Developmental changes of sleep spindles and their impact on sleep-dependent memory consolidation and general cognitive abilities: A longitudinal approach

Spindle chirp and other sleep oscillatory features in young children with autism

OBJECTIVES

To determine whether spindle chirp and other sleep oscillatory features differ in young children with and without autism.

METHODS

Automated processing software was used to re-assess an extant set of polysomnograms representing 121 children (91 with autism [ASD], 30 typically-developing [TD]), with an age range of 1.35-8.23 years. Spindle metrics, including chirp, and slow oscillation (SO) characteristics were compared between groups. SO and fast and slow spindle (FS, SS) interactions were also investigated. Secondary analyses were performed assessing behavioural data associations, as well as exploratory cohort comparisons to children with non-autism developmental delay (DD).

RESULTS

Posterior FS and SS chirp was significantly more negative in ASD than TD. Both groups had comparable intra-spindle frequency range and variance. Frontal and central SO amplitude were decreased in ASD. In contrast to previous manual findings, no differences were detected in other spindle or SO metrics. The ASD group displayed a higher parietal coupling angle. No differences were observed in phase-frequency coupling. The DD group demonstrated lower FS chirp and higher coupling angle than TD. Parietal SS chirp was positively associated with full developmental quotient.

CONCLUSIONS

For the first time spindle chirp was investigated in autism and was found to be significantly more negative than in TD in this large cohort of young children. This finding strengthens previous reports of spindle and SO abnormalities in ASD. Further investigation of spindle chirp in healthy and clinical populations across development will help elucidate the significance of this difference and better understand this novel metric.

Impaired episodic verbal memory recall after 1 week and elevated forgetting in children after mild traumatic brain injury - results from a short-term longitudinal study

Objective

There is preliminary evidence that children after traumatic brain injury (TBI) have accelerated long-term forgetting (ALF), i.e., an adequate learning and memory performance in standardized memory tests, but an excessive rate of forgetting over delays of days or weeks. The main aim of this study was to investigate episodic memory performance, including delayed retrieval 1 week after learning, in children after mild TBI (mTBI).

Methods

This prospective study with two time-points (T1: 1 week after injury and T2: 3-6 months after injury), included data of 64 children after mTBI and 57 healthy control children aged between 8 and 16 years. We assessed episodic learning and memory using an auditory word learning test and compared executive functions (interference control, working memory, semantic fluency and flexibility) and divided attention between groups. We explored correlations between memory performance and executive functions. Furthermore, we examined predictive factors for delayed memory retrieval 1 week after learning as well as for forgetting over time.

Results

Compared to healthy controls, patients showed an impaired delayed recall and recognition performance 3-6 months after injury. Executive functions, but not divided attention, were reduced in children after mTBI. Furthermore, parents rated episodic memory as impaired 3-6 months after injury. Additionally, verbal learning and group, but not executive functions, were predictive for delayed recall performance at both time-points, whereas forgetting was predicted by group.

Discussion

Delayed recall and forgetting over time were significantly different between groups, both post-acutely and in the chronic phase after pediatric mTBI, even in a very mildly injured patient sample. Delayed memory performance should be included in clinical evaluations of episodic memory and further research is needed to understand the mechanisms of ALF.

Impaired sleep-dependent memory consolidation predicted by reduced sleep spindles in Rolandic epilepsy

Background and Objectives

Sleep spindles are prominent thalamocortical brain oscillations during sleep that have been mechanistically linked to sleep-dependent memory consolidation in animal models and healthy controls. Sleep spindles are decreased in Rolandic epilepsy and related sleep-activated epileptic encephalopathies. We investigate the relationship between sleep spindle deficits and deficient sleep dependent memory consolidation in children with Rolandic epilepsy.

Methods

In this prospective case-control study, children were trained and tested on a validated probe of memory consolidation, the motor sequence task (MST). Sleep spindles were measured from high-density EEG during a 90-minute nap opportunity between MST training and testing using a validated automated detector.

Results

Twenty-three children with Rolandic epilepsy (14 with resolved disease), and 19 age- and sex-matched controls were enrolled. Children with active Rolandic epilepsy had decreased memory consolidation compared to control children (p=0.001, mean percentage reduction: 25.7%, 95% CI [10.3, 41.2]%) and compared to children with resolved Rolandic epilepsy (p=0.007, mean percentage reduction: 21.9%, 95% CI [6.2, 37.6]%). Children with active Rolandic epilepsy had decreased sleep spindle rates in the centrotemporal region compared to controls (p=0.008, mean decrease 2.5 spindles/min, 95% CI [0.7, 4.4] spindles/min). Spindle rate positively predicted sleep-dependent memory consolidation (p=0.004, mean MST improvement of 3.9%, 95% CI [1.3, 6.4]%, for each unit increase in spindles per minute).

Discussion

Children with Rolandic epilepsy have a sleep spindle deficit during the active period of disease which predicts deficits in sleep dependent memory consolidation. This finding provides a mechanism and noninvasive biomarker to aid diagnosis and therapeutic discovery for cognitive dysfunction in Rolandic epilepsy and related sleep activated epilepsy syndromes.

Sleep-slow oscillation-spindle coupling precedes spindle-ripple coupling during development

STUDY OBJECTIVES

Sleep supports systems memory consolidation through the precise temporal coordination of specific oscillatory events during slow-wave sleep, i.e. the neocortical slow oscillations (SOs), thalamic spindles, and hippocampal ripples. Beneficial effects of sleep on memory are also observed in infants, although the contributing regions, especially hippocampus and frontal cortex, are immature. Here, we examined in rats the development of these oscillatory events and their coupling during early life.

METHODS

EEG and hippocampal local field potentials were recorded during sleep in male rats at postnatal days (PD)26 and 32, roughly corresponding to early (1-2 years) and late (9-10 years) human childhood, and in a group of adult rats (14-18 weeks, corresponding to ~22-29 years in humans).

RESULTS

SO and spindle amplitudes generally increased from PD26 to PD32. In parallel, frontocortical EEG spindles increased in density and frequency, while changes in hippocampal ripples remained nonsignificant. The proportion of SOs co-occurring with spindles also increased from PD26 to PD32. Whereas parietal cortical spindles were phase-locked to the depolarizing SO-upstate already at PD26, over frontal cortex SO-spindle phase-locking emerged not until PD32. Co-occurrence of hippocampal ripples with spindles was higher during childhood than in adult rats, but significant phase-locking of ripples to the excitable spindle troughs was observed only in adult rats.

CONCLUSIONS

Results indicate a protracted development of synchronized thalamocortical processing specifically in frontocortical networks (i.e. frontal SO-spindle coupling). However, synchronization within thalamocortical networks generally precedes synchronization of thalamocortical with hippocampal processing as reflected by the delayed occurrence of spindle-ripple phase-coupling.

Bedtime to the brain: how infants' sleep behaviours intertwine with non-rapid eye movement sleep electroencephalography features

Adequate sleep is critical for development and facilitates the maturation of the neurophysiological circuitries at the basis of cognitive and behavioural function. Observational research has associated early life sleep problems with worse later cognitive, psychosocial, and somatic health outcomes. Yet, the extent to which day-to-day sleep behaviours (e.g., duration, regularity) in early life relate to non-rapid eye movement (NREM) neurophysiology-acutely and the long-term-remains to be studied. We measured sleep behaviours in 32 healthy 6-month-olds assessed with actimetry and neurophysiology with high-density electroencephalography (EEG) to investigate the association between NREM sleep and habitual sleep behaviours. Our study revealed four findings: first, daytime sleep behaviours are related to EEG slow-wave activity (SWA). Second, night-time movement and awakenings from sleep are connected with spindle density. Third, habitual sleep timing is linked to neurophysiological connectivity quantified as delta coherence. And lastly, delta coherence at 6 months predicts night-time sleep duration at 12 months. These novel findings widen our understanding that infants' sleep behaviours are closely intertwined with three particular levels of neurophysiology: sleep pressure (determined by SWA), the maturation of the thalamocortical system (spindles), and the maturation of cortical connectivity (coherence). The crucial next step is to extend this concept to clinical groups to objectively characterise infants' sleep behaviours 'at risk' that foster later neurodevelopmental problems.

