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He J, Chan SH, Lin J, Tsang HW. Integration of tai chi and repetitive transcranial magnetic stimulation for sleep disturbances in older adults: A pilot randomized controlled trial. Sleep Med 2024; 122:35-44. [PMID: 39121822 DOI: 10.1016/j.sleep.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND The arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances. METHODS Thirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2). RESULTS Significant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's d = 1.62, p = 0.003) and T2 (Cohen's d = 1.97, p < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's d = 1.03, p = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (p = 0.015) and total sleep time (p = 0.004), depression (p = 0.003) and stress scores (p = 0.002), and mental function in relation to quality of life (p = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity. CONCLUSION The research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. Future studies are needed to unravel the underlying mechanism and optimize the protocol to maximize the therapeutic benefits.
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Affiliation(s)
- Jiali He
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Sunny Hw Chan
- Centre for Health and Clinical Research, University of the West of England, United Kingdom
| | - Jingxia Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; Mental Health Research Centre, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Hector Wh Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; Mental Health Research Centre, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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Rahimi S, Joyce L, Fenzl T, Drexel M. Crosstalk between the subiculum and sleep-wake regulation: A review. J Sleep Res 2024; 33:e14134. [PMID: 38196146 DOI: 10.1111/jsr.14134] [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: 09/25/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 01/11/2024]
Abstract
The circuitry underlying the initiation, maintenance, and coordination of wakefulness, rapid eye movement sleep, and non-rapid eye movement sleep is not thoroughly understood. Sleep is thought to arise due to decreased activity in the ascending reticular arousal system, which originates in the brainstem and awakens the thalamus and cortex during wakefulness. Despite the conventional association of sleep-wake states with hippocampal rhythms, the mutual influence of the hippocampal formation in regulating vigilance states has been largely neglected. Here, we focus on the subiculum, the main output region of the hippocampal formation. The subiculum, particulary the ventral part, sends extensive monosynaptic projections to crucial regions implicated in sleep-wake regulation, including the thalamus, lateral hypothalamus, tuberomammillary nucleus, basal forebrain, ventrolateral preoptic nucleus, ventrolateral tegmental area, and suprachiasmatic nucleus. Additionally, second-order projections from the subiculum are received by the laterodorsal tegmental nucleus, locus coeruleus, and median raphe nucleus, suggesting the potential involvement of the subiculum in the regulation of the sleep-wake cycle. We also discuss alterations in the subiculum observed in individuals with sleep disorders and in sleep-deprived mice, underscoring the significance of investigating neuronal communication between the subiculum and pathways promoting both sleep and wakefulness.
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Affiliation(s)
- Sadegh Rahimi
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Leesa Joyce
- Clinic of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, München, Germany
| | - Thomas Fenzl
- Clinic of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, München, Germany
| | - Meinrad Drexel
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
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He F, Yan Y, Peng M, Gao M, Zhou L, Chen F, Yang L, Li L, Yang X. Therapeutic potential of Rosa roxburghii folium extract in insomnia treatment: a comprehensive evaluation of behavioral and neurochemical effects in a PCPA-induced mouse model. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2024. [PMID: 39286895 DOI: 10.1002/jsfa.13895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/21/2024] [Accepted: 07/15/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Insomnia, a prevalent sleep disorder, detrimentally affects quality of life and is often challenging to manage with conventional treatments. This study delved into identifying and quantifying the main compounds by employing ultra-performance liquid chromatography-Q-Exactive-Orbitrap mass spectrometry, and further to evaluate the therapeutic potential of Rosa roxburghii folium (RRF) extract, with multiple pharmacological activities. Previous research had hinted at the efficacy of glycosides in influencing the γ-aminobutyric acid (GABAergic) system, which plays a pivotal role in sleep regulation. Utilizing a p-chlorophenylalanine-induced insomnia model in BALB/C mice, this investigation aimed to unravel the effects of various dosages of RRF extract on sleep quality and elucidated its mechanism of action. RESULTS A total of 66 compounds in the RRF extract were analyzed. Behavioral assessments demonstrated notable enhancements in sleep duration and latency. Biochemical analyses further corroborated these findings, revealing modulation in neurotransmitter levels indicative of a potential mechanism through the GABAergic and serotoninergic pathways. Additionally, histological evaluations suggested anti-inflammatory and antioxidant effects of the RRF extract. CONCLUSION The findings from this study underscored the therapeutic efficacy of RRF extract in combating insomnia, particularly highlighting its glycoside components' role. The extract's significant improvement in sleep duration and latency, alongside its modulation of neurotransmitter levels, showcases its potential as a natural remedy for insomnia. Through its action on the GABAergic and serotoninergic pathways, as well as its anti-inflammatory and antioxidant effects, RRF extract emerges as a promising candidate for insomnia treatment, offering a holistic approach to sleep disorder management. © 2024 Society of Chemical Industry.
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Affiliation(s)
- Fengjin He
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Natural Products Research Center of Guizhou Province, Guiyang, China
| | - Yanfang Yan
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Natural Products Research Center of Guizhou Province, Guiyang, China
| | - Mei Peng
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Natural Products Research Center of Guizhou Province, Guiyang, China
| | - Ming Gao
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Natural Products Research Center of Guizhou Province, Guiyang, China
| | - Lang Zhou
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Natural Products Research Center of Guizhou Province, Guiyang, China
| | - Faju Chen
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Natural Products Research Center of Guizhou Province, Guiyang, China
| | - Lishou Yang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Natural Products Research Center of Guizhou Province, Guiyang, China
| | - Liangqun Li
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Natural Products Research Center of Guizhou Province, Guiyang, China
| | - Xiaosheng Yang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Natural Products Research Center of Guizhou Province, Guiyang, China
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Cheaha D, Basor N, Manor R, Hayeemasae N, Samerphob N. Sedative and hypnotic effects with cortical EEG sleep-wake profiles of Millingtonia hortensis dried flower aqueous in mice. Heliyon 2024; 10:e37531. [PMID: 39296192 PMCID: PMC11409071 DOI: 10.1016/j.heliyon.2024.e37531] [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: 04/17/2024] [Revised: 08/26/2024] [Accepted: 09/04/2024] [Indexed: 09/21/2024] Open
Abstract
The ethnopharmacological relevance of the Millingtonia hortensis (M. hortensis) flower's aqueous extract lies in its traditional use as a herbal remedy in Southeast Asia. With a rich history in folk medicine, this aqueous has been esteemed for its purported sedative and anxiolytic properties. Our research delves into the scientific basis of these traditional claims, exploring the potential mechanisms underlying the observed effects of M. hortensis flower's aqueous extract on sleep promotion and mood regulation. This study aimed to explore the sleep-promoting effects of M. hortensis dried flower in mice, using an aqueous concentration equivalent to a human concentration of 2.7 mg/mL. Anxiolytic and antidepressant properties were evaluated using behavioural tests, while electroencephalography (EEG) analysis probed the neural mechanisms underlying sleep promotion post-consumption. The aqueous extract of M. hortensis dried flower administered to mice showed a decrease in immobility in the forced swimming test, demonstrating antidepressant-like effects. Moreover, mice treated with M. hortensis aqueous exhibited increased non-rapid eye movement (NREM) sleep duration, corroborating sleep-promoting potential. EEG analysis of mice treated with M. hortensis aqueous revealed heightened beta oscillations in the frontal and parietal cortex, while pre-treatment with M. hortensis aqueous or diazepam enhanced rapid eye movement (REM) sleep after thiopental administration. Interestingly, M. hortensis aqueous pre-treatment augmented delta frequency ranges in the frontal cortex. Overall, these findings indicate that M. hortensis dried flower's aqueous extract, at a human-equivalent dosage, exerts significant behavioural and neural effects specifically, sedative and hypnotic aspects in mice, corroborating its potential as a natural remedy to promote sleep and regulate mood.
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Affiliation(s)
- Dania Cheaha
- Division of Biological Science, Faculty of Science, Prince of Songkla University, Thailand
| | - Nurulhuda Basor
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Thailand
| | - Rodiya Manor
- Faculty of Science and Technology, Prince of Songkla University, Thailand
| | - Nabil Hayeemasae
- Faculty of Science and Technology, Prince of Songkla University, Thailand
| | - Nifareeda Samerphob
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Thailand
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Gonçalves DS, Moscaleski LA, da Silva GM, Morgans R, Okano AH, Moreira A. The Effect of Combined Transcranial Direct Current Stimulation and Pneumatic Compression as Part of a Comprehensive Recovery Strategy in Professional Male Top-Level Soccer Players. J Strength Cond Res 2024; 38:1658-1666. [PMID: 39074250 DOI: 10.1519/jsc.0000000000004844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
ABSTRACT Gonçalves, DS, Moscaleski, LA, da Silva, GM, Morgans, R, Okano, AH, and Moreira, A. The effect of combined transcranial direct current stimulation and pneumatic compression as part of a comprehensive recovery strategy in professional male top-level soccer players. J Strength Cond Res 38(9): 1658-1666, 2024-This retrospective study aimed to examine the effect of transcranial direct current stimulation (tDCS) combined with lower limb pneumatic compression during the postmatch recovery period in top-level professional male soccer players' physiological and perceptual markers of recovery status. During the 2022 season (baseline), pneumatic compression was performed as part of the recovery strategy, applied the day after official match play and psychophysiological measurements (pain, sleep, perceived recovery, and creatine kinase [CK] sampling) were performed on the second day postmatch. During the 2023 season, the tDCS protocol was introduced, with its application being performed simultaneously (in conjunction) with pneumatic compression. Recovery sessions following 10 matches in the 2022 season and following 10 matches in the 2023 season were included in the analyses. Compared with 2022 (baseline; pneumatic compression isolated), the players perceived an increased recovery on the second day postmatch when tDCS was used in conjunction with the pneumatic compression (mean = 12%; p = 0.008) and rated improved sleep quality for the nights after applying tDCS combined with pneumatic compression (mean = 7.5%; p = 0.029). On the second day postmatch, a significant reduction was observed in muscle pain/soreness (mean = 64%; p < 0.0001) and the CK concentration decreased when baseline (pneumatic compression isolated) was compared with tDCS + pneumatic compression (mean = 76%; p = 0.001). In summary, combining pneumatic compression with tDCS may enhance the effects of both interventions, leading to greater overall improvements in recovery. Further research is warranted to confirm these findings and explore the underlying mechanisms in more detail.
