Vestibular loss disrupts daily rhythm in rats

Repeated electrical vestibular nerve stimulation (VeNS) reduces severity in moderate to severe insomnia; a randomized, sham-controlled trial; The Modius Sleep Study

BACKGROUND

Insomnia is a prevalent health concern in the general population associated with a range of adverse health effects. New, effective, safe and low-cost treatments, suitable for long-term use, are urgently required. Previous studies have shown the potential of electrical vestibular nerve stimulation (VeNS) in improving insomnia symptoms, however only one sham-controlled trial has been conducted on people with chronic insomnia.

OBJECTIVES

/Hypothesis: Repeated VeNS delivered by the Modius Sleep device prior to sleep onset will show superior improvement in Insomnia Severity Index (ISI) scores over a 4-week period compared to sham stimulation.

METHODS

In this double-blinded, multi-site, randomised, sham-controlled study, 147 participants with moderate to severe insomnia (ISI≥15) were recruited and allocated a VeNS or a sham device (1:1 ratio) which they were asked to use at home for 30 minutes daily (minimum 5 days per week) for 4 weeks.

RESULTS

After 4 weeks, mean ISI score reduction was 2.26 greater in the VeNS treatment group than the sham group (p=0.002). In the per protocol analysis, the treatment group had a mean ISI score decrease of 5.8 (95% CI [-6.8, -4.81], approaching the clinically meaningful threshold of a 6-point reduction, with over half achieving a clinically significant decrease. Furthermore, the treatment group showed superior improvement to the sham group in the SF-36 (Quality of Life) energy/fatigue component (PP p=0.004, effect size 0.26; ITT p=0.006, effect size 0.22).

CONCLUSIONS

Modius sleep has the potential to provide a viable, non-invasive and safe clinically meaningful alternative treatment option for insomnia.

Vestibular dysfunction in Parkinson's disease: a neglected topic

Dizziness and postural instability are frequently observed symptoms in patient with Parkinson's disease (PD), potentially linked to vestibular dysfunction. Despite their significant impact on quality of life, these symptoms are often overlooked and undertreated in clinical practice. This review aims to summarize symptoms associated with vestibular dysfunction in patients with PD and discusses vestibular-targeted therapies for managing non-specific dizziness and related symptoms. We conducted searches in PubMed and Web of Science using keywords related to vestibular dysfunction, Parkinson's disease, dizziness, and postural instability, alongside the reference lists of relevant articles. The available evidence suggests the prevalence of vestibular dysfunction-related symptoms in patients with PD and supports the idea that vestibular-targeted therapies may be effective in improving PD symptoms.

Does sleep quality affect balance? The perspective from the somatosensory, vestibular, and visual systems

OBJECTIVE

Previous studies have focused on the balance system's involvement in sleep deprivation or disorders. This study investigated how daily routine sleep quality affects the balance system of people without sleep deprivation or diagnosed sleep disorders.

METHODS

The study included 45 participants with a BMI score of <25. The PSQI was used to determine sleep quality. The SOT, HS-SOT, and ADT evaluated the vestibular system's functionality.

RESULTS

In SOT, condition 3, 4, 5, and 6 composite scores, VIS and VEST composite balance scores, and HS-SOT 5 scores were lower in the HPSQI group. At the same time, there is a statistically significant negative correlation between these scores and PSQI scores.

CONCLUSION

Poor sleep quality may be a factor influencing the balance system. Sleep quality affects the visual and vestibular systems rather than the somatosensory system. The population should be made aware of this issue, and clinicians should consider the potential impact of sleep quality when evaluating the balance system.

Changes in sleep performance and chronotype behaviour after vestibular rehabilitation in unilateral vestibular hypofunction

OBJECTIVE

This study aimed to investigate changes in sleep parameters and self-perceived sleep quality in unilateral vestibular hypofunction participants after vestibular rehabilitation.

METHOD

Forty-six unilateral vestibular hypofunction participants (before and after vestibular rehabilitation) along with a control group of 60 healthy patients underwent otoneurological examination, a one-week actigraphy sleep analysis and a series of self-report and performance measures.

