Sleep promotes consolidation of emotional memory in healthy children but not in children with attention-deficit hyperactivity disorder

Does sleep help children to generalise features like adults?

Children and adults have been shown to benefit from sleep with regard to the consolidation of declarative memories. Especially during childhood, the generalisation of information from social and non-social contexts is important for adaptable behaviour in new situations and might show specific features in children. Here, we investigated whether adults (n = 18) and children (n = 19) differ in their generalisation of features assessed in wake and sleep conditions. In a social paradigm, certain face features were associated with different types of offers (fair, unfair, friendly). While children tended to better recognise these faces, adults were better than children at associating the type of offer to unknown faces sharing these features with the previously encoded faces in the sleep condition. To assess generalisation of features in a non-social context, a probabilistic evaluative conditioning paradigm was used, where stimuli were associated with positive or negative values. We found no difference between children and adults or between the sleep and wake condition in the change in evaluation of the conditioned stimuli when paired congruently with a predefined value (positive/negative). Together, our results suggest a differential feature generalisation from mainly social contexts in children compared with adults.

The effects of shared, depression-specific, and anxiety-specific internalizing symptoms on negative and neutral episodic memories following post-learning sleep

Emotional memory bias is a common characteristic of internalizing symptomatology and is enhanced during sleep. The current study employs bifactor S-1 modeling to disentangle depression-specific anhedonia, anxiety-specific anxious arousal, and the common internalizing factor, general distress, and test whether these internalizing symptoms interact with sleep to influence memory for emotional and neutral information. Healthy adults (N = 281) encoded scenes featuring either negative objects (e.g., a vicious looking snake) or neutral objects (e.g., a chipmunk) placed on neutral backgrounds (e.g., an outdoor scene). After a 12-hour period of daytime wakefulness (n = 140) or nocturnal sleep (n = 141), participants judged whether objects and backgrounds were the same, similar, or new compared with what they viewed during encoding. Participants also completed the mini version of the Mood and Anxiety Symptom Questionnaire. Higher anxious arousal predicted worse memory across all stimuli features, but only after a day spent being awake-not following a night of sleep. No significant effects were found for general distress and anhedonia in either the sleep or wake condition. In this study, internalizing symptoms were not associated with enhanced emotional memory. Instead, memory performance specifically in individuals with higher anxious arousal was impaired overall, regardless of emotional valence, but this was only the case when the retention interval spanned wakefulness (i.e., not when it spanned sleep). This suggests that sleep may confer a protective effect on general memory impairments associated with anxiety.

NREM Slow-Wave Activity in Adolescents Is Differentially Associated With ADHD Levels and Normalized by Pharmacological Treatment

BACKGROUND

A compelling hypothesis about attention-deficit/hyperactivity disorder (ADHD) etiopathogenesis is that the ADHD phenotype reflects a delay in cortical maturation. Slow-wave activity (SWA) of non-rapid eye movement (NREM) sleep electroencephalogram (EEG) is an electrophysiological index of sleep intensity reflecting cortical maturation. Available data on ADHD and SWA are conflicting, and developmental differences, or the effect of pharmacological treatment, are relatively unknown.

METHODS

We examined, in samples (Mage = 16.4, SD = 1.2), of ever-medicated adolescents at risk for ADHD (n = 18; 72% boys), medication-naïve adolescents at risk for ADHD (n = 15, 67% boys), and adolescents not at risk for ADHD (n = 31, 61% boys) matched for chronological age and controlling for non-ADHD pharmacotherapy, whether ADHD pharmacotherapy modulates the association between NREM SWA and ADHD risk in home sleep.

RESULTS

Findings indicated medication-naïve adolescents at risk for ADHD exhibited greater first sleep cycle and entire night NREM SWA than both ever-medicated adolescents at risk for ADHD and adolescents not at risk for ADHD and no difference between ever-medicated, at-risk adolescents, and not at-risk adolescents.

CONCLUSIONS

Results support atypical cortical maturation in medication-naïve adolescents at risk for ADHD that appears to be normalized by ADHD pharmacotherapy in ever-medicated adolescents at risk for ADHD. Greater NREM SWA may reflect a compensatory mechanism in middle-later adolescents at risk for ADHD that normalizes an earlier occurring developmental delay.

REM Sleep Preserves Affective Response to Social Stress-Experimental Study

Sleep's contribution to affective regulation is insufficiently understood. Previous human research has focused on memorizing or rating affective pictures and less on physiological affective responsivity. This may result in overlapping definitions of affective and declarative memories and inconsistent deductions for how rapid eye movement sleep (REMS) and slow-wave sleep (SWS) are involved. Literature associates REMS theta (4-8 Hz) activity with emotional memory processing, but its contribution to social stress habituation is unknown. Applying selective sleep stage suppression and oscillatory analyses, we investigated how sleep modulated affective adaptation toward social stress and retention of neutral declarative memories. Native Finnish participants (N = 29; age, M = 25.8 years) were allocated to REMS or SWS suppression conditions. We measured physiological (skin conductance response, SCR) and subjective stress response and declarative memory retrieval thrice: before laboratory night, the next morning, and after 3 d. Linear mixed models were applied to test the effects of condition and sleep parameters on emotional responsivity and memory retrieval. Greater overnight increase in SCR toward the stressor emerged after suppressed SWS (intact REMS) relative to suppressed REMS (20.1% vs 6.1%; p = 0.016). The overnight SCR increase was positively associated with accumulated REMS theta energy irrespective of the condition (r = 0.601; p = 0.002). Subjectively rated affective response and declarative memory recall were comparable between the conditions. The contributions of REMS and SWS to habituation of social stress are distinct. REMS theta activity proposedly facilitates the consolidation of autonomic affective responses. Declarative memory consolidation may not have greater dependence on intact SWS relative to intact REMS.

A Thalamocortical Perspective on Sleep Spindle Alterations in Neurodevelopmental Disorders

Purpose of Review

Neurodevelopmental disorders are a group of conditions that affect the development and function of the nervous system, typically arising early in life. These disorders can have various genetic, environmental, and/or neural underpinnings, which can impact the thalamocortical system. Sleep spindles, brief bursts of oscillatory activity that occur during NREM sleep, provide a unique in vivo measure of the thalamocortical system. In this manuscript, we review the development of the thalamocortical system and sleep spindles in rodent models and humans. We then utilize this as a foundation to discuss alterations in sleep spindle activity in four of the most pervasive neurodevelopmental disorders-intellectual disability, attention deficit hyperactivity disorder, autism, and schizophrenia.

Recent Findings

Recent work in humans has shown alterations in sleep spindles across several neurodevelopmental disorders. Simultaneously, rodent models have elucidated the mechanisms which may underlie these deficits in spindle activity. This review merges recent findings from these two separate lines of research to draw conclusions about the pathogenesis of neurodevelopmental disorders.

Summary

We speculate that deficits in the thalamocortical system associated with neurodevelopmental disorders are exquisitely reflected in sleep spindle activity. We propose that sleep spindles may represent a promising biomarker for drug discovery, risk stratification, and treatment monitoring.

Does the brain sleep differently depending on intellectual abilities?

AIMS

To compare the children's sleep electroencephalogram according to their intellectual profile.

