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Yazdi M, Samaee M, Massicotte D. A Review on Automated Sleep Study. Ann Biomed Eng 2024; 52:1463-1491. [PMID: 38493234 DOI: 10.1007/s10439-024-03486-0] [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: 09/07/2023] [Accepted: 02/25/2024] [Indexed: 03/18/2024]
Abstract
In recent years, research on automated sleep analysis has witnessed significant growth, reflecting advancements in understanding sleep patterns and their impact on overall health. This review synthesizes findings from an exhaustive analysis of 87 papers, systematically retrieved from prominent databases such as Google Scholar, PubMed, IEEE Xplore, and ScienceDirect. The selection criteria prioritized studies focusing on methods employed, signal modalities utilized, and machine learning algorithms applied in automated sleep analysis. The overarching goal was to critically evaluate the strengths and weaknesses of the proposed methods, shedding light on the current landscape and future directions in sleep research. An in-depth exploration of the reviewed literature revealed a diverse range of methodologies and machine learning approaches employed in automated sleep studies. Notably, K-Nearest Neighbors (KNN), Ensemble Learning Methods, and Support Vector Machine (SVM) emerged as versatile and potent classifiers, exhibiting high accuracies in various applications. However, challenges such as performance variability and computational demands were observed, necessitating judicious classifier selection based on dataset intricacies. In addition, the integration of traditional feature extraction methods with deep structures and the combination of different deep neural networks were identified as promising strategies to enhance diagnostic accuracy in sleep-related studies. The reviewed literature emphasized the need for adaptive classifiers, cross-modality integration, and collaborative efforts to drive the field toward more accurate, robust, and accessible sleep-related diagnostic solutions. This comprehensive review serves as a solid foundation for researchers and practitioners, providing an organized synthesis of the current state of knowledge in automated sleep analysis. By highlighting the strengths and challenges of various methodologies, this review aims to guide future research toward more effective and nuanced approaches to sleep diagnostics.
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Affiliation(s)
- Mehran Yazdi
- Laboratory of Signal and System Integration, Department of Electrical and Computer Engineering, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
- Signal and Image Processing Laboratory, School of Electrical and Computer Engineering, Shiraz University, Shiraz, Iran.
| | - Mahdi Samaee
- Signal and Image Processing Laboratory, School of Electrical and Computer Engineering, Shiraz University, Shiraz, Iran
| | - Daniel Massicotte
- Laboratory of Signal and System Integration, Department of Electrical and Computer Engineering, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Howarth T, Tashakori M, Karhu T, Rusanen M, Pitkänen H, Oksenberg A, Nikkonen S. Excessive daytime sleepiness is associated with relative delta frequency power among patients with mild OSA. Front Neurol 2024; 15:1367860. [PMID: 38645747 PMCID: PMC11026663 DOI: 10.3389/fneur.2024.1367860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/07/2024] [Indexed: 04/23/2024] Open
Abstract
Background Excessive daytime sleepiness (EDS) is a cause of low quality of life among obstructive sleep apnoea (OSA) patients. Current methods of assessing and predicting EDS are limited due to time constraints or differences in subjective experience and scoring. Electroencephalogram (EEG) power spectral densities (PSDs) have shown differences between OSA and non-OSA patients, and fatigued and non-fatigued patients. Therefore, polysomnographic EEG PSDs may be useful to assess the extent of EDS among patients with OSA. Methods Patients presenting to Israel Loewenstein hospital reporting daytime sleepiness who recorded mild OSA on polysomnography and undertook a multiple sleep latency test. Alpha, beta, and delta relative powers were assessed between patients categorized as non-sleepy (mean sleep latency (MSL) ≥10 min) and sleepy (MSL <10 min). Results 139 patients (74% male) were included for analysis. 73 (53%) were categorized as sleepy (median MSL 6.5 min). There were no significant differences in demographics or polysomnographic parameters between sleepy and non-sleepy groups. In multivariate analysis, increasing relative delta frequency power was associated with increased odds of sleepiness (OR 1.025 (95% CI 1.024-1.026)), while relative alpha and beta powers were associated with decreased odds. The effect size of delta PSD on sleepiness was significantly greater than that of either alpha or beta frequencies. Conclusion Delta PSD during polysomnography is significantly associated with a greater degree of objective daytime sleepiness among patients with mild OSA. Further research is needed to corroborate our findings and identify the direction of potential causal correlation between delta PSD and EDS.