RESULTS

After vestibular rehabilitation, unilateral vestibular hypofunction participants showed a significant score decrease in the Pittsburgh Sleep Quality Index, a self-rated reliable questionnaire depicting sleep quality during the last month, as well as a reduction in sleep onset latency and an increase in total sleep time, indicating an objective improvement in sleep quality as measured by actigraphy analysis. However, after vestibular rehabilitation, unilateral vestibular hypofunction participants still showed statistically significant differences with respect to the control group in both self-rated and objective measurements of sleep quality.

CONCLUSION

Vestibular rehabilitation may impact on sleep performance and chronotype behaviour, possibly by opposing long-term structural changes along neural pathways entangled in sleep activity because of the deafferentation of the vestibular nuclei.

Chronic Vestibular Hypofunction Is Associated with Impaired Sleep: Results from the DizzyReg Patient Registry

Temporary or permanent vestibular hypofunction has been hypothesized to affect circadian rhythm, sleep, and thermoregulation. Chronic or long-term vestibular disorders such as unilateral vestibular hypofunction may have an even greater negative impact on sleep quality than acute vestibular problems. This study examines self-reported sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI), and its association with vestibular symptom duration in a group of patients with vestibular disorders. We used data from the cross-sectional DizzyReg patient registry of the German Center for Vertigo and Balance Disorders outpatient clinic. Vestibular diagnoses were ascertained based on the International Classification of Vestibular Disorders. A total of 137 patients were included (60% female, mean age 55.4 years, standard deviation, SD, 16.7). The mean PSQI total score was 6.3 (SD = 3.2), with 51% reporting overall poor sleep quality. Patients who had vertigo for two years or longer reported significantly poorer global sleep quality (63% vs. 37%, p = 0.021) and significantly more difficulties with sleep latency (79% vs. 56%, p = 0.013) and sleep efficiency (56% vs. 34%, p = 0.022). The association of poor sleep quality with a longer duration of vertigo remained significant after multivariable adjustment. Further research should investigate the interaction of vestibular disorders, sleep, and their potential mechanisms.

Tackling Insomnia Symptoms through Vestibular Stimulation in Patients with Breast Cancer: A Perspective Paper

Insomnia symptoms are common among patients with breast cancer (BC; 20-70%) and are predictors of cancer progression and quality of life. Studies have highlighted sleep structure modifications, including increased awakenings and reduced sleep efficiency and total sleep time. Such modifications may result from circadian rhythm alterations consistently reported in this pathology and known as carcinogenic factors, including lower melatonin levels, a flattened diurnal cortisol pattern, and lower rest-activity rhythm amplitude and robustness. Cognitive behavioral therapy and physical activity are the most commonly used non-pharmacological interventions to counter insomnia difficulties in patients with BC. However, their effects on sleep structure remain unclear. Moreover, such approaches may be difficult to implement shortly after chemotherapy. Innovatively, vestibular stimulation would be particularly suited to tackling insomnia symptoms. Indeed, recent reports have shown that vestibular stimulation could resynchronize circadian rhythms and improve deep sleep in healthy volunteers. Moreover, vestibular dysfunction has been reported following chemotherapy. This perspective paper aims to support the evidence of using galvanic vestibular stimulation to resynchronize circadian rhythms and reduce insomnia symptoms in patients with BC, with beneficial effects on quality of life and, potentially, survival.

Relationships between the Pittsburgh Sleep Quality Index (PSQI) and vertigo outcome

OBJECTIVE

This retrospective cohort study aimed to investigate the association of sleep characteristics measured by the Pittsburgh Sleep Quality Index (PSQI) with the vertigo outcome in vertiginous patients with comorbid cardiometabolic diseases.

METHODS

Four hundred and thirteen patients with comorbid cardiometabolic diseases who consecutively visiting vertigo and dizziness clinic were enrolled between October 2018 and January 2020 in a tertiary teaching medical center. Regression analyses and stratified analyses were used to explore the relationship between PSQI and vertigo outcome, which was measured by the visual analogue scale (VAS) score.