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Affiliation(s)
| | - Luciane Aparecida Moscaleski
- Health and Performance Center, Sociedade Esportiva Palmeiras, São Paulo, Brazil
- Center of Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
- Department of Sport, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil; and
| | | | - Ryland Morgans
- Football Performance Hub, Institute of Coaching and Performance, University of Central Lancashire, Preston, United Kingdom
| | - Alexandre Hideki Okano
- Center of Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Alexandre Moreira
- Department of Sport, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil; and
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He C, Fang Z, Wu H, Li X, Cheng L, Wen Y, Lin J. A flexible and dissolving traditional Chinese medicine microneedle patch for sleep-aid intervention. Heliyon 2024; 10:e33025. [PMID: 38984296 PMCID: PMC11231539 DOI: 10.1016/j.heliyon.2024.e33025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
About a quarter of the world's population suffers from insomnia, and the number of the insomniacs is gradually increasing. However, the current drug therapy and non-drug therapy sleep-aid methods have certain limitations. In general, the sleep-aid effect of drug therapy is better than that of Non-drug therapy, but western medicine may lead to some side effects and drug abuse. Although the side effects of Chinese Herbal Medicine (CHM) are relatively small, making the herbal decoction is complex and time-consuming. Therefore, exploring a novel sleep-aid method is very significant. In this paper, a flexible and dissolving Traditional Chinese Medicine (TCM) microneedle patch is proposed for sleep-aid intervention. The TCM microneedle patch is a micrometer-scale intrusive object, and the herbal extracts are carried by the patch. The materials, design method, and fabrication process of the microneedle patch have been described in detail. Besides, the mechanical characteristics of the microneedle patch, sleep-aid effect evaluation method, and experimental scheme have been presented. Three microneedle tips with radii of 5 μm, 15 μm, and 22 μm are selected for simulation analysis. Abaqus simulation results indicate that the smaller the radius of the microneedle tip, the smaller the piercing force. Considering that the microneedle should easily penetrate the skin without buckling, that is, the piercing force should be larger than the buckling force, thus 15 μm, instead of 5 μm or 22 μm, is more suitable to be adopted as the radius of the microneedle tip. For the microneedle with the radius of 15 μm, the piercing force is 0.033 N, and the difference between the piercing force and buckling force is 0.036 N. Experimental results demonstrate that the fracture force of the microneedle is about 0.29 N, which is far larger than the piercing force and buckling force. The single-lead EEG signals of the frontal lobe are used to evaluate the sleep-aid effect of the TCM microneedle patch. After sleep-aid intervention on the Anmian and Yintang acupoints using the patches, for most subjects, the ratios of the low-frequency brain wave energies to the high-frequency brain wave energies are increased obviously, indicating that the proposed sleep-aid method is effective.
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Affiliation(s)
- Chunhua He
- School of Computer, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Zewen Fang
- School of Computer, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Heng Wu
- School of Automation, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Xiaoping Li
- School of Computer, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Lianglun Cheng
- School of Computer, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Yangxing Wen
- First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Juze Lin
- Guangdong Provincial People's Hospital, Guangzhou, 510000, Guangdong, PR China
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Gebodh N, Miskovic V, Laszlo S, Datta A, Bikson M. Frontal HD-tACS enhances behavioral and EEG biomarkers of vigilance in continuous attention task. Brain Stimul 2024; 17:683-686. [PMID: 38797371 DOI: 10.1016/j.brs.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/25/2024] [Accepted: 05/18/2024] [Indexed: 05/29/2024] Open
Affiliation(s)
- Nigel Gebodh
- The Department of Biomedical Engineering, The City College of New York, The City University of New York, 85 St. Nicholas Terrace, Center for Discovery and Innovation (CDI), Rm 3.121, New York, NY, 10031, USA; Soterix Medical Inc., New York, USA.
| | - Vladimir Miskovic
- Google X Development LLC, The Moonshot Factory, Mountain View, CA, USA
| | - Sarah Laszlo
- Google X Development LLC, The Moonshot Factory, Mountain View, CA, USA
| | | | - Marom Bikson
- The Department of Biomedical Engineering, The City College of New York, The City University of New York, 85 St. Nicholas Terrace, Center for Discovery and Innovation (CDI), Rm 3.121, New York, NY, 10031, USA
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Yu S, Shen Z, Xu H, Xia Z, Peng W, Hu Y, Feng F, Zeng F. Top-down and bottom-up alterations of connectivity patterns of the suprachiasmatic nucleus in chronic insomnia disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:245-254. [PMID: 36811711 DOI: 10.1007/s00406-022-01534-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/16/2022] [Indexed: 02/24/2023]
Abstract
The importance of the suprachiasmatic nucleus (SCN, also called the master circadian clock) in regulating sleep and wakefulness has been confirmed by multiple animal research. However, human studies of SCN in vivo are still nascent. Recently, the development of resting-state functional magnetic resonance imaging (fMRI) has made it possible to study SCN-related connectivity changes in patients with chronic insomnia disorder (CID). Hence, this study aimed to explore whether sleep-wake circuitry (i.e., communication between the SCN and other brain regions) is disrupted in human insomnia. Forty-two patients with CID and 37 healthy controls (HCs) underwent fMRI scanning. Resting-state functional connectivity (rsFC) and Granger causality analysis (GCA) were performed to find abnormal functional and causal connectivity of the SCN in CID patients. In addition, correlation analyses were conducted to detect associations between features of disrupted connectivity and clinical symptoms. Compared to HCs, CID patients showed enhanced rsFC of the SCN-left dorsolateral prefrontal cortex (DLPFC), as well as reduced rsFC of the SCN-bilateral medial prefrontal cortex (MPFC); these altered cortical regions belong to the "top-down" circuit. Moreover, CID patients exhibited disrupted functional and causal connectivity between the SCN and the locus coeruleus (LC) and the raphe nucleus (RN); these altered subcortical regions constitute the "bottom-up" pathway. Importantly, the decreased causal connectivity from the LC-to-SCN was associated with the duration of disease in CID patients. These findings suggest that the disruption of the SCN-centered "top-down" cognitive process and "bottom-up" wake-promoting pathway may be intimately tied to the neuropathology of CID.
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Affiliation(s)
- Siyi Yu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Zhifu Shen
- Department of Traditional Chinese Medicine, the Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of Traditional Chinese and Western Medicine, North Sichuan Medical College, Nanchong, China
| | - Hao Xu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zihao Xia
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Peng
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Youping Hu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fen Feng
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zeng
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Pereira FES, Jagatheesaperumal SK, Benjamin SR, Filho PCDN, Duarte FT, de Albuquerque VHC. Advancements in non-invasive microwave brain stimulation: A comprehensive survey. Phys Life Rev 2024; 48:132-161. [PMID: 38219370 DOI: 10.1016/j.plrev.2024.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
This survey provides a comprehensive insight into the world of non-invasive brain stimulation and focuses on the evolving landscape of deep brain stimulation through microwave research. Non-invasive brain stimulation techniques provide new prospects for comprehending and treating neurological disorders. We investigate the methods shaping the future of deep brain stimulation, emphasizing the role of microwave technology in this transformative journey. Specifically, we explore antenna structures and optimization strategies to enhance the efficiency of high-frequency microwave stimulation. These advancements can potentially revolutionize the field by providing a safer and more precise means of modulating neural activity. Furthermore, we address the challenges that researchers currently face in the realm of microwave brain stimulation. From safety concerns to methodological intricacies, this survey outlines the barriers that must be overcome to fully unlock the potential of this technology. This survey serves as a roadmap for advancing research in microwave brain stimulation, pointing out potential directions and innovations that promise to reshape the field.
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Affiliation(s)
| | - Senthil Kumar Jagatheesaperumal
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza, 60455-970, Ceará, Brazil; Department of Electronics and Communication Engineering, Mepco Schlenk Engineering College, Sivakasi, 626005, Tamilnadu, India
| | - Stephen Rathinaraj Benjamin
- Department of Pharmacology and Pharmacy, Laboratory of Behavioral Neuroscience, Faculty of Medicine, Federal University of Ceará, Fortaleza, 60430-160, Ceará, Brazil
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Hohenester M, Langguth B, Wetter TC, Geisler P, Schecklmann M, Reissmann A. Single sessions of transcranial direct current stimulation and transcranial random noise stimulation exert no effect on sleepiness in patients with narcolepsy and idiopathic hypersomnia. Front Psychiatry 2023; 14:1288976. [PMID: 38146280 PMCID: PMC10749348 DOI: 10.3389/fpsyt.2023.1288976] [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] [Received: 09/05/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023] Open
Abstract
Background Hypersomnia poses major challenges to treatment providers given the limitations of available treatment options. In this context, the application of non-invasive brain stimulation techniques such as transcranial electrical stimulation (tES) may open up new avenues to effective treatment. Preliminary evidence suggests both acute and longer-lasting positive effects of transcranial direct current stimulation (tDCS) on vigilance and sleepiness in hypersomniac patients. Based on these findings, the present study sought to investigate short-term effects of single sessions of tDCS and transcranial random noise stimulation (tRNS) on sleepiness in persons suffering from hypersomnia. Methods A sample of 29 patients suffering from narcolepsy or idiopathic hypersomnia (IH) was recruited from the Regensburg Sleep Disorder Center and underwent single sessions of tES (anodal tDCS, tRNS, sham) over the left and right dorsolateral prefrontal cortex on three consecutive days in a double-blind, sham-controlled, pseudorandomized crossover trial. The primary study endpoint was the mean reaction time measured by the Psychomotor Vigilance Task (PVT) before and directly after the daily tES sessions. Secondary endpoints were additional PVT outcome metrics as well as subjective outcome parameters (e.g., Karolinska Sleepiness Scale; KSS). Results There were no significant treatment effects neither on objective (i.e., PVT) nor on subjective indicators of sleepiness. Conclusion We could not demonstrate any clinically relevant effects of single sessions of tDCS or tRNS on objective or subjective measures of sleepiness in patients with hypersomnia. However, we cannot exclude that repeated sessions of tES may affect vigilance or sleepiness in hypersomniac patients.
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Affiliation(s)
- Michaela Hohenester
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Department of Hematology and Oncology, Krankenhaus der Barmherzigen Brüder Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | | | - Peter Geisler
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Andreas Reissmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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11
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Krone LB, Fehér KD, Rivero T, Omlin X. Brain stimulation techniques as novel treatment options for insomnia: A systematic review. J Sleep Res 2023; 32:e13927. [PMID: 37202368 PMCID: PMC10909439 DOI: 10.1111/jsr.13927] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Despite the success of cognitive behavioural therapy for insomnia and recent advances in pharmacotherapy, many patients with insomnia do not sufficiently respond to available treatments. This systematic review aims to present the state of science regarding the use of brain stimulation approaches in treating insomnia. To this end, we searched MEDLINE, Embase and PsycINFO from inception to 24 March 2023. We evaluated studies that compared conditions of active stimulation with a control condition or group. Outcome measures included standardized insomnia questionnaires and/or polysomnography in adults with a clinical diagnosis of insomnia. Our search identified 17 controlled trials that met inclusion criteria, and assessed a total of 967 participants using repetitive transcranial magnetic stimulation, transcranial electric stimulation, transcutaneous auricular vagus nerve stimulation or forehead cooling. No trials using other techniques such as deep brain stimulation, vestibular stimulation or auditory stimulation met the inclusion criteria. While several studies report improvements of subjective and objective sleep parameters for different repetitive transcranial magnetic stimulation and transcranial electric stimulation protocols, important methodological limitations and risk of bias limit their interpretability. A forehead cooling study found no significant group differences in the primary endpoints, but better sleep initiation in the active condition. Two transcutaneous auricular vagus nerve stimulation trials found no superiority of active stimulation for most outcome measures. Although modulating sleep through brain stimulation appears feasible, gaps in the prevailing models of sleep physiology and insomnia pathophysiology remain to be filled. Optimized stimulation protocols and proof of superiority over reliable sham conditions are indispensable before brain stimulation becomes a viable treatment option for insomnia.
