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Shetty M, Davey MJ, Nixon GM, Walter LM, Horne RSC. Sleep spindles are reduced in children with Down syndrome and sleep-disordered breathing. Pediatr Res 2023:10.1038/s41390-023-02854-1. [PMID: 37845520 DOI: 10.1038/s41390-023-02854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB). We investigated sleep spindle activity, as a marker of sleep quality, and its relationship with daytime functioning in children with DS compared to typically developing (TD) children. METHODS Children with DS and SDB (n = 44) and TD children matched for age, sex and SDB severity underwent overnight polysomnography. Fast or Slow sleep spindles were identified manually during N2/N3 sleep. Spindle activity was characterized as spindle number, density (number of spindles/h) and intensity (density × average duration) on central (C) and frontal (F) electrodes. Parents completed the Child Behavior Check List and OSA-18 questionnaires. RESULTS In children with DS, spindle activity was lower compared to TD children for F Slow and F Slow&Fast spindles combined (p < 0.001 for all). Furthermore, there were no correlations between spindle activity and CBCL subscales; however, spindle activity for C Fast and C Slow&Fast was negatively correlated with OSA-18 emotional symptoms and caregiver concerns and C Fast activity was also negatively correlated with daytime function and total problems. CONCLUSIONS Reduced spindle activity in children with DS may underpin the increased sleep disruption and negative effects of SDB on quality of life and behavior. IMPACT Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. Sleep spindles are a sensitive marker of sleep quality. We identified for the first time that children with DS had reduced sleep spindle activity compared to typically developing children matched for SDB severity. The reduced spindle activity likely underpins the more disrupted sleep and may be associated with reduced daytime functioning and quality of life and may also be an early biomarker for an increased risk of developing dementia later in life in children with DS.
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Affiliation(s)
- Marisha Shetty
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Margot J Davey
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Lisa M Walter
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Rosemary S C Horne
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
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Rial RV, Akaârir M, Canellas F, Barceló P, Rubiño JA, Martín-Reina A, Gamundí A, Nicolau MC. Mammalian NREM and REM sleep: Why, when and how. Neurosci Biobehav Rev 2023; 146:105041. [PMID: 36646258 DOI: 10.1016/j.neubiorev.2023.105041] [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: 09/23/2022] [Revised: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
This report proposes that fish use the spinal-rhombencephalic regions of their brain to support their activities while awake. Instead, the brainstem-diencephalic regions support the wakefulness in amphibians and reptiles. Lastly, mammals developed the telencephalic cortex to attain the highest degree of wakefulness, the cortical wakefulness. However, a paralyzed form of spinal-rhombencephalic wakefulness remains in mammals in the form of REMS, whose phasic signs are highly efficient in promoting maternal care to mammalian litter. Therefore, the phasic REMS is highly adaptive. However, their importance is low for singletons, in which it is a neutral trait, devoid of adaptive value for adults, and is mal-adaptive for marine mammals. Therefore, they lost it. The spinal-rhombencephalic and cortical wakeful states disregard the homeostasis: animals only attend their most immediate needs: foraging defense and reproduction. However, these activities generate allostatic loads that must be recovered during NREMS, that is a paralyzed form of the amphibian-reptilian subcortical wakefulness. Regarding the regulation of tonic REMS, it depends on a hypothalamic switch. Instead, the phasic REMS depends on an independent proportional pontine control.
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Affiliation(s)
- Rubén V Rial
- Laboratori de Fisiologia del son i els ritmes biologics. Universitat de les Illes Balears, Ctra. Valldemossa Km 7.5, 07122 Palma de Mallorca (España); IDISBA. Institut d'Investigació Sanitaria de les Illes Balears; IUNICS Institut Universitari d'Investigació en Ciències de la Salut.
| | - Mourad Akaârir
- Laboratori de Fisiologia del son i els ritmes biologics. Universitat de les Illes Balears, Ctra. Valldemossa Km 7.5, 07122 Palma de Mallorca (España); IDISBA. Institut d'Investigació Sanitaria de les Illes Balears; IUNICS Institut Universitari d'Investigació en Ciències de la Salut.
| | - Francesca Canellas
- Laboratori de Fisiologia del son i els ritmes biologics. Universitat de les Illes Balears, Ctra. Valldemossa Km 7.5, 07122 Palma de Mallorca (España); IDISBA. Institut d'Investigació Sanitaria de les Illes Balears; IUNICS Institut Universitari d'Investigació en Ciències de la Salut; Hospital Son Espases, 07120, Palma de Mallorca (España).