RESULTS

In the study sample, 73.8% (305/413) were defined as 'poor sleep' (PSQI>5). Participants with better recovery tended to have better baseline PSQI global score, PSQI sleep quality, PSQI sleep onset latency, PSQI daytime dysfunction, less severe baseline vertigo symptoms indicated by VAS, Vertigo Symptom Scale (VSS) and Dizziness Handicap Inventory (DHI) scores. Moreover, baseline PSQI global score and PSQI daytime dysfunction score were independently associated with the vertigo VAS scores at the last follow-up.

CONCLUSION

The present results clearly indicated that poor sleep is common and inversely associated with vertigo outcome in vertiginous patients with co-morbid cardiometabolic diseases. Therefore, sleep deserves greater attention in the total medical care in specific subgroup of vertiginous patients.

Vestibular Disorders and Hormonal Dysregulations: State of the Art and Clinical Perspectives

The interaction between endocrine and vestibular systems remains poorly documented so far, despite numerous observations in humans and animals revealing direct links between the two systems. For example, dizziness or vestibular instabilities often accompany the menstrual cycle and are highly associated with the pre-menopause period, while sex hormones, together with their specific receptors, are expressed at key places of the vestibular sensory network. Similarly, other hormones may be associated with vestibular disorders either as causal/inductive factors or as correlates of the pathology. This review was carried out according to the PRISMA method, covering the last two decades and using the MEDLINE and COCHRANE databases in order to identify studies associating the terms vestibular system and/or vestibular pathologies and hormones. Our literature search identified 646 articles, 67 of which referred directly to vestibular dysfunction associated with hormonal variations. While we noted specific hormonal profiles depending on the pathology considered, very few clinical studies attempted to establish a direct link between the expression of the vestibular syndrome and the level of circulating hormones. This review also proposes different approaches to shed new light on the link between hormones and vestibular disorders, and to improve both the diagnosis and the therapeutic management of dizzy patients.

The Role of the Cerebellar and Vestibular Networks in Anxiety Disorders and Depression: the Internal Model Hypothesis

Clinical data and animal studies confirmed that the cerebellum and the vestibular system are involved in emotions. Nowadays, no real consensus has really emerged to explain the clinical symptoms in humans and behavioral deficits in the animal models. We envisage here that the cerebellum and the vestibular system play complementary roles in emotional reactivity. The cerebellum integrates a large variety of exteroceptive and proprioceptive information necessary to elaborate and to update the internal model: in emotion, as in motor processes, it helps our body and self to adapt to the environment, and to anticipate any changes in such environment in order to produce a time-adapted response. The vestibular system provides relevant environmental stimuli (i.e., gravity, self-position, and movement) and is involved in self-perception. Consequently, cerebellar or vestibular disorders could generate « internal fake news» (due to lack or false sensory information and/or integration) that could, in turn, generate potential internal model deficiencies. In this case, the alterations provoke false anticipation of motor command and external sensory feedback, associated with unsuited behaviors. As a result, the individual becomes progressively unable to cope with the environmental solicitation. We postulate that chronically unsuited, and potentially inefficient, behavioral and visceral responses to environmental solicitations lead to stressful situations. Furthermore, this inability to adapt to the context of the situation generates chronic anxiety which could precede depressive states.