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Affiliation(s)
- Lukas B. Krone
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
- Centre for Experimental NeurologyUniversity of BernBernSwitzerland
- Department of Physiology Anatomy and Genetics, Sir Jules Thorn Sleep and Circadian Neuroscience InstituteUniversity of OxfordOxfordUK
- The Kavli Institute for Nanoscience DiscoveryUniversity of OxfordOxfordUK
| | - Kristoffer D. Fehér
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
- Geneva University Hospitals (HUG), Division of Psychiatric SpecialtiesUniversity of GenevaGenevaSwitzerland
| | - Tania Rivero
- Medical LibraryUniversity Library of Bern, University of BernBernSwitzerland
| | - Ximena Omlin
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
- Geneva University Hospitals (HUG), Division of Psychiatric SpecialtiesUniversity of GenevaGenevaSwitzerland
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12
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Zhuang Y, Zhai W, Li Q, Jiao H, Ge Q, Rong P, He J. Effects of simultaneous transcutaneous auricular vagus nerve stimulation and high-definition transcranial direct current stimulation on disorders of consciousness: a study protocol. Front Neurol 2023; 14:1165145. [PMID: 37693756 PMCID: PMC10483839 DOI: 10.3389/fneur.2023.1165145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Background Non-invasive brain stimulation (NIBS) techniques are now widely used in patients with disorders of consciousness (DOC) for accelerating their recovery of consciousness, especially minimally conscious state (MCS). However, the effectiveness of single NIBS techniques for consciousness rehabilitation needs further improvement. In this regard, we propose to enhance from bottom to top the thalamic-cortical connection by using transcutaneous auricular vagus nerve stimulation (taVNS) and increase from top to bottom cortical-cortical connections using simultaneous high-definition transcranial direct current stimulation (HD-tDCS) to reproduce the network of consciousness. Methods/design The study will investigate the effect and safety of simultaneous joint stimulation (SJS) of taVNS and HD-tDCS for the recovery of consciousness. We will enroll 84 MCS patients and randomize them into two groups: a single stimulation group (taVNS and HD-tDCS) and a combined stimulation group (SJS and sham stimulation). All patients will undergo a 4-week treatment. The primary outcome will be assessed using the coma recovery scale-revised (CRS-R) at four time points to quantify the effect of treatment: before treatment (T0), after 1 week of treatment (T1), after 2 weeks of treatment (T2), and after 4 weeks of treatment (T3). At the same time, nociception coma scale-revised (NCS-R) and adverse effects (AEs) will be collected to verify the safety of the treatment. The secondary outcome will involve an analysis of electroencephalogram (EEG) microstates to assess the response mechanisms of dynamic brain networks to SJS. Additionally, CRS-R and AEs will continue to be obtained for a 3-month follow-up (T4) after the end of the treatment. Discussion This study protocol aims to innovatively develop a full-time and multi-brain region combined neuromodulation paradigm based on the mesocircuit model to steadily promote consciousness recovery by restoring thalamocortical and cortical-cortical interconnections.
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Affiliation(s)
- Yutong Zhuang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, The Second Clinical College of Southern Medical University, Guangzhou, China
| | - Weihang Zhai
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qinghua Li
- College of Anesthesiology, Shanxi Medical University, Taiyuan, China
| | - Haoyang Jiao
- Institute of Documentation, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Qianqian Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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13
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Zhong H, Xu H, Li X, Xie RG, Shi Y, Wang Y, Tong L, Zhu Q, Han J, Tao H, Zhang L, Hu Z, Zhang X, Gu N, Dong H, Xu X. A role of prefrontal cortico-hypothalamic projections in wake promotion. Cereb Cortex 2023; 33:3026-3042. [PMID: 35764255 PMCID: PMC10016045 DOI: 10.1093/cercor/bhac258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/13/2022] Open
Abstract
Ventromedial prefrontal cortex (vmPFC) processes many critical brain functions, such as decision-making, value-coding, thinking, and emotional arousal/recognition, but whether vmPFC plays a role in sleep-wake promotion circuitry is still unclear. Here, we find that photoactivation of dorsomedial hypothalamus (DMH)-projecting vmPFC neurons, their terminals, or their postsynaptic DMH neurons rapidly switches non-rapid eye movement (NREM) but not rapid eye movement sleep to wakefulness, which is blocked by photoinhibition of DMH outputs in lateral hypothalamus (LHs). Chemoactivation of DMH glutamatergic but not GABAergic neurons innervated by vmPFC promotes wakefulness and suppresses NREM sleep, whereas chemoinhibition of vmPFC projections in DMH produces opposite effects. DMH-projecting vmPFC neurons are inhibited during NREM sleep and activated during wakefulness. Thus, vmPFC neurons innervating DMH likely represent the first identified set of cerebral cortical neurons for promotion of physiological wakefulness and suppression of NREM sleep.
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Affiliation(s)
| | | | - Xin Li
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China
| | - Rou-gang Xie
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China
| | - Yunxin Shi
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China
| | - Ying Wang
- Institute of Neuropsychiatric Diseases, Qingdao University, No. 308, Ning-Xia Road, Qingdao, 266071, China
| | - Li Tong
- Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, 100853 China
| | - Qianqian Zhu
- Institute of Neuropsychiatric Diseases, Qingdao University, No. 308, Ning-Xia Road, Qingdao, 266071, China
| | - Jing Han
- Key Laboratory of Modern Teaching Technology & College of Life Sciences, Shanxi Normal University, Xi’an, 710062, China
| | - Huiren Tao
- Department of Spine Surgery, Shenzhen University General Hospital, Shenzhen, Guangdong, 518055, China
| | - Li Zhang
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Zhian Hu
- Department of Physiology, Collaborative Innovation Center for Brain Science, Third Military Medical University, Chongqing 400038, China
| | - Xia Zhang
- Institute of Neuropsychiatric Diseases, Qingdao University, No. 308, Ning-Xia Road, Qingdao, 266071, China
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China
- University of Ottawa Institute of Mental Health Research at the Royal, 1145 Carling Avenue, Ottawa, K1Z7K4, Canada
- Key Laboratory of Modern Teaching Technology & College of Life Sciences, Shanxi Normal University, Xi’an, 710062, China
| | - Ning Gu
- Corresponding authors: (X.Z.), (H.D.) or (N.G.)
| | | | - Xufeng Xu
- Corresponding authors: (X.Z.), (H.D.) or (N.G.)
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14
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Alfonsi V, D'Atri A, Scarpelli S, Gorgoni M, Giacinti F, Annarumma L, Salfi F, Amicucci G, Corigliano D, De Gennaro L. The effects of bifrontal anodal transcranial direct current stimulation (tDCS) on sleepiness and vigilance in partially sleep-deprived subjects: A multidimensional study. J Sleep Res 2023:e13869. [PMID: 36871580 DOI: 10.1111/jsr.13869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
In recent years, transcranial electrical stimulation techniques have demonstrated their ability to modulate our levels of sleepiness and vigilance. However, the outcomes differ among the specific aspects considered (physiological, behavioural or subjective). This study aimed to observe the effects of bifrontal anodal transcranial direct current stimulation. Specifically, we tested the ability of this stimulation protocol to reduce sleepiness and increase vigilance in partially sleep-deprived healthy participants. Twenty-three subjects underwent a within-subject sham-controlled stimulation protocol. We compared sleepiness and vigilance levels before and after the two stimulation conditions (active versus sham) by using behavioural (reaction-time task), subjective (self-report scales) and physiological (sleep-onset latency and electroencephalogram power [n = 20] during the Maintenance of Wakefulness Test) measures. We showed the efficacy of the active stimulation in reducing physiological sleepiness and preventing vigilance drop compared with the sham stimulation. Consistently, we observed a reduction of perceived sleepiness following the active stimulation for both self-report scales. However, the stimulation effect on subjective measures was not statistically significant probably due to the underpowered sample size for these measures, and to the possible influence of motivational and environmental factors. Our findings confirm the ability of this technique to influence vigilance and sleepiness, pointing out the potential for new treatment developments based on transcranial electrical stimulation.
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Affiliation(s)
| | - Aurora D'Atri
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Serena Scarpelli
- Department of Psychology, University of Rome Sapienza, Rome, Italy
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome Sapienza, Rome, Italy.,Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | | | - Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giulia Amicucci
- Department of Psychology, University of Rome Sapienza, Rome, Italy
| | | | - Luigi De Gennaro
- Department of Psychology, University of Rome Sapienza, Rome, Italy.,Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
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15
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Transcutaneous auricular vagus stimulation (taVNS) improves human working memory performance under sleep deprivation stress. Behav Brain Res 2023; 439:114247. [PMID: 36473677 DOI: 10.1016/j.bbr.2022.114247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Many human activities require high cognitive performance over long periods, while impairments induced by sleep deprivation influence various aspects of cognitive abilities, including working memory (WM), attention, and processing speed. Based on previous research, vagal nerve stimulation can modulate cognitive abilities, attention, and arousal. Two experiments were conducted to assess the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) to relieve the deleterious effects of sleep deprivation. In the first experiment, 35 participants completed N-back tasks at 8:00 a.m. for two consecutive days in a within-subject study. Then, the participants received either taVNS or earlobe stimulation (active control) intervention in two sessions at random orders after 24 h of sustained wakefulness. Then, they completed the N-back tasks again. In the second experiment, 30 participants completed the psychomotor vigilance task (PVT), and 32 completed the N-back tasks at 8:00 a.m. on the first and second days. Then, they received either taVNS or earlobe stimulation at random orders and finished the N-back and PVT tasks immediately after one hour. In Experiment 1, taVNS could significantly improve the accuracy rate of participants in spatial 3-back tasks compared to active control, which was consistent with experiment 2. However, taVNS did not specifically enhance PVT performance. Therefore, taVNS could be a powerful intervention for acute sleep deprivation as it can improve performance on high cognitive load tasks and is easy to administer.