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Affiliation(s)
- Timothy Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia
- College of Health and Human Sciences, Charles Darwin University, Darwin, NT, Australia
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Masoumeh Tashakori
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Matias Rusanen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble Alpes University Hospital, Grenoble, France
| | - Henna Pitkänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital – Rehabilitation Center, Ra’anana, Israel
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Xu S, Faust O, Seoni S, Chakraborty S, Barua PD, Loh HW, Elphick H, Molinari F, Acharya UR. A review of automated sleep disorder detection. Comput Biol Med 2022; 150:106100. [PMID: 36182761 DOI: 10.1016/j.compbiomed.2022.106100] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 12/22/2022]
Abstract
Automated sleep disorder detection is challenging because physiological symptoms can vary widely. These variations make it difficult to create effective sleep disorder detection models which support hu-man experts during diagnosis and treatment monitoring. From 2010 to 2021, authors of 95 scientific papers have taken up the challenge of automating sleep disorder detection. This paper provides an expert review of this work. We investigated whether digital technology and Artificial Intelligence (AI) can provide automated diagnosis support for sleep disorders. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines during the content discovery phase. We compared the performance of proposed sleep disorder detection methods, involving differ-ent datasets or signals. During the review, we found eight sleep disorders, of which sleep apnea and insomnia were the most studied. These disorders can be diagnosed using several kinds of biomedical signals, such as Electrocardiogram (ECG), Polysomnography (PSG), Electroencephalogram (EEG), Electromyogram (EMG), and snore sound. Subsequently, we established areas of commonality and distinctiveness. Common to all reviewed papers was that AI models were trained and tested with labelled physiological signals. Looking deeper, we discovered that 24 distinct algorithms were used for the detection task. The nature of these algorithms evolved, before 2017 only traditional Machine Learning (ML) was used. From 2018 onward, both ML and Deep Learning (DL) methods were used for sleep disorder detection. The strong emergence of DL algorithms has considerable implications for future detection systems because these algorithms demand significantly more data for training and testing when compared with ML. Based on our review results, we suggest that both type and amount of labelled data is crucial for the design of future sleep disorder detection systems because this will steer the choice of AI algorithm which establishes the desired decision support. As a guiding principle, more labelled data will help to represent the variations in symptoms. DL algorithms can extract information from these larger data quantities more effectively, therefore; we predict that the role of these algorithms will continue to expand.
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Affiliation(s)
- Shuting Xu
- Cogninet Brain Team, Sydney, NSW, 2010, Australia
| | - Oliver Faust
- Anglia Ruskin University, East Rd, Cambridge CB1 1PT, UK.