Hormones and Vestibular Disorders: The Quest for Biomarkers

The vestibular system exerts control over various functions through neural pathways that are not yet fully mapped. Functional dysregulations or tissue lesions at different levels of the peripheral and the central vestibular networks can alter these different functions, causing a wide variety of symptoms, ranging from posturo-locomotor alterations to psychiatric syndromes such as PPPD, including the deregulation of the main biological functions. These different symptoms differ by their expression kinetics (they each appear and regress with their own kinetics) by the targets affected (muscles, organs, and brain areas) and by the sensitivity specific to each individual. Vestibular pathologies thus cover a mosaic of distinct effects, and they involve various effectors—which constitute the many markers of their different types and stages. It is therefore crucial, to predict the onset of a vertigo syndrome, to follow its temporal course, or to monitor the impact of therapeutic approaches, and to have specific and reliable biomarkers. Hormonal variations are among the possible sources of biomarkers for neurotology. We know that specific hormonal profiles can promote the appearance of vestibular disorders. We also know that the expression of vertigo syndrome is accompanied by measurable hormonal variations. The link between endocrine deregulation and vestibular alterations therefore no longer needs to be proven. However, there are still few data on their precise correlations with the vertigo syndrome. This study was undertaken with the aim to deliver an extensive review of the hormonal alterations linked to vestibular disorders. A review of the literature covering the last two decades was carried out using the MEDLINE and COCHRANE databases in order to identify studies associating the terms vestibular system or vestibular pathologies and hormones. Bibliographic data provides several outcomes in terms of therapeutic innovation in the diagnosis and therapeutic follow-up of vestibular pathologies.

Expression of circadian clock genes in leukocytes of patients with Meniere's disease

Objectives

The underlying etiology of Meniere's disease (MD) is not completely clear, but the precipitated triggers may alter the circadian clock in patients with MD. This study aims to survey the expression of circadian clock genes in peripheral blood (PB) leukocytes of MD patients.

Methods

We investigated the expression of nine circadian clock genes in the PB leukocytes of patients with MD and normal controls using real‐time quantitative reverse transcriptase‐polymerase chain reaction (qRT‐PCR).

Results

We observed significantly lower expression of PER1 gene and higher expression of CLOCK gene in MD patients than those in normal controls (p < 0.05). PER1 did not associate with the degree of dizziness handicap in the patients with MD, but a lower expression of PER1 was significantly correlated with higher pure tone average (PTA) and speech reception threshold of the affected ear (p < 0.05). Patients with PTA > 30 dB had significantly lower PER1 expression than those with PTA ≤30 dB in the affected ear (p < 0.05). Our qRT‐PCR result was validated by fewer positively stained leukocytes for PER1 protein in the MD patients using the immunocytochemical study.

Conclusion

Our study implies the alteration of the circadian clock in patients with MD. In particular, the downregulation of PER1 correlated with the degree of hearing loss in the affected ear. PER1 in PB leukocytes may be a potential marker for the progression of hearing loss in MD.

Sleep Performance and Chronotype Behavior in Unilateral Vestibular Hypofunction

OBJECTIVE

To evaluate sleep behavior and its relation to otoneurological parameters in a group of patients with chronic unilateral vestibular hypofunction (UVH) without self-reported sleep disturbances when compared with healthy subjects serving as a control group (CG).

METHODS

Fifty-one patients affected by UVH underwent a retrospective clinical and instrumental otoneurological examination, a 1-week actigraphy sleep analysis, and a series of self-report and performance measures (SRM/PM). A CG of 60 gender- and age-matched healthy subjects was also enrolled. A between-group analysis of variance was performed for each variable, while correlation analysis was performed in UVH patients between otoneurological, SRM/PM, and actigraphy measure scores.

RESULTS

When compared with CG subjects, UVH patients were found to be spending less time sleeping and taking more time to go from being fully awake to asleep, based on actigraphy-based sleep analysis. Also, SRM/PM depicted UVH patients to have poor sleep quality and to be more prone to an evening-type behavior. Correlations were found between vestibular-related functionality indexes and subjective sleep quality, as well as between longer disease duration and reduced sleep time.

CONCLUSION

For the first time, a multiparametric sleep analysis was performed on a large population-based sample of chronic UVH patients. While a different pattern in sleep behavior was found, the cause is still unclear. Further research is needed to expand the extent of knowledge about sleep disruption in vestibular disorders.

LEVEL OF EVIDENCE

Level 3 Laryngoscope, 2021.