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16
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Zhang Y, Ren R, Yang L, Zhang H, Shi Y, Vitiello MV, Sanford LD, Tang X. Sleep in multiple sclerosis: a systematic review and meta-analysis of polysomnographic findings. J Clin Sleep Med 2023; 19:253-265. [PMID: 36117421 PMCID: PMC9892728 DOI: 10.5664/jcsm.10304] [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: 06/26/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES This study aims to explore the polysomnographically measured sleep differences between patients with multiple sclerosis (MS) and healthy control patients. METHODS An electronic literature search was conducted in EMBASE, MEDLINE, all EBM databases, CINAHL, and PsycINFO from inception to March 2022. A random-effects model was applied to explore the pooled effect sizes of polysomnographic differences between patients with MS and control patients. RESULTS Thirteen studies were identified for meta-analysis. The meta-analyses revealed significant reductions in stage N2 sleep and sleep efficiency and increases in wake time after sleep onset, the periodic limb movement index, and the periodic limb movement arousal index in patients with MS compared with control patients. Meta-regression analyses showed that some of the heterogeneity was explained by age and daytime sleepiness of patients with MS. CONCLUSIONS Our study showed that polysomnographic abnormalities are present in MS. Our findings also underscore the need for a comprehensive polysomnographic assessment of sleep changes in patients with MS. Furthermore, the effects of age and daytime sleepiness in patients with MS on sleep changes should also be carefully considered and closely monitored in the management of MS. CITATION Zhang Y, Ren R, Yang L, et al. Sleep in multiple sclerosis: a systematic review and meta-analysis of polysomnographic findings. J Clin Sleep Med. 2023;19(2):253-265.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Haipeng Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V. Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Larry D. Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, Virginia
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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17
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Lai J, Price CN, Bidelman GM. Brainstem speech encoding is dynamically shaped online by fluctuations in cortical α state. Neuroimage 2022; 263:119627. [PMID: 36122686 PMCID: PMC10017375 DOI: 10.1016/j.neuroimage.2022.119627] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022] Open
Abstract
Experimental evidence in animals demonstrates cortical neurons innervate subcortex bilaterally to tune brainstem auditory coding. Yet, the role of the descending (corticofugal) auditory system in modulating earlier sound processing in humans during speech perception remains unclear. Here, we measured EEG activity as listeners performed speech identification tasks in different noise backgrounds designed to tax perceptual and attentional processing. We hypothesized brainstem speech coding might be tied to attention and arousal states (indexed by cortical α power) that actively modulate the interplay of brainstem-cortical signal processing. When speech-evoked brainstem frequency-following responses (FFRs) were categorized according to cortical α states, we found low α FFRs in noise were weaker, correlated positively with behavioral response times, and were more "decodable" via neural classifiers. Our data provide new evidence for online corticofugal interplay in humans and establish that brainstem sensory representations are continuously yoked to (i.e., modulated by) the ebb and flow of cortical states to dynamically update perceptual processing.
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Affiliation(s)
- Jesyin Lai
- Institute for Intelligent Systems, University of Memphis, Memphis, TN, USA; School of Communication Sciences and Disorders, University of Memphis, Memphis, TN, USA; Diagnostic Imaging Department, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Caitlin N Price
- Institute for Intelligent Systems, University of Memphis, Memphis, TN, USA; School of Communication Sciences and Disorders, University of Memphis, Memphis, TN, USA; Department of Audiology and Speech Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gavin M Bidelman
- Institute for Intelligent Systems, University of Memphis, Memphis, TN, USA; School of Communication Sciences and Disorders, University of Memphis, Memphis, TN, USA; Department of Speech, Language and Hearing Sciences, Indiana University, 2631 East Discovery Parkway, Bloomington, IN 47408, USA; Program in Neuroscience, Indiana University, 1101 E 10th St, Bloomington, IN 47405, USA.
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18
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Palagini L, Bianchini C. Pharmacotherapeutic management of insomnia and effects on sleep processes, neural plasticity, and brain systems modulating stress: A narrative review. Front Neurosci 2022; 16:893015. [PMID: 35968380 PMCID: PMC9374363 DOI: 10.3389/fnins.2022.893015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionInsomnia is a stress-related sleep disorder, may favor a state of allostatic overload impairing brain neuroplasticity, stress immune and endocrine pathways, and may contribute to mental and physical disorders. In this framework, assessing and targeting insomnia is of importance.AimSince maladaptive neuroplasticity and allostatic overload are hypothesized to be related to GABAergic alterations, compounds targeting GABA may play a key role. Accordingly, the aim of this review was to discuss the effect of GABAA receptor agonists, short-medium acting hypnotic benzodiazepines and the so called Z-drugs, at a molecular level.MethodLiterature searches were done according to PRISMA guidelines. Several combinations of terms were used such as “hypnotic benzodiazepines” or “brotizolam,” or “lormetazepam” or “temazepam” or “triazolam” or “zolpidem” or “zopiclone” or “zaleplon” or “eszopiclone” and “insomnia” and “effects on sleep” and “effect on brain plasticity” and “effect on stress system”. Given the complexity and heterogeneity of existing literature, we ended up with a narrative review.ResultsAmong short-medium acting compounds, triazolam has been the most studied and may regulate the stress system at central and peripheral levels. Among Z-drugs eszopiclone may regulate the stress system. Some compounds may produce more “physiological” sleep such as brotizolam, triazolam, and eszopiclone and probably may not impair sleep processes and related neural plasticity. In particular, triazolam, eszopiclone, and zaleplon studied in vivo in animal models did not alter neuroplasticity.ConclusionCurrent models of insomnia may lead us to revise the way in which we use hypnotic compounds in clinical practice. Specifically, compounds should target sleep processes, the stress system, and sustain neural plasticity. In this framework, among the short/medium acting hypnotic benzodiazepines, triazolam has been the most studied compound while among the Z-drugs eszopiclone has demonstrated interesting effects. Both offer potential new insight for treating insomnia.
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Affiliation(s)
- Laura Palagini
- Psychiatry Division, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Laura Palagini,
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Translational Approaches to Influence Sleep and Arousal. Brain Res Bull 2022; 185:140-161. [PMID: 35550156 PMCID: PMC9554922 DOI: 10.1016/j.brainresbull.2022.05.002] [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: 01/12/2022] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 12/16/2022]
Abstract
Sleep disorders are widespread in society and are prevalent in military personnel and in Veterans. Disturbances of sleep and arousal mechanisms are common in neuropsychiatric disorders such as schizophrenia, post-traumatic stress disorder, anxiety and affective disorders, traumatic brain injury, dementia, and substance use disorders. Sleep disturbances exacerbate suicidal ideation, a major concern for Veterans and in the general population. These disturbances impair quality of life, affect interpersonal relationships, reduce work productivity, exacerbate clinical features of other disorders, and impair recovery. Thus, approaches to improve sleep and modulate arousal are needed. Basic science research on the brain circuitry controlling sleep and arousal led to the recent approval of new drugs targeting the orexin/hypocretin and histamine systems, complementing existing drugs which affect GABAA receptors and monoaminergic systems. Non-invasive brain stimulation techniques to modulate sleep and arousal are safe and show potential but require further development to be widely applicable. Invasive viral vector and deep brain stimulation approaches are also in their infancy but may be used to modulate sleep and arousal in severe neurological and psychiatric conditions. Behavioral, pharmacological, non-invasive brain stimulation and cell-specific invasive approaches covered here suggest the potential to selectively influence arousal, sleep initiation, sleep maintenance or sleep-stage specific phenomena such as sleep spindles or slow wave activity. These manipulations can positively impact the treatment of a wide range of neurological and psychiatric disorders by promoting the restorative effects of sleep on memory consolidation, clearance of toxic metabolites, metabolism, and immune function and by decreasing hyperarousal.
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Zhang H, Huang X, Wang C, Liang K. Alteration of gamma-aminobutyric acid in the left dorsolateral prefrontal cortex of individuals with chronic insomnia: a combined transcranial magnetic stimulation-magnetic resonance spectroscopy study. Sleep Med 2022; 92:34-40. [DOI: 10.1016/j.sleep.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
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DiNuzzo M, Mangia S, Giove F. Manipulations of sleep‐like slow‐wave activity by noninvasive brain stimulation. J Neurosci Res 2022; 100:1218-1225. [DOI: 10.1002/jnr.25029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/18/2022] [Accepted: 01/29/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Mauro DiNuzzo
- Magnetic Resonance for Brain Investigation Laboratory Museo Storico della Fisica e Centro di Studi e Ricerche Enrico Fermi Rome Italy
| | - Silvia Mangia
- Center for Magnetic Resonance Research, Department of Radiology University of Minnesota Minneapolis Minnesota USA
| | - Federico Giove
- Magnetic Resonance for Brain Investigation Laboratory Museo Storico della Fisica e Centro di Studi e Ricerche Enrico Fermi Rome Italy
- Laboratory of Neurophysics and Neuroimaging Fondazione Santa Lucia IRCCS Rome Italy
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22
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Cerebellar Transcranial Direct Current Stimulation in Children with Autism Spectrum Disorder: A Pilot Study on Efficacy, Feasibility, Safety, and Unexpected Outcomes in Tic Disorder and Epilepsy. J Clin Med 2021; 11:jcm11010143. [PMID: 35011884 PMCID: PMC8745597 DOI: 10.3390/jcm11010143] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with autism spectrum disorder (ASD) display distinctive neurophysiological characteristics associated with significant cognitive, emotional, and behavioral symptoms. Transcranial direct current stimulation (tDCS) applied to the frontal or temporoparietal lobes has demonstrated potential to reduce the severity of ASD-related symptoms. Recently, the cerebellum has been identified as a brain area involved in ASD pathophysiology. In this open-label pilot study, seven ASD patients aged between 9 and 13 years underwent 20 daily sessions of 20 min cathodal stimulation of the right cerebellar lobe. At the end of the treatment, the Aberrant Behavior Checklist (ABC) scores showed a 25% mean reduction in global severity of symptoms, with a more pronounced reduction in the “social withdrawal and lethargy” (−35%), “hyperactivity and noncompliance” (−26%), and “irritability, agitation, and crying” (−25%) subscales. Minor and no improvement were observed in the “stereotypic behavior” (−18%) and “inappropriate speech” (−0%) subscales, respectively. Improvements were not detected in the two patients who were taking psychotropic drugs during the study. Clinical response showed a symptom-specific time course. Quality of sleep and mood improved earlier than hyperactivity and social withdrawal. The treatment was generally accepted by patients and well tolerated. No serious adverse events were reported. Stimulation also appeared to markedly reduce the severity of tics in a patient with comorbid tic disorder and led to the disappearance of a frontal epileptogenic focus in another patient with a history of seizures. In conclusion, cerebellar tDCS is safe, feasible, and potentially effective in the treatment of ASD symptoms among children. Strategies to improve recruitment and retention are discussed.