METHODS

Children were grouped according to their Wechsler Intelligence Scale for Children (WISC) scores (17 with normal intelligence quotient [IQ, NIQ] and 24 with high IQ [HIQ]). Comparisons of spectral power between groups and its relationship with WISC scores were assessed using analyses of variance and linear regression models, adjusted for age and sex.

RESULTS

Children with HIQ had more rapid eye movement (REM) sleep, especially late at night, and more power in slow-frequency bands during REM sleep than those with NIQ. There were also positive associations between the processing speed index and the spectral power in β bands in NREM sleep, and with the spectral power in α, σ, β, and γ bands in REM sleep, with different associations between groups.

CONCLUSION

The enhanced power in slow bands during REM sleep in children with HIQ overlaps with that of typical REM sleep oscillations thought to be involved in emotional memory consolidation. The dissimilar relationships between spectral power and WISC scores in NIQ and HIQ groups may underlie functional differences in brain activity related to cognitive efficiency, questioning the direction of the relationship between sleep and cognitive functioning.

Age-related positivity effect in emotional memory consolidation from middle age to late adulthood

Background

While younger adults are more likely to attend to, process, and remember negative relative to positive information, healthy older adults show the opposite pattern. The current study evaluates when, exactly, this positivity shift begins, and how it influences memory performance for positive, negative, and neutral information.

Methods

A total of 274 healthy early middle-aged (35-47), late middle-aged (48-59), and older adults (>59) viewed scenes consisting of a negative, positive, or a neutral object placed on a plausible neutral background, and rated each scene for its valence and arousal. After 12 h spanning a night of sleep (n = 137) or a day of wakefulness (n = 137), participants completed an unexpected memory test during which they were shown objects and backgrounds separately and indicated whether the scene component was the "same," "similar," or "new" to what they viewed during the study session.

Results and conclusions

We found that both late middle-aged and older adults rated positive and neutral scenes more positively compared to early middle-aged adults. However, only older adults showed better memory for positive objects relative to negative objects, and a greater positive memory trade-off magnitude (i.e., remembering positive objects at the cost of their associated neutral backgrounds) than negative memory trade-off magnitude (i.e., remembering negative objects at the cost of their associated neutral backgrounds). Our findings suggest that while the positivity bias may not emerge in memory until older adulthood, a shift toward positivity in terms of processing may begin in middle age.

Parent-Report Sleep Disturbances and Everyday Executive Functioning Difficulties in Children with Tourette Syndrome

There is an increasing need to identify and treat sleep disturbances in Tourette syndrome (TS), a neurodevelopmental condition characterized by tics. This study explored sleep, tics, and executive functioning in children with TS (n=136) and neurotypical controls (n=101) through parent-report scales and open-ended questions. 85% of children with TS scored in the clinical range for a sleep disorder. Higher tic severity predicted increased sleep disturbances and executive difficulties. Qualitative insights indicated a bidirectional link between sleep and tics, which warrants consideration in clinical settings. Further research is needed to explore causal links.

Physical Activity Patterns, Circadian Rhythms, and Aggressive and Suicidal Behavior among a Larger Sample of the General Population Aged 15 to 34 Years

BACKGROUND

From a psychological perspective, aggressive behavior, non-suicidal self-injury and suicidal behavior could be considered dysfunctional coping strategies. Poor sleep patterns may further increase such dysfunctional coping. In contrast, regular physical activity may have the power to counteract such dysfunctional coping. Given this background, the aim of the present study was to combine categories of circadian rhythms as a proxy of normative sleep patterns and categories of physical activity patterns, and to associate these categories with aggressive behavior, non-suicidal self-injury and suicidal behavior among a larger sample of adolescents and young adults, aged 15 to 34 years.

METHOD

A total of 2991 (55.6% females) individuals aged 15 to 34 years of the so-called Ravansar non-communicable disease cohort study (RaNCD) took part in this study. Participants completed self-rating questionnaires covering circadian-related sleep patterns, regular physical activity, socio-demographic information and dimensions of aggression, non-suicidal self-injury and suicidal behavior.

RESULTS

In a first step, both sleep patterns (circadian rhythm disorder: yes vs. no) and physical activity patterns (high vs. low) were dichotomized. Next, participants were assigned to one of four prototypical clusters: No circadian sleep disorders and high physical activity ("Hi-Sleep-Hi-PA"); no circadian sleep disorders and low physical activity ("Hi-Sleep-Lo-PA"); circadian sleep disorders and high physical activity ("Lo-Sleep-Hi-PA"); circadian sleep disorders and low physical activity ("Lo-Sleep-Lo-PA"). Projecting these four clusters on dimensions of aggressive behavior, non-suicidal self-injury and suicidal behavior, the following findings were observed: Participants of the "Hi-Sleep-Hi-PA" reported the lowest scores for aggressive behavior, self-injury and suicidal behavior, compared to participants of the "Lo-Sleep-Lo-PA" cluster. No differences for aggressive behavior, self-injury and suicidal behavior were observed among participants of the "Hi-Sleep-Lo-PA" and the "Lo-Sleep-Hi-PA" clusters.

CONCLUSIONS

It appeared that the combination of favorable circadian sleep patterns and high physical activity patterns was associated with lower aggressive behavior, lower self-injury and suicidal behavior as proxies of favorable psychological functioning. In contrast, persons reporting high circadian sleep disorders and low physical activity patterns appeared to demand particular attention and counseling for both their lifestyle issues (sleep and physical activity) and their dysfunctional coping strategies.

A failure of sleep-dependent consolidation of visuoperceptual procedural learning in young adults with ADHD

ADHD has been associated with cortico-striatal dysfunction that may lead to procedural memory abnormalities. Sleep plays a critical role in consolidating procedural memories, and sleep problems are an integral part of the psychopathology of ADHD. This raises the possibility that altered sleep processes characterizing those with ADHD could contribute to their skill-learning impairments. On this basis, the present study tested the hypothesis that young adults with ADHD have altered sleep-dependent procedural memory consolidation. Participants with ADHD and neurotypicals were trained on a visual discrimination task that has been shown to benefit from sleep. Half of the participants were tested after a 12-h break that included nocturnal sleep (sleep condition), whereas the other half were tested after a 12-h daytime break that did not include sleep (wakefulness condition) to assess the specific contribution of sleep to improvement in task performance. Despite having a similar degree of initial learning, participants with ADHD did not improve in the visual discrimination task following a sleep interval compared to neurotypicals, while they were on par with neurotypicals during the wakefulness condition. These findings represent the first demonstration of a failure in sleep-dependent consolidation of procedural learning in young adults with ADHD. Such a failure is likely to disrupt automatic control routines that are normally provided by the non-declarative memory system, thereby increasing the load on attentional resources of individuals with ADHD.

Maximum downward slope of sleep slow waves as a potential marker of attention-deficit/hyperactivity disorder clinical phenotypes

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly heterogeneous diagnostic category, encompassing several endophenotypes and comorbidities, including sleep problems. However, no predictor of clinical long-term trajectories or comorbidity has yet been established. Sleep EEG has been proposed as a potential tool for evaluating the synaptic strength during development, as well as the cortical thickness, which is presumed to be altered in ADHD. We investigated whether the slope of the Slow Waves (SWs), a microstructural parameter of the sleep EEG, was a potential predictive parameter for psychiatric comorbidities and neuropsychological dimensions in ADHD.