| | - Pere Barceló
- Laboratori de Fisiologia del son i els ritmes biologics. Universitat de les Illes Balears, Ctra. Valldemossa Km 7.5, 07122 Palma de Mallorca (España); IDISBA. Institut d'Investigació Sanitaria de les Illes Balears; IUNICS Institut Universitari d'Investigació en Ciències de la Salut.
| | - José A Rubiño
- Laboratori de Fisiologia del son i els ritmes biologics. Universitat de les Illes Balears, Ctra. Valldemossa Km 7.5, 07122 Palma de Mallorca (España); IDISBA. Institut d'Investigació Sanitaria de les Illes Balears; IUNICS Institut Universitari d'Investigació en Ciències de la Salut; Hospital Son Espases, 07120, Palma de Mallorca (España).
| | - Aida Martín-Reina
- Laboratori de Fisiologia del son i els ritmes biologics. Universitat de les Illes Balears, Ctra. Valldemossa Km 7.5, 07122 Palma de Mallorca (España); IDISBA. Institut d'Investigació Sanitaria de les Illes Balears; IUNICS Institut Universitari d'Investigació en Ciències de la Salut.
| | - Antoni Gamundí
- Laboratori de Fisiologia del son i els ritmes biologics. Universitat de les Illes Balears, Ctra. Valldemossa Km 7.5, 07122 Palma de Mallorca (España); IDISBA. Institut d'Investigació Sanitaria de les Illes Balears; IUNICS Institut Universitari d'Investigació en Ciències de la Salut.
| | - M Cristina Nicolau
- Laboratori de Fisiologia del son i els ritmes biologics. Universitat de les Illes Balears, Ctra. Valldemossa Km 7.5, 07122 Palma de Mallorca (España); IDISBA. Institut d'Investigació Sanitaria de les Illes Balears; IUNICS Institut Universitari d'Investigació en Ciències de la Salut.
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Betavani VMP, Davey MJ, Nixon GM, Walter LM, Horne RSC. Effects of Treatment of Sleep Disordered Breathing on Sleep Macro- and Micro-Architecture in Children with Down Syndrome. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070984. [PMID: 35883968 PMCID: PMC9317623 DOI: 10.3390/children9070984] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/03/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022]
Abstract
Background: Children with Down syndrome (DS) are at increased risk of obstructive sleep disordered breathing (SDB), which is associated with intermittent hypoxia and sleep disruption affecting daytime functioning. We aimed to examine the effects of treatment of SDB on sleep quality and daytime functioning in children with DS. Methods: Children with DS and SDB (n = 24) completed a baseline and follow-up overnight polysomnographic (PSG) study 22 ± 7 months (mean ± SD) later. Sleep micro-architecture was assessed using EEG spectral analysis, and parents completed a number of questionnaires assessing sleep, behavior, daytime functioning, and quality of life (QOL). Results: A total of nine children (38%) were treated. At baseline, the treated group had more severe SDB compared to the untreated group. SDB severity was significantly improved from 40.3 ± 46.9 events/h to 17.9 ± 26.9 events/h (p < 0.01) at follow up in children who were treated. There were no significant differences in sleep macro-architecture parameters from baseline to follow up in either the treated or untreated group. Sleep micro-architecture was not different between studies in the treated group, however this tended to improve in the untreated group, particularly in REM sleep. Daytime functioning and behavior were not different between the studies in either group, however, QOL improved after treatment. Conclusions: Our study identified that treatment of SDB improves severity of the disease as defined by PSG, and this was associated with parental reports of improved QOL, despite treatment having no demonstrable impacts on sleep quality, behavior, or daytime functioning.