Stratification of hippocampal electrophysiological activation evoked by selective electrical stimulation of different angular and linear acceleration sensors in the rat peripheral vestibular system

It has become well established that vestibular information is important for hippocampal function and spatial memory. However, as yet, relatively little is known about how different kinds of vestibular information are 'represented' in different parts of the hippocampus. This study used selective electrical stimulation of each of the 5 vestibular sensors (the horizontal (HC), anterior (AC) and posterior (PC) semi-circular canals, and the utricle and saccule) in the rat and recorded local field potentials (LFPs) across the hippocampus, using a 16 electrode microarray. We found that stimulation of any vestibular sensor in the left labyrinth evoked triphasic LFPs in both hippocampi, although it was clear that, in general, the amplitudes were greater for the right, contralateral side. This was particularly true for Phase 1 for the HC, AC, utricle and saccule, Phase 2 for the HC, PC, utricle and saccule, and Phase 3 for the AC, PC and saccule. Overall, our results suggest that vestibular input to the hippocampus is bilateral, preferentially contralateral, but highly stratified in that stimulation of the same vestibular sensor results in activation of different specific areas of the hippocampus, with different LFP amplitudes and latencies. This suggests the possibility that different regions of the hippocampus use different kinds of vestibular information for different purposes and that there may be a high degree of redundancy in the representation of vestibular input, perhaps ensuring that the hippocampus is more robust to the partial loss of vestibular information.

Whole-brain monosynaptic inputs and outputs of glutamatergic neurons of the vestibular nuclei complex in mice

Vestibular nuclei complex (VN) glutamatergic neurons play a critical role in the multisensory and multimodal processing. The dysfunction of VN leads to a series of vestibular concurrent symptoms, such as disequilibrium, spatial disorientation, autonomic disorders and even emotion disorders. However, the reciprocal neural connectivity in the whole brain of VN glutamatergic neurons was incompletely understood. Here, we employed a cell-type-specific, cre-dependent, modified virus vector to retrogradely and anterogradely trace VN glutamatergic neurons in the VGLUT2-IRES-Cre mouse line. We identified and analyzed statistically the afferents and efferents of VN glutamatergic neurons in the whole brain, and also reconstructed monosynaptic inputs distribution of VN glutamatergic neurons at the three-dimensional level with the combination of a fluorescence micro-optical sectioning tomography system (fMOST). We found that VN glutamatergic neurons primarily received afferents from 57 nuclei and send efferents to 59 nuclei in the whole brain, intensively located in the brainstem and cerebellum. Projections from nuclei in the cerebellum targeting VN glutamatergic neurons mainly performed the balance control - the principal function of the vestibular system. In addition, VN glutamatergic neurons sent projections to oculomotor nucleus, trochlear nucleus and abducens nucleus dominating the eye movement. Except for the maintenance of balance, VN glutamatergic neurons were also directly connected with other functional regions, such as sleep-wake state (locus coeruleus, dorsal raphe nucleus, and laterodorsal tegmental nucleus, gigantocellular reticular nucleus, lateral paragigantocellular nucleus, periaqueductal gray, subcoeruleus nucleus, parvicellular reticular nucleus, paramedian raphe nucleus), and emotional regulation (locus coeruleus and dorsal raphe nucleus). Hence, this study revealed a comprehensive whole-brain neural connectivity of VN glutamatergic neurons and provided with a neuroanatomic foundation to further study on central vestibular circuits.

Twenty-four-hour variation of vestibular function in young and elderly adults

Animal and human studies demonstrate anatomical and functional links between the vestibular nuclei and the circadian timing system. This promotes the hypothesis of a circadian rhythm of vestibular function. The objective of this study was to evaluate the vestibular function through the vestibulo-ocular reflex using a rotatory chair at different times of the day to assess circadian rhythmicity of vestibular function. Two identical studies evaluating temporal variation of the vestibulo-ocular reflex (VOR) were performed, the first in young adults (age: 22.4 ± 1.5 y), and the second in older adults (70.7 ± 4.7 y). The slow phase velocity and time constant of the VOR were evaluated in six separate test sessions, i.e., 02:00, 06:00, 10:00, 14:00, 18:00, and 22:00 h. In both studies, markers of circadian rhythmicity (temperature, fatigue, and sleepiness) displayed expected usual temporal variation. In young adults, the time constant of the VOR showed variation throughout the day (p < .005), being maximum 12:25 h (06:00 h test session) before the acrophase of temperature circadian rhythm. In older adults, the slow phase velocity and time constant also displayed temporal variation (p < .05). Maximum values were recorded at 10:35 h (06:00 h test session) before the acrophase of temperature circadian rhythm. The present study demonstrates that vestibular function is not constant throughout the day. The implication of the temporal variation in vestibular system in equilibrium potentially exposes the elderly, in particular, to differential risk during the 24 h of losing balance and falling.