| | - Silvia Seoni
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Subrata Chakraborty
- School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia; Centre for Advanced Modelling and Geospatial Lnformation Systems (CAMGIS), Faculty of Engineer and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Prabal Datta Barua
- Cogninet Brain Team, Sydney, NSW, 2010, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia; School of Business (Information System), University of Southern Queensland, Australia
| | - Hui Wen Loh
- School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, 599494, Singapore
| | | | - Filippo Molinari
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - U Rajendra Acharya
- School of Business (Information System), University of Southern Queensland, Australia; School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, 599494, Singapore; Department of Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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4
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Maski K, Trotti LM. How should disrupted nocturnal sleep be characterized in narcolepsy type 1? Sleep 2022; 45:6573301. [PMID: 35460560 PMCID: PMC10139759 DOI: 10.1093/sleep/zsac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kiran Maski
- Department of Neurology, Harvard Medical School and Boston Children’s Hospital , Boston, MA , USA
| | - Lynn Marie Trotti
- Department of Neurology, Emory Sleep Center, Emory University School of Medicine , Atlanta, GA , USA
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Maski K, Mignot E, Plazzi G, Dauvilliers Y. Disrupted nighttime sleep and sleep instability in narcolepsy. J Clin Sleep Med 2022; 18:289-304. [PMID: 34463249 PMCID: PMC8807887 DOI: 10.5664/jcsm.9638] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES This review aimed to summarize current knowledge about disrupted nighttime sleep (DNS) and sleep instability in narcolepsy, including self-reported and objective assessments, potential causes of sleep instability, health consequences and functional burden, and management. METHODS One hundred two peer-reviewed publications from a PubMed search were included. RESULTS DNS is a key symptom of narcolepsy but has received less attention than excessive daytime sleepiness and cataplexy. There has been a lack of clarity regarding the definition of DNS, as many sleep-related symptoms and conditions disrupt sleep quality in narcolepsy (eg, hallucinations, sleep paralysis, rapid eye movement sleep behavior disorder, nightmares, restless legs syndrome/periodic leg movements, nocturnal eating, sleep apnea, depression, anxiety). In addition, the intrinsic sleep instability of narcolepsy results in frequent spontaneous wakings and sleep stage transitions, contributing to DNS. Sleep instability likely emerges in the setting of orexin insufficiency/deficiency, but its exact pathophysiology remains unknown. DNS impairs quality of life among people with narcolepsy, and more research is needed to determine its contributions to cardiovascular risk. Multimodal treatment is appropriate for DNS management, including behavioral therapies, counseling on sleep hygiene, and/or medication. There is strong evidence showing improvement in self-reported sleep quality and objective sleep stability measures with sodium oxybate, but rigorous clinical trials with other pharmacotherapies are needed. Treatment may be complicated by comorbidities, concomitant medications, and mood disorders. CONCLUSIONS DNS is a common symptom of narcolepsy deserving consideration in clinical care and future research. CITATION Maski K, Mignot E, Plazzi G, Dauvilliers Y. Disrupted nighttime sleep and sleep instability in narcolepsy. J Clin Sleep Med. 2022;18(1):289-304.
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Affiliation(s)
- Kiran Maski
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts,Address correspondence to: Kiran Maski, MD, MPH, Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02130; Phone: +01 857-218-5536; Fax: +01 617-730-0282;
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Redwood City, California
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy,IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France,University of Montpellier, INSERM Institute for Neurosciences Montpellier, Montpellier, France
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Watson NF, Fernandez CR. Artificial intelligence and sleep: Advancing sleep medicine. Sleep Med Rev 2021; 59:101512. [PMID: 34166990 DOI: 10.1016/j.smrv.2021.101512] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
Artificial intelligence (AI) allows analysis of "big data" combining clinical, environmental and laboratory based objective measures to allow a deeper understanding of sleep and sleep disorders. This development has the potential to transform sleep medicine in coming years to the betterment of patient care and our collective understanding of human sleep. This review addresses the current state of the field starting with a broad definition of the various components and analytic methods deployed in AI. We review examples of AI use in screening, endotyping, diagnosing, and treating sleep disorders and place this in the context of precision/personalized sleep medicine. We explore the opportunities for AI to both facilitate and extend providers' clinical impact and present ethical considerations regarding AI derived prognostic information. We cover early adopting specialties of AI in the clinical realm, such as radiology and pathology, to provide a road map for the challenges sleep medicine is likely to face when deploying this technology. Finally, we discuss pitfalls to ensure clinical AI implementation proceeds in the safest and most effective manner possible.
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Affiliation(s)
- Nathaniel F Watson
- Department of Neurology, University of Washington (UW) School of Medicine, USA; UW Medicine Sleep Center, USA.
