Temperature, time-of-night of testing, and responsiveness to stimuli presented while sleeping

The Circadian System Contributes to Apnea Lengthening across the Night in Obstructive Sleep Apnea

STUDY OBJECTIVE

To test the hypothesis that respiratory event duration exhibits an endogenous circadian rhythm.

DESIGN

Within-subject and between-subjects.

SETTINGS

Inpatient intensive physiologic monitoring unit at the Brigham and Women's Hospital.

PARTICIPANTS

Seven subjects with moderate/severe sleep apnea and four controls, age 48 (SD = 12) years, 7 males.

INTERVENTIONS

Subjects completed a 5-day inpatient protocol in dim light. Polysomnography was recorded during an initial control 8-h night scheduled at the usual sleep time, then through 10 recurrent cycles of 2 h 40 min sleep and 2 h 40 min wake evenly distributed across all circadian phases, and finally during another 8-h control sleep period.

MEASUREMENTS AND RESULTS

Event durations, desaturations, and apnea-hypopnea index for each sleep opportunity were assessed according to circadian phase (derived from salivary melatonin), time into sleep, and sleep stage. Average respiratory event durations in NREM sleep significantly lengthened across both control nights (21.9 to 28.2 sec and 23.7 to 30.2 sec, respectively). During the circadian protocol, event duration in NREM increased across the circadian phases that corresponded to the usual sleep period, accounting for > 50% of the increase across normal 8-h control nights. AHI and desaturations were also rhythmic: AHI was highest in the biological day while desaturations were greatest in the biological night.

CONCLUSIONS

The endogenous circadian system plays an important role in the prolongation of respiratory events across the night, and might provide a novel therapeutic target for modulating sleep apnea.

Asleep but aware?

Despite sleep-induced drastic decrease of self-awareness, human sleep allows some cognitive processing of external stimuli. Here we report the fortuitous observation in a patient who, while being recorded with intra-cerebral electrodes, was able, during paradoxical sleep, to reproduce a motor behaviour previously performed at wake to consciously indicate her perception of nociceptive stimulation. Noxious stimuli induced behavioural responses only if they reached the cortex during periods when mid-frontal networks (pre-SMA, pre-motor cortex) were pre-activated. Sensory responses in the opercular cortex and insula were identical whether the noxious stimulus was to evoke or not a motor behaviour; conversely, the responses in mid-anterior cingulate were specifically enhanced for stimuli yielding motor responses. Neuronal networks implicated in the voluntary preparation of movements may be reactivated during paradoxical sleep, but only if behavioural-relevant stimuli reach the cortex during specific periods of "motor awareness". These local activation appeared without any global sleep stage change. This observation opens the way to further studies on the currently unknown capacity of the sleeping brain to interact meaningfully with its environment.

Auditory arousal responses and thresholds during REM and NREM sleep of sleepwalkers and controls

BACKGROUND

It has been suggested that sleepwalkers are more difficult to awaken from sleep than are controls. However, no quantified comparisons have been made between these two populations. The main goal of this study was to assess arousal responsiveness via the presentation of auditory stimuli (AS) in sleepwalkers and controls during normal sleep and recovery sleep following sleep deprivation.

METHODS

Ten adult sleepwalkers and 10 age-matched control subjects were investigated. After a screening night, participants were presented with AS during slow-wave sleep (SWS), REM, and stage 2 sleep either during normal sleep or daytime recovery sleep following 25 h of sleep deprivation. The AS conditions were then reversed one week later.

RESULTS

When compared to controls sleepwalkers necessitated a significantly higher mean AS intensity (in dB) to induce awakenings and arousal responses during REM sleep whereas the two groups' mean values did not differ significantly during SWS and stage 2 sleep. Moreover, when compared to controls sleepwalkers had a significantly lower mean percentage of AS that induced arousal responses during REM sleep while the opposite pattern of results was found during SWS.

CONCLUSIONS

The data indicate that sleepwalkers have a higher auditory awakening threshold than controls, but only for REM sleep. These findings may reflect a compensatory mechanism of the homeostatic process underlying sleep regulation during sleepwalkers' REM sleep in reaction to their difficulties maintaining consolidated periods of NREM sleep.