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Affiliation(s)
- Viecky M. P. Betavani
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
| | - Margot J. Davey
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Gillian M. Nixon
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Lisa M. Walter
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
| | - Rosemary S. C. Horne
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
- Department of Paediatrics, Level 5, Monash Children’s Hospital, 246 Clayton Road, Clayton, Melbourne, VIC 3168, Australia
- Correspondence: ; Tel.: +61-385722827
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Sibarani CR, Walter LM, Davey MJ, Nixon GM, Horne RSC. Sleep-disordered breathing and sleep macro- and micro-architecture in children with Down syndrome. Pediatr Res 2022; 91:1248-1256. [PMID: 34230620 DOI: 10.1038/s41390-021-01642-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB), which is associated with intermittent hypoxia and sleep disruption affecting daytime functioning. We aimed to compare the impact of SDB on sleep quality in children with DS compared to typically developing (TD) children with and without SDB. METHODS Children with DS and SDB (n = 44) were age- and sex-matched with TD children without SDB (TD-) and also for SDB severity with TD children with SDB (TD+). Children underwent overnight polysomnography with sleep macro- and micro-architecture assessed using electroencephalogram (EEG) spectral analysis, including slow-wave activity (SWA, an indicator of sleep propensity). RESULTS Children with DS had greater hypoxic exposure, more respiratory events during REM sleep, higher total, delta, sigma, and beta EEG power in REM than TD+ children, despite the same overall frequency of obstructive events. Compared to TD- children, they also had more wake after sleep-onset and lower sigma power in N2 and N3. The DS group had reduced SWA, indicating reduced sleep drive, compared to both TD groups. CONCLUSIONS Our findings suggest that SDB has a greater impact on sleep quality in children with DS compared to TD children. IMPACT SDB in children with DS exacerbates disruption of sleep quality, compared to TD children. The prevalence of SDB is very high in children with DS; however, studies on the effects of SDB on sleep quality are limited in this population. Our findings suggest that SDB has a greater impact on sleep quality in children with DS compared to TD children, and should be screened for and treated as soon as possible.
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Affiliation(s)
- Christy R Sibarani
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia
| | - Lisa M Walter
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia
| | - Margot J Davey
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Gillian M Nixon
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Rosemary S C Horne
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia.
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Qin H, Steenbergen N, Glos M, Wessel N, Kraemer JF, Vaquerizo-Villar F, Penzel T. The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea. Front Psychiatry 2021; 12:642333. [PMID: 34366907 PMCID: PMC8339263 DOI: 10.3389/fpsyt.2021.642333] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures.
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Affiliation(s)
- Hua Qin
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Jan F Kraemer
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red-Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Saratov State University, Russian Federation, Saratov, Russia
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Horne RSC. Consequences of paediatric sleep disordered breathing: contributions from Australian and New Zealand investigators. Sleep Med 2020; 77:147-160. [PMID: 33373901 DOI: 10.1016/j.sleep.2020.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022]
Abstract
AIMS To highlight the contributions of Australian and New Zealand researchers to the identification of the consequences of paediatric sleep disordered breathing (SDB). METHODS A search was conducted in PubMed using the terms "sleep disordered breathing" "child" and "Australia or New Zealand". All abstracts were reviewed and those which focused on the consequences of SDB have been included. RESULTS Australasian research into the consequences of SDB has grown exponentially over the last 35 years. SDB has significant adverse consequences for quality of life, behaviour, neurocognition and the cardiovascular system and the Australasian research studies investigating these are summarised. CONCLUSIONS Australian and New Zealand researchers have played a significant role in understanding the consequences of paediatric SDB and the mechanisms which underpin these. The research conducted "Downunder" has led the world in this field of research and will continue to provide evidence to improve the lives of children not only in Australasia but around the world.
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Affiliation(s)
- Rosemary S C Horne
- Department of Paediatrics, Monash University, Level 5, Monash Children's Hospital, 246 Clayton Rd, Melbourne, 3168, Victoria, Australia.
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Luo A, Tang X, Zhao Y, Zhou Z, Yan J, Li S. General Anesthetic-Induced Neurotoxicity in the Immature Brain: Reevaluating the Confounding Factors in the Preclinical Studies. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7380172. [PMID: 31998797 PMCID: PMC6970503 DOI: 10.1155/2020/7380172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/17/2019] [Indexed: 01/30/2023]
Abstract
General anesthetic (GA) is used clinically to millions of young children each year to facilitate surgical procedures, relieve perioperative stress, and provide analgesia and amnesia. During recent years, there is a growing concern regarding a causal association between early life GA exposure and subsequently long-term neurocognitive abnormalities. To address the increasing concern, mounting preclinical studies and clinical trials have been undergoing. Until now, nearly all of the preclinical findings show that neonatal exposure to GA causally leads to acute neural cell injury and delayed cognitive impairment. Unexpectedly, several influential clinical findings suggest that early life GA exposure, especially brief and single exposure, does not cause adverse neurodevelopmental outcome, which is not fully in line with the experimental findings and data from several previous cohort trials. As the clinical data have been critically discussed in previous reviews, in the present review, we try to analyze the potential factors of the experimental studies that may overestimate the adverse effect of GA on the developing brain. Meanwhile, we briefly summarized the advance in experimental research. Generally, our purpose is to provide some useful suggestions for forthcoming preclinical studies and strengthen the powerfulness of preclinical data.
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Affiliation(s)
- Ailin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Xiaole Tang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Yilin Zhao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Zhiqiang Zhou
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Jing Yan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Shiyong Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
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