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Brink-Kjaer A, Christensen JAE, Cesari M, Mignot E, Sorensen HBD, Jennum P. Cortical arousal frequency is increased in narcolepsy type 1. Sleep 2021; 44:6009075. [PMID: 33249455 DOI: 10.1093/sleep/zsaa255] [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] [Received: 05/15/2020] [Revised: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Hypocretin deficient narcolepsy (type 1, NT1) presents with multiple sleep abnormalities including sleep-onset rapid eye movement (REM) periods (SOREMPs) and sleep fragmentation. We hypothesized that cortical arousals, as scored by an automatic detector, are elevated in NT1 and narcolepsy type 2 (NT2) patients as compared to control subjects. METHODS We analyzed nocturnal polysomnography (PSG) recordings from 25 NT1 patients, 20 NT2 patients, 18 clinical control subjects (CC, suspected central hypersomnia but with normal cerebrospinal (CSF) fluid hypocretin-1 (hcrt-1) levels and normal results on the multiple sleep latency test), and 37 healthy control (HC) subjects. Arousals were automatically scored using Multimodal Arousal Detector (MAD), a previously validated automatic wakefulness and arousal detector. Multiple linear regressions were used to compare arousal index (ArI) distributions across groups. Comparisons were corrected for age, sex, body-mass index, medication, apnea-hypopnea index, periodic leg movement index, and comorbid rapid eye movement sleep behavior disorder. RESULTS NT1 was associated with an average increase in ArI of 4.02 events/h (p = 0.0246) compared to HC and CC, while no difference was found between NT2 and control groups. Additionally, a low CSF hcrt-1 level was predictive of increased ArI in all the CC, NT2, and NT1 groups. CONCLUSIONS The results further support the hypothesis that a loss of hypocretin neurons causes fragmented sleep, which can be measured as an increased ArI as scored by the MAD.
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Affiliation(s)
- Andreas Brink-Kjaer
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark.,Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark.,Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA
| | - Julie A E Christensen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark.,Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark
| | - Matteo Cesari
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA
| | - Helge B D Sorensen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Poul Jennum
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
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8
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Sleep State Classification Using Power Spectral Density and Residual Neural Network with Multichannel EEG Signals. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10217639] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This paper proposes a classification framework for automatic sleep stage detection in both male and female human subjects by analyzing the electroencephalogram (EEG) data of polysomnography (PSG) recorded for three regions of the human brain, i.e., the pre-frontal, central, and occipital lobes. Without considering any artifact removal approach, the residual neural network (ResNet) architecture is used to automatically learn the distinctive features of different sleep stages from the power spectral density (PSD) of the raw EEG data. The residual block of the ResNet learns the intrinsic features of different sleep stages from the EEG data while avoiding the vanishing gradient problem. The proposed approach is validated using the sleep dataset of the Dreams database, which comprises of EEG signals for 20 healthy human subjects, 16 female and 4 male. Our experimental results demonstrate the effectiveness of the ResNet based approach in identifying different sleep stages in both female and male subjects compared to state-of-the-art methods with classification accuracies of 87.8% and 83.7%, respectively.
