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McCabe SM, Abbiss CR, Libert JP, Bach V. Functional links between thermoregulation and sleep in children with neurodevelopmental and chronic health conditions. Front Psychiatry 2022; 13:866951. [PMID: 36451768 PMCID: PMC9703054 DOI: 10.3389/fpsyt.2022.866951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
The bi-directional relationship between sleep and wake is recognized as important for all children. It is particularly consequential for children who have neurodevelopmental disorders (NDDs) or health conditions which challenge their sleep and biological rhythms, and their ability to maintain rhythms of participation in everyday activities. There are many studies which report the diverse reasons for disruption to sleep in these populations. Predominantly, there is focus on respiratory, pharmaceutical, and behavioral approaches to management. There is, however, little exploration and explanation of the important effects of body thermoregulation on children's sleep-wake patterns, and associated behaviors. Circadian patterns of sleep-wake are dependent on patterns of body temperature change, large enough to induce sleep preparedness but remaining within a range to avoid sleep disturbances when active thermoregulatory responses against heat or cold are elicited (to maintain thermoneutrality). Additionally, the subjective notion of thermal comfort (which coincides with the objective concept of thermoneutrality) is of interest as part of general comfort and associated behavioral responses for sleep onset and maintenance. Children's thermoregulation and thermal comfort are affected by diverse biological functions, as well as their participation in everyday activities, within their everyday environments. Hence, the aforementioned populations are additionally vulnerable to disruption of their thermoregulatory system and their capacity for balance of sleep and wakefulness. The purpose of this paper is to present hitherto overlooked information, for consideration by researchers and clinicians toward determining assessment and intervention approaches to support children's thermoregulation functions and promote their subjective thermal comfort, for improved regulation of their sleep and wake functions.
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Affiliation(s)
- Susan M McCabe
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Chris R Abbiss
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | | | - Véronique Bach
- PeriTox UMR_I 01, University of Picardie Jules Verne, Amiens, France
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Haghayegh S, Smolensky MH, Khoshnevis S, Hermida RC, Castriotta RJ, Diller KR. The Circadian Rhythm of Thermoregulation Modulates both the Sleep/Wake Cycle and 24 h Pattern of Arterial Blood Pressure. Compr Physiol 2021; 11:2645-2658. [PMID: 34636410 DOI: 10.1002/cphy.c210008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Borbély proposed an interacting two-component model of sleep regulation comprising a homeostatic Process S and a circadian Process C. The model has provided understanding of the association between core body temperature (CBT) as a key element of Process C that is deterministic of sleep onset and offset. However, it additionally provides a new perspective of the importance of the thermoregulatory mechanisms of Process C in modulating the circadian rhythm of arterial blood pressure (ABP). Herein, we examine the circadian physiology of thermoregulation, including at the end of the activity span the profound redistribution of cardiac output from the systemic circulation to the arteriovenous anastomoses of the glabrous skin that markedly enhances convective transfer of heat from the body to the environment to cause (i) decrease of the CBT as a pathway to sleep onset and (ii) attenuation of the asleep ABP mean and augmentation of the ABP decline (dipping) from the wake-time mean, in combination the strongest predictors of the risk for blood vessel and organ pathology and morbid and mortal cardiovascular disease events. We additionally review the means by which blood perfusion to the glabrous skin can be manipulated on demand by selective thermal stimulation, that is, mild warming, on the skin of the cervical spinal cord to intensify Process C as a way to facilitate sleep induction and promote healthy asleep ABP. © 2021 American Physiological Society. Compr Physiol 11:1-14, 2021.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biostatics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, Vigo, Spain
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
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Bach V, Abbiss CR, Libert JP, McCabe SM. Skin Temperatures of Back or Neck Are Better Than Abdomen for Indication of Average Proximal Skin Temperature During Sleep of School-Aged Children. Front Psychiatry 2020; 11:494528. [PMID: 33061911 PMCID: PMC7530240 DOI: 10.3389/fpsyt.2020.494528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The tight association between sleep, body temperature regulation, and patterns of skin temperature change highlights the necessity for accurate and valid assessment of skin temperatures during sleep. With increased interest in this functional relationship in infants and children, it is important to identify where to best measure proximal skin temperature and whether it is possible to reduce the number of sites of measures, in order to limit the experimental effects in natural settings. Thus, the aim of this study was to determine the most suitable single skin temperature sites for representation of average proximal skin temperature during sleep of school aged children. METHODS Statistical analyses were applied to skin temperature data of 22 children, aged 6 to 12 years, measured over four consecutive school nights in their home settings, to compare single site measures of abdomen, back, neck, forehead and subclavicular skin temperatures (local temperatures) with average proximal skin temperatures. RESULTS Abdomen and forehead skin temperatures were significantly different (respectively higher and lower) to the other local proximal temperatures and to average proximal skin temperatures. Moreover, the time pattern of forehead temperature was very different from that of the other local temperatures. CONCLUSIONS Local forehead and abdomen skin temperatures are least suitable as single site representations of average proximal skin temperatures in school aged children when considering both the level and the time course pattern of the temperature across the night. Conversely, back and neck temperatures provide most fitting representation of average proximal skin temperatures.