Neurocognitive Effects of Sleep Disruption in Children and Adolescents

A main childhood task is learning. In this task, the role of sleep is increasingly demonstrated. Although most literature examining this role focuses on preadolescence and middle adolescence, some studies apply napping designs in preschoolers. Studies overall conclude that without proper sleep a child's cognitive abilities suffer, but questions on how and to what extent linger. Observational studies show the hazards of potential confounders such as an individual's resilience to poor sleep as well as developmental risk factors (eg, disorders, stressors). A better understanding of cognitive sleep neuroscience may have a big impact on pediatric sleep research and clinical applications.

New Electrographic Marker? Evaluation of Sleep Spindles in Children with Attention Deficit Hyperactivity Disorder

Introduction: Attention deficit and hyperactivity disorder (ADHD) is one of the most common developmental disorders in childhood which lasts lifelong. Sleep structure and sleep spindle features are disorganized in ADHD. In this study, we aimed to look for a new, simple, inexpensive, and an easily detectable electrographic marker in the diagnosis of ADHD by using electroencephalography (EEG). Method: We included treatment free 35 patients with ADHD and 32 healthy children (HC) who were examined by polysomnography (PSG) and EEG for sleep disorders. The ADHD group were separated into three groups according to predominant presentations of ADHD. We determined the sleep staging and slow and fast sleep spindles, calculated each spindle's amplitude, frequency, activity, duration and density at non rapid eye movement (REM) sleep stage 2. Results: Slow sleep spindle's amplitude, duration, density and activity are significantly higher in ADHD group (most significant in ADHD-I) than the HC group (p < 0,05). Sleep spindle's features are not statistically significant between in ADHD subgroups. Conclusions: In children with ADHD, slow sleep spindles showed higher amplitude, activity, density and duration in the frontal regions. These results indicate that slow sleep spindles in children with ADHD may reflect executive dysfunction and slow frontal spindles may be useful as a new electrographic marker in children with ADHD. This is the first study of its kind evaluating all aspects of sleep spindles in ADHD patients.

Sleep spindle maturity promotes slow oscillation-spindle coupling across child and adolescent development

The synchronization of canonical fast sleep spindle activity (12.5-16 Hz, adult-like) precisely during the slow oscillation (0.5-1 Hz) up peak is considered an essential feature of adult non-rapid eye movement sleep. However, there is little knowledge on how this well-known coalescence between slow oscillations and sleep spindles develops. Leveraging individualized detection of single events, we first provide a detailed cross-sectional characterization of age-specific patterns of slow and fast sleep spindles, slow oscillations, and their coupling in children and adolescents aged 5-6, 8-11, and 14-18 years, and an adult sample of 20- to 26-year-olds. Critically, based on this, we then investigated how spindle and slow oscillation maturity substantiate age-related differences in their precise orchestration. While the predominant type of fast spindles was development-specific in that it was still nested in a frequency range below the canonical fast spindle range for the majority of children, the well-known slow oscillation-spindle coupling pattern was evident for sleep spindles in the adult-like canonical fast spindle range in all four age groups-but notably less precise in children. To corroborate these findings, we linked personalized measures of fast spindle maturity, which indicate the similarity between the prevailing development-specific and adult-like canonical fast spindles, and slow oscillation maturity, which reflects the extent to which slow oscillations show frontal dominance, with individual slow oscillation-spindle coupling patterns. Importantly, we found that fast spindle maturity was uniquely associated with enhanced slow oscillation-spindle coupling strength and temporal precision across the four age groups. Taken together, our results suggest that the increasing ability to generate adult-like canonical fast sleep spindles actuates precise slow oscillation-spindle coupling patterns from childhood through adolescence and into young adulthood.

Memory ability and retention performance relate differentially to sleep depth and spindle type

Temporal interactions between non-rapid eye movement (NREM) sleep rhythms especially the coupling between cortical slow oscillations (SO, ∼1 Hz) and thalamic spindles (∼12 Hz) have been proposed to contribute to multi-regional interactions crucial for memory processing and cognitive ability. We investigated relationships between NREM sleep depth, sleep spindles and SO-spindle coupling regarding memory ability and memory consolidation in healthy humans. Findings underscore the functional relevance of spindle dynamics (slow versus fast), SO-phase, and most importantly NREM sleep depth for cognitive processing. Cross-frequency coupling analyses demonstrated stronger precise temporal coordination of slow spindles to SO down-state in N2 for subjects with higher general memory ability. A GLM model underscored this relationship, and furthermore that fast spindle properties were predictive of overnight memory consolidation. Our results suggest cognitive fingerprints dependent on conjoint fine-tuned SO-spindle temporal coupling, spindle properties, and brain sleep state.

Functional networks of working memory abilities in children with complex congenital heart disease: a sleep EEG study

Working memory is frequently impaired in children with complex congenital heart disease (CHD), but little is known about the functional neuronal correlates. Sleep slow wave activity (SWA; 1-4.5 Hz EEG power) has previously been shown to reliably map neurofunctional networks of cognitive abilities in children with and without neurodevelopmental impairments. This study investigated whether functional networks of working memory abilities are altered in children with complex CHD using EEG recordings during sleep. Twenty-one children with complex CHD (aged 10.9 [SD: 0.3] years) and 17 typically-developing peers (10.5 [0.7] years) completed different working memory tasks and an overnight high-density sleep EEG recording (128 electrodes). The combined working memory score tended to be lower in children with complex CHD (CHD group: -0.44 [1.12], typically-developing group: 0.55 [1.24], d = 0.59, p = .06). The working memory score and sleep SWA of the first hour of deep sleep were correlated over similar brain regions in both groups: Strong positive associations were found over prefrontal and fronto-parietal brain regions - known to be part of the working memory network - and strong negative associations were found over central brain regions. Within these working memory networks, the associations between working memory abilities and sleep SWA (r between -.36 and .58, all p < .03) were not different between the two groups (no interactions, all p > .05). The current findings suggest that sleep SWA reliably maps working memory networks in children with complex CHD and that these functional networks are generally preserved in these patients.

Spindle Chirp and other Sleep Oscillatory Features in Young Children with Autism

Objectives

To determine whether spindle chirp and other sleep oscillatory features differ in young children with and without autism.

Methods

Automated processing software was used to re-assess an extant set of polysomnograms representing 121 children (91 with autism [ASD], 30 typically-developing [TD]), with an age range of 1.35-8.23 years. Spindle metrics, including chirp, and slow oscillation (SO) characteristics were compared between groups. SO and fast and slow spindle (FS, SS) interactions were also investigated. Secondary analyses were performed assessing behavioural data associations, as well as exploratory cohort comparisons to children with non-autism developmental delay (DD).

Results

Posterior FS and SS chirp was significantly more negative in ASD than TD. Both groups had comparable intra-spindle frequency range and variance. Frontal and central SO amplitude were decreased in ASD. In contrast to previous manual findings, no differences were detected in other spindle or SO metrics. The ASD group displayed a higher parietal coupling angle. No differences were observed in phase-frequency coupling. The DD group demonstrated lower FS chirp and higher coupling angle than TD. Parietal SS chirp was positively associated with full developmental quotient.

Conclusions

For the first time spindle chirp was investigated in autism and was found to be significantly more negative than in TD in this large cohort of young children. This finding strengthens previous reports of spindle and SO abnormalities in ASD. Further investigation of spindle chirp in healthy and clinical populations across development will help elucidate the significance of this difference and better understand this novel metric.

The Importance of Sleep for Successful Neurorehabilitation after Stroke

Sleep has important clinical implications for neurorehabilitation after stroke. We aimed to systematically explore sleep (including naps) as an essential factor in the neurorehabilitation of patients after stroke. After titles and abstracts were screened, 49 full texts were reviewed, and 7 were included in this review. Data were extracted and assessed for quality and risk of bias. We looked at any neurorehabilitation setting, and compared sleep with no sleep and explored these factors in stroke patients versus healthy individuals. Rehabilitation is critical for many activities that may need to be learned or re-learned following stroke and for returning to everyday life. In this context, sleep is essential in neurorehabilitation and physical therapy practice as it supports neuroplasticity, memory, and learning. The available data suggest that sleep should be considered in the treatment plan for successfully targeted physiotherapy to optimize cognitive and motor learning. Physical therapists should advise about sleep hygiene and therapies to improve sleep, both quality and quantity.