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9
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Lammers GJ, Bassetti CL, Dolenc-Groselj L, Jennum PJ, Kallweit U, Khatami R, Lecendreux M, Manconi M, Mayer G, Partinen M, Plazzi G, Reading PJ, Santamaria J, Sonka K, Dauvilliers Y. Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. Sleep Med Rev 2020; 52:101306. [DOI: 10.1016/j.smrv.2020.101306] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 01/22/2023]
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10
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Olesen AN, Cesari M, Christensen JAE, Sorensen HBD, Mignot E, Jennum P. A comparative study of methods for automatic detection of rapid eye movement abnormal muscular activity in narcolepsy. Sleep Med 2018. [DOI: 10.1016/j.sleep.2017.11.1141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Cheung J, Ruoff C, Moore H, Hagerman KA, Perez J, Sakamuri S, Warby SC, Mignot E, Day J, Sampson J. Increased EEG Theta Spectral Power in Sleep in Myotonic Dystrophy Type 1. J Clin Sleep Med 2018; 14:229-235. [PMID: 29394960 PMCID: PMC5786842 DOI: 10.5664/jcsm.6940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/24/2017] [Accepted: 10/23/2017] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Myotonic dystrophy type 1 (DM1) is a multisystemic disorder that involves the central nervous system (CNS). Individuals with DM1 commonly present with sleep dysregulation, including excessive daytime sleepiness and sleep-disordered breathing. We aim to characterize electroencephalogram (EEG) power spectra from nocturnal polysomnography (PSG) in patients with DM1 compared to matched controls to better understand the potential CNS sleep dysfunction in DM1. METHODS A retrospective, case-control (1:2) chart review of patients with DM1 (n = 18) and matched controls (n = 36) referred for clinical PSG at the Stanford Sleep Center was performed. Controls were matched based on age, sex, apnea-hypopnea index (AHI), body mass index (BMI), and Epworth Sleepiness Scale (ESS). Sleep stage and respiratory metrics for the two groups were compared. Power spectral analysis of the EEG C3-M2 signal was performed using the fast Fourier transformation. RESULTS Patients with DM1 had significantly increased theta percent power in stage N2 sleep compared to matched controls. Theta/beta and theta/alpha percent power spectral ratios were found to be significantly increased in stage N2, N3, all sleep stages combined, and all wake periods combined in patients with DM1 compared to controls. A significantly lower nadir O2 saturation was also found in patients with DM1 versus controls. CONCLUSIONS Compared to matched controls, patients with DM1 had increased EEG theta spectral power. Increased theta/beta and theta/alpha power spectral ratios in nocturnal PSG may reflect DM1 pathology in the CNS.
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Affiliation(s)
- Joseph Cheung
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Chad Ruoff
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Hyatt Moore
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Katharine A. Hagerman
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
| | - Jennifer Perez
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
| | - Sarada Sakamuri
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
| | - Simon C. Warby
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - John Day
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
| | - Jacinda Sampson
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
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12
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Christensen JAE, Nikolic M, Hvidtfelt M, Kornum BR, Jennum P. Sleep spindle density in narcolepsy. Sleep Med 2017; 34:40-49. [DOI: 10.1016/j.sleep.2017.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/03/2017] [Accepted: 02/16/2017] [Indexed: 02/07/2023]
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13
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Murillo-Rodríguez E, Di Marzo V, Machado S, Rocha NB, Veras AB, Neto GAM, Budde H, Arias-Carrión O, Arankowsky-Sandoval G. Role of N-Arachidonoyl-Serotonin (AA-5-HT) in Sleep-Wake Cycle Architecture, Sleep Homeostasis, and Neurotransmitters Regulation. Front Mol Neurosci 2017; 10:152. [PMID: 28611585 PMCID: PMC5447686 DOI: 10.3389/fnmol.2017.00152] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/05/2017] [Indexed: 12/19/2022] Open
Abstract