METHODS

70 children (58 m; 8.76 ± 2.77 y) with ADHD who underwent psychiatric and neurologic evaluations and a standard EEG recording during naps were investigated. After sleep EEG analysis, we grouped the extracted SWs in bins of equal amplitude and then measured the associations, through generalized linear regression, between their maximum downward slopes (MDS) and the individual scores obtained from clinical rating scales.

RESULTS

The presence of Multiple Anxiety Disorders was positively associated with MDS of medium amplitude SWs in temporo-posterior left areas. The Child Behavior Checklist scores showed negative associations in the same areas for small SWs. The presence of autistic traits was positively associated with MDS of high amplitude SWs in bilateral anterior and temporal left areas. The WISC-IV Processing Speed Index showed negative associations with MDS of small-to-medium SWs in anterior and temporal right areas, while positive associations in posterior and temporal left areas.

CONCLUSIONS

Consistency of association clusters' localization on the scalp suggests that variations in the local MDS, revealing alterations of local synaptic strength and/or in daytime use of certain cortical circuits, could underlie specific neurodevelopmental trajectories resulting in different ADHD clinical phenotypes.

Sleep preferentially consolidates negative aspects of human memory: Well-powered evidence from two large online experiments

Recent research has called into question whether sleep improves memory, especially for emotional information. However, many of these studies used a relatively small number of participants and focused only on college student samples, limiting both the power of these findings and their generalizability to the wider population. Here, using the well-established emotional memory trade-off task, we investigated sleep’s impact on memory for emotional components of scenes in a large online sample of adults ranging in age from 18 to 59 y. Despite the limitations inherent in using online samples, this well-powered study provides strong evidence that sleep selectively consolidates negative emotional aspects of memory and that this effect generalizes to participants across young adulthood and middle age.

Research suggests that sleep benefits memory. Moreover, it is often claimed that sleep selectively benefits memory for emotionally salient information over neutral information. However, not all scientists are convinced by this relationship [e.g., J. M. Siegel. Curr. Sleep Med. Rep., 7, 15–18 (2021)]. One criticism of the overall sleep and memory literature—like other literature—is that many studies are underpowered and lacking in generalizability [M. J. Cordi, B. Rasch. Curr. Opin. Neurobiol., 67, 1–7 (2021)], thus leaving the evidence mixed and confusing to interpret. Because large replication studies are sorely needed, we recruited over 250 participants spanning various age ranges and backgrounds in an effort to confirm sleep’s preferential emotional memory consolidation benefit using a well-established task. We found that sleep selectively benefits memory for negative emotional objects at the expense of their paired neutral backgrounds, confirming our prior work and clearly demonstrating a role for sleep in emotional memory formation. In a second experiment also using a large sample, we examined whether this effect generalized to positive emotional memory. We found that while participants demonstrated better memory for positive objects compared to their neutral backgrounds, sleep did not modulate this effect. This research provides strong support for a sleep-specific benefit on memory consolidation for specifically negative information and more broadly affirms the benefit of sleep for cognition.

Sleep electroencephalogram evidence of delayed brain maturation in attention deficit hyperactivity disorder: a longitudinal study

Study Objectives

This study investigates whether longitudinally measured changes in adolescent brain electrophysiology corroborate the maturational lag associated with attention deficit hyperactivity disorder (ADHD) reported in magnetic resonance imaging (MRI) studies and cross-sectional sleep electroencephalogram (EEG) data.

Methods

Semiannually nine adolescents diagnosed with ADHD (combined presentation, DSM-V criteria, mean age 12.39 ± 0.61 years at first time-point, two females) and nine typically developing controls (12.08 ± 0.35 years, four females) underwent all-night laboratory polysomnography, yielding four recordings.

Results

Sleep macrostructure was similar between groups. A quadratic model of the age change in non-rapid eye movement (NREM) delta (1.07–4 Hz) power, with sex effects accounted for, found that delta power peaked 0.92 ± 0.37 years later in the ADHD group. A Gompertz function fit to the same data showed that the age of most rapid delta power decline occurred 0.93 ± 0.41 years later in the ADHD group (p = 0.037), but this group difference was not significant (p = 0.38) with sex effects accounted for. For very low frequency (0.29–1.07 Hz) EEG, the ADHD lag (1.07 ± 0.42 years later, p = 0.019) was significant for a Gompertz model with sex effects accounted for (p = 0.044). Theta (4–7.91 Hz) showed a trend (p = 0.064) toward higher power in the ADHD group. Analysis of the EEG decline across the night found that standardized delta and theta power in NREMP1 were significantly (p < 0.05 for both) lower in adolescents with ADHD.

Conclusions

This is the first longitudinal study to reveal electrophysiological evidence of a maturational lag associated with ADHD. In addition, our findings revealed basically unaltered sleep macrostructure but altered sleep homeostasis associated with ADHD.

Sleep Fosters Odor Recognition in Children with Attention Deficit Hyperactivity Disorder but Not in Typically Developing Children

Prior experience represents a prerequisite for memory consolidation across various memory systems. In the context of olfaction, sleep was found to enhance the consolidation of odors in adults but not in typically developing children (TDC), likely due to differences in pre-experience. Interestingly, unmedicated children with attention deficit hyperactivity disorder (ADHD), a neurodevelopmental condition related to dopamine dysfunction, showed lower perceptive thresholds for odors, potentially allowing for more odor experience compared to TDC. We investigated sleep-associated odor memory consolidation in ADHD. Twenty-eight children with ADHD and thirty age-matched TDC participated in an incidental odor recognition task. For the sleep groups (ADHD: n = 14, TDC: n = 15), the encoding of 10 target odorants took place in the evening, and the retention of odorants was tested with 10 target odorants and 10 distractor odorants the next morning. In the wake groups (ADHD: n = 14, TDC: n = 15), the time schedule was reversed. Odor memory consolidation was superior in the ADHD sleep group compared to the TDC sleep and the ADHD wake groups. Intensity and familiarity ratings during encoding were substantially higher in ADHD compared to TDC. Sleep-associated odor memory consolidation in ADHD is superior to TDC. Abundant pre-experience due to lower perceptive thresholds is suggested as a possible explanation. Olfaction might serve as a biomarker in ADHD.

Investigating the effects of sleep and sleep loss on the different stages of episodic emotional memory: A narrative review and guide to the future

For two decades, sleep has been touted as one of the primary drivers for the encoding, consolidation, retention, and retrieval of episodic emotional memory. Recently, however, sleep's role in emotional memory processing has received renewed scrutiny as meta-analyses and reviews have indicated that sleep may only contribute a small effect that hinges on the content or context of the learning and retrieval episodes. On the one hand, the strong perception of sleep's importance in maintaining memory for emotional events may have been exacerbated by publication bias phenomena, such as the "winner's curse" and "file drawer problem." On the other hand, it is plausible that there are sets of circumstances that lead to consistent and reliable effects of sleep on emotional memory; these circumstances may depend on factors such as the placement and quality of sleep relative to the emotional experience, the content and context of the emotional experience, and the probes and strategies used to assess memory at retrieval. Here, we review the literature on how sleep (and sleep loss) influences each stage of emotional episodic memory. Specifically, we have separated previous work based on the placement of sleep and sleep loss in relation to the different stages of emotional memory processing: (1) prior to encoding, (2) immediately following encoding during early consolidation, (3) during extended consolidation, separated from initial learning, (4) just prior to retrieval, and (5) post-retrieval as memories may be restructured and reconsolidated. The goals of this review are three-fold: (1) examine phases of emotional memory that sleep may influence to a greater or lesser degree, (2) explicitly identify problematic overlaps in traditional sleep-wake study designs that are preventing the ability to better disentangle the potential role of sleep in the different stages of emotional memory processing, and (3) highlight areas for future research by identifying the stages of emotional memory processing in which the effect of sleep and sleep loss remains under-investigated. Here, we begin the task of better understanding the contexts and factors that influence the relationship between sleep and emotional memory processing and aim to be a valuable resource to facilitate hypothesis generation and promote important future research.