Preliminary evidence of a relationship between sleep spindles and treatment response in epileptic encephalopathy

OBJECTIVE

Epileptic encephalopathy with spike-wave activation in sleep (EE-SWAS) is a challenging neurodevelopmental disease characterized by abundant epileptiform spikes during non-rapid eye movement (NREM) sleep accompanied by cognitive dysfunction. The mechanism of cognitive dysfunction is unknown, but treatment with high-dose diazepam may improve symptoms. Spike rate does not predict treatment response, but spikes may disrupt sleep spindles. We hypothesized that in patients with EE-SWAS: (1) spikes and spindles would be anti-correlated, (2) high-dose diazepam would increase spindles and decrease spikes, and (3) spindle response would be greater in those with cognitive improvement.

METHODS

Consecutive EE-SWAS patients treated with high-dose diazepam that met the criteria were included. Using a validated automated spindle detector, spindle rate, duration, and percentage were computed in pre- and post-treatment NREM sleep. Spikes were quantified using a validated automated spike detector. The cognitive response was determined from a chart review.

RESULTS

Spindle rate was anti-correlated with the spike rate in the channel with the maximal spike rate (p = 0.002) and averaged across all channels (p = 0.0005). Spindle rate, duration, and percentage each increased, and spike rate decreased, after high-dose diazepam treatment (p ≤ 2e-5, all tests). Spindle rate, duration, and percentage (p ≤ 0.004, all tests) were increased in patients with cognitive improvement after treatment, but not those without. Changes in spindle rate but not changes in spike rate distinguished between groups.

INTERPRETATION

These findings confirm thalamocortical disruption in EE-SWAS, identify a mechanism through which benzodiazepines may support cognitive recovery, and introduce sleep spindles as a promising mechanistic biomarker to detect treatment response in severe epileptic encephalopathies.

Preliminary evidence of a relationship between sleep spindles and treatment response in epileptic encephalopathy

Objective

Epileptic encephalopathy with spike wave activation in sleep (EE-SWAS) is a challenging neurodevelopmental disease characterized by abundant epileptiform spikes during non-rapid eye movement (NREM) sleep accompanied by cognitive dysfunction. The mechanism of cognitive dysfunction is unknown, but treatment with high-dose diazepam may improve symptoms. Spike rate does not predict treatment response, but spikes may disrupt sleep spindles. We hypothesized that in patients with EE-SWAS: 1) spikes and spindles would be anticorrelated, 2) high-dose diazepam would increase spindles and decrease spikes, and 3) spindle response would be greater in those with cognitive improvement.

Methods

Consecutive EE-SWAS patients treated with high-dose diazepam that met criteria were included. Using a validated automated spindle detector, spindle rate, duration, and percentage were computed in pre- and post-treatment NREM sleep. Spikes were quantified using a validated automated spike detector. Cognitive response was determined from chart review.

Results

Spindle rate was anticorrelated with spike rate in the channel with the maximal spike rate ( p =0.002) and averaged across all channels ( p =0.0005). Spindle rate, duration, and percentage each increased, and spike rate decreased, after high-dose diazepam treatment ( p≤ 2e-5, all tests). Spindle rate, duration, and percentage ( p ≤0.004, all tests) were increased in patients with cognitive improvement after treatment, but not those without. Changes in spike rate did not distinguish between groups.

Interpretation

These findings confirm thalamocortical disruption in EE-SWAS, identify a mechanism through which benzodiazepines may support cognitive recovery, and introduce sleep spindles as a promising mechanistic biomarker to detect treatment response in severe epileptic encephalopathies.

Sleep spindles in the healthy brain from birth through 18 years

STUDY OBJECTIVE

Sleep spindles are present from birth and reflect cognitive functions across the lifespan, but normative values for this cognitive biomarker across development are lacking. This study aims to establish normative spindle features over development.

METHODS

All available normal 19-channel electroencephalograms from developmentally normal children between February 2002 and June 2021 in the MGH EEG lab were analyzed. Approximately, 20 000 spindles were hand-marked to train and validate an automated spindle detector across ages. Normative values for spindle rate, duration, frequency, refractory period, and interhemispheric lag are provided for each channel and each age.

RESULTS

Sleep EEGs from 567 developmentally normal children (range 0 days to 18 years) were included. The detector had excellent performance (F1 = 0.47). Maximal spindle activity is seen over central regions during infancy and adolescence and frontopolar regions during childhood. Spindle rate and duration increase nonlinearly, with the most rapid changes during the first 4 months of life and between ages 3 and 14 years. Peak spindle frequency follows a U-shaped curve and discrete frontal slow and central fast spindles are evident by 18 months. Spindle refractory periods decrease between ages 1 and 14 years while interhemispheric asynchrony decreases over the first 3 months of life and between ages 1 and 14 years.

CONCLUSIONS

These data provide age- and region-specific normative values for sleep spindles across development, where measures that deviate from these values can be considered pathological. As spindles provide a noninvasive biomarker for cognitive function across the lifespan, these normative measures can accelerate the discovery and diagnosis in neurodevelopmental disorders.

An infant sleep electroencephalographic marker of thalamocortical connectivity predicts behavioral outcome in late infancy

Infancy represents a critical period during which thalamocortical brain connections develop and mature. Deviations in the maturation of thalamocortical connectivity are linked to neurodevelopmental disorders. There is a lack of early biomarkers to detect and localize neuromaturational deviations, which can be overcome with mapping through high-density electroencephalography (hdEEG) assessed in sleep. Specifically, slow waves and spindles in non-rapid eye movement (NREM) sleep are generated by the thalamocortical system, and their characteristics, slow wave slope and spindle density, are closely related to neuroplasticity and learning. Spindles are often subdivided into slow (11.0-13.0 Hz) and fast (13.5-16.0 Hz) frequencies, for which not only different functions have been proposed, but for which also distinctive developmental trajectories have been reported across the first years of life. Recent studies further suggest that information processing during sleep underlying sleep-dependent learning is promoted by the temporal coupling of slow waves and spindles, yet slow wave-spindle coupling remains unexplored in infancy. Thus, we evaluated three potential biomarkers: 1) slow wave slope, 2) spindle density, and 3) the temporal coupling of slow waves with spindles. We use hdEEG to first examine the occurrence and spatial distribution of these three EEG features in healthy infants and second to evaluate a predictive relationship with later behavioral outcomes. We report four key findings: First, infants' EEG features appear locally: slow wave slope is maximal in occipital and frontal areas, whereas slow and fast spindle density is most pronounced frontocentrally. Second, slow waves and spindles are temporally coupled in infancy, with maximal coupling strength in the occipital areas of the brain. Third, slow wave slope, fast spindle density, and slow wave-spindle coupling are not associated with concurrent behavioral status (6 months). Fourth, fast spindle density in central and frontocentral regions at age 6 months predicts overall developmental status at age 12 months, and motor skills at age 12 and 24 months. Neither slow wave slope nor slow wave-spindle coupling predict later behavioral development. We further identified spindle frequency as a determinant of slow and fast spindle density, which accordingly, also predicts motor skills at 24 months. Our results propose fast spindle density, or alternatively spindle frequency, as early EEG biomarker for identifying thalamocortical maturation, which can potentially be used for early diagnosis of neurodevelopmental disorders in infants. These findings are in support of a role of sleep spindles in sensorimotor microcircuitry development. A crucial next step will be to evaluate whether early therapeutic interventions may be effective to reverse deviations in identified individuals at risk.

A comparative analysis of sleep spindle characteristics of sleep-disordered patients and normal subjects

Spindles differ in density, amplitude, and frequency, and these variations reflect different physiological processes. Sleep disorders are characterized by difficulty in falling asleep and maintaining sleep. In this study, we proposed a new spindle wave detection algorithm, which was more effective compared with traditional detection algorithms such as wavelet algorithm. Besides, we recorded EEG data from 20 subjects with sleep disorders and 10 normal subjects, and then we compared the spindle characteristics of sleep-disordered subjects and normal subjects (those without any sleep disorder) to assess the spindle activity during human sleep. Specifically, we scored 30 subjects on the Pittsburgh Sleep Quality Index and then analyzed the association between their sleep quality scores and spindle characteristics, reflecting the effect of sleep disorders on spindle characteristics. We found a significant correlation between the sleep quality score and spindle density (p = 1.84 × 10−8, p-value &lt;0.05 was considered statistically significant.). We, therefore, concluded that the higher the spindle density, the better the sleep quality. The correlation analysis between the sleep quality score and mean frequency of spindles yielded a p-value of 0.667, suggesting that the spindle frequency and sleep quality score were not significantly correlated. The p-value between the sleep quality score and spindle amplitude was 1.33 × 10−4, indicating that the mean amplitude of the spindle decreases as the score increases, and the mean spindle amplitude is generally slightly higher in the normal population than in the sleep-disordered population. The normal and sleep-disordered groups did not show obvious differences in the number of spindles between symmetric channels C3/C4 and F3/F4. The difference in the density and amplitude of the spindles proposed in this paper can be a reference characteristic for the diagnosis of sleep disorders and provide valuable objective evidence for clinical diagnosis. In summary, our proposed detection method can effectively improve the accuracy of sleep spindle wave detection with stable performance. Meanwhile, our study shows that the spindle density, frequency and amplitude are different between the sleep-disordered and normal populations.