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Affiliation(s)
- Véronique Bach
- Peritox, UMR_I 01, University of Picardy Jules Verne, Amiens, France
| | - Chris R Abbiss
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | | | - Susan M McCabe
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Abstract
In homeothermic animals sleep preparatory behaviours often promote thermal efficiency, including warmth-seeking, adopting particular postures (curling up, head tucking) and nest building, all promoting warmer skin microclimates. Skin warmth induces NREM sleep and body cooling via circuitry that connects skin sensation to the preoptic hypothalamus. Coupling sleep induction and lower body temperature could serve to minimise energy expenditure or allow energy reallocation. Cooling during NREM sleep may also induce transcriptional changes in genes whose products facilitate housekeeping functions or measure the time spent sleeping.
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Affiliation(s)
- Edward C Harding
- Department of Life Sciences, Imperial College London, South Kensington, SW7 2AZ, UK
| | - Nicholas P Franks
- Department of Life Sciences, Imperial College London, South Kensington, SW7 2AZ, UK.,Centre for Neurotechnology, Imperial College London, SW7 2AZ, UK.,UK Dementia Research Institute at Imperial College London, UK
| | - William Wisden
- Department of Life Sciences, Imperial College London, South Kensington, SW7 2AZ, UK.,Centre for Neurotechnology, Imperial College London, SW7 2AZ, UK.,UK Dementia Research Institute at Imperial College London, UK
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Topalidou A, Ali N, Sekulic S, Downe S. Thermal imaging applications in neonatal care: a scoping review. BMC Pregnancy Childbirth 2019; 19:381. [PMID: 31651266 PMCID: PMC6814124 DOI: 10.1186/s12884-019-2533-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/24/2019] [Indexed: 12/16/2022] Open
Abstract
Background In neonatal care, assessment of the temperature of the neonate is essential to confirm on-going health, and as an early signal of potential pathology. However, some methods of temperature assessment involve disturbing the baby, disrupting essential sleep patterns, and interrupting maternal/infant interaction. Thermal imaging is a completely non-invasive and non-contact method of assessing emitted temperature, but it is not a standard method for neonatal thermal monitoring. To examine the potential utility of using thermal imaging in neonatal care, we conducted a comprehensive systematic scoping review of thermal imaging applications in this context. Methods We searched EMBASE, MEDLINE and MIDIRS. Results From 442 hits, 21 met the inclusion criteria and were included in the review. A significant number (n = 9) were published in the last 8 years. All the studies were observational studies, with 20 out of 21 undertaken in North America or Europe. Most of them had small cohorts (range 4–29 participants). The findings were analysed narratively, to establish the issues identified in the included studies. Five broad themes emerged for future examination. These were: general thermal physiology; heat loss and respiratory monitoring; identification of internal pathologies, including necrotising enterocolitis; other uses of thermal imaging; and technical concerns. The findings suggest that thermal imaging is a reliable and non-invasive method for continuous monitoring of the emitted temperature of the neonates, with potential for contributing to the assurance of wellbeing, and to the diagnosis of pathologies, including internal abnormalities. However, the introduction of thermal imaging into everyday neonatology practice has several methodological challenges, including environmental parameters, especially when infants are placed in incubators or open radiant warmers. Conclusion In conclusion, although the first attempt at using thermal imaging in neonatal care started in the early-1970s, with promising results, and subsequent small cohort studies have recently reinforced this potential, there have not been any large prospective studies in this area that examine both the benefits and the barriers to its use in practice.
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Affiliation(s)
- Anastasia Topalidou
- Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK.
| | - Nazmin Ali
- Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Slobodan Sekulic
- Department of Neurology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Soo Downe
- Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Harding EC, Franks NP, Wisden W. The Temperature Dependence of Sleep. Front Neurosci 2019; 13:336. [PMID: 31105512 PMCID: PMC6491889 DOI: 10.3389/fnins.2019.00336] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/22/2019] [Indexed: 12/18/2022] Open
Abstract
Mammals have evolved a range of behavioural and neurological mechanisms that coordinate cycles of thermoregulation and sleep. Whether diurnal or nocturnal, sleep onset and a reduction in core temperature occur together. Non-rapid eye movement (NREM) sleep episodes are also accompanied by core and brain cooling. Thermoregulatory behaviours, like nest building and curling up, accompany this circadian temperature decline in preparation for sleeping. This could be a matter of simply comfort as animals seek warmth to compensate for lower temperatures. However, in both humans and other mammals, direct skin warming can shorten sleep-latency and promote NREM sleep. We discuss the evidence that body cooling and sleep are more fundamentally connected and that thermoregulatory behaviours, prior to sleep, form warm microclimates that accelerate NREM directly through neuronal circuits. Paradoxically, this warmth might also induce vasodilation and body cooling. In this way, warmth seeking and nesting behaviour might enhance the circadian cycle by activating specific circuits that link NREM initiation to body cooling. We suggest that these circuits explain why NREM onset is most likely when core temperature is at its steepest rate of decline and why transitions to NREM are accompanied by a decrease in brain temperature. This connection may have implications for energy homeostasis and the function of sleep.