Sleep Disturbances in Children with Attentional Deficit Hyperactivity Disorder and Specific Learning Disorders

Sleep disturbances may be a significant source of distress for children with neurodevelopmental disorders, and consequently also for their families. Crucially, sleep disturbances might be influenced by comorbidity. Attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD) often co-occur, and consequently, investigating sleep disturbances in children with comorbidity of ADHD and SLD is essential. Our study aimed at detecting sleep difficulties in a group of 74 children with ADHD, 78 children with SLD, and 76 children with ADHD and SLD by using the Sleep Disturbances Scale for Children. The results showed that sleep difficulties emerge more clearly in children with comorbid ADHD and SLD compared to children with only ADHD or SLD. These sleep difficulties were not due to differences in ages and behavioral/emotional problems. In conclusion, evaluating sleep disturbances is important when assessing and managing children with ADHD, SLD, and particularly with the two comorbid conditions, to better understand their difficulties and develop tailored interventions.

Association of a novel EEG metric of sleep depth/intensity with attention-deficit/hyperactivity, learning, and internalizing disorders and their pharmacotherapy in adolescence

STUDY OBJECTIVES

Psychiatric/learning disorders are associated with sleep disturbances, including those arising from abnormal cortical activity. The odds ratio product (ORP) is a standardized electroencephalogram metric of sleep depth/intensity validated in adults, while ORP data in youth are lacking. We tested ORP as a measure of sleep depth/intensity in adolescents with and without psychiatric/learning disorders.

METHODS

Four hundred eighteen adolescents (median 16 years) underwent a 9-hour, in-lab polysomnography. Of them, 263 were typically developing (TD), 89 were unmedicated, and 66 were medicated for disorders including attention-deficit/hyperactivity (ADHD), learning (LD), and internalizing (ID). Central ORP during non-rapid eye movement (NREM) sleep was the primary outcome. Secondary/exploratory outcomes included central and frontal ORP during NREM stages, in the 9-seconds following arousals (ORP-9), in the first and second halves of the night, during REM sleep and wakefulness.

RESULTS

Unmedicated youth with ADHD/LD had greater central ORP than TD during stage 3 and in central and frontal regions during stage 2 and the second half of the sleep period, while ORP in youth with ADHD/LD on stimulants did not significantly differ from TD. Unmedicated youth with ID did not significantly differ from TD in ORP, while youth with ID on antidepressants had greater central and frontal ORP than TD during NREM and REM sleep, and higher ORP-9.

CONCLUSIONS

The greater ORP in unmedicated youth with ADHD/LD, and normalized levels in those on stimulants, suggests ORP is a useful metric of decreased NREM sleep depth/intensity in ADHD/LD. Antidepressants are associated with greater ORP/ORP-9, suggesting these medications induce cortical arousability.

Transient Destabilization of Declarative Memory—Opposing Impact of Physical Exercise or Rest after Encoding in Typically Developing Children and Children with Attention Deficit Hyperactivity Disorder but No Difference after Subsequent Sleep

Background: Children are especially sensitive to a broad range of influences and show a remarkable capacity for learning. One prominent example is declarative memory, which may be influenced by a variety of factors and is impaired in attention deficit hyperactivity disorder (ADHD). Exercise and sleep, or both combined, might foster declarative memory. Methods: Here, 12 typically developing children (TDC) and 12 age-matched children with ADHD participated in an exercise and rest condition before a night in the sleep laboratory. Declarative memory was encoded before exercise or rest and retrieved before and after a night of sleep. Results: Exercise in TDC but rest in ADHD lead to a transient destabilization of declarative memory, while there were no more differences after a night of sleep. Rapid eye movement (REM) sleep latency was prolonged after exercise in both groups. Conclusions: Exercise leads to opposing effects on immediate declarative memory formation. The factors or contexts that promote or hinder declarative memory formation in children ADHD and TDC differ, and further work is needed to determine the recommendations for declarative learning in children with ADHD.

Sleep Power Topography in Children with Attention Deficit Hyperactivity Disorder (ADHD)

OBJECTIVE

Recent years saw an increasing interest towards sleep microstructure abnormalities in attention-deficit/hyperactivity disorder (ADHD). However, the existing literature on sleep electroencephalographic (EEG) power in ADHD is still controversial, often based on single electrode recordings, and mainly focused on slow wave activity (SWA) during NREM sleep. This study aimed to systematically investigate sleep power topography in all traditional frequency bands, in all sleep stages and across sleep cycles using high-density EEG (HD-EEG).

METHOD

Thirty drug-naïve children with ADHD (10.5 ± 2.1 years, 21 male) and 23 typically developing (TD) control participants (mean age: 10.2 ± 1.6 years, 13 male) were included in the current analysis. Signal power topography was computed in classical frequency bands during sleep, contrasted between groups and sleep cycles, and correlated with measures of ADHD severity, cognitive functioning and estimated total sleep time.

RESULTS

Compared to TD subjects, patients with ADHD consistently displayed a widespread increase in low-frequency activity (between 3 and 10 Hz) during NREM sleep, but not during REM sleep and wake before sleep onset. Such a difference involved a wide centro-posterior cluster of channels in the upper SWA range, in Theta, and low-Alpha. Between-group difference was maximal in sleep stage N3 in the first sleep cycle, and positively correlated with average total sleep time.

CONCLUSIONS

These results support the concept that children with ADHD, compared to TD peers, have a higher sleep pressure and altered sleep homeostasis, which possibly interfere with (and delay) cortical maturation.

Memory for emotional images across sleep versus wake in school-aged children

Sleep is important for emotional well-being, memory, and development in children. Regarding memory, sleep has been shown to advantage accuracy for declarative tasks but not procedural tasks. There is some evidence to suggest that sleep provides a relatively greater benefit for memory of negative emotional versus neutral images. However, the extent to which sleep benefits emotionally positive memories in children is not clear. This study assessed memory after nocturnal sleep versus daytime wake in a within-person design involving a sample of 40 children aged 7 to 14 years (M = 10.6 ± 1.9 years; 18 boys and 22 girls) for images of negative, neutral, and positive valences. Results show that after accounting for response time, memory accuracy overall was greater after sleep compared with equivalent time of wake and memory accuracy was greatest for positive images compared with both negative and neutral images. However, there was no difference between memory for negative images and that for neutral images in children, and there was no condition by valence interaction. Sleep characteristics as recorded using actigraphy, diary, and parent report were not predictive of memory performance after sleep when correcting for multiple comparisons. Overall, the results suggest that sleep may benefit memory in otherwise healthy children but that despite a bias toward memory for positive items over both negative and neutral items, there is not a relatively greater benefit for emotional versus neutral memory consolidation across sleep periods compared with wake periods.