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23
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Xie J, Wang L, Xiao C, Ying S, Ren J, Chen Z, Yu Y, Xu D, Yao D, Wu B, Liu T. Low Frequency Transcranial Alternating Current Stimulation Accelerates Sleep Onset Process. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2540-2549. [PMID: 34851828 DOI: 10.1109/tnsre.2021.3131728] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
GOAL The aim of this study is to find a kind of low frequency oscillation transcranial alternating current stimulation, which is directly applied to the scalp epidermal, to stimulate the cerebral cortex with a large spatial range of electric field oscillation across the brain hemisphere, and then trigger the start of the Top-Down processing of sleep homeostasis, in the daytime nap. METHODS Thirty healthy subjects, to take naps, underwent an intervention of electrical stimulation at 5 Hz, applied to the dorsal lateral prefrontal cortex. The subjects in the experiments were strictly controlled, and opened their eyes when stimulation was transmitted. Subsequently, after 15 min transcranial alternating current stimulation, subjects entered the experimental procedure of sleep. Electroencephalograph was taken at baseline and during sleep. Behavioral indicators were also added to the experiment. RESULTS We found that the total power of Electroencephalograph activity in the theta band, as well as low-frequency power at 1-7 Hz, was significantly entrained and increased, and that alpha activity was attenuated faster and spindle activity active earlier. Even more, the transition from awake to Non-rapid eye movement stages occurs earlier. Alertness also decreased when the subjects woke up after brief sleep. CONCLUSION The intervention of low frequency brain rhythmic transcranial alternating current stimulation may induce accelerated effect on sleep onset process, thereby possibly alleviating the problems related to sleep disorders such as difficulty to reach the real sleep state quickly after lying down.
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Guo W, Fan S, Xiao D, Dong H, Xu G, Wan Z, Ma Y, Wang Z, Xue T, Zhou Y, Li Y, Xiong W. A Brainstem reticulotegmental neural ensemble drives acoustic startle reflexes. Nat Commun 2021; 12:6403. [PMID: 34737329 PMCID: PMC8568936 DOI: 10.1038/s41467-021-26723-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/20/2021] [Indexed: 11/21/2022] Open
Abstract
The reticulotegmental nucleus (RtTg) has long been recognized as a crucial component of brainstem reticular formation (RF). However, the function of RtTg and its related circuits remain elusive. Here, we report a role of the RtTg in startle reflex, a highly conserved innate defensive behaviour. Optogenetic activation of RtTg neurons evokes robust startle responses in mice. The glutamatergic neurons in the RtTg are significantly activated during acoustic startle reflexes (ASR). Chemogenetic inhibition of the RtTg glutamatergic neurons decreases the ASR amplitudes. Viral tracing reveals an ASR neural circuit that the cochlear nucleus carrying auditory information sends direct excitatory innervations to the RtTg glutamatergic neurons, which in turn project to spinal motor neurons. Together, our findings describe a functional role of RtTg and its related neural circuit in startle reflexes, and demonstrate how the RF connects auditory system with motor functions.
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Affiliation(s)
- Weiwei Guo
- grid.59053.3a0000000121679639Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, 230026 China
| | - Sijia Fan
- grid.59053.3a0000000121679639Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, 230026 China
| | - Dan Xiao
- grid.59053.3a0000000121679639Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, 230026 China
| | - Hui Dong
- grid.11135.370000 0001 2256 9319State Key Laboratory of Membrane Biology, Peking University School of Life Sciences, Beijing, 100871 China
| | - Guangwei Xu
- grid.59053.3a0000000121679639Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, 230026 China
| | - Zhikun Wan
- grid.59053.3a0000000121679639Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, 230026 China
| | - Yuqian Ma
- grid.59053.3a0000000121679639Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, 230026 China
| | - Zhen Wang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Tian Xue
- grid.59053.3a0000000121679639Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, 230026 China ,grid.9227.e0000000119573309Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, 200031 China
| | - Yifeng Zhou
- grid.59053.3a0000000121679639Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, 230026 China
| | - Yulong Li
- grid.11135.370000 0001 2256 9319State Key Laboratory of Membrane Biology, Peking University School of Life Sciences, Beijing, 100871 China ,grid.11135.370000 0001 2256 9319PKU-IDG–McGovern Institute for Brain Research, Beijing, 100871 China
| | - Wei Xiong
- Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, 230026, China. .,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, 200031, China.
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25
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Abstract
Cortical and subcortical circuitry are thought to play distinct roles in the generation of sleep oscillations and global state control, respectively. Here we silenced a subset of neocortical layer 5 pyramidal and archicortical dentate gyrus granule cells in male mice by ablating SNAP25. This markedly increased wakefulness and reduced rebound of electroencephalographic slow-wave activity after sleep deprivation, suggesting a role for the cortex in both vigilance state control and sleep homeostasis.
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26
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Silva-Filho E, Albuquerque J, Bikson M, Pegado R, da Cruz Santos A, do Socorro Brasileiro-Santos M. Effects of transcranial direct current stimulation associated with an aerobic exercise bout on blood pressure and autonomic modulation of hypertensive patients: A pilot randomized clinical trial. Auton Neurosci 2021; 235:102866. [PMID: 34380099 DOI: 10.1016/j.autneu.2021.102866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/16/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
The objective of this article was to evaluate the effects of an aerobic exercise bout associated with a single session of anodal transcranial direct current stimulation (tDCS) over the left temporal lobe on blood pressure (BP) and heart rate variability (HRV) in hypertensive people. After met the inclusion criteria, twenty hypertensive people were randomized to active-tDCS or sham-tDCS group. Initially, they provided their sociodemographic data, a blood sample, and went through an evaluation of the cardiorespiratory performance. Then, a single session of tDCS with an intensity of 2 mA over the left lobe during 20 min was carried out. After tDCS, it was performed a session of moderate-intensity aerobic exercise during 40 min. BP during 24 h and HRV measurements were performed before (baseline) and after the intervention. Systolic BP during sleep time decreased in the active-tDCS group (p = 0.008). Diastolic BP showed a significant decrease 3 h after the intervention in the active-tDCS group (p = 0.01). An intragroup comparison showed a significant decrease in systolic BP 3 h after intervention only for the active-tDCS group (p = 0.04). Besides, there was a trend toward a difference in wake for diastolic BP for active-tDCS (p = 0.07). Lastly, there were no changes in the HRV for both groups. It is suggested that anodal tDCS associated with moderate-intensity aerobic exercise can decrease systolic and diastolic BP of hypertensive people during sleep time and 3 h after the intervention.
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Affiliation(s)
- Edson Silva-Filho
- Associated Postgraduate Program in Physical Education, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
| | - Jéssica Albuquerque
- Department of Social Psychology, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, New York, USA
| | - Rodrigo Pegado
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Amilton da Cruz Santos
- Associated graduate Program in Physical Education, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
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27
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Geiser T, Hertenstein E, Fehér K, Maier JG, Schneider CL, Züst MA, Wunderlin M, Mikutta C, Klöppel S, Nissen C. Targeting Arousal and Sleep through Noninvasive Brain Stimulation to Improve Mental Health. Neuropsychobiology 2021; 79:284-292. [PMID: 32408296 DOI: 10.1159/000507372] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/14/2020] [Indexed: 01/29/2023]
Abstract
Arousal and sleep represent fundamental physiological domains, and alterations in the form of insomnia (difficulty falling or staying asleep) or hypersomnia (increased propensity for falling asleep or increased sleep duration) are prevalent clinical problems. Current first-line treatments include psychotherapy and pharmacotherapy. Despite significant success, a number of patients do not benefit sufficiently. Progress is limited by an incomplete understanding of the -neurobiology of insomnia and hypersomnia. This work summarizes current concepts of the regulation of arousal and sleep and its modulation through noninvasive brain stimulation (NIBS), including transcranial magnetic, current, and auditory stimulation. Particularly, we suggest: (1) characterization of patients with sleep problems - across diagnostic entities of mental disorders - based on specific alterations of sleep, including alterations of sleep slow waves, sleep spindles, cross-frequency coupling of brain oscillations, local sleep-wake regulation, and REM sleep and (2) targeting these with specific NIBS techniques. While evidence is accumulating that the modulation of specific alterations of sleep through NIBS is feasible, it remains to be tested whether this translates to clinically relevant effects and new treatment developments.
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Affiliation(s)
- Tim Geiser
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kristoffer Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jonathan G Maier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Privatklinik Meiringen, Meiringen, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,
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28
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Tang HYJ, McCurry SM, Pike KC, Riegel B, Vitiello MV. Open-loop Audio-Visual Stimulation for sleep promotion in older adults with comorbid insomnia and osteoarthritis pain: results of a pilot randomized controlled trial. Sleep Med 2021; 82:37-42. [PMID: 33878522 DOI: 10.1016/j.sleep.2021.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
Osteoarthritis is commonly comorbid with insomnia in older adults. While cognitivebehavioral therapy for insomnia is the recommended first-line treatment for insomnia, alternative efficacious non-pharmacological options are needed. This study examined sleep and pain in 30 community-dwelling older adults with comorbid insomnia and osteoarthritis pain randomized to two weeks of 30 min of bedtime active (n = 15, mean age 66.7 ± 5.2) or placebo control (n = 15, mean age 68.9 ± 5.0) Audiovisual Stimulation (AVS). After AVS use, improvements in sleep, pain, and depression were reported for both groups but between-group comparisons were non-significant. A posthoc analysis examined the effects of AVS in the 11 subjects who reported sleep latency complaints (≥30 min). No significant group differences were found for this small sleep latency subsample; however, the pre-post effect sizes (ES) of active AVS versus placebo were greatly increased for the subsample relative to the total sample for sleep (ES = 0.41 versus 0.18 for the Insomnia Severity Index, and 0.60 versus 0.03 for the Pittsburgh Sleep Quality Index, respectively). A similar enhanced effect pattern was found for pain (ES = 0.41 versus 0.15 for the Brief Pain Inventory). Study findings suggest that the 30-min AVS program may have potential to improve sleep in older adults with sleep onset but not sleep maintenance difficulty. Despite study limitations of a small sample size and lack of follow-up, results offer valuable insights into the functionality of AVS treatment. Future research should focus on subjects with sleep onset complaints, who are most likely to receive benefit from this treatment modality.