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Affiliation(s)
- Edward C Harding
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Nicholas P Franks
- Department of Life Sciences, Imperial College London, London, United Kingdom.,Centre for Neurotechnology, Imperial College London, London, United Kingdom.,UK Dementia Research Institute, Imperial College London, London, United Kingdom
| | - William Wisden
- Department of Life Sciences, Imperial College London, London, United Kingdom.,Centre for Neurotechnology, Imperial College London, London, United Kingdom.,UK Dementia Research Institute, Imperial College London, London, United Kingdom
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Bach V, Delanaud S, Barcat L, Bodin E, Tourneux P, Libert JP. Distal skin vasodilation in sleep preparedness, and its impact on thermal status in preterm neonates. Sleep Med 2019; 60:26-30. [PMID: 30777678 DOI: 10.1016/j.sleep.2018.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/11/2018] [Accepted: 12/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prior to sleep onset in human adults, distal body temperatures change progressively from wakefulness levels (low skin temperatures and a high core temperature) to sleep levels (high skin temperatures and a low core temperature) due to distal skin vasodilation and greater body cooling. It is not known whether this sleep preparedness exists in preterm neonates, even though sleep has a key role in neonatal health and neurodevelopment. The present study's objectives were to determine whether sleep preparedness (as observed in adults) can be evidenced in preterm neonates, and to assess repercussions on thermal stress. METHODS During a 12-h night-time polysomnography session, skin temperatures (recorded with an infrared camera), sleep, and wakefulness episodes were measured in 18 nine-day-old preterm neonates. RESULTS Fifteen wakefulness episodes were considered. Our results highlighted significant pre-sleep distal skin vasodilation (mainly at the foot: an increase of 0.38 °C in the 20 min preceding sleep onset) for the first time in preterm neonates. This vasodilation occurred even though (1) most factors known to influence pre-sleep vasodilation in adults were not present in these neonates, and (2) the neonates were nursed in a nearly constant thermal environment. The vasodilatation-related increase in body heat loss corresponded to a 0.15°C/h fall in mean body temperature (calculated using partitional calorimetry). CONCLUSION Compensation for this body heat loss and the maintenance of body homeothermia would require a 4% increase in metabolic heat production. In neonates, this type of energy expenditure cannot be maintained for a long period of time.
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Affiliation(s)
- Véronique Bach
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France.
| | - Stéphane Delanaud
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France
| | - Lucie Barcat
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France; Médecine Néonatale et Réanimation Pédiatrique, Pôle Femme Couple Enfant, CHU Amiens, Amiens, France
| | - Emilie Bodin
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France; Neurologie Pédiatrique, Pôle Femme Couple Enfant, CHU Amiens, Amiens, France
| | - Pierre Tourneux
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France; Médecine Néonatale et Réanimation Pédiatrique, Pôle Femme Couple Enfant, CHU Amiens, Amiens, France
| | - Jean-Pierre Libert
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France
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McCabe SM, Elliott C, Langdon K, Abbiss CR. Patterns and reliability of children's skin temperature prior to and during sleep in the home setting. Physiol Behav 2018; 194:292-301. [PMID: 29885918 DOI: 10.1016/j.physbeh.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 01/13/2023]
Abstract
The relationship between patterns of change in skin temperature and sleep is well recognized. In particular, there is a rapid rise in distal skin temperature (Tdistal) and slower rise in proximal skin temperature (Tproximal) prior to sleep onset. The difference between Tdistal and Tproximal is known as the distal-proximal gradient (DPG). Rise in DPG is known as a measure of distal vasodilation, which contributes to the drop in core body temperature (Tcore) that is important to sleep onset and maintenance. Patterns of change in skin temperature before and during sleep are reported for neonates, infants, adults and elderly, however they are not known for school aged children. Therefore, the current observational study aimed to determine the patterns and reliability of skin temperatures (Tskin) and DPG in relation to sleep of school aged children in their home settings. Participants (22 children, aged 6-12) completed the Children's Sleep Habits Questionnaire and used Thermochron iButtons and actigraphy for four school nights in their typical sleep settings. There were evident patterns of Tskin change before and during sleep. In particular, Tdistal was lower but rose more rapidly than Tproximal after reported bedtime and prior to sleep onset. This reflected a timely rise in DPG, and shows that distal vasodilation precedes sleep onset in school aged children. The measures of Tskin and sleep were practical for children in their home settings, and the observed patterns were consistent across consecutive school nights. Environmental and behavioural strategies that manage skin temperature before and during sleep should be explored for their potential as valuable components of treatment of childhood insomnia.
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Affiliation(s)
- Susan M McCabe
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.
| | - Catherine Elliott
- School of Occupational Therapy and Social Work, Curtin University, Bentley, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Princess Margaret Hospital, Subiaco, Australia
| | - Chris R Abbiss
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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