Do naps benefit novel word learning? Developmental differences and white matter correlates

Memory representations of newly learned words undergo changes during nocturnal sleep, as evidenced by improvements in explicit recall and lexical integration (i.e., after sleep, novel words compete with existing words during online word recognition). Some studies have revealed larger sleep-benefits in children relative to adults. However, whether daytime naps play a similar facilitatory role is unclear. We investigated the effect of a daytime nap (relative to wake) on explicit memory (recall/recognition) and lexical integration (lexical competition) of newly learned novel words in young adults and children aged 10-12 years, also exploring white matter correlates of the pre- and post-nap effects of word learning in the child group with diffusion weighted MRI. In both age groups, a nap maintained explicit memory of novel words and wake led to forgetting. However, there was an age group interaction when comparing change in recall over the nap: children showed a slight improvement whereas adults showed a slight decline. There was no evidence of lexical integration at any point. Although children spent proportionally more time in slow-wave sleep (SWS) than adults, neither SWS nor spindle parameters correlated with over-nap changes in word learning. For children, increased fractional anisotropy (FA) in the uncinate fasciculus and arcuate fasciculus were associated with the recognition of novel words immediately after learning, and FA in the right arcuate fasciculus was further associated with changes in recall of novel words over a nap, supporting the importance of these tracts in the word learning and consolidation process. These findings point to a protective role of naps in word learning (at least under the present conditions), and emphasize the need to better understand both the active and passive roles that sleep plays in supporting vocabulary consolidation over development.

Season is related to the slow wave and sigma activity of infants and toddlers

OBJECTIVE/BACKGROUND

Slow wave activity (SWA) and sigma frequency activity (SFA) are hallmarks of NREM sleep EEG and important indicators of neural plasticity, development of the central nervous system, and cognition. However, little is known about the factors that modulate these sleep EEG activities, especially in small children.

PATIENTS/METHODS

We analyzed the power spectral densities of SWA (1-4 Hz) and SFA range (10-15 Hz) from six EEG derivations of 56 infants (8 months) and 60 toddlers (24 months) during their all-night sleep and during the first and the last half of night sleep. The spectral values were compared between the four seasons.

RESULTS

In the spring group of infants, compared with the darker seasons, SFA was lower in the centro-occipital EEG derivations during both halves of the night. The SWA findings of the infants were restricted to the last half of the night (SWA2) and frontally, where SWA2 was higher during winter than spring. The toddlers presented less frontal SWA2 during winter compared with autumn. Both age groups showed a reduction in both SWA and SFA towards the last half of the night.

CONCLUSIONS

The sleep EEG spectral power densities are more often associated with seasons in infants' SFA range. The results might stem from seasonally changing light exposure, but the exact mechanism warrants further study. Moreover, contrary to the adult-like increment of SFA, the SFA at both ages was lower at the last part of the night sleep. This suggests different regulation of spindle activity in infants and toddlers.

Deep-spindle: An automated sleep spindle detection system for analysis of infant sleep spindles

BACKGROUND

Sleep spindles are an indicator of the development and integrity of the central nervous system in infants. Identifying sleep spindles manually in EEG is time-consuming and typically requires experienced experts. Automated detection of sleep spindles would greatly facilitate this analysis. Deep learning methods have been widely used recently in EEG analysis.

METHOD

We have developed a deep learning-based automated sleep spindle detection system, Deep-spindle, which employs a convolutional neural network (CNN) combined with a bidirectional Long Short-Term Memory (LSTM) network, which could assist in the analysis of infant sleep spindles. Deep-spindle was trained on the EEGs of ex-term infants to estimate the number and duration of sleep spindles. The ex-term EEG on channel F4-C4 was split into training (N=81) and validation (N=30) sets. An additional 30 ex-term EEG and 54 ex-preterm infant EEGs (channel F4-C4 and F3-C3) were used as an independent test set.

RESULT

Deep-spindle detected the number of sleep spindles with 91.9% to 96.5% sensitivity and 95.3% to 96.7% specificity, and estimated sleep spindle duration with a percent error of 13.1% to 19.1% in the independent test set. For each detected spindle event, the user is presented with amplitude, power spectral density and the spectrogram of the corresponding spindle EEG, and the probability of the event being a sleep spindle event, providing the user with insight into why the event is predicted as a sleep spindle to provide confidence in the predictions.

CONCLUSION

The Deep-spindle system can reduce physicians' workload, demonstrating the potential to assist physicians in the automated analysis of sleep spindles in infants.

The space-time profiles of sleep spindles and their coordination with slow oscillations on the electrode manifold

Sleep spindles are important for sleep quality and cognitive functions, with their coordination with slow oscillations (SOs) potentially organizing cross-region reactivation of memory traces. Here, we describe the organization of spindles on the electrode manifold and their relation to SOs. We analyzed the sleep night EEG of 34 subjects and detected spindles and SOs separately at each electrode. We compared spindle properties (frequency, duration, and amplitude) in slow wave sleep (SWS) and Stage 2 sleep (S2); and in spindles that coordinate with SOs or are uncoupled. We identified different topographical spindle types using clustering analysis that grouped together spindles co-detected across electrodes within a short delay (±300 ms). We then analyzed the properties of spindles of each type, and coordination to SOs. We found that SWS spindles are shorter than S2 spindles, and spindles at frontal electrodes have higher frequencies in S2 compared to SWS. Furthermore, S2 spindles closely following an SO (about 10% of all spindles) show faster frequency, shorter duration, and larger amplitude than uncoupled ones. Clustering identified Global, Local, Posterior, Frontal-Right and Left spindle types. At centro-parietal locations, Posterior spindles show faster frequencies compared to other types. Furthermore, the infrequent SO-spindle complexes are preferentially recruiting Global SO waves coupled with fast Posterior spindles. Our results suggest a non-uniform participation of spindles to complexes, especially evident in S2. This suggests the possibility that different mechanisms could initiate an SO-spindle complex compared to SOs and spindles separately. This has implications for understanding the role of SOs-spindle complexes in memory reactivation.

Sleep Deficiency in Adolescents: The School Start Time Debate

Adolescence is commonly accepted as a challenging time for sleep, with multiple factors contributing to sleep deficiency in adolescents. These include physiologic changes with shifts in their circadian rhythm; medical sleep disorders; and social, cultural, and environmental factors. Early school start times negatively affect sleep in adolescents as well, with poorer outcomes in their overall health, wellbeing, and performance. This article highlights the different contributing factors for sleep deficiency in adolescents and the consequences of sleep deficiency. In addition, the authors discuss the impact of delayed school start times in improving adolescents' sleep and overall function.

Relations between sleep patterns early in life and brain development: A review

Sleep supports healthy cognitive functioning in adults. Over the past decade, research has emerged advancing our understanding of sleep’s role in cognition during development. Infancy and early childhood are marked by unique changes in sleep physiology and sleep patterns as children transition from biphasic to monophasic sleep. Growing evidence suggests that, during development, there are parallel changes in sleep and the brain and that sleep may modulate brain structure and activity and vice versa. In this review, we survey studies of sleep and brain development across childhood. By summarizing these findings, we provide a unique understanding of the importance of healthy sleep for healthy brain and cognitive development. Moreover, we discuss gaps in our understanding, which will inform future research.

Topographical relocation of adolescent sleep spindles reveals a new maturational pattern in the human brain

Current theories of human neural development emphasize the posterior-to-anterior pattern of brain maturation. However, this scenario leaves out significant brain areas not directly involved with sensory input and behavioral control. Suggesting the relevance of cortical activity unrelated to sensory stimulation, such as sleep, we investigated adolescent transformations in the topography of sleep spindles. Sleep spindles are known to be involved in neural plasticity and in adults have a bimodal topography: slow spindles are frontally dominant, while fast spindles have a parietal/precuneal origin. The late functional segregation of the precuneus from the frontoparietal network during adolescence suggests that spindle topography might approach the adult state relatively late in development, and it may not be a result of the posterior-to-anterior maturational pattern. We analyzed the topographical distribution of spindle parameters in HD-EEG polysomnographic sleep recordings of adolescents and found that slow spindle duration maxima traveled from central to anterior brain regions, while fast spindle density, amplitude and frequency peaks traveled from central to more posterior brain regions. These results provide evidence for the gradual posteriorization of the anatomical localization of fast sleep spindles during adolescence and indicate the existence of an anterior-to-posterior pattern of human brain maturation.