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Affiliation(s)
- Hsin-Yi Jean Tang
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States.
| | - Susan M McCurry
- Department of Child, Family and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
| | - Kenneth C Pike
- Department of Child, Family and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
| | - Barbara Riegel
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
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29
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The effects of non-invasive brain stimulation on sleep disturbances among different neurological and neuropsychiatric conditions: A systematic review. Sleep Med Rev 2021; 55:101381. [DOI: 10.1016/j.smrv.2020.101381] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/17/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
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30
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Fehér KD, Wunderlin M, Maier JG, Hertenstein E, Schneider CL, Mikutta C, Züst MA, Klöppel S, Nissen C. Shaping the slow waves of sleep: A systematic and integrative review of sleep slow wave modulation in humans using non-invasive brain stimulation. Sleep Med Rev 2021; 58:101438. [PMID: 33582581 DOI: 10.1016/j.smrv.2021.101438] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 10/14/2020] [Accepted: 11/10/2020] [Indexed: 01/19/2023]
Abstract
The experimental study of electroencephalographic slow wave sleep (SWS) stretches over more than half a century and has corroborated its importance for basic physiological processes, such as brain plasticity, metabolism and immune system functioning. Alterations of SWS in aging or pathological conditions suggest that modulating SWS might constitute a window for clinically relevant interventions. This work provides a systematic and integrative review of SWS modulation through non-invasive brain stimulation in humans. A literature search using PubMed, conducted in May 2020, identified 3220 studies, of which 82 fulfilled inclusion criteria. Three approaches have been adopted to modulate the macro- and microstructure of SWS, namely auditory, transcranial electrical and transcranial magnetic stimulation. Our current knowledge about the modulatory mechanisms, the space of stimulation parameters and the physiological and behavioral effects are reported and evaluated. The integration of findings suggests that sleep slow wave modulation bears the potential to promote our understanding of the functions of SWS and to develop new treatments for conditions of disrupted SWS.
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Affiliation(s)
- Kristoffer D Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Jonathan G Maier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; Privatklinik Meiringen, Meiringen, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
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31
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Dondé C, Brunelin J, Micoulaud-Franchi JA, Maruani J, Lejoyeux M, Polosan M, Geoffroy PA. The Effects of Transcranial Electrical Stimulation of the Brain on Sleep: A Systematic Review. Front Psychiatry 2021; 12:646569. [PMID: 34163380 PMCID: PMC8215269 DOI: 10.3389/fpsyt.2021.646569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/19/2021] [Indexed: 01/23/2023] Open
Abstract
Transcranial Electrical Stimulation (tES) is a promising non-invasive brain modulation tool. Over the past years, there have been several attempts to modulate sleep with tES-based approaches in both the healthy and pathological brains. However, data about the impact on measurable aspects of sleep remain scattered between studies, which prevent us from drawing firm conclusions. We conducted a systematic review of studies that explored the impact of tES on neurophysiological sleep oscillations, sleep patterns measured objectively with polysomnography, and subjective psychometric assessments of sleep in both healthy and clinical samples. We searched four main electronic databases to identify studies until February 2020. Forty studies were selected including 511 healthy participants and 452 patients. tES can modify endogenous brain oscillations during sleep. Results concerning changes in sleep patterns are conflicting, whereas subjective assessments show clear improvements after tES. Possible stimulation-induced mechanisms within specific cortico-subcortical sleep structures and networks are discussed. Although these findings cannot be directly transferred to the clinical practice and sleep-enhancing devices development for healthy populations, they might help to pave the way for future researches in these areas. PROSPERO registration number 178910.
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Affiliation(s)
- Clément Dondé
- University Grenoble Alpes, Grenoble, France.,U1216 INSERM, Grenoble Institut of Neuroscience, La Tronche, France.,Psychiatry Department, CHU Grenoble Alpes, Grenoble, France
| | - Jerome Brunelin
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon, France.,Lyon University, Lyon, France.,Centre Hospitalier le Vinatier, Batiment 416, Bron, France
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Bordeaux, France.,USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, Bordeaux, France
| | - Julia Maruani
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France.,Université de Paris, Paris, France.,INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | - Michel Lejoyeux
- Paris Diderot University-Paris VII, 5 Rue Thomas Mann, Paris, France.,University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, Paris, France
| | - Mircea Polosan
- University Grenoble Alpes, Grenoble, France.,U1216 INSERM, Grenoble Institut of Neuroscience, La Tronche, France.,Psychiatry Department, CHU Grenoble Alpes, Grenoble, France
| | - Pierre A Geoffroy
- Paris Diderot University-Paris VII, 5 Rue Thomas Mann, Paris, France.,University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, Paris, France.,Université de Paris, NeuroDiderot, Inserm, Paris, France
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32
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Schmid SR, Nissen C, Riemann D, Spiegelhalder K, Frase L. Auditorische Stimulation während des Schlafs. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungDie Insomnie, d. h. eine Ein- und/oder Durchschlafstörung, die sich negativ auf die Leistungsfähigkeit und Tagesbefindlichkeit auswirkt, ist eine der häufigsten Erkrankungen in der Allgemeinbevölkerung. Sie wird derzeit meistens pharmakologisch und/oder psychotherapeutisch behandelt, wobei die pharmakologische Behandlung mit Benzodiazepin-Rezeptor-Agonisten zu Abhängigkeit führen kann und die Verfügbarkeit von für die Insomnie-Therapie ausgebildeten Psychotherapeuten momentan nicht in ausreichendem Maße gegeben ist. Durch innovative Behandlungsmethoden könnte hier eine Versorgungslücke effektiv geschlossen werden. Hierzu zählt die auditorische Stimulation, welche vorhandene Sinneskanäle nutzt, um den Schlaf zu beeinflussen. Bisher wurde die auditorische Stimulation vor allem zur Untersuchung von Prozessen der Gedächtniskonsolidierung bei gesunden Probanden angewendet, wobei erfolgreich eine Erhöhung langsamer Oszillationen erreicht wurde, welche vor allem während des Tiefschlafs auftreten. Erste Befunde und sekundäre Outcome-Parameter liefern Hinweise, dass die Potenzierung langsamer Oszillationen durch auditorische Stimulation den Schlaf vertiefen kann, jedoch wurde hierzu bislang keine Studie mit Insomniepatienten durchgeführt. Weitere Forschung bezüglich des Einflusses der Potenzierung langsamer Oszillationen auf die Linderung von Ein- und Durchschlafproblemen bei vorliegender nichtorganischer Insomnie erscheint daher geboten zu sein, um der hohen Beschwerdelast dieser Patientengruppe entgegenzuwirken.
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33
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Roach M, Juday T, Tuly R, Chou JW, Jena AB, Doghramji PP. Challenges and opportunities in insomnia disorder. Int J Neurosci 2020; 131:1058-1065. [PMID: 32449423 DOI: 10.1080/00207454.2020.1773460] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | | | | | | | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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34
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Sun N, He Y, Wang Z, Zou W, Liu X. The effect of repetitive transcranial magnetic stimulation for insomnia: a systematic review and meta-analysis. Sleep Med 2020; 77:226-237. [PMID: 32830052 DOI: 10.1016/j.sleep.2020.05.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/03/2020] [Accepted: 05/12/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) might be a promising technique in treating insomnia. A comprehensive meta-analysis of the available literature is conducted to offer evidence. OBJECTIVE To evaluate the efficacy and safety of rTMS for insomnia, either as monotherapy or as a complementary strategy. METHODS CENTRAL, PubMed, EMBASE, PsycINFO, CINAHL, PEDro, CBM, CNKI, WANFANG, and VIP were searched from earliest record to August 2019. Randomized control trials (RCTs) published in English and Chinese examining effects of rTMS on patients with insomnia were included. Two authors independently completed the article selection, data extraction and rating. Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. The RevMan software was used for meta-analysis. The quality of the evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of 36 trials from 28 eligible studies were included, involving a total of 2357 adult participants (mean age, 48.80 years; 45.33% males). Compared with sham rTMS, rTMS was associated with improved PSQI total score (SMD -2.31, 95% CI -2.95 to -1.66; Z = 7.01, P < 0.00001) and scores of seven subscales. Compared to other treatment, rTMS as an adjunct to other treatment was associated with improved PSQI total score (SMD -1.44, 95% CI -2.00 to -0.88; Z = 5.01, P < 0.00001), and may have effects on scores of seven subscales. Compared with other treatment, rTMS was associated with improved Pittsburgh sleep quality index (PSQI) total score (SMD -0.63, 95% CI -1.22 to -0.04; Z = 2.08, P = 0.04), and may have a better score in sleep latency, sleep disturbance and hypnotic using of seven subscales. In the three pair of comparisons, the results for polysomnography (PSG) outcomes were varied. In general, rTMS may improve sleep quality through increasing slow wave and rapid eye movement (REM) sleep. The rTMS group was more prone to headache than the sham or blank control group (RR 1.71, 95% CI 1.03 to 2.85; Z = 2.07, P = 0.04). No severe adverse events were reported. Reporting biases and low and very low grade of some evidences should be considered when interpreting the results of this meta-analysis. CONCLUSIONS Our findings indicate that rTMS may be a safe and effective option for insomnia. Further international, multicenter, high-quality RCTs with more objective, quality of life related and follow-up assessments are needed.
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Affiliation(s)
- Nianyi Sun
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China; Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, People's Republic of China
| | - Yu He
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China; Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, People's Republic of China
| | - Zhiqiang Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China; Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, People's Republic of China
| | - Wenchen Zou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xueyong Liu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China; Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, People's Republic of China.
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35
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Frase L, Jahn F, Tsodor S, Krone L, Selhausen P, Feige B, Maier JG, Piosczyk H, Riemann D, Nitsche MA, Nissen C. Offline Bi-Frontal Anodal Transcranial Direct Current Stimulation Decreases Total Sleep Time Without Disturbing Overnight Memory Consolidation. Neuromodulation 2020; 24:910-915. [PMID: 32394544 DOI: 10.1111/ner.13163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES A proposed replay of memory traces between the hippocampus and frontal cortical brain areas during sleep is of high relevance for overnight memory consolidation. Recently, we demonstrated that bi-frontal anodal transcranial direct current stimulation (tDCS) prior to sleep increases waking EEG gamma power and decreases total sleep time during the night. It is unclear whether this effect on cortical excitability has an influence on overnight memory consolidation. We hypothesized that bi-frontal evening tDCS interferes with overnight memory consolidation with a polarity specific impairment following anodal tDCS. MATERIALS AND METHODS Nineteen healthy participants underwent a within-subject, repeated-measures protocol in the sleep laboratory with bi-frontal tDCS applied prior to sleep according to the experimental protocol (anodal, cathodal, sham stimulation). Memory tasks for declarative and procedural memory were assessed prior to tDCS and on the following morning. RESULTS No deterioration of overnight memory consolidation following evening offline bi-frontal tDCS could be detected. CONCLUSION(S) The application of tDCS can be considered safe regarding overnight memory consolidation and represents a promising treatment approach in conditions of decreased vigilance and arousal.