The endocannabinoid system comprises several molecular entities such as endogenous ligands [anandamide (AEA) and 2-arachidonoylglycerol (2-AG)], receptors (CB1 and CB2), enzymes such as [fatty acid amide hydrolase (FAHH) and monoacylglycerol lipase (MAGL)], as well as the anandamide membrane transporter. Although the role of this complex neurobiological system in the sleep–wake cycle modulation has been studied, the contribution of the blocker of FAAH/transient receptor potential cation channel subfamily V member 1 (TRPV1), N-arachidonoyl-serotonin (AA-5-HT) in sleep has not been investigated. Thus, in the present study, varying doses of AA-5-HT (5, 10, or 20 mg/Kg, i.p.) injected at the beginning of the lights-on period of rats, caused no statistical changes in sleep patterns. However, similar pharmacological treatment given to animals at the beginning of the dark period decreased wakefulness (W) and increased slow wave sleep (SWS) as well as rapid eye movement sleep (REMS). Power spectra analysis of states of vigilance showed that injection of AA-5-HT during the lights-off period diminished alpha spectrum across alertness in a dose-dependent fashion. In opposition, delta power spectra was enhanced as well as theta spectrum, during SWS and REMS, respectively. Moreover, the highest dose of AA-5-HT decreased wake-related contents of neurotransmitters such as dopamine (DA), norepinephrine (NE), epinephrine (EP), serotonin (5-HT) whereas the levels of adenosine (AD) were enhanced. In addition, the sleep-inducing properties of AA-5-HT were confirmed since this compound blocked the increase in W caused by stimulants such as cannabidiol (CBD) or modafinil (MOD) during the lights-on period. Additionally, administration of AA-5-HT also prevented the enhancement in contents of DA, NE, EP, 5-HT and AD after CBD of MOD injection. Lastly, the role of AA-5-HT in sleep homeostasis was tested in animals that received either CBD or MOD after total sleep deprivation (TSD). The injection of CBD or MOD increased alertness during sleep rebound period after TSD. However, AA-5-HT blocked this effect by allowing animals to display an enhancement in sleep across sleep rebound period. Overall, our findings provide evidence that AA-5-HT is an important modulator of sleep, sleep homeostasis and neurotransmitter contents.
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Affiliation(s)
- Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac MayabMérida, Mexico.,Grupo de Investigación en Envejecimiento, División Ciencias de la Salud, Universidad Anáhuac MayabMérida, Mexico.,Grupo de Investigación Desarrollos Tecnológicos para la Salud, División de Ingeniería y Ciencias Exactas, Universidad Anáhuac MayabMérida, Mexico.,Intercontinental Neuroscience Research Group
| | - Vincenzo Di Marzo
- Intercontinental Neuroscience Research Group.,Endocannabinoid Research Group, Istituto di Chimica Biomolecolare, Consiglio Nazionale delle RicerchePozzuoli, Italy
| | - Sergio Machado
- Intercontinental Neuroscience Research Group.,Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de JaneiroRio de Janeiro, Brazil.,Postgraduate Program, Salgado de Oliveira UniversityRio de Janeiro, Brazil
| | - Nuno B Rocha
- Intercontinental Neuroscience Research Group.,Faculty of Health Sciences, Polytechnic Institute of PortoPorto, Portugal
| | - André B Veras
- Intercontinental Neuroscience Research Group.,Institute of Psychiatry, Federal University of Rio de JaneiroRio de Janeiro, Brazil.,Dom Bosco Catholic UniversityRio de Janeiro, Brazil
| | - Geraldo A M Neto
- Intercontinental Neuroscience Research Group.,Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de JaneiroRio de Janeiro, Brazil
| | - Henning Budde
- Intercontinental Neuroscience Research Group.,Faculty of Human Sciences, Medical School HamburgHamburg, Germany.,Physical Activity, Physical Education, Health and Sport Research Centre (PAPESH), Sports Science Department, School of Science and Engineering Reykjavik UniversityReykjavik, Iceland.,Department of Health, Physical and Social Education, Lithuanian Sports UniversityKaunas, Lithuania
| | - Oscar Arias-Carrión
- Intercontinental Neuroscience Research Group.,Unidad de Trastornos del Movimiento y Sueño (TMS), Hospital General "Dr. Manuel Gea González"Ciudad de México, Mexico
| | - Gloria Arankowsky-Sandoval
- Intercontinental Neuroscience Research Group.,Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de YucatánMérida, Mexico