The Impact of Preterm Birth on Sleep through Infancy, Childhood and Adolescence and Its Implications

There is emergent literature on the relationship between the development of sleep-wake cycles, sleep architecture, and sleep duration during the neonatal period on neurodevelopmental outcomes among children born preterm. There is also a growing literature on techniques to assess sleep staging in preterm neonates using either EEG methods or heart and respiration rate. Upon discharge from hospital, sleep in children born preterm has been assessed using parent report, actigraphy, and polysomnography. This review describes the ontogeny and measurement of sleep in the neonatal period, the current evidence on the impact of preterm birth on sleep both in the NICU and in childhood and adolescence, and the interaction between sleep, cognition, and social-emotional outcomes in this population.

Dyscoordination of non-rapid eye movement sleep oscillations in autism spectrum disorder

Study Objectives

Converging evidence from neuroimaging, sleep, and genetic studies suggest that dysregulation of thalamocortical interactions mediated by the thalamic reticular nucleus (TRN) contribute to autism spectrum disorder (ASD). Sleep spindles assay TRN function, and their coordination with cortical slow oscillations (SOs) indexes thalamocortical communication. These oscillations mediate memory consolidation during sleep. In the present study, we comprehensively characterized spindles and their coordination with SOs in relation to memory and age in children with ASD.

Methods

Nineteen children and adolescents with ASD, without intellectual disability, and 18 typically developing (TD) peers, aged 9–17, completed a home polysomnography study with testing on a spatial memory task before and after sleep. Spindles, SOs, and their coordination were characterized during stages 2 (N2) and 3 (N3) non-rapid eye movement sleep.

Results

ASD participants showed disrupted SO-spindle coordination during N2 sleep. Spindles peaked later in SO upstates and their timing was less consistent. They also showed a spindle density (#/min) deficit during N3 sleep. Both groups showed significant sleep-dependent memory consolidation, but their relations with spindle density differed. While TD participants showed the expected positive correlations, ASD participants showed the opposite.

Conclusions

The disrupted SO-spindle coordination and spindle deficit provide further evidence of abnormal thalamocortical interactions and TRN dysfunction in ASD. The inverse relations of spindle density with memory suggest a different function for spindles in ASD than TD. We propose that abnormal sleep oscillations reflect genetically mediated disruptions of TRN-dependent thalamocortical circuit development that contribute to the manifestations of ASD and are potentially treatable.

Covering the Gap Between Sleep and Cognition – Mechanisms and Clinical Examples

A growing number of studies have shown the strong relationship between sleep and different cognitive processes, especially those that involve memory consolidation. Traditionally, these processes were attributed to mechanisms related to the macroarchitecture of sleep, as sleep cycles or the duration of specific stages, such as the REM stage. More recently, the relationship between different cognitive traits and specific waves (sleep spindles or slow oscillations) has been studied. We here present the most important physiological processes induced by sleep, with particular focus on brain electrophysiology. In addition, recent and classical literature were reviewed to cover the gap between sleep and cognition, while illustrating this relationship by means of clinical examples. Finally, we propose that future studies may focus not only on analyzing specific waves, but also on the relationship between their characteristics as potential biomarkers for multiple diseases.

Nonrapid eye movement sleep characteristics and relations with motor, memory, and cognitive ability from infancy to preadolescence

Sleep plays a critical role in neural neurodevelopment. Hallmarks of sleep reflected in the electroencephalogram during nonrapid eye movement (NREM) sleep are associated with learning processes, cognitive ability, memory, and motor functioning. Research in adults is well-established; however, the role of NREM sleep in childhood is less clear. Growing evidence suggests the importance of two NREM sleep features: slow-wave activity and sleep spindles. These features may be critical for understanding maturational change and the functional role of sleep during development. Here, we review the literature on NREM sleep from infancy to preadolescence to provide insight into the network dynamics of the developing brain. The reviewed findings show distinct relations between topographical and maturational aspects of slow waves and sleep spindles; however, the direction and consistency of these relationships vary, and associations with cognitive ability remain unclear. Future research investigating the role of NREM sleep and development would benefit from longitudinal approaches, increased control for circadian and homeostatic influences, and in early childhood, studies recording daytime naps and overnight sleep to yield increased precision for detecting age-related change. Such evidence could help explicate the role of NREM sleep and provide putative physiological markers of neurodevelopment.

EEG sleep macrostructure and sleep spindles in early infancy

Study Objectives

Sleep features in infancy are potential biomarkers for brain maturation but poorly characterized. We describe normative values for sleep macrostructure and sleep spindles at 4–5 months of age.

Methods

Healthy term infants were recruited at birth and had daytime sleep electroencephalograms (EEGs) at 4–5 months. Sleep staging was performed and five features were analyzed. Sleep spindles were annotated and seven quantitative features were extracted. Features were analyzed across sex, recording time (am/pm), infant age, and from first to second sleep cycles.

Results

We analyzed sleep recordings from 91 infants, 41% females. Median (interquartile range [IQR]) macrostructure results: sleep duration 49.0 (37.8–72.0) min (n = 77); first sleep cycle duration 42.8 (37.0–51.4) min; rapid eye movement (REM) percentage 17.4 (9.5–27.7)% (n = 68); latency to REM 36.0 (30.5–41.1) min (n = 66). First cycle median (IQR) values for spindle features: number 241.0 (193.0–286.5), density 6.6 (5.7–8.0) spindles/min (n = 77); mean frequency 13.0 (12.8–13.3) Hz, mean duration 2.9 (2.6–3.6) s, spectral power 7.8 (4.7–11.4) µV², brain symmetry index 0.20 (0.16–0.29), synchrony 59.5 (53.2–63.8)% (n = 91). In males, spindle spectral power (µV²) was 24.5% lower (p = .032) and brain symmetry index 24.2% higher than females (p = .011) when controlling for gestational and postnatal age and timing of the nap. We found no other significant associations between studied sleep features and sex, recording time (am/pm), or age. Spectral power decreased (p < .001) on the second cycle.

Conclusion

This normative data may be useful for comparison with future studies of sleep dysfunction and atypical neurodevelopment in infancy.

Clinical Trial Registration: BABY SMART (Study of Massage Therapy, Sleep And neurodevelopMenT) (BabySMART)

URL: https://clinicaltrials.gov/ct2/show/results/NCT03381027?view=results.

ClinicalTrials.gov Identifier: NCT03381027

Diazepam induced sleep spindle increase correlates with cognitive recovery in a child with epileptic encephalopathy

BACKGROUND

Continuous spike and wave of sleep with encephalopathy (CSWS) is a rare and severe developmental electroclinical epileptic encephalopathy characterized by seizures, abundant sleep activated interictal epileptiform discharges, and cognitive regression or deceleration of expected cognitive growth. The cause of the cognitive symptoms is unknown, and efforts to link epileptiform activity to cognitive function have been unrevealing. Converging lines of evidence implicate thalamocortical circuits in these disorders. Sleep spindles are generated and propagated by the same thalamocortical circuits that can generate spikes and, in healthy sleep, support memory consolidation. As such, sleep spindle deficits may provide a physiologically relevant mechanistic biomarker for cognitive dysfunction in epileptic encephalopathies.

CASE PRESENTATION

We describe the longitudinal course of a child with CSWS with initial cognitive regression followed by dramatic cognitive improvement after treatment. Using validated automated detection algorithms, we analyzed electroencephalograms for epileptiform discharges and sleep spindles alongside contemporaneous neuropsychological evaluations over the course of the patient's disease. We found that sleep spindles increased dramatically with high-dose diazepam treatment, corresponding with marked improvements in cognitive performance. We also found that the sleep spindle rate was anticorrelated to spike rate, consistent with a competitively shared underlying thalamocortical circuitry.