Association of sleep symptoms with mood and vestibular subtypes following sport-related concussion

Sport-related concussion (SRC) is a heterogenous injury with diverse symptoms and impairments that can be aggregated into clinical subtypes (cognitive, headache/migraine, vestibular, ocular-motor, anxiety/mood). Sleep disruption has been defined as potential exacerbating conditions that may accompany the five clinical subtypes. The authors sought to better characterize the role of impaired sleep in each clinical subtype and to identify other risk factors for sleep impairment after SRC. 281 patients (15.3 ± 2.1 years) aged 10-22 years within 21 days of SRC completed the Post-Concussion Symptom Scale (PCSS), the Vestibular/Ocular Motor Screening (VOMS), and a clinical assessment to identify clinical subtype. Subjects were then divided into HIGH (≥7; n = 82) and LOW (≤3; n = 132) sleep symptom groups for comparison. HIGH participants had greater proportions of females (p < 0.001), history of psychiatric disorder (p < 0.001); total PCSS (p < 0.001); and impairment on all VOMS items (p < 0.001). HIGH participants were associated with mood/anxiety (p < 0.001), vestibular (p = 0.003) and ocular (p = 0.03) subtypes. Results of a logistic regression (LR) model with adjusted odds ratios (OR) to predict HIGH sleep symptoms supported anxiety/mood profile (OR = 2.98), vestibular profile (OR = 2.81), psychiatric history (OR = 4.99), and history of motion sickness (OR = 2.13) as significant predictors. Prescribing behavioral and sleep interventions may improve outcomes in cases where these factors co-occur.

Dual orexin receptor antagonist induces changes in core body temperature in rats after exercise

Hypothalamic orexin neurons are involved in various physiological functions, including thermoregulation. The orexinergic system has been considered as a potent mediator of the exercise response. The present study describes how the antagonization of the orexinergic system by a dual orexin receptor antagonist (DORA) modifies the thermoregulatory process during exercise. Core Body Temperature (CBT) and Spontaneous Locomotor Activity (SLA) of 12 male Wistar rats were recorded after either oral administration of DORA (30 mg/kg or 60 mg/kg) or placebo solution, both at rest and in exercise conditions with treadmill running. DORA ingestion decreased SLA for 8 hours (p < 0.001) and CBT for 4 hours (p < 0.01). CBT (°C) response was independent of SLA. The CBT level decreased from the beginning to the end of exercise when orexin receptors were antagonized, with a dose-dependent response (39.09 ± 0.36 and 38.88 ± 0.28 for 30 and 60 mg/kg; p < 0.001) compared to placebo (39.29 ± 0.31; p < 0.001). CBT increased during exercise was also blunted after DORA administration, but without dose effects of DORA. In conclusion, our results favor the role of orexin in the thermoregulation under stress related to exercise conditions.

Cooperation of the vestibular and cerebellar networks in anxiety disorders and depression

The discipline of affective neuroscience is concerned with the neural bases of emotion and mood. The past decades have witnessed an explosion of research in affective neuroscience, increasing our knowledge of the brain areas involved in fear and anxiety. Besides the brain areas that are classically associated with emotional reactivity, accumulating evidence indicates that both the vestibular and cerebellar systems are involved not only in motor coordination but also influence both cognition and emotional regulation in humans and animal models. The cerebellar and the vestibular systems show the reciprocal connection with a myriad of anxiety and fear brain areas. Perception anticipation and action are also major centers of interest in cognitive neurosciences. The cerebellum is crucial for the development of an internal model of action and the vestibular system is relevant for perception, gravity-related balance, navigation and motor decision-making. Furthermore, there are close relationships between these two systems. With regard to the cooperation between the vestibular and cerebellar systems for the elaboration and the coordination of emotional cognitive and visceral responses, we propose that altering the function of one of the systems could provoke internal model disturbances and, as a result, anxiety disorders followed potentially with depressive states.