Sleep EEG microstructure in children and adolescents with attention deficit hyperactivity disorder: a systematic review and meta-analysis

Attention deficit hyperactivity disorder (ADHD) is commonly associated with sleep problems, possibly due to shared pathophysiology. Microstructural sleep electroencephalographic (EEG) alterations may likely represent markers of disordered cortical maturation in ADHD, although literature data are still conflicting, deserving further assessment. After having systematically reviewed the literature, we included 11 studies from 598 abstracts, and assessed 23 parameters of cyclic alternating pattern (CAP), four parameters of sleep EEG power and one parameter of sleep graphoelements through 29 meta-analyses and, when possible, univariate meta-regressions. Slow wave activity (SWA) in ADHD was significantly higher in early childhood and lower in late childhood/adolescence compared to controls, with an inversion point at 10 years. Total CAP rate and CAP A1 index in non-rapid eye movement (NREM) stage 2 sleep, and CAP A1 rate in NREM sleep were significantly lower in ADHD patients than controls. SWA and CAP A1 changes are therefore possible markers of altered cortical maturation in ADHD, consistently with the neuropsychological deficits characterizing the disorder, likely fostering earlier detection of at-risk/milder conditions, and more tailored therapeutic interventions.

Sleep and emotion processing in paediatric posttraumatic stress disorder: A pilot investigation

Emotion processing abnormalities and sleep pathology are central to the phenomenology of paediatric posttraumatic stress disorder, and sleep disturbance has been linked to the development, maintenance and severity of the disorder. Given emerging evidence indicating a role for sleep in emotional brain function, it has been proposed that dysfunctional processing of emotional experiences during sleep may play a significant role in affective disorders, including posttraumatic stress disorder. Here we sought to examine the relationship between sleep and emotion processing in typically developing youth, and youth with a diagnosis of posttraumatic stress disorder . We use high-density electroencephalogram to compare baseline sleep with sleep following performance on a task designed to assess both memory for and reactivity to negative and neutral imagery in 10 youths with posttraumatic stress disorder, and 10 age- and sex-matched non-traumatized typically developing youths. Subjective ratings of arousal to negative imagery (ΔArousal = post-sleep minus pre-sleep arousal ratings) remain unchanged in youth with posttraumatic stress disorder following sleep (mean increase 0.15, CI -0.28 to +0.58), but decreased in TD youth (mean decrease -1.0, 95% CI -1.44 to -0.58). ΔArousal, or affective habituation, was negatively correlated with global change in slow-wave activity power (ρ = -0.58, p = .008). When considered topographically, the correlation between Δslow-wave activity power and affective habituation was most significant in a frontal cluster of 27 electrodes (Spearman, ρ = -0.51, p = .021). Our results highlight the importance of slow-wave sleep for adaptive emotional processing in youth, and have implications for symptom persistence in paediatric posttraumatic stress disorder. Impairments in slow-wave activity may represent a modifiable risk factor in paediatric posttraumatic stress disorder.

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.

REM Sleep EEG Activity and Clinical Correlates in Adults With Autism

We tested the hypothesis of an atypical scalp distribution of electroencephalography (EEG) activity during Rapid Eye Movement (REM) sleep in young autistic adults. EEG spectral activity and ratios along the anteroposterior axis and across hemispheres were compared in 16 neurotypical (NT) young adults and 17 individuals with autism spectrum disorder (ASD). EEG spectral power was lower in the ASD group over the bilateral central and right parietal (beta activity) as well as bilateral occipital (beta, theta, and total activity) recording sites. The NT group displayed a significant posterior polarity of intra-hemispheric EEG activity while EEG activity was more evenly or anteriorly distributed in ASD participants. No significant inter-hemispheric EEG lateralization was found. Correlations between EEG distribution and ASD symptoms using the Autism Diagnostic Interview-Revised (ADI-R) showed that a higher posterior ratio was associated with a better ADI-R score on communication skills, whereas a higher anterior ratio was related to more restricted interests and repetitive behaviors. EEG activity thus appears to be atypically distributed over the scalp surface in young adults with autism during REM sleep within cerebral hemispheres, and this correlates with some ASD symptoms. These suggests the existence in autism of a common substrate between some of the symptoms of ASD and an atypical organization and/or functioning of the thalamo-cortical loop during REM sleep.

Identification of Brain Regions with Enhanced Functional Connectivity with the Cerebellum Region in Children with Attention Deficit Hyperactivity Disorder: A Resting-State fMRI Study

Background

To explore the brain regions with higher functional connectivity with the cerebellum at resting state and the brain functions related to cognitive function in children with attention-deficit hyperactivity disorder (ADHD).

Methods

Thirty children with ADHD and 33 typically developing children (TDC) were examined using resting-state functional magnetic resonance imaging (fMRI) scans. Seed-based functional connectivity (FC) analysis was performed.

Results

Four brain areas with higher FC values were identified in ADHD children. These four areas were the left middle frontal gyrus, right middle frontal gyrus, right superior temporal gyrus and left parahippocampal gyrus (P < 0.05). The results of the CPT show that the number of omission errors was significantly higher in the children with ADHD than in the TD group (5.13±5.12 vs 2.18±2.36, P = 0.000). The commission number in the ADHD group was also significantly higher than that of the TD group (4.03±6.56 vs 2.00±2.85, P = 0.002). However, no statistically significant difference was observed in the correct reaction time between the two groups (641.54±146.79 ms vs 584.81±145.82 ms, P = 0.835).

Conclusion

The dysfunction of cerebellar functional connectivity in specific brain regions may be one of the pathological and physiological causes of cognitive impairment of ADHD.

Maturational trajectories of non-rapid eye movement slow wave activity and odds ratio product in a population-based sample of youth

BACKGROUND

Brain maturation is reflected in the sleep electroencephalogram (EEG) by a decline in non-rapid eye movement (NREM) slow wave activity (SWA) throughout adolescence and a related decrease in sleep depth. However, this trajectory and its sex and pubertal differences lack replication in population-based samples. We tested age-related changes in SWA (0.4-4 Hz) power and odds ratio product (ORP), a standardized measure of sleep depth.

METHODS

We analyzed the sleep EEG of 572 subjects aged 6-21 y (48% female, 26% racial/ethnic minority) and 332 subjects 5-12 y followed-up at 12-22 y. Multivariable-adjusted analyses tested age-related cross-sectional and longitudinal trajectories of SWA and ORP.

RESULTS

SWA remained stable from age 6 to 10, decreased between ages 11 and 17, and plateaued from age 18 to 21 (p-cubic<0.001); females showed a longitudinal decline 23% greater than males by 13 y, while males experienced a steeper slope after 14 y and their longitudinal decline was 21% greater by 19 y. More mature adolescents (75% female) experienced a greater longitudinal decline in SWA than less mature adolescents by 14 y. ORP showed an age-related increasing trajectory (p-linear<0.001) with no sex or pubertal differences.