CONCLUSIONS

Epileptic encephalopathies are challenging electroclinical syndromes characterized by combined seizures and a deceleration or regression in cognitive skills over childhood. This report identifies thalamocortical circuit dysfunction in a case of epileptic encephalopathy and motivates future investigations of sleep spindles as a biomarker of cognitive function and a potential therapeutic target in this challenging disease.

Abnormal sleep physiology in children with 15q11.2-13.1 duplication (Dup15q) syndrome

BACKGROUND

Sleep disturbances in autism spectrum disorder (ASD) represent a common and vexing comorbidity. Clinical heterogeneity amongst these warrants studies of the mechanisms associated with specific genetic etiologies. Duplications of 15q11.2-13.1 (Dup15q syndrome) are highly penetrant for neurodevelopmental disorders (NDDs) such as intellectual disability and ASD, as well as sleep disturbances. Genes in the 15q region, particularly UBE3A and a cluster of GABA_A receptor genes, are critical for neural development, synaptic protein synthesis and degradation, and inhibitory neurotransmission. During awake electroencephalography (EEG), children with Dup15q syndrome demonstrate increased beta band oscillations (12-30 Hz) that likely reflect aberrant GABAergic neurotransmission. Healthy sleep rhythms, necessary for robust cognitive development, are also highly dependent on GABAergic neurotransmission. We therefore hypothesized that sleep physiology would be abnormal in children with Dup15q syndrome.

METHODS

To test the hypothesis that elevated beta oscillations persist in sleep in Dup15q syndrome and that NREM sleep rhythms would be disrupted, we computed: (1) beta power, (2) spindle density, and (3) percentage of slow-wave sleep (SWS) in overnight sleep EEG recordings from a cohort of children with Dup15q syndrome (n = 15) and compared them to age-matched neurotypical children (n = 12).

RESULTS

Children with Dup15q syndrome showed abnormal sleep physiology with elevated beta power, reduced spindle density, and reduced or absent SWS compared to age-matched neurotypical controls.

LIMITATIONS

This study relied on clinical EEG where sleep staging was not available. However, considering that clinical polysomnograms are challenging to collect in this population, the ability to quantify these biomarkers on clinical EEG-routinely ordered for epilepsy monitoring-opens the door for larger-scale studies. While comparable to other human studies in rare genetic disorders, a larger sample would allow for examination of the role of seizure severity, medications, and developmental age that may impact sleep physiology.

CONCLUSIONS

We have identified three quantitative EEG biomarkers of sleep disruption in Dup15q syndrome, a genetic condition highly penetrant for ASD. Insights from this study not only promote a greater mechanistic understanding of the pathophysiology defining Dup15q syndrome, but also lay the foundation for studies that investigate the association between sleep and cognition. Abnormal sleep physiology may undermine healthy cognitive development and may serve as a quantifiable and modifiable target for behavioral and pharmacological interventions.

Changes in sleep structure and sleep spindles are associated with the neuropsychiatric profile in paradoxical insomnia

AIM

Sleep spindles have an important role in the pathophysiology and perception of sleep. We aimed to investigate the link between sleep spindles and microstructural architecture of sleep in regard to psychiatric characteristics in paradoxical insomnia.

METHOD

A total of 40 participants (20 with paradoxical insomnia, 20 healthy controls) were included in the study. All participants were evaluated by somnologists and undergone a full-night polysomnography at sleep laboratory. In addition, psychiatric interview was made by the same psychiatrist, and questionnaires were performed to assess the dimensions of the personality such as the neuroticism or extroversion (Eysenck Personality Questionnaire, EPQR-A); to evaluate the tendency to exaggerate somatic perceptions (Somatosensory Amplification Scale, SSAS), somatic parts of dissociation (Somatoform Dissociation Questionnaire, SDQ-20), and somatization (Somatization Scale, SS); to measure participants' feelings about their health and disease anxiety (Health Anxiety Inventory, HAI-18), and the level of uncontrollable and persistent anxiety (Penn State Worry Questionnaire, PSWQ); to investigate the tendency to ruminative thinking (Ruminative Thought Style Questionnaire, RTSQ), alexithymia (Toronto Alexithymia Scale, TAS-20); and to define the presence and the severity of depressive symptoms (Beck Depression Inventory, BDI).

RESULTS

The duration and frequency of the sleep spindles were similar between two groups, while the density was significantly decreased in paradoxical insomnia. The duration of sleep spindles, on the other hand, showed positive correlations with the extroversion dimension scores of EPQR-A and PSWQ scores.

DISCUSSION

Sleep protective mechanisms are disturbed in paradoxical insomnia as shown by the lower density of sleep spindles. In addition, fast spindle activity is associated with the personality traits, characterized by an increase in the expression of feelings and the level of anxiety.

Sex and Pubertal Differences in the Maturational Trajectories of Sleep Spindles in the Transition from Childhood to Adolescence: A Population-Based Study

Sleep spindles, bursts of electroencephalogram (EEG) activity in the σ-frequency (11–16 Hz) range, may be biomarkers of cortical development. Studies capturing the transition to adolescence are needed to delineate age-related, sex-related, and pubertal-related changes in sleep spindles at the population-level. We analyzed the sleep EEG of 572 subjects 6–21 years (48% female) and 332 subjects 5–12 years (46% female) followed-up at 12–22 years. From 6 to 21 years, spindle density (p quadratic = 0.019) and fast (12–16 Hz) spindle percent (p quadratic = 0.016) showed inverted U-shaped trajectories, with plateaus after 15 and 19 years, respectively. Spindle frequency increased (p linear < 0.001), while spindle power decreased (p linear < 0.001) from 6 to 21 years. The trajectories of spindle density, frequency, and fast spindle percent diverged between females and males, in whom density plateaued by 14 years, fast spindle percent by 16 years, and frequency by 18 years, while fast spindle percent and spindle frequency continued to increase until 21 years in females. Males experienced a longitudinal increase in spindle density 31% greater than females by 12–14 years (p = 0.006). Females experienced an increase in spindle frequency and fast spindle percent 2% and 41% greater, respectively, than males by 18–22 years (both p = 0.004), while males experienced a 14% greater decline in spindle power by 18–22 years (p = 0.018). Less mature adolescents (86% male) experienced a longitudinal increase in spindle density 36% greater than mature adolescents by 12–14 years (p = 0.002). Overall, males experience greater maturational changes in spindle density in the transition to adolescence, driven by later pubertal development, and sex differences become prominent in early adulthood when females have greater spindle power, frequency, and fast spindle percent.

How do children with autism spectrum disorder form gist memory during sleep? A study of slow oscillation-spindle coupling

Sleep is assumed to support memory through an active systems consolidation process that does not only strengthen newly encoded representations but also facilitates the formation of more abstract gist memories. Studies in humans and rodents indicate a key role of the precise temporal coupling of sleep slow oscillations (SO) and spindles in this process. The present study aimed at bolstering these findings in typically developing (TD) children, and at dissecting particularities in SO-spindle coupling underlying signs of enhanced gist memory formation during sleep found in a foregoing study in children with autism spectrum disorder (ASD) without intellectual impairment. Sleep data from 19 boys with ASD and 20 TD boys (9-12 years) were analyzed. Children performed a picture-recognition task and the Deese-Roediger-McDermott (DRM) task before nocturnal sleep (encoding) and in the next morning (retrieval). Sleep-dependent benefits for visual-recognition memory were comparable between groups but were greater for gist abstraction (recall of DRM critical lure words) in ASD than TD children. Both groups showed a closely comparable SO-spindle coupling, with fast spindle activity nesting in SO-upstates, suggesting that a key mechanism of memory processing during sleep is fully functioning already at childhood. Picture-recognition at retrieval after sleep was positively correlated to frontocortical SO-fast-spindle coupling in TD children, and less in ASD children. Critical lure recall did not correlate with SO-spindle coupling in TD children but showed a negative correlation (r = -.64, p = .003) with parietal SO-fast-spindle coupling in ASD children, suggesting other mechanisms specifically conveying gist abstraction, that may even compete with SO-spindle coupling.

