The consolidation of implicit sequence memory in obstructive sleep apnea

Overnight declarative memory consolidation and non-rapid eye movement sleep electroencephalographic oscillations in older adults with obstructive sleep apnea

STUDY OBJECTIVES

To compare overnight declarative memory consolidation and non-rapid eye movement (NREM) sleep electroencephalogram (EEG) oscillations in older adults with obstructive sleep apnea (OSA) to a control group and assess slow-wave activity (SWA) and sleep spindles as correlates of memory consolidation.

METHODS

Forty-six older adults (24 without OSA and 22 with OSA) completed a word-pair associate's declarative memory task before and after polysomnography. Recall and recognition were expressed as a percentage of the morning relative to evening scores. Power spectral analysis was performed on EEG recorded at frontal (F3-M2, F4-M1) and central (C3-M2, C4-M1) sites. We calculated NREM absolute slow oscillation (0.25-1 Hz) and delta (0.5-4.5 Hz) EEG power, and slow (11-13 Hz) spindle density (number of events per minute of N2 sleep) and fast (13-16 Hz) spindle density.

RESULTS

There were no significant differences in overnight recall and recognition between OSA (mean age 58.7 ± 7.1 years, apnea-hypopnea index (AHI) 41.9 ± 29.7 events/hour) and non-OSA (age 61.1 ± 10.3 years, AHI 6.6 ± 4.2 events/hour) groups. The OSA group had lower fast spindle density in the frontal region (p = 0.007). No between-group differences in SWA were observed. In the Control group, overnight recognition positively correlated with slow spindle density in frontal (rho = 0.555, p = 0.020) and central regions (rho = 0.490, p = 0.046). Overnight recall was not related to SWA or spindle measures in either group.

CONCLUSIONS

Older adults with OSA had deficits in fast sleep spindles but showed preserved overnight declarative memory consolidation. It is possible that compensatory mechanisms are being recruited by OSA patients to preserve declarative memory consolidation despite the presence of sleep spindle deficits.

The Effect of Obstructive Sleep Apnea on Sleep-dependent Emotional Memory Consolidation

Rationale: A growing body of evidence suggests that sleep is critical for the adaptive processing and consolidation of emotional information into long-term memory. Previous research has indicated that emotional components of scenes particularly benefit from sleep in healthy groups, yet sleep-dependent emotional memory processes remain unexplored in clinical cohorts, including those with obstructive sleep apnea (OSA). This line of research is important as it will add to the understanding of how disrupted sleep in OSA contributes to both impaired cognition and emotion dysregulation. Objectives: To test the hypothesis that individuals with OSA will have impaired sleep-dependent memory consolidation, with the greatest impact being on memory for emotional content. Methods: In this study, a group of newly diagnosed patients with OSA (n = 26; 10 female; average age, 42.5 years) and a matched group of healthy control subjects (n = 24; 13 female; average age, 37 years) were enrolled in the study at Beth Israel Deaconess Medical Center. Participants encoded scenes with negative or neutral foreground objects placed on neutral backgrounds before a night of polysomnographically recorded sleep. In the morning, they completed a recognition test in which old and new scene objects and backgrounds, presented separately and one at a time, were judged as old, new, or similar compared with what had been previously viewed. Results: Patients with OSA had a deficit in recognition memory for the scenes. Overall recognition (the ability to recognize old items as either old or similar) was impaired across all scene elements, both negative and neutral objects and backgrounds, whereas specific recognition (correctly identifying old items as old) was impaired only for negative objects. Across all participants, successful overall recognition correlated positively with sleep efficiency and rapid eye movement (REM) sleep, whereas successful specific memory recognition correlated only with REM sleep. Conclusions: Our findings indicate that fragmented sleep and reduced REM sleep, both hallmarks of OSA, are associated with disruptions in general memory impairment and veridical memory for emotional content, which could alter emotional regulation and contribute to comorbid emotional distress in OSA.

Measuring statistical learning by eye-tracking

Statistical learning—the skill to pick up probability-based regularities of the environment—plays a crucial role in adapting to the environment and learning perceptual, motor, and language skills in healthy and clinical populations. Here, we developed a new method to measure statistical learning without any manual responses. We used the Alternating Serial Reaction Time (ASRT) task, adapted to eye-tracker, which, besides measuring reaction times (RTs), enabled us to track learning-dependent anticipatory eye movements. We found robust, interference-resistant learning on RT; moreover, learning-dependent anticipatory eye movements were even more sensitive measures of statistical learning on this task. Our method provides a way to apply the widely used ASRT task to operationalize statistical learning in clinical populations where the use of manual tasks is hindered, such as in Parkinson’s disease. Furthermore, it also enables future basic research to use a more sensitive version of this task to measure predictive processing.