CONCLUSIONS

We provide population-level evidence for the maturational decline and sex and pubertal differences in SWA in the transition from childhood to adolescence, while introducing ORP as a novel metric in youth. Along with previous studies, the distinct trajectories observed suggest that age-related changes in SWA reflect brain maturation and local/synaptic processes during this developmental period, while those of ORP may reflect global/state control of NREM sleep depth.

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.

Overlapping sleep disturbances in persistent tic disorders and attention-deficit hyperactivity disorder: A systematic review and meta-analysis of polysomnographic findings

INTRODUCTION

Persistent tic disorders (PTDs) and attention-deficit hyperactivity disorder (ADHD) are common neurodevelopmental conditions which tend to co-occur. Both diagnoses are associated with sleep problems. This systematic review and meta-analysis investigates overlaps and distinctions in objective sleep parameters based on diagnosis (PTD-only, PTD + ADHD, and ADHD-only).

METHODS

Databases were searched to identify studies with objective sleep measures in each population. Meta-analyses were conducted using a random effects model.

RESULTS

Polysomnography was the only measure included in all three groups. Twenty studies met final inclusion criteria, combining PTD-only (N = 108), PTD + ADHD (N = 79), and ADHD-only (N = 316). Compared to controls (N = 336), PTD-only and PTD + ADHD groups had significantly lower sleep efficiency and higher sleep onset latency. PTD + ADHD also had significantly increased time in bed and total sleep time. No significant differences were observed between ADHD-only groups and controls.

DISCUSSION

Different sleep profiles appear to characterise each population. PTD + ADHD was associated with more pronounced differences. Further research is required to elucidate disorder-specific sleep problems, ensuring appropriate identification and monitoring of sleep in clinical settings.

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.

Sleep's role in memory consolidation: What can we learn from atypical development?

Research conducted over the last century has suggested a role for sleep in the processes guiding healthy cognition and development, including memory consolidation. Children with intellectual and developmental disabilities (IDDs) tend to have higher rates of sleep disturbances, which could relate to behavior issues, developmental delays, and learning difficulties. While several studies examine whether sleep exacerbates daytime difficulties and attention deficits in children with IDDs, this chapter focuses on the current state of knowledge regarding sleep and memory consolidation in typically developing (TD) groups and those at risk for learning difficulties. In particular, this chapter summarizes the current literature on sleep-dependent learning across developmental disabilities, including Down syndrome, Williams syndrome, Autism Spectrum Disorder, and Learning Disabilities (Attention-Deficit/Hyperactivity Disorder and Dyslexia). We also highlight the gaps in the current literature and identify challenges in studying sleep-dependent memory in children with different IDDs. This burgeoning new field highlights the importance of considering the role of sleep in memory retention across long delays when evaluating children's memory processes. Further, an understanding of typical and atypical development can mutually inform recent theories of sleep's role in memory.

Longitudinal assessment of NREM sleep EEG in typically developing and medication-free ADHD adolescents: first year results

OBJECTIVE

Clinical observation and structural MRI studies suggest that delayed brain maturation is a major cause of attention deficit hyperactivity disorder (ADHD). Sleep electroencephalogram (EEG) which exhibits major changes across adolescence provides an opportunity to investigate brain electrophysiology evidence for maturational delay. We present data from an ongoing longitudinal study of sleep EEG in medication-free ADHD and typically developing adolescents to investigate brain electrophysiological evidence for this maturational delay.

METHODS

Nine adolescents diagnosed with ADHD (combined presentation, DSM-V criteria, mean age 12.39 ± 0.61 years, 2 females), and nine typically developing controls (12.08 ± 0.35 years, 4 females) were recruited. Subjects underwent an adaptation night and all night polysomnography twice yearly at the Laboratory.

RESULTS

Basic sleep structure did not differ between the ADHD and control groups. In addition, we found no group differences on delta power (p = 0.77), but found a possible trend toward higher theta power (p = 0.057) for the ADHD group. The decline of standardized delta power across the 4 non-rapid eye movement (NREM) periods differed by group (p < 0.05) with the percent delta power in the first NREM period being lower in the ADHD group.

CONCLUSIONS

Our data support the preponderant evidence that basic sleep structure is unaltered with ADHD. Our data do suggest altered sleep homeostatic recuperative processes in ADHD. The theta findings from the first two recordings are suggestive of a maturational delay associated with ADHD, but follow-up data-points are needed.

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.

Sleep, academic achievement, and cognitive performance in children with attention-deficit hyperactivity disorder: A polysomnographic study

The objective of this study was to examine the influence of parent-reported and polysomnography (PSG)-measured sleep patterns on the academic and cognitive performance of children with attention-deficit hyperactivity disorder (ADHD). We assessed 91 children (18 girls) diagnosed with ADHD aged 7-11 years (29 ADHD-Inattentive, 32 ADHD-Hyperactive/Impulsive, and 31 ADHD-Combined). The Paediatric Sleep Questionnaire (PSQ) and Paediatric Daytime Sleepiness Scale (PDSS) were used to assess subjective sleep quality, as perceived by parents, and objective sleep variables were assessed by PSG. Cognitive performance was evaluated using the Wechsler Intelligence Scale for Children (WISC), and the final average grade of the last school year was used as a measure of academic performance. Academic performance was predicted by the following sleep variables: Sleep time, time in bed, night awakenings, and daytime sleepiness. The best predictors of cognitive performance in children with ADHD were rapid eye movement latency, light sleep, periodic limb movements index (PLMs), awakenings, and daytime sleepiness. In conclusion, sleep parameters are closely associated with the academic and cognitive functioning of children with ADHD.

Does Sleep Selectively Strengthen Certain Memories Over Others Based on Emotion and Perceived Future Relevance?

Sleep has been found to have a beneficial effect on memory consolidation. It has furthermore frequently been suggested that sleep does not strengthen all memories equally. The first aim of this review paper was to examine whether sleep selectively strengthens emotional declarative memories more than neutral ones. We examined this first by reviewing the literature focusing on sleep/wake contrasts, and then the literature on whether any specific factors during sleep preferentially benefit emotional memories, with a special focus on the often-suggested claim that rapid eye movement sleep primarily consolidates emotional memories. A second aim was to examine if sleep preferentially benefits memories based on other cues of future relevance such as reward, test-expectancy or different instructions during encoding. Once again, we first focused on studies comparing sleep and wake groups, and then on studies examining the contributions of specific factors during sleep (for each future relevance paradigm, respectively). The review revealed that although some support exists that sleep is more beneficial for certain kinds of memories based on emotion or other cues of future relevance, the majority of studies does not support such an effect. Regarding specific factors during sleep, our review revealed that no sleep variable has reliably been found to be specifically associated with the consolidation of certain kinds of memories over others based on emotion or other cues of future relevance.

