David K McKenzie
- Neuroscience Research Australia, Sydney, Australia ; Prince of Wales Hospital, Department of Respiratory Medicine, Sydney, Australia
| | - Luke A Henderson
- Discipline of Anatomy and Histology, University of Sydney, Sydney, Australia
| | - Vaughan G Macefield
- University of Western Sydney, School of Medicine, Sydney, Australia ; Neuroscience Research Australia, Sydney, Australia
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Duffin J, Kubin L, Mateika JH. Foreword. Respir Physiol Neurobiol 2013; 188:231-2. [DOI: 10.1016/j.resp.2013.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/14/2013] [Indexed: 10/26/2022]
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