Cautious or causal? Key implicit sequence learning paradigms should not be overlooked when assessing the role of DLPFC (Commentary on Prutean et al.)

The role of the dorsolateral prefrontal cortex (DLPFC) in implicit sequence/statistical learning has received considerable attention in recent cognitive neuroscience research. Studies have used non-invasive brain stimulation methods to test whether the DLPFC plays a role in the incidental acquisition and expression of implicit sequence learning. In a recent study, Prutean et al. has concluded that stimulating the left or the right DLPFC might not affect the expression of implicit sequence learning measured by the Serial Reaction Time (SRT) task. The authors speculated that the previous results revealing improved implicit sequence learning following DLPFC stimulation might have been found because explicit awareness accumulated with the use of Alternating Serial Reaction Time (ASRT) task. Our response presents solid evidence that the ASRT task measures implicit sequence learning that remains unconscious both at the judgment and structural level. Therefore, contrary to the conclusion of Prutean et al., we argue that the DLPFC could have a crucial effect on implicit sequence learning that may be task-dependent. We suggest that future research should focus on the specific cognitive processes that may be differentially involved in the SRT versus ASRT tasks, and test what the role of the DLPFC is in those specific cognitive processes.

Day versus night consolidation of implicit sequence learning using manual and oculomotor activation versions of the serial reaction time task: reaction time and anticipation measures

This study presents two experiments that explored consolidation of implicit sequence learning based on two dependent variables-reaction time (RT) and correct anticipations to clarify the role of sleep, and whether the manual component is necessary for consolidation processes. Experiment 1 (n = 37) explored the performance of adults using an ocular variant of the serial reaction time task (O-SRT) with manual activation (MA), and Experiment 2 (n = 37) used the ocular activation (OA) version of the task. Each experiment consisted of a Day and a Night group that performed two sessions of the O-SRT with an intervening 12-h offline period (morning/evening in Day group, evening/following morning in Night group). Night offline had an advantage only when manual response was required and when correct anticipations (i.e., accuracy) but not RT (i.e., speed) were measured. We associated this finding with the dual-learning processes required in the MA O-SRT that led to increased sequence specific learning overnight. When using the OA O-SRT, both groups demonstrated similar rates after offline in RT and correct anticipations. We interpreted this finding to reflect stabilization, which confirmed our hypothesis. As expected, all the groups demonstrated reduced performance when another sequence was introduced, thus reflecting sequence-specific learning. This study used a powerful procedure that allows measurement of implicit sequence learning in several ways: by evaluating two different measures (RT, correct anticipations) and by isolating different aspects of the task (i.e., with/without the manual learning component, more/less general skill learning), which are known to affect learning and consolidation.

Reversible Verbal Memory Integration Deficits in Obstructive Sleep Apnoea

When presented with novel but semantically related elements after learning verbal material, healthy participants tend to endorse these items as previously learned. This reflects the normal integration and association of novel verbal information into long-term memory. How obstructive sleep apnoea (OSA) negatively impacts verbal memory performance, and whether deficits are reversible following positive airway pressure (PAP) treatment, remain elusive. We investigated immediate and delayed OSA- and PAP treatment-related effects on verbal memory integration, using a false memory paradigm. Twenty-three patients with OSA learned lists of words semantically related to target non-presented words (1) at baseline after a polysomnography diagnosis night, (2) after a consecutive polysomnography night under PAP titration, and (3) after three months of compliant PAP treatment. At each session, participants learned 10 different lists of words, each list comprising 15 semantically related items. They had then to recognize 15 minutes later (after an intermediate vigilance task) previously learned words within a list including studied words (learned), unstudied but semantically related items (lures), and non-related unstudied items (controls). Sleep quality and fatigue questionnaires, and psychomotor vigilance tests (PVT) were administered at each session. PAP treatment led to OSA remission and improvement in objective and subjective sleep quality. Crucially, recognition of learned and lure words increased after the first night under treatment and remained stable three months later, suggesting successful memory integration and restoration of semantic processes. No treatment-related outcome was found on PVT performance. OSA exerts a detrimental but PAP-reversible effect on verbal learning and semantic memory integration mechanisms underlying the acquisition of novel memory representations.