Individual alpha frequency modulates sleep-related emotional memory consolidation

Alpha-band oscillatory activity is involved in modulating memory and attention. However, few studies have investigated individual differences in oscillatory activity during the encoding of emotional memory, particularly in sleep paradigms where sleep is thought to play an active role in memory consolidation. The current study aimed to address the question of whether individual alpha frequency (IAF) modulates the consolidation of declarative memory across periods of sleep and wake. 22 participants aged 18-41 years (mean age = 25.77) viewed 120 emotionally valenced images (positive, negative, neutral) and completed a baseline memory task before a 2hr afternoon sleep opportunity and an equivalent period of wake. Following the sleep and wake conditions, participants were required to distinguish between 120 learned (target) images and 120 new (distractor) images. This method allowed us to delineate the role of different oscillatory components of sleep and wake states in the emotional modulation of memory. Linear mixed-effects models revealed interactions between IAF, rapid eye movement sleep theta power, and slow-wave sleep slow oscillatory density on memory outcomes. These results highlight the importance of individual factors in the EEG in modulating oscillatory-related memory consolidation and subsequent behavioural outcomes and test predictions proposed by models of sleep-based memory consolidation.

The experience-dependent increase in deep sleep activity is reduced in children with attention-deficit/hyperactivity disorder

OBJECTIVE/BACKGROUND

Learning of a visuomotor adaptation task during wakefulness leads to a local increase in slow-wave activity (SWA, EEG power between 1 and 4.5 Hz) during subsequent deep sleep. Here, we examined this relationship between learning and SWA in children with attention-deficit/hyperactivity disorder (ADHD).

PATIENTS/METHODS

Participants were 15 children with ADHD (9.7-14.8 y, one female) and 15 age-matched healthy controls (9.6-15.7 y, three female). After the completion of a visuomotor adaptation task in the evening, participants underwent an all-night high-density (HD, 128 electrodes) sleep-EEG measurement.

RESULTS

Healthy control children showed the expected right-parietal increase in sleep SWA after visuomotor learning. Despite no difference in visuomotor learning, the local up-regulation during sleep was significantly reduced in ADHD patients compared to healthy controls.

CONCLUSIONS

Our results indicate that the local, experience-dependent regulation of SWA is different in ADHD patients. Because the customarily observed heightened regulation in children was related to sensitive period maturation, ADHD patients may lack certain sensitive periods or show a developmental delay.

Acoustic closed-loop stimulation during sleep improves consolidation of reward-related memory information in healthy children but not in children with attention-deficit hyperactivity disorder

Study Objectives

Slow oscillations (SO) during slow-wave sleep foster the consolidation of declarative memory. Children with attention-deficit hyperactivity disorder (ADHD) display deficits in the sleep-associated consolidation of declarative memory, possibly due to an altered function of SO. The present study aimed at enhancing SO activity using closed-looped acoustic stimulation during slow-wave sleep in children with ADHD.

Methods

A total of 29 male children (14 with ADHD; aged 8–12 years) participated in a double-blind, placebo-controlled study trial. Children spent two experimental nights in a sleep lab, one stimulation night and one sham night. A declarative learning task (word-pair learning) with a reward condition was used as a primary outcome. Secondary outcome variables were a procedural memory (serial reaction time) and working memory (WM; n-back) task. Encoding of declarative and procedural memory took place in the evening before sleep. After sleep, the retrieval took place followed by the n-back task.

Results

The stimulation successfully induced SO activity during sleep in children with and without ADHD. After stimulation, only healthy children performed better on high-rewarded memory items (primary outcome). In contrast, there were indications that only children with ADHD benefitted from the stimulation with respect to procedural as well as WM performance (secondary outcome).

Conclusions

We were able to show that the acoustic closed-loop stimulation can be applied to enhance SO activity in children with and without ADHD. Our data indicate that SO activity during sleep interacts with subsequent memory performance (primary outcome: rewarded declarative memory; secondary outcome: procedural and WM) in children with and without ADHD.

Sleep spindle density is associated with worry in children with generalized anxiety disorder and healthy controls

BACKGROUND

Childhood generalized anxiety disorder (GAD), characterized by uncontrollable worry, is associated with long-term psychopathology risk, yet understanding of developmental trajectories is limited. Despite common complaints about sleep, 'macro' sleep abnormalities have not been identified. Emerging findings suggest micro-architectural features of sleep, including sleep spindles, differentiate various psychiatric populations. The current study investigated sleep spindle density during non-rapid eye movement (NREM) sleep among youth with GAD and healthy controls, including relationships with anxiety, worry, global functioning, and subjective sleep quality.

METHODS

58 pre-pubertal children, n = 26 with GAD and n = 32 matched healthy controls, aged 7-11 years (M = 8.86, SD=1.47), completed diagnostic assessments and a week of actigraphy monitoring prior to a night of polysomnography (PSG) either at home or in a sleep laboratory. NREM spindle activity was detected in frontal and central regions.

RESULTS

Sleep spindle activity did not differ based on diagnostic group or sex. Sleep spindles were unassociated with anxiety and sleep quality but showed a significant positive association with worry in all youth. Among youth with GAD, global functioning was negatively associated with spindle density in frontal regions during NREM stage 3. Spindle density was significantly greater during in-lab compared to at-home PSG.

LIMITATIONS

The small sample size and reliance on only one night of PSG necessitate additional studies.

CONCLUSIONS

The identified link between spindle activity and worry in pre-pubertal children highlights a need for investigations on transdiagnostic features of child psychopathology rather than specific disorders. Longitudinal studies are needed to explore spindle characteristics and affective risk across development.

Associations between cognitive performance and sigma power during sleep in children with attention-deficit/hyperactivity disorder, healthy children, and healthy adults

Sigma power during sleep is associated with cognitive abilities in healthy humans. We examined the relationship between sigma power in sleep EEG and intelligence and alertness in schoolchildren with ADHD (n = 17) in comparison to mentally healthy children (n = 16) and adults (n = 23). We observed a positive correlation between sigma power in sleep stage 2 and IQ in healthy adults but a negative correlation in children with ADHD. Furthermore, children with ADHD showed slower reaction times in alertness testing than both control groups. In contrast, only healthy children displayed a positive correlation between sigma power and reaction times. These data suggest that the associations between sigma power and cognitive performance underlie distinct developmental processes. A negative association between IQ and sigma power indicates a disturbed function of sleep in cognitive functions in ADHD, whereas the function of sleep appears to be matured early in case of motor-related alertness performance.

Atypicalities in sleep and semantic consolidation in autism

Sleep is known to support the neocortical consolidation of declarative memory, including the acquisition of new language. Autism spectrum disorder (ASD) is often characterized by both sleep and language learning difficulties, but few studies have explored a potential connection between the two. Here, 54 children with and without ASD (matched on age, nonverbal ability and vocabulary) were taught nine rare animal names (e.g., pipa). Memory was assessed via definitions, naming and speeded semantic decision tasks immediately after learning (pre‐sleep), the next day (post‐sleep, with a night of polysomnography between pre‐ and post‐sleep tests) and roughly 1 month later (follow‐up). Both groups showed comparable performance at pre‐test and similar levels of overnight change on all tasks; but at follow‐up children with ASD showed significantly greater forgetting of the unique features of the new animals (e.g., pipa is a flat frog). Children with ASD had significantly lower central non‐rapid eye movement (NREM) sigma power. Associations between spindle properties and overnight changes in speeded semantic decisions differed by group. For the TD group, spindle duration predicted overnight changes in responses to novel animals but not familiar animals, reinforcing a role for sleep in the stabilization of new semantic knowledge. For the ASD group, sigma power and spindle duration were associated with improvements in responses to novel and particularly familiar animals, perhaps reflecting more general sleep‐associated improvements in task performance. Plausibly, microstructural sleep atypicalities in children with ASD and differences in how information is prioritized for consolidation may lead to cumulative consolidation difficulties, compromising the quality of newly formed semantic representations in long‐term memory.