Quantitative modelling of sleep dynamics

Arousal is largely controlled by the ascending arousal system of the hypothalamus and brainstem, which projects to the corticothalamic system responsible for electroencephalographic (EEG) signatures of sleep. Quantitative physiologically based modelling of brainstem dynamics theory is described here, using realistic parameters, and links to EEG are outlined. Verification against a wide range of experimental data is described, including arousal dynamics under normal conditions, sleep deprivation, stimuli, stimulants and jetlag, plus key features of wake and sleep EEGs.

Modeling the impact of impulsive stimuli on sleep-wake dynamics

A neuronal population model of the sleep-wake switch is extended to incorporate impulsive external stimuli. The model includes the mutual inhibition of the sleep-active neurons in the hypothalamic ventrolateral preoptic area (VLPO) and the wake-active monoaminergic brainstem populations (MA), as well as circadian and homeostatic drives. Arbitrary stimuli are described in terms of their relative effects on the VLPO and MA nuclei and represent perturbations on the normal sleep-wake dynamics. By separating the model's intrinsic time scales, an analytic characterization of the dynamics in a reduced model space is developed. Using this representation, the model's response to stimuli is studied, including the latency to return to wake or sleep, or to elicit a transition between the two states. Since sensory stimuli are known to excite the MA, we correspondingly investigate the model's response to auditory tones during sleep, as in clinical sleep fragmentation studies. The arousal threshold is found to vary approximately linearly with the model's total sleep drive, which includes circadian and homeostatic components. This relationship is used to reproduce the clinically observed variation of the arousal threshold across the night, which rises to a maximum near the middle of the night and decreases thereafter. In a further application of the model, time-of-night arousal threshold and body temperature variations in an experimental sleep fragmentation study are replicated. It is proposed that the shift of the extrema of these curves to a greater magnitude later in the night is due to the homeostatic impact of the frequent nocturnal disturbances. By modeling the underlying neuronal interactions, the methods presented here allow the prediction of arousal state responses to external stimuli. This methodology is fundamentally different to previous approaches that model the clinical data within a phenomenological framework. As a result, a broader understanding of how impulsive external stimuli modulate arousal is gained.

The effects of sleep stages and time of night on NREM sleep ERPs

Event-related potential (ERP) is one of the best techniques for studying information processing during sleep because it does not require behavioral responses or consciousness awareness. Several ERP components have been identified during non-rapid eye movement (NREM) sleep, but the associated underlying processes of these waveforms remain unclear. The present study examines the effect of sleep stage and time of night on the NREM ERPs to further understand these processes. An oddball paradigm was conducted in 11 healthy subjects to elicit ERPs throughout the night. Polysomnographic recordings were also applied to identify sleep stages. The results showed that P220, N350, and P900 decreased during the second half of the night, when the NREM sleep drive is partially satiated. This finding is consistent with the notion that the NREM ERPs reflect an inhibitory process associated with sleep drive. P220 and P900 were also found to increase as subjects entering deep sleep. However, the N350 was not affected by the deepening of sleep and peaked earlier during stage 1 sleep. Although these components are all related to the process for sleep preservation, the N350 may be more associated with sleep-wake transition and the P220 and P900 with the process of deepening of sleep.

CIRCADIAN PREFERENCE AND COGNITIVE FUNCTIONING AMONG REHABILITATION INPATIENTS

The influence of circadian preference was examined among 56 morning-oriented rehabilitation inpatients with cognitive (n=28) and noncognitive (n=28) impairments. Each individual was tested twice: morning (preferred time) and evening (nonpreferred time); sessions and test batteries were counterbalanced to control for practice effects. Standard measures assessed attention, language, memory, visuospatial, and executive functions. Persons with cognitive impairment showed disproportionate vulnerability to the effects of circadian preference and time of testing, performing more poorly at nonpreferred than preferred times. Substantial effects (eta2 .12 to .48) were found on tests of executive functioning and tasks incorporating similar higher-order demands (e/g/. complex figure copy). Results are supported by tympanic temperature changes during a vigilance task, and index of cerebral blood flow in response to cognitive challenge. Cognitive reserve theory is suggested as an explanation for the differential effects. These findings may have implications for inpatient therapeutic interventions and discharge planning.