Sleep and gravity

What is known about sleep results from years of observation at the surface of the Earth. Since a few decade man has been able to reach space, escape from the earth attraction and spend days and nights in a weightless condition. Some major physiological changes have been observed during long stays and in particular the sleep duration in space is shorter than on ground. This paper reviews a novel hypothesis proposing that sleep is partly due to gravity. Gravity is a fundamental part of our environment, but is elusive and difficult to apprehend. At the same time, all creatures on Earth undergo cycles of activity and periods of rest (although not always sleep). Careful analysis of previous research on sleep, on Earth, in space and in water, shows that gravity differs in these three situations, and sleep also varies, at least in its duration. On Earth, Rapid Eye Movement (REM) sleep is conditioned by gravity; in space, astronauts have a shorter sleep duration and this is even more striking when a test subject is immersed in water for a week. In conclusion, sleep is partly due to gravity, which acts on our body and brain during the wake period.

Impaired math achievement in patients with acute vestibular neuritis

Broad cognitive difficulties have been reported in patients with peripheral vestibular deficit, especially in the domain of spatial cognition. Processing and manipulating numbers relies on the ability to use the inherent spatial features of numbers. It is thus conceivable that patients with acute peripheral vestibular deficit show impaired numerical cognition. Using the number Stroop task and a short math achievement test, we tested 20 patients with acute vestibular neuritis and 20 healthy, age-matched controls. On the one hand, patients showed normal congruency and distance effects in the number Stroop task, which is indicative of normal number magnitude processing. On the other hand, patients scored lower than healthy controls in the math achievement test. We provide evidence that the lower performance cannot be explained by either differences in prior math knowledge (i.e., education) or slower processing speed. Our results suggest that peripheral vestibular deficit negatively affects numerical cognition in terms of the efficient manipulation of numbers. We discuss the role of executive functions in math performance and argue that previously reported executive deficits in patients with peripheral vestibular deficit provide a plausible explanation for the lower math achievement scores. In light of the handicapping effects of impaired numerical cognition in daily living, it is crucial to further investigate the mechanisms that cause mathematical deficits in acute PVD and eventually develop adequate means for cognitive interventions.

Sleep on manned space flights: Zero gravity reduces sleep duration

The success of a manned space mission depends on the well-being of the crew. Sleep in space has been the concern of researchers from the earliest days of manned space flight. In the new frontier of space exploration one of the great problems to be solved relates to sleep. Although many reports indicate that sleep in space differs only in minor ways from terrestrial sleep, such as being somewhat less comfortable, a consistent finding has been that sleep duration in space is shorter than that on the ground. This review considers the accumulating evidence that the main reason for the shorter duration of sleep in space is the absence of gravity. This evidence shows that, similar to the effect of many other environmental variables like light, sound and cold, gravity has a measurable impact on sleep structure. As opposed to ground, in zero gravity conditions the innate, permanent, and almost unconscious effort to maintain posture and equilibrium is reduced while simultaneously the vigilance against gravity or "the fear of falling" diminishes. These phenomena may potentially explain research findings that REM sleep latency and duration are shorter in space. This assumption also implies that sleep on ground is due in part to the effort to compensate for the presence of gravity and its effects on the posture and motion of the human body: an ignored and unsuspected contribution to sleep.