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Christensen JA, Kempfner L, Leonthin HL, Hvidtfelt M, Nikolic M, Kornum BR, Jennum P. Novel method for evaluation of eye movements in patients with narcolepsy. Sleep Med 2017; 33:171-180. [DOI: 10.1016/j.sleep.2016.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
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Olsen AV, Stephansen J, Leary E, Peppard PE, Sheungshul H, Jennum PJ, Sorensen H, Mignot E. Diagnostic value of sleep stage dissociation as visualized on a 2-dimensional sleep state space in human narcolepsy. J Neurosci Methods 2017; 282:9-19. [PMID: 28219726 DOI: 10.1016/j.jneumeth.2017.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/11/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Type 1 narcolepsy (NT1) is characterized by symptoms believed to represent Rapid Eye Movement (REM) sleep stage dissociations, occurrences where features of wake and REM sleep are intermingled, resulting in a mixed state. We hypothesized that sleep stage dissociations can be objectively detected through the analysis of nocturnal Polysomnography (PSG) data, and that those affecting REM sleep can be used as a diagnostic feature for narcolepsy. NEW METHOD A Linear Discriminant Analysis (LDA) model using 38 features extracted from EOG, EMG and EEG was used in control subjects to select features differentiating wake, stage N1, N2, N3 and REM sleep. Sleep stage differentiation was next represented in a 2D projection. Features characteristic of sleep stage differences were estimated from the residual sleep stage probability in the 2D space. Using this model we evaluated PSG data from NT1 and non-narcoleptic subjects. An LDA classifier was used to determine the best separation plane. COMPARISON WITH EXISTING METHODS This method replicates the specificity/sensitivity from the training set to the validation set better than many other methods. RESULTS Eight prominent features could differentiate narcolepsy and controls in the validation dataset. Using a composite measure and a specificity cut off 95% in the training dataset, sensitivity was 43%. Specificity/sensitivity was 94%/38% in the validation set. Using hypersomnia subjects, specificity/sensitivity was 84%/15%. Analyzing treated narcoleptics the specificity/sensitivity was 94%/10%. CONCLUSION Sleep stage dissociation can be used for the diagnosis of narcolepsy. However the use of some medications and presence of undiagnosed hypersomnolence patients impacts the result.
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Affiliation(s)
- Anders Vinther Olsen
- Center for Sleep Sciences and Medicine, Stanford School of Medicine, Palo Alto, CA, USA; Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark.
| | - Jens Stephansen
- Center for Sleep Sciences and Medicine, Stanford School of Medicine, Palo Alto, CA, USA; Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Eileen Leary
- Center for Sleep Sciences and Medicine, Stanford School of Medicine, Palo Alto, CA, USA
| | - Paul E Peppard
- Department of Preventive medicine, U Madison Wisconsin Madison, Wisconsin, USA
| | - Hong Sheungshul
- Sleep Disorder Center, Catholic University, Seoul, South Korea
| | - Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark
| | - Helge Sorensen
- Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Stanford School of Medicine, Palo Alto, CA, USA
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Pizza F, Ferri R, Vandi S, Rundo F, Iloti M, Neccia G, Plazzi G. Spectral electroencephalography profile of rapid eye movement sleep at sleep onset in narcolepsy type 1. Eur J Neurol 2016; 24:334-340. [DOI: 10.1111/ene.13204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- F. Pizza
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
- IRCCS Institute of the Neurological Sciences; Ospedale Bellaria; Bologna Italy
| | - R. Ferri
- Department of Neurology; Oasi Institute for Research on Mental Retardation and Brain Aging; Troina Italy
| | - S. Vandi
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
- IRCCS Institute of the Neurological Sciences; Ospedale Bellaria; Bologna Italy
| | - F. Rundo
- Department of Neurology; Oasi Institute for Research on Mental Retardation and Brain Aging; Troina Italy
| | - M. Iloti
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - G. Neccia
- IRCCS Institute of the Neurological Sciences; Ospedale Bellaria; Bologna Italy
| | - G. Plazzi
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
- IRCCS Institute of the Neurological Sciences; Ospedale Bellaria; Bologna Italy
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