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Affiliation(s)
- Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friederike Jahn
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sulamith Tsodor
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Krone
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, England, UK.,Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, England, UK
| | - Peter Selhausen
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonathan G Maier
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hannah Piosczyk
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
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36
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Migliorelli C, Bachiller A, Andrade AG, Alonso JF, Mañanas MA, Borja C, Giménez S, Antonijoan RM, Varga AW, Osorio RS, Romero S. Alterations in EEG connectivity in healthy young adults provide an indicator of sleep depth. Sleep 2020; 42:5427094. [PMID: 30944934 DOI: 10.1093/sleep/zsz081] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/19/2018] [Indexed: 11/14/2022] Open
Abstract
Current sleep analyses have used electroencephalography (EEG) to establish sleep intensity through linear and nonlinear measures. Slow wave activity (SWA) and entropy are the most commonly used markers of sleep depth. The purpose of this study is to evaluate changes in brain EEG connectivity during sleep in healthy subjects and compare them with SWA and entropy. Four different connectivity metrics: coherence (MSC), synchronization likelihood (SL), cross mutual information function (CMIF), and phase locking value (PLV), were computed focusing on their correlation with sleep depth. These measures provide different information and perspectives about functional connectivity. All connectivity measures revealed to have functional changes between the different sleep stages. The averaged CMIF seemed to be a more robust connectivity metric to measure sleep depth (correlations of 0.78 and 0.84 with SWA and entropy, respectively), translating greater linear and nonlinear interdependences between brain regions especially during slow wave sleep. Potential changes of brain connectivity were also assessed throughout the night. Connectivity measures indicated a reduction of functional connectivity in N2 as sleep progresses. The validation of connectivity indexes is necessary because they can reveal the interaction between different brain regions in physiological and pathological conditions and help understand the different functions of deep sleep in humans.
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Affiliation(s)
- Carolina Migliorelli
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Department of Automatic Control (ESAII), Biomedical Engineering Research Center (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Alejandro Bachiller
- Department of Automatic Control (ESAII), Biomedical Engineering Research Center (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Andreia G Andrade
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
| | - Joan F Alonso
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Department of Automatic Control (ESAII), Biomedical Engineering Research Center (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Miguel A Mañanas
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Department of Automatic Control (ESAII), Biomedical Engineering Research Center (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Cristina Borja
- Department of Automatic Control (ESAII), Biomedical Engineering Research Center (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Sandra Giménez
- Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, CIBERSAM, Barcelona, Spain
| | - Rosa M Antonijoan
- Department of Clinical Psychology and Psychobiology of the University of Barcelona, Barcelona, Spain.,Medicament Research Center (CIM), Research Institute Hospital de la Santa Creu I San Pau, IIB-Sant Pau, Barcelona, Spain
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
| | - Sergio Romero
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Department of Automatic Control (ESAII), Biomedical Engineering Research Center (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
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37
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Riemann D, Krone LB, Wulff K, Nissen C. Sleep, insomnia, and depression. Neuropsychopharmacology 2020; 45:74-89. [PMID: 31071719 PMCID: PMC6879516 DOI: 10.1038/s41386-019-0411-y] [Citation(s) in RCA: 343] [Impact Index Per Article: 85.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 12/23/2022]
Abstract
Since ancient times it is known that melancholia and sleep disturbances co-occur. The introduction of polysomnography into psychiatric research confirmed a disturbance of sleep continuity in patients with depression, revealing not only a decrease in Slow Wave Sleep, but also a disinhibition of REM (rapid eye movement) sleep, demonstrated as a shortening of REM latency, an increase of REM density, as well as total REM sleep time. Initial hopes that these abnormalities of REM sleep may serve as differential-diagnostic markers for subtypes of depression were not fulfilled. Almost all antidepressant agents suppress REM sleep and a time-and-dose-response relationship between total REM sleep suppression and therapeutic response to treatment seemed apparent. The so-called Cholinergic REM Induction Test revealed that REM sleep abnormalities can be mimicked by administration of cholinomimetic agents. Another important research avenue is the study of chrono-medical timing of sleep deprivation and light exposure for their positive effects on mood in depression. Present day research takes the view on insomnia, i.e., prolonged sleep latency, problems to maintain sleep, and early morning awakening, as a transdiagnostic symptom for many mental disorders, being most closely related to depression. Studying insomnia from different angles as a transdiagnostic phenotype has opened many new perspectives for research into mechanisms but also for clinical practice. Thus, the question is: can the early and adequate treatment of insomnia prevent depression? This article will link current understanding about sleep regulatory mechanisms with knowledge about changes in physiology due to depression. The review aims to draw the attention to current and future strategies in research and clinical practice to the benefits of sleep and depression therapeutics.
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Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Lukas B Krone
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Katharina Wulff
- Departments of Radiation Sciences & Molecular Biology, Umea University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine (WCMM), Umea University, Umeå, Sweden
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
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38
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Bryant NB, Nadel L, Gómez RL. Associations between sleep and episodic memory updating. Hippocampus 2019; 30:794-805. [PMID: 31743543 DOI: 10.1002/hipo.23178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 10/02/2019] [Accepted: 10/28/2019] [Indexed: 11/06/2022]
Abstract
Prior research shows that contextual reminders can reactivate hippocampal links to previously consolidated memories, rendering them susceptible to being updated with new information which then is reconsolidated. Studies implicate sleep in the reconsolidation of reactivated memories, but it is unknown what role sleep plays in updating of a previously consolidated trace with new information. We tracked participants' sleep during an episodic reconsolidation paradigm, first with actigraphy (Experiment 1) then with polysomnography (Experiment 2). Our paradigm involved two learning sessions and a retrieval session, each separated by 48 hr. We reminded participants of the first learning experience immediately prior to the second, which led them to update the earlier memory with elements of the later experience. In Experiment 1, less sleep after Session 1 and more sleep after Session 2 are associated with increased updating. In Experiment 2, N2 sleep spindles (SSs) after the reminder and new learning are associated with more updating, but primarily when spindle activity after Session 1 is low. Thus, total sleep time and N2 SSs contribute to sleep-dependent updating of episodic memory. This outcome is consistent with other work connecting SS activity to the integration of novel information into existing knowledge structures, extended here with the study of how variations in sleep over successive nights contribute to this process. We discuss some possible roles of spindles in the decontextualization of hippocampal memory over time. Although much work addresses the role of sleep in the consolidation of new memories, this work uniquely addresses the contribution of sleep to the updating of a previously consolidated trace with new information.
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Affiliation(s)
- Natalie B Bryant
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Lynn Nadel
- Department of Psychology and Program in Cognitive science, University of Arizona, Tucson, Arizona
| | - Rebecca L Gómez
- Department of Psychology, University of Arizona, Tucson, Arizona
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39
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Liu J, Cai W, Zhao M, Cai W, Sui F, Hou W, Wang H, Yu D, Yuan K. Reduced resting-state functional connectivity and sleep impairment in abstinent male alcohol-dependent patients. Hum Brain Mapp 2019; 40:4941-4951. [PMID: 31379038 PMCID: PMC6865575 DOI: 10.1002/hbm.24749] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 01/17/2023] Open
Abstract
Alcohol dependence is associated with poor sleep quality, which has both been implicated with thalamocortical circuits function. To identify the possible roles of these circuits in the alcohol-sleep association, we investigated the volume of both left and right thalamus and corresponding resting-state functional connectivity (RSFC) differences between 15 alcohol-dependent patients (AD) and 15 healthy controls (HC) male participants. The neuroimaging findings were then correlated with clinical variables, that is, Alcohol Use Disorders Identification Test (AUDIT) and Pittsburgh Sleep Quality Index (PSQI). Additionally, mediation analysis was carried out to test whether the thalamocortical RSFC mediates the relationship between drinking behavior and sleep impairments in AD when applicable. We observed a significant positive correlation between AUDIT score and PSQI score in AD. Compared with HC, AD showed reduced RSFC between the left thalamus and medial prefrontal cortex (mPFC), orbitofrontal cortex, anterior cingulate cortex (ACC), and right caudate. We also observed a negative correlation between RSFC of the left thalamus-mPFC and PSQI score in AD. More importantly, the left thalamus-mPFC RSFC strength mediated the relationship between AUDIT score and PSQI score in AD. No significant difference was detected in the normalized volume of both left and right thalamus, and volumes were not significantly correlated with clinical variables. Our results demonstrate that AD show abnormal interactions within thalamocortical circuits in association with drinking behaviors and sleep impairments. It is hoped that our study focusing on thalamocortical circuits could provide new information on potential novel therapeutic targets for treatment of sleep impairment in alcohol-dependent patients.
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Affiliation(s)
- Jingjing Liu
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Wanye Cai
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Meng Zhao
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Wenlong Cai
- Xilinguole Meng Mongolian General Hospital, Xilinhaote, Inner Mongolian, People's Republic of China
| | - Feng Sui
- Xilinguole Meng Mongolian General Hospital, Xilinhaote, Inner Mongolian, People's Republic of China
| | - Wenbao Hou
- Xilinguole Meng Mongolian General Hospital, Xilinhaote, Inner Mongolian, People's Republic of China
| | - Hongde Wang
- Xilinguole Meng Mongolian General Hospital, Xilinhaote, Inner Mongolian, People's Republic of China
| | - Dahua Yu
- Inner Mongolia Key Laboratory of Pattern Recognition and Intelligent Image Processing, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China
| | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China.,Inner Mongolia Key Laboratory of Pattern Recognition and Intelligent Image Processing, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China.,Guangxi Key Laboratory of Multi-Source Information Mining and Security, Guangxi Normal University, Guilin, People's Republic of China
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40
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Tang HY(J, McCurry SM, Riegel B, Pike KC, Vitiello MV. Open-Loop Audiovisual Stimulation Induces Delta EEG Activity in Older Adults With Osteoarthritis Pain and Insomnia. Biol Res Nurs 2019; 21:307-317. [PMID: 30862174 PMCID: PMC6700899 DOI: 10.1177/1099800419833781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE People with chronic insomnia tend to have cortical hyperarousal marked by excessive beta-/gamma-frequency brain activity during both wake and sleep. Currently, treatment options for managing hyperarousal are limited. Open-loop audiovisual stimulation (AVS) may be such a treatment. The purpose of this study was to provide a mechanistic foundation for future AVS research in sleep promotion by examining quantitative electroencephalogram (QEEG) responses to an AVS sleep-induction program. METHOD Sixteen older adults with both chronic insomnia and osteoarthritis pain were randomly assigned to either active- or placebo-control AVS. Electroencephalogram (EEG) was collected during baseline (5 min, eyes closed/resting) and throughout 30 min of AVS. RESULTS Findings showed significantly elevated mean baseline gamma (35-45 Hz) power in both groups compared to an age- and gender-matched, noninsomnia normative database, supporting cortical hyperarousal. After 30 min of exposure to AVS, the active group showed significantly increased delta power compared to the placebo-control group, providing the first controlled evidence that active AVS induction increases delta QEEG activity in insomnia patients and that these changes are immediate. In the active group, brain locations that showed the most delta induction (Cz, Fp, O1, and O2) were associated with the sensory-thalamic pathway, consistent with the sensory stimulation provided by the active AVS program. CONCLUSIONS Findings demonstrate that delta induction, which can promote sleep, is achievable using a 30-min open-loop AVS program. The potential for AVS treatment of insomnia in the general population remains to be demonstrated in well-designed clinical trials.