Advances in Understanding the Relationship between Sleep and Attention Deficit-Hyperactivity Disorder (ADHD)

Starting from the consolidated relationship between sleep and cognition, we reviewed the available literature on the association between Attention Deficit-Hyperactivity Disorder (ADHD) and sleep. This review analyzes the macrostructural and microstructural sleep features, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA). We included the polysomnographic studies published in the last 15 years. The results of macrostructural parameters are mixed. Almost half of the 18 selected investigations did not find differences between sleep architecture of children with ADHD and controls. Five studies observed that children with ADHD show a longer Rapid Eye Movement (REM) sleep duration than controls. Eight studies included microstructural measures. Remarkable alterations in sleep microstructure of ADHD are related to slow wave activity (SWA) and theta oscillations, respectively, during Non-REM (NREM) and REM sleep. Specifically, some studies found higher SWA in the ADHD group than controls. Similarly, higher theta activity appears to be detrimental for memory performance and inhibitory control in ADHD. These patterns could be interpreted as a maturational delay in ADHD. Also, the increased amount of these activities would be consistent with the hypothesis that the poor sleep could imply a chronic sleep deprivation in children with ADHD, which in turn could affect their cognitive functioning.

Poor Sleep Has Negative Implications for Children With and Without ADHD, but in Different Ways

Background: Sleep problems are commonly reported in attention deficit hyperactivity disorder (ADHD), and are also a familiar characteristic of typical development (TD). We sought to elucidate the relationship between sleep, ADHD trait behaviors, and cognitive inattention, and how it manifests between ADHD and TD children. Participants: Eighteen children diagnosed with ADHD and 20 age-matched TD controls aged 5 to 11 years old participated in the study. Methods: Sleep profiles were assessed using Children's Sleep Habits Questionnaire and actigraphy measures. Behavioral functioning was examined using Conners' Parent Report Scale and attention using the computerized Conners' Continuous Performance Task. Results: We found evidence of (a) poorer sleep quality in the ADHD group, despite no difference in actual sleep time, (b) poor sleep quality in TD children predicting increased ADHD-trait behaviors, despite no association with attention, and (c) a consistent trend for poor sleep quality predicting reduced attentional control in ADHD children, despite no association with behavior. Conclusions: Poor sleep quality affects developmental subgroups in different ways. For ADHD children, poor sleep worsens their predisposed attentional deficit, while for TD children it mimics ADHD behaviors. These findings have important implications for the debate on overdiagnosis of childhood ADHD, and the use of sleep-based interventions. Above all, they highlight the importance of promoting good sleep hygiene in all children.

Preferential Consolidation of Emotional Memory During Sleep: A Meta-Analysis

It is uncertain whether sleep preferentially consolidates emotional over neutral material. Some studies suggest that sleep enhances emotional memory (i.e., that there are large differences in strength of memory for valenced material compared to neutral material after a sleep-filled interval, but that this difference is smaller after a wake-filled interval). Others find no such effect. We attempted to resolve this uncertainty by conducting a meta-analysis that compared valenced to neutral material after both sleep- and wake-filled delays. Standard search strategies identified 31 studies (containing 36 separate datasets) that met our inclusion criteria. Using random effects modeling, we conducted separate analyses for datasets comparing (a) negative vs. neutral material, (b) positive vs. neutral material, or (c) combined negative and positive vs. neutral material. We then specified several subgroup analyses to investigate potential moderators of the relationship between sleep and emotional memory consolidation. Results showed no overall effect for preferential sleep-dependent consolidation of emotional over neutral material. However, moderation analyses provided evidence for stronger effects when (a) studies used free recall rather than recognition outcome measures, or (b) delayed recall or recognition outcomes were controlled for initial learning. Those analyses also suggested that other methodological features (e.g., whether participants experience a full night of sleep and a regular daytime waking control condition rather than a nap and a night-time sleep deprivation control condition) and sample characteristics (e.g. all-male or not, young adult or not) should be carefully addressed in future research in this field. These findings suggest that sleep does enhance emotional memory, but that in the laboratory the effect is only observed under particular methodological conditions. The conditions we identify as being critical to consider are consistent with general theories guiding scientific understanding of memory consolidation during sleep.

The Functional Role of Dreaming in Emotional Processes

Dream experience (DE) represents a fascinating condition linked to emotional processes and the human inner world. Although the overlap between REM sleep and dreaming has been overcome, several studies point out that emotional and perceptually vivid contents are more frequent when reported upon awakenings from this sleep stage. Actually, it is well-known that REM sleep plays a pivotal role in the processing of salient and emotional waking-life experiences, strongly contributing to the emotional memory consolidation. In this vein, we highlighted that, to some extent, neuroimaging studies showed that the processes that regulate dreaming and emotional salience in sleep mentation share similar neural substrates of those controlling emotions during wakefulness. Furthermore, the research on EEG correlates of the presence/absence of DE and the results on EEG pattern related to the incorporated memories converged to assign a crucial role of REM theta oscillations in emotional re-processing. In particular, the theta activity is involved in memory processes during REM sleep as well as during the waking state, in line with the continuity hypothesis. Also, the gamma activity seems to be related to emotional processes and dream recall as well as to lucid dreams. Interestingly, similar EEG correlates of DE have been found in clinical samples when nightmares or dreams occur. Research on clinical samples revealed that promoting the rehearsal of frightening contents aimed to change them is a promising method to treat nightmares, and that lucid dreams are associated with an attenuation of nightmares. In this view, DE can defuse emotional traumatic memories when the emotional regulation and the fear extinction mechanisms are compromised by traumatic and frightening events. Finally, dreams could represent a sort of simulation of reality, providing the possibility to create a new scenario with emotional mastery elements to cope with dysphoric items included in nightmares. In addition, it could be hypothesized that the insertion of bizarre items besides traumatic memories might be functional to "impoverish" the negative charge of the experiences.

Incorporation of recent waking-life experiences in dreams correlates with frontal theta activity in REM sleep

Rapid eye movement (REM) sleep and its main oscillatory feature, frontal theta, have been related to the processing of recent emotional memories. As memories constitute much of the source material for our dreams, we explored the link between REM frontal theta and the memory sources of dreaming, so as to elucidate the brain activities behind the formation of dream content. Twenty participants were woken for dream reports in REM and slow wave sleep (SWS) while monitored using electroencephalography. Eighteen participants reported at least one REM dream and 14 at least one SWS dream, and they, and independent judges, subsequently compared their dream reports with log records of their previous daily experiences. The number of references to recent waking-life experiences in REM dreams was positively correlated with frontal theta activity in the REM sleep period. No such correlation was observed for older memories, nor for SWS dreams. The emotional intensity of recent waking-life experiences incorporated into dreams was higher than the emotional intensity of experiences that were not incorporated. These results suggest that the formation of wakefulness-related dream content is associated with REM theta activity, and accords with theories that dreaming reflects emotional memory processing taking place in REM sleep.