Electrophysiological indicators of sleep-associated memory consolidation in 5- to 6-year-old children

In adults, the synchronized interplay of sleep spindles (SP) and slow oscillations (SO) supports memory consolidation. Given tremendous developmental changes in SP and SO morphology, it remains elusive whether across childhood the same mechanisms as identified in adults are functional. Based on topography and frequency, we characterize slow and fast SPs and their temporal coupling to SOs in 24 pre-school children. Further, we ask whether slow and fast SPs and their modulation during SOs are associated with behavioral indicators of declarative memory consolidation as suggested by the literature on adults. Employing an individually tailored approach, we reliably identify an inherent, development-specific fast centro-parietal SP type, nested in the adult-like slow SP frequency range, along with a dominant slow frontal SP type. Further, we provide evidence that the modulation of fast centro-parietal SPs during SOs is already present in pre-school children. However, the temporal coordination between fast centro-parietal SPs and SOs is weaker and less precise than expected from research on adults. While we do not find evidence for a critical contribution of SP-SO coupling for memory consolidation, crucially, slow frontal and fast centro-parietal SPs are each differentially related to sleep-associated consolidation of items of varying quality. Whereas a higher number of slow frontal SPs is associated with stronger maintenance of medium-quality memories, a higher number of fast centro-parietal SPs is linked to a greater gain of low-quality items. Our results demonstrate two functionally relevant inherent SP types in pre-school children although SP-SO coupling is not yet fully mature.

Characteristics of sleep spindles in school-aged children with attention-deficit/hyperactivity disorder

OBJECTIVE

Attention deficit/hyperactivity disorder (ADHD) is a complex disorder, characterized by different presentations with distinct cognitive and neurobiological characterizations. Here we aimed to investigate whether sleep spindle activity, which has been associated with brain maturation, may be a potential biomarker able to differentiate ADHD presentations in school-aged children (7-11 years).

METHOD

Spindle characteristics were extracted from overnight polysomnography in 74 children (27 ADHD-Inattentive [IQ = 96.04], 25 ADHD-hyperactive/impulsive [IQ = 98.9], and 22 ADHD-combined [IQ = 96.1]). We obtained data of the frontal (Fz) and parietal (Pz) derivations using a validated spindle detection algorithm.

RESULTS

Children with ADHD showed a higher number and density of slow compared to fast spindles which were more frequent in frontal area. No differences were observed among ADHD presentations for any spindle characteristics. Spindle frequency and density increased with age, indicating an age-dependent maturation of different sleep spindles. However, no associations between IQ and spindle characteristics were observed.

CONCLUSIONS

In children with ADHD the spindle characteristics evolve with age but sleep spindle activity does not seem to be a valid biomarker of ADHD phenotypes or general cognitive ability.

Aerobic fitness and the sleeping brain of adolescents-a pilot study

STUDY OBJECTIVES

Aerobic fitness (AF) and sleep are major determinants of health in adolescents and impact neurocognitive and psychological development. However, little is known about the interactions between AF and sleep during the developmental transition experienced across adolescence. This study aimed to consider the relationships between AF and habitual sleep patterns and sleep neurophysiology in healthy adolescents.

METHODS

Subjects (mean age = 14.6 ± 2.3 years old, range 11-17, 11 females) were evaluated for AF (peak VO2 assessed by ramp-type progressive cycle ergometry in the laboratory), habitual sleep duration and efficiency (7-14 days actigraphy), and topographic patterns of spectral power in slow wave, theta, and sleep spindle frequencies in non-rapid eye movement (NREM) sleep using overnight polysomnography (PSG) with high-density electroencephalography (hdEEG, 128 channels).

RESULTS

Significant relationships were observed between peak VO2 and habitual bedtime (r = -0.650, p = .009) and wake-up time (r = -0.603, p = .017), with greater fitness associated with going to bed and waking up earlier. Peak VO2 significantly predicted slow oscillations (0.5-1 Hz, p = .018) and theta activity (4.5-7.5 Hz, p = .002) over anterior frontal and central derivations (p < .001 and p = .001, respectively) after adjusting for sex and pubertal development stage. Similar associations were detected for fast sleep spindle activity (13-16 Hz, p = .006), which was greater over temporo-parietal derivations.

CONCLUSIONS

Greater AF was associated with a more mature pattern of topographically-specific features of sleep EEG known to support neuroplasticity and cognitive processes and which are dependent on prefrontal cortex and hippocampal function in adolescents and adults. AF was also correlated with a smaller behavioral sleep phase delay commonly seen during adolescence.

Sleep and human cognitive development

Emerging studies across learning domains have shed light on mechanisms underlying sleep's benefits during numerous developmental periods. In this conceptual review, we survey recent studies of sleep and cognition across infancy, childhood, and adolescence. By summarizing recent findings and integrating across studies with disparate approaches, we provide a novel understanding of sleep's role in human cognitive function. Collectively, these studies point to an interrelation between brain development, sleep, and cognition. Moreover, we point to gaps in our understanding, which inform the agenda for future research in developmental and sleep science.

The relation between sigma power and internalizing problems across development

Internalizing problems are characterized by deficits in emotion processing and regulation. They are among the most common problems in children and adolescents and mark an increased risk for depressive and anxiety disorders in later life. First evidence suggests that sleep alterations are related to the development and/or persistence of mood and anxiety disorders in children, adolescents, and adults. Most recently, data from clinical samples showed that brain activity in the sigma frequency band (9-16 Hz, i.e. sleep spindle frequency) is associated with internalizing problems in children and adolescents. However, less is known about the association between sigma power and internalizing problems in healthy participants within this age group. Here, we re-analyzed longitudinal data (25 healthy subjects (18 females) at two time points (T1: childhood mean age: 9.52 ± 0.77; T2: adolescence mean age: 16.08 ± 0.91) by correlating sigma power with measures for internalizing problems. Moreover, we calculated sigma power ratios (frontal/central, frontal/parietal, frontal/occipital) to examine whether these measures would reflect developmental changes more accurately. We found that higher values of internalizing problems at T1 were related to a lower decrease in sigma power from T1 to T2 at frontal and central derivations. Furthermore, higher values of internalizing problems at T1 as well as at T2 were related to higher sigma power ratios at T2. We suggest that sigma power may reflect maturational processes (e.g. network efficiency, integrity) related to the development of internalizing problems. In particular, a stronger decrease in frontal sigma power from childhood to adolescence may indicate a healthier development. Thus, our results emphasize the role of sigma power as a useful marker for internalizing problems during adolescence.

Sleep Spindle Features and Neurobehavioral Performance in Healthy School-Aged Children

PURPOSE

In adults, central fast-frequency sleep spindles are involved in learning and memory functions. The density of local spindles is higher than global spindles, emphasizing the importance of local plastic neural processes. In children, findings on the association of spindles with cognition are more variable. Hence, we aim to study whether the local spindles are also important for neurobehavioral performance in children.

METHODS

We studied the correlations between local (occurring in only one channel: Fp1, Fp2, C3, or C4), bilateral, and diffuse (occurring in all four channels) spindles and neurobehavioral performance in 17 healthy children (median age 9.6 years).

RESULTS

Local spindles were not as frequent as bilateral spindles (P-values < 0.05). Central spindle types had significant correlations with sensorimotor and language functions (e.g., the density of bilateral central spindles correlated positively with the Object Assembly in NEPSY, r = 0.490). Interestingly, frontopolar spindles correlated with behavior (e.g., the more bilateral the frontopolar spindles, the less hyperactive the children, r = -0.618).

CONCLUSIONS

In children, the local spindles, but also more widespread central spindles, seem to be involved in the cognitive processes. Based on our findings, it is important that ageadjusted frequency limits are used in studies evaluating the frequencies of spindles in children.

Deficits of Learning in Procedural Memory and Consolidation in Declarative Memory in Adults With Developmental Language Disorder

Purpose This study examined procedural and declarative learning and consolidation abilities in adults with developmental language disorder (DLD) relative to their typical language (TD) peers. Method A total of 100 young adults (age 18-24 years) with (n = 21) and without (n = 79) DLD participated across two sites. Performance measures on a recognition memory task and a serial reaction time task were used to assess declarative and procedural memory, respectively. Performance was measured shortly after learning (8 a.m.) and again after a 12-hr, overnight delay (8 a.m.). Results Linear mixed-effects modeling was used to examine the effects of time and group membership on task performance. For the serial reaction time task, there were significant effects of group (TD > DLD) and time (Day 1 > Day 2), but no interaction between them. For the recognition memory task, there was a significant interaction between group and time, driven by overnight gains in the TD group, combined with stable performance across days by those with DLD. Conclusions In procedural memory, adults with DLD demonstrate a learning deficit relative to adults without DLD, but appear to have comparable retention of learned information. In declarative memory, adults with DLD demonstrate a deficit in the overnight enhancement of memory retrieval, despite typical-like learning exhibited when tested shortly after encoding. Supplemental Material https://doi.org/10.23641/asha.13626485.