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Affiliation(s)
| | | | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth C. Pike
- School of Nursing, University of Washington, Seattle, WA, USA
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41
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Frase L, Selhausen P, Krone L, Tsodor S, Jahn F, Feige B, Maier JG, Mainberger F, Piosczyk H, Kuhn M, Klöppel S, Sterr A, Baglioni C, Spiegelhalder K, Riemann D, Nitsche MA, Nissen C. Differential effects of bifrontal tDCS on arousal and sleep duration in insomnia patients and healthy controls. Brain Stimul 2019; 12:674-683. [DOI: 10.1016/j.brs.2019.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 12/14/2022] Open
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42
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D'Atri A, Scarpelli S, Gorgoni M, Alfonsi V, Annarumma L, Giannini AM, Ferrara M, Ferlazzo F, Rossini PM, De Gennaro L. Bilateral Theta Transcranial Alternating Current Stimulation (tACS) Modulates EEG Activity: When tACS Works Awake It Also Works Asleep. Nat Sci Sleep 2019; 11:343-356. [PMID: 31819688 PMCID: PMC6875492 DOI: 10.2147/nss.s229925] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/21/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Recent studies demonstrate that 5-Hz bilateral transcranial alternating current stimulation (θ-tACS) on fronto-temporal areas affects resting EEG enhancing cortical synchronization, but it does not affect subjective sleepiness. This dissociation raises questions on the resemblance of this effect to the physiological falling asleep process. The current study aimed to evaluate the ability of fronto-temporal θ-tACS to promote sleep. SUBJECTS AND METHODS Twenty subjects (10 F/10 M; mean age: 24.60 ± 2.9 y) participated in a single-blind study consisting of two within-subject sessions (active/sham), one week apart in counterbalanced order. Stimulation effects on EEG were assessed during wake and post-stimulation nap. The final sample included participants who fell asleep in both sessions (n=17). RESULTS Group analyses on the whole sample reported no θ-tACS effects on subjective sleepiness and sleep measures, while a different scenario came to light by analysing data of responders to the stimulation (ie, subjects actually showing the expected increase of theta activity in the wake EEG after the θ-tACS, n=7). Responders reported a significant increase in subjective sleepiness during wakefulness after the active stimulation as compared to the sham. Moreover, the sleep after the θ-tACS compared to sham in this sub-group showed: (1) greater slow-wave activity (SWA); (2) SWA time-course revealing increases much larger as closer to the sleep onset; (3) stimulation-induced changes in SWA during sleep topographically associated to those in theta activity during wake. CONCLUSION Subjects who show the expected changes during wake after the stimulation also had a consistent pattern of changes during sleep. The enhancement of cortical synchronization by θ-tACS during wakefulness actually corresponds to increased sleep pressure, but it occurs only in some individuals. Thus, θ-tACS can enhance sleep, although individual factors to be further investigated affect the actual responsiveness to this treatment.
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Affiliation(s)
- Aurora D'Atri
- Department of Psychology, University of Rome "Sapienza", Rome, Italy.,Area of Neuroscience, IRCCS San Raffaele Pisana, Rome, Italy
| | - Serena Scarpelli
- Department of Psychology, University of Rome "Sapienza", Rome, Italy
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome "Sapienza", Rome, Italy
| | - Valentina Alfonsi
- Department of Psychology, University of Rome "Sapienza", Rome, Italy
| | | | | | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabio Ferlazzo
- Department of Psychology, University of Rome "Sapienza", Rome, Italy
| | - Paolo Maria Rossini
- Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy.,Department Geriatrics, Neuroscience & Orthopaedics, Policlinic A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, University of Rome "Sapienza", Rome, Italy.,Area of Neuroscience, IRCCS San Raffaele Pisana, Rome, Italy
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43
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Frase L, Nissen C, Riemann D, Spiegelhalder K. Making sleep easier: pharmacological interventions for insomnia. Expert Opin Pharmacother 2018; 19:1465-1473. [DOI: 10.1080/14656566.2018.1511705] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- University Hospital of Psychiatry and Psychotherapy, University Psychiatric Services, Bern, Switzerland
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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44
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The Efficacy of Transcranial Current Stimulation Techniques to Modulate Resting-State EEG, to Affect Vigilance and to Promote Sleepiness. Brain Sci 2018; 8:brainsci8070137. [PMID: 30037023 PMCID: PMC6071002 DOI: 10.3390/brainsci8070137] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 02/05/2023] Open
Abstract
Transcranial Current Stimulations (tCSs) are non-invasive brain stimulation techniques which modulate cortical excitability and spontaneous brain activity by the application of weak electric currents through the scalp, in a safe, economic, and well-tolerated manner. The direction of the cortical effects mainly depend on the polarity and the waveform of the applied current. The aim of the present work is to provide a broad overview of recent studies in which tCS has been applied to modulate sleepiness, sleep, and vigilance, evaluating the efficacy of different stimulation techniques and protocols. In recent years, there has been renewed interest in these stimulations and their ability to affect arousal and sleep dynamics. Furthermore, we critically review works that, by means of stimulating sleep/vigilance patterns, in the sense of enhancing or disrupting them, intended to ameliorate several clinical conditions. The examined literature shows the efficacy of tCSs in modulating sleep and arousal pattern, likely acting on the top-down pathway of sleep regulation. Finally, we discuss the potential application in clinical settings of this neuromodulatory technique as a therapeutic tool for pathological conditions characterized by alterations in sleep and arousal domains and for sleep disorders per se.
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45
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Sterr A, Kuhn M, Nissen C, Ettine D, Funk S, Feige B, Umarova R, Urbach H, Weiller C, Riemann D. Post-stroke insomnia in community-dwelling patients with chronic motor stroke: Physiological evidence and implications for stroke care. Sci Rep 2018; 8:8409. [PMID: 29849087 PMCID: PMC5976765 DOI: 10.1038/s41598-018-26630-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/16/2018] [Indexed: 01/30/2023] Open
Abstract
Questionnaire studies suggest that stroke patients experience sustained problems with sleep and daytime sleepiness, but physiological sleep studies focussing specifically on the chronic phase of stroke are lacking. Here we report for the first time physiological data of sleep and daytime sleepiness obtained through the two gold-standard methods, nocturnal polysomnography and the Multiple Sleep Latency Test. Data from community-dwelling patients with chronic right-hemispheric stroke (>12 months) were compared to sex- and age-matched controls. Behavioural and physiological measures suggested that stroke patients had poorer sleep with longer sleep latencies and lower sleep efficiency. Patients further spent more time awake during the night, and showed greater high-frequency power during nonREM sleep than controls. At the same time the Multiple Sleep Latency Test revealed greater wake efficiency in patients than controls. Importantly these findings were not due to group differences in sleep disordered breathing or periodic limb movements. Post-stroke insomnia is presently not adequately addressed within the care pathway for stroke. A holistic approach to rehabilitation and care provision, that includes targeted sleep interventions, is likely to enhance long-term outcome and quality of live in those living with chronic deficits after stroke.
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Affiliation(s)
- A Sterr
- School of Psychology, University of Surrey, Guildford, UK.
| | - M Kuhn
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Nissen
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
- Sleep Wake Epilepsy Center, Neuroscience Center, Bern, Switzerland
| | - D Ettine
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Funk
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - B Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Umarova
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - H Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Weiller
- Department of Neurology, Medical Center, University of Freiburg, Freiburg, Germany
| | - D Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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46
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47
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D'Atri A, Romano C, Gorgoni M, Scarpelli S, Alfonsi V, Ferrara M, Ferlazzo F, Rossini PM, De Gennaro L. Bilateral 5 Hz transcranial alternating current stimulation on fronto-temporal areas modulates resting-state EEG. Sci Rep 2017; 7:15672. [PMID: 29142322 PMCID: PMC5688177 DOI: 10.1038/s41598-017-16003-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 11/03/2017] [Indexed: 02/08/2023] Open
Abstract
Rhythmic non-invasive brain stimulations are promising tools to modulate brain activity by entraining neural oscillations in specific cortical networks. The aim of the study was to assess the possibility to influence the neural circuits of the wake-sleep transition in awake subjects via a bilateral transcranial alternating current stimulation at 5 Hz (θ-tACS) on fronto-temporal areas. 25 healthy volunteers participated in two within-subject sessions (θ-tACS and sham), one week apart and in counterbalanced order. We assessed the stimulation effects on cortical EEG activity (28 derivations) and self-reported sleepiness (Karolinska Sleepiness Scale). θ-tACS induced significant increases of the theta activity in temporo-parieto-occipital areas and centro-frontal increases in the alpha activity compared to sham but failed to induce any online effect on sleepiness. Since the total energy delivered in the sham condition was much less than in the active θ-tACS, the current data are unable to isolate the specific effect of entrained theta oscillatory activity per se on sleepiness scores. On this basis, we concluded that θ-tACS modulated theta and alpha EEG activity with a topography consistent with high sleep pressure conditions. However, no causal relation can be traced on the basis of the current results between these rhythms and changes on sleepiness.
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Affiliation(s)
- Aurora D'Atri
- Department of Psychology, University of Rome "Sapienza", Via dei Marsi 78, 00185, Rome, Italy
- IRCCS San Raffaele Pisana, Via della Pisana 235, 00163, Rome, Italy
| | - Claudia Romano
- Department of Psychology, University of Rome "Sapienza", Via dei Marsi 78, 00185, Rome, Italy
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome "Sapienza", Via dei Marsi 78, 00185, Rome, Italy
| | - Serena Scarpelli
- Department of Psychology, University of Rome "Sapienza", Via dei Marsi 78, 00185, Rome, Italy
| | - Valentina Alfonsi
- Department of Psychology, University of Rome "Sapienza", Via dei Marsi 78, 00185, Rome, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100 Coppito, L'Aquila, Italy
| | - Fabio Ferlazzo
- Department of Psychology, University of Rome "Sapienza", Via dei Marsi 78, 00185, Rome, Italy
| | - Paolo Maria Rossini
- IRCCS San Raffaele Pisana, Via della Pisana 235, 00163, Rome, Italy
- Institute of Neurology, Catholic University of The Sacred Heart, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, University of Rome "Sapienza", Via dei Marsi 78, 00185, Rome, Italy.
- IRCCS San Raffaele Pisana, Via della Pisana 235, 00163, Rome, Italy.
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48
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Cellini N. Memory consolidation in sleep disorders. Sleep Med Rev 2017; 35:101-112. [DOI: 10.1016/j.smrv.2016.09.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 09/18/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
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