Symposium: Cognitive processes and sleep disturbances: Sleep, dreams and memory: an overview

Investigations into the role played by sleep in information processing have consistently shown that the retention of information is better when the memory storage is followed by a period of sleep than of waking. Less definitive evidence, however, is available as to whether the better performance is mainly due to (a) reduction of interference during sleep, (b) slowing down of decay, or (c) consolidation processes at work during sleep. Important insights as to whether consolidation takes place during sleep have recently been provided by the thematic continuity of dreams elaborated in the same night and by the repeated incorporation of pre-sleep stimuli into dream contents. The analysis of such aspects of dreaming indicates that the items of information which are repeatedly accessed during sleep and elaborated for insertion into the ongoing dream experience are better retained at delayed recall. Finally, it is suggested that the use of the strategies applied in studying the information processing in normals may also be extended to sleep-disturbed individuals, in order to establish how memory functioning during sleep is influenced by sleep disturbances.

Ontogenetic variations in auditory arousal threshold during sleep

Developmental variations in auditory arousal thresholds during sleep were investigated in four groups of normal male subjects--children, preadolescents, adolescents, and young adults. Arousal thresholds were determined during NREM and REM sleep for tones presented via earphone insert on a single night following two adaptation nights of undisturbed sleep. Age-related relationships were observed for both awakening frequency and stimulus intensity required to effect awakening, with awakenings occurring more frequently in response to lower stimulus intensities with increasing age. Although stimulus intensities required for awakening were high and statistically equivalent across sleep stages in nonadults, higher intensity stimuli were required in Stage 4 relative to Stage 2 and REM sleep in adults. These results confirm previous observations of marked resistance to awakening during sleep in preadolescent children and suggest that processes underlying awakening from sleep undergo systematic modification during ontogenetic development.

Motor responsiveness to stimuli presented during sleep: the influence of time-of-testing on sleep stage analyses

The relationship between time-of-night of testing (circadian factors) and motor responsiveness to stimuli presented during different stages of sleep was examined. Nine males slept for two nonconsecutive nights in the laboratory. On Night 1, tympanic temperature was assessed at 30 min intervals. On Night 2, responsiveness was assessed with an incremental series of tones presented in sleep stages 2, 3/4, and REM throughout the night. Subjects were instructed to make a microswitch closure to the tones. Results showed that for all stages, responsiveness decreased across thirds of the night. Because the distribution of each sleep stage differed across the night, the effects on responsiveness due to time-of-testing and to sleep stage were confounded. When time-of-testing was held constant, responsiveness was greater in stages 2 and REM than in stage 3/4. When time-of-testing was not held constant, effects nearly opposite of the latter could be demonstrated.

Ultradian rhythms in responsiveness to stimuli presented during sleep

The present study examined rhythmicity in responding to stimuli presented during sleep. Subjects were trained while awake to respond (by taking a deep breath) to an auditory stimulus that was subsequently presented after every 4 min (8 subjects) or after every 1 min (8 subjects) of continuous sleep. Visual inspection of the response data revealed, for most subjects, a tendency for response latencies to vary rhythmically with 3-5 response cycles per night. Relatively slow, "time-of-night", changes in responsiveness were also seen. Spectral analysis supported the observation of response rhythmicity. Frequency bands with centers corresponding to periods of 133, 100, and 80 min accounted for a significant proportion of the spectral variance for both the 4-min and 1-min group. Sleep was severely disrupted under the 1-min condition, but response rhythmicity was as evident as under the 4-min condition. For subjects having nearly normal sleep structure, the longer latencies in the response cycles tended to occur during nonrapid eye movement periods, while the shorter latencies tended to occur near REM. Response variability during REM often obscured cyclic tendencies. The data suggest that responsiveness during sleep