Shared and unique features of mammalian sleep spindles - insights from new and old animal models

Sleep spindles are phasic events observed in mammalian non-rapid eye movement sleep. They are relevant today in the study of memory consolidation, sleep quality, mental health and ageing. We argue that our advanced understanding of their mechanisms has not exhausted the utility and need for animal model work. This is both because some topics, like cognitive ageing, have not yet been addressed sufficiently in comparative efforts and because the evolutionary history of this oscillation is still poorly understood. Comparisons across species often are either limited to referencing the classical cat and rodent models, or are over-inclusive, uncritically including reports of sleep spindles in rarely studied animals. In this review, we discuss the emergence of new (dog and sheep) models for sleep spindles and compare the strengths and shortcomings of new and old models based on the three validation criteria for animal models - face, predictive, and construct validity. We conclude that an emphasis on cognitive ageing might dictate the future of comparative sleep spindle studies, a development that is already becoming visible in studies on dogs. Moreover, reconstructing the evolutionary history of sleep spindles will require more stringent criteria for their identification, across more species. In particular, a stronger emphasis on construct and predictive validity can help verify if spindle-like events in other species are actual sleep spindles. Work in accordance with such stricter validation suggests that sleep spindles display more universally shared features, like defining frequency, than previously thought.

Focal Sleep Spindle Deficits Reveal Focal Thalamocortical Dysfunction and Predict Cognitive Deficits in Sleep Activated Developmental Epilepsy

Childhood epilepsy with centrotemporal spikes (CECTS) is the most common focal epilepsy syndrome, yet the cause of this disease remains unknown. Now recognized as a mild epileptic encephalopathy, children exhibit sleep-activated focal epileptiform discharges and cognitive difficulties during the active phase of the disease. The association between the abnormal electrophysiology and sleep suggests disruption to thalamocortical circuits. Thalamocortical circuit dysfunction resulting in pathologic epileptiform activity could hinder the production of sleep spindles, a brain rhythm essential for memory processes. Despite this pathophysiologic connection, the relationship between spindles and cognitive symptoms in epileptic encephalopathies has not been previously evaluated. A significant challenge limiting such work has been the poor performance of available automated spindle detection methods in the setting of sharp activities, such as epileptic spikes. Here, we validate a robust new method to accurately measure sleep spindles in patients with epilepsy. We then apply this detector to a prospective cohort of male and female children with CECTS with combined high-density EEGs during sleep and cognitive testing at varying time points of disease. We show that: (1) children have a transient, focal deficit in spindles during the symptomatic phase of disease; (2) spindle rate anticorrelates with spike rate; and (3) spindle rate, but not spike rate, predicts performance on cognitive tasks. These findings demonstrate focal thalamocortical circuit dysfunction and provide a pathophysiological explanation for the shared seizures and cognitive symptoms in CECTS. Further, this work identifies sleep spindles as a potential treatment target of cognitive dysfunction in this common epileptic encephalopathy.SIGNIFICANCE STATEMENT Childhood epilepsy with centrotemporal spikes is the most common idiopathic focal epilepsy syndrome, characterized by self-limited focal seizures and cognitive symptoms. Here, we provide the first evidence that focal thalamocortical circuit dysfunction underlies the shared seizures and cognitive dysfunction observed. In doing so, we identify sleep spindles as a mechanistic biomarker, and potential treatment target, of cognitive dysfunction in this common developmental epilepsy and provide a novel method to reliably quantify spindles in brain recordings from patients with epilepsy.

Sleep-Related Declarative Memory Consolidation in Children and Adolescents with Developmental Dyslexia

Sleep has a crucial role in memory processes, and maturational changes in sleep electrophysiology are involved in cognitive development. Albeit both sleep and memory alterations have been observed in Developmental Dyslexia (DD), their relation in this population has been scarcely investigated, particularly concerning topographical aspects. The study aimed to compare sleep topography and associated sleep-related declarative memory consolidation in participants with DD and normal readers (NR). Eleven participants with DD and 18 NR (9–14 years old) underwent a whole-night polysomnography. They were administered a word pair task before and after sleep to assess for declarative memory consolidation. Memory performance and sleep features (macro and microstructural) were compared between the groups, and the intercorrelations between consolidation rate and sleep measures were assessed. DD showed a deeper worsening in memory after sleep compared to NR and reduced slow spindles in occipito-parietal and left fronto-central areas. Our results suggest specific alterations in local sleep EEG (i.e., sleep spindles) and in sleep-dependent memory consolidation processes in DD. We highlight the importance of a topographical approach, which might shed light on potential alteration in regional cortical oscillation dynamics in DD. The latter might represent a target for therapeutic interventions aimed at enhancing cognitive functioning in DD.

Neurocognitive Effects of Sleep Disruption in Children and Adolescents

A main childhood task is learning. In this task, the role of sleep is increasingly demonstrated. Although most literature examining this role focuses on preadolescence and middle adolescence, some studies apply napping designs in preschoolers. Studies overall conclude that without proper sleep a child's cognitive abilities suffer, but questions on how and to what extent linger. Observational studies show the hazards of potential confounders such as an individual's resilience to poor sleep as well as developmental risk factors (eg, disorders, stressors). A better understanding of cognitive sleep neuroscience may have a big impact on pediatric sleep research and clinical applications.

Sleep and Memory in Children

Purpose of Review

This short review article aims at emphasizing interesting and important new insights about investigating sleep and memory in children aged between 6 and 13 years (middle childhood).

Recent Findings

That sleep in comparison to wakefulness benefits the consolidation of memories is well established—especially for the adult population. However, the underlying theoretical frameworks trying to explain the benefits of sleep for memory still strive for more substantiate findings including biological and physiological correlates.

Summary

Based on the most recent literature about sleep-related memory consolidation and its physiological markers during middle childhood, this article provides a review and highlights recent updates in this field.

Wide awake at bedtime? Effects of caffeine on sleep and circadian timing in male adolescents - A randomized crossover trial

Adolescents often suffer from short and mistimed sleep. To counteract the resulting daytime sleepiness they frequently consume caffeine. However, caffeine intake may exaggerate sleep problems by disturbing sleep and circadian timing. In a 28-hour double-blind randomized crossover study, we investigated to what extent caffeine disturbs slow-wave sleep (SWS) and delays circadian timing in teenagers. Following a 6-day ambulatory phase of caffeine abstinence and fixed sleep-wake cycles, 18 male teenagers (14-17 years old) ingested 80 mg caffeine vs. placebo in the laboratory four hours prior to an electro-encephalographically (EEG) recorded nighttime sleep episode. Data were analyzed using both frequentist and Bayesian statistics. The analyses suggest that subjective sleepiness is reduced after caffeine compared to placebo. However, we did not observe a strong caffeine-induced reduction in subjective sleep quality or SWS, but rather a high inter-individual variability in caffeine-induced SWS changes. Exploratory analyses suggest that particularly those individuals with a higher level of SWS during placebo reduced SWS in response to caffeine. Regarding salivary melatonin onsets, caffeine-induced delays were not evident at group level, and only observed in participants exposed to a higher caffeine dose relative to individual bodyweight (i.e., a dose > 1.3 mg/kg). Together, the results suggest that 80 mg caffeine are sufficient to induce alertness at a subjective level. However, particularly teenagers with a strong need for deep sleep might pay for these subjective benefits by a loss of SWS during the night. Thus, caffeine-induced sleep-disruptions might change along with the maturation of sleep need.

Slow oscillation-spindle coupling predicts enhanced memory formation from childhood to adolescence

Precise temporal coordination of slow oscillations (SO) and sleep spindles is a fundamental mechanism of sleep-dependent memory consolidation. SO and spindle morphology changes considerably throughout development. Critically, it remains unknown how the precise temporal coordination of these two sleep oscillations develops during brain maturation and whether their synchronization indexes the development of memory networks. Here, we use a longitudinal study design spanning from childhood to adolescence, where participants underwent polysomnography and performed a declarative word-pair learning task. Performance on the memory task was better during adolescence. After disentangling oscillatory components from 1/f activity, we found frequency shifts within SO and spindle frequency bands. Consequently, we devised an individualized cross-frequency coupling approach, which demonstrates that SO-spindle coupling strength increases during maturation. Critically, this increase indicated enhanced memory formation from childhood to adolescence. Our results provide evidence that improved coordination between SOs and spindles indexes the development of sleep-dependent memory networks.