Evidence for a Role of Orexin/Hypocretin System in Vestibular Lesion-Induced Locomotor Abnormalities in Rats

Vestibular damage can induce locomotor abnormalities in both animals and humans. Rodents with bilateral vestibular loss showed vestibular deficits syndrome such as circling, opisthotonus as well as locomotor and exploratory hyperactivity. Previous studies have investigated the changes in the dopamine system after vestibular loss, but the results are inconsistent and inconclusive. Numerous evidences indicate that the orexin system is implicated in central motor control. We hypothesized that orexin may be potentially involved in vestibular loss-induced motor disorders. In this study, we examined the effects of arsanilate- or 3,3′-iminodipropionitrile (IDPN)-induced vestibular lesion (AVL or IVL) on the orexin-A (OXA) labeling in rat hypothalamus using immunohistochemistry. The vestibular lesion-induced locomotor abnormalities were recorded and verified using a histamine H4 receptor antagonist JNJ7777120 (20 mg/kg, i.p.). The effects of the orexin receptor type 1 antagonist SB334867 (16 μg, i.c.v.) on these behavior responses were also investigated. At 72 h post-AVL and IVL, animals exhibited vestibular deficit syndrome and locomotor hyperactivity in the home cages. These responses were significantly alleviated by JNJ7777120 which also eliminated AVL-induced increases in exploratory behavior in an open field. The numbers of OXA-labeled neurons in the hypothalamus were significantly increased in the AVL animals at 72 h post-AVL and in the IVL animals at 24, 48, and 72 h post-IVL. SB334867 significantly attenuated the vestibular deficit syndrome and locomotor hyperactivity at 72 h post-AVL and IVL. It also decreased exploratory behavior in the AVL animals. These results suggested that the alteration of OXA expression might contribute to locomotor abnormalities after acute vestibular lesion. The orexin receptors might be the potential therapeutic targets for vestibular disorders.

Exploration of Circadian Rhythms in Patients with Bilateral Vestibular Loss

BACKGROUND

New insights have expanded the influence of the vestibular system to the regulation of circadian rhythmicity. Indeed, hypergravity or bilateral vestibular loss (BVL) in rodents causes a disruption in their daily rhythmicity for several days. The vestibular system thus influences hypothalamic regulation of circadian rhythms on Earth, which raises the question of whether daily rhythms might be altered due to vestibular pathology in humans. The aim of this study was to evaluate human circadian rhythmicity in people presenting a total bilateral vestibular loss (BVL) in comparison with control participants.

METHODOLOGY AND PRINCIPAL FINDINGS

Nine patients presenting a total idiopathic BVL and 8 healthy participants were compared. Their rest-activity cycle was recorded by actigraphy at home over 2 weeks. The daily rhythm of temperature was continuously recorded using a telemetric device and salivary cortisol was recorded every 3 hours from 6:00AM to 9:00PM over 24 hours. BVL patients displayed a similar rest activity cycle during the day to control participants but had higher nocturnal actigraphy, mainly during weekdays. Sleep efficiency was reduced in patients compared to control participants. Patients had a marked temperature rhythm but with a significant phase advance (73 min) and a higher variability of the acrophase (from 2:24 PM to 9:25 PM) with no correlation to rest-activity cycle, contrary to healthy participants. Salivary cortisol levels were higher in patients compared to healthy people at any time of day.

CONCLUSION

We observed a marked circadian rhythmicity of temperature in patients with BVL, probably due to the influence of the light dark cycle. However, the lack of synchronization between the temperature and rest-activity cycle supports the hypothesis that the vestibular inputs are salient input to the circadian clock that enhance the stabilization and precision of both external and internal entrainment.

Self-motion direction discrimination in the visually impaired

Despite the close interrelation between vestibular and visual processing (e.g., vestibulo-ocular reflex), surprisingly little is known about vestibular function in visually impaired people. In this study, we investigated thresholds of passive whole-body motion discrimination (leftward vs. rightward) in nine visually impaired participants and nine age-matched sighted controls. Participants were rotated in yaw, tilted in roll, and translated along the interaural axis at two different frequencies (0.33 and 2 Hz) by means of a motion platform. Superior performance of visually impaired participants was found in the 0.33 Hz roll tilt condition. No differences were observed in the other motion conditions. Roll tilts stimulate the semicircular canals and otoliths simultaneously. The results could thus reflect a specific improvement in canal-otolith integration in the visually impaired and are consistent with the compensatory hypothesis, which implies that the visually impaired are able to compensate the absence of visual input.