Sleep spindle activity correlates with implicit statistical learning consolidation in untreated obstructive sleep apnea patients

OBJECTIVE/BACKGROUND

The aim of this study was to examine the relationship between overnight consolidation of implicit statistical learning with spindle frequency EEG activity and slow frequency delta power during non-rapid eye movement (NREM) sleep in obstructive sleep apnea (OSA).

PATIENTS/METHODS

Forty-seven OSA participants completed the experiment. Prior to sleep, participants performed a reaction time cover task containing hidden patterns of pictures, about which participants were not informed. After the familiarisation phase, participants underwent overnight polysomnography. 24 h after the familiarisation phase, participants performed a test phase to assess their learning of the hidden patterns, expressed as a percentage of the number of correctly identified patterns. Spindle frequency activity (SFA) and delta power (0.5-4.5 Hz), were quantified from NREM electroencephalography. Associations between statistical learning and sleep EEG, and OSA severity measures were examined.

RESULTS

SFA in NREM sleep in frontal and central brain regions was positively correlated with statistical learning scores (r = 0.41 to 0.31, p = 0.006 to 0.044). In multiple regression, greater SFA and longer sleep onset latency were significant predictors of better statistical learning performance. Delta power and OSA severity were not significantly correlated with statistical learning.

CONCLUSIONS

These findings suggest spindle activity may serve as a marker of statistical learning capability in OSA. This work provides novel insight into how altered sleep physiology relates to consolidation of implicitly learnt information in patients with moderate to severe OSA.

Speed or Accuracy Instructions During Skill Learning do not Affect the Acquired Knowledge

A crucial question in skill learning research is how instruction affects the performance or the underlying representations. Little is known about the effects of instructions on one critical aspect of skill learning, namely, picking-up statistical regularities. More specifically, the present study tests how prelearning speed or accuracy instructions affect the acquisition of non-adjacent second-order dependencies. We trained 2 groups of participants on an implicit probabilistic sequence learning task: one group focused on being fast and the other on being accurate. As expected, we detected a strong instruction effect: accuracy instruction resulted in a nearly errorless performance, and speed instruction caused short reaction times (RTs). Despite the differences in the average RTs and accuracy scores, we found a similar level of statistical learning performance in the training phase. After the training phase, we tested the 2 groups under the same instruction (focusing on both speed and accuracy), and they showed comparable performance, suggesting a similar level of underlying statistical representations. Our findings support that skill learning can result in robust representations, and they highlight that this form of knowledge may appear with almost errorless performance. Moreover, multiple sessions with different instructions enabled the separation of competence from performance.

The relationship between subjective sleep quality and cognitive performance in healthy young adults: Evidence from three empirical studies

The role of subjective sleep quality in cognitive performance has gained increasing attention in recent decades. In this paper, our aim was to test the relationship between subjective sleep quality and a wide range of cognitive functions in a healthy young adult sample combined across three studies. Sleep quality was assessed by the Pittsburgh Sleep Quality Index, the Athens Insomnia Scale, and a sleep diary to capture general subjective sleep quality, and the Groningen Sleep Quality Scale to capture prior night's sleep quality. Within cognitive functions, we tested working memory, executive functions, and several sub-processes of procedural learning. To provide more reliable results, we included robust frequentist as well as Bayesian statistical analyses. Unequivocally across all analyses, we showed that there is no association between subjective sleep quality and cognitive performance in the domains of working memory, executive functions and procedural learning in healthy young adults. Our paper can contribute to a deeper understanding of subjective sleep quality and its measures, and we discuss various factors that may affect whether associations can be observed between subjective sleep quality and cognitive performance.

Is there more room to improve? The lifespan trajectory of procedural learning and its relationship to the between- and within-group differences in average response times

Characterizing the developmental trajectories of cognitive functions such as learning, memory and decision making across the lifespan faces fundamental challenges. Cognitive functions typically encompass several processes that can be differentially affected by age. Methodological issues also arise when comparisons are made across age groups that differ in basic performance measures, such as in average response times (RTs). Here we focus on procedural learning–a fundamental cognitive function that underlies the acquisition of cognitive, social, and motor skills–and demonstrate how disentangling subprocesses of learning and controlling for differences in average RTs can reveal different developmental trajectories across the human lifespan. Two hundred-seventy participants aged between 7 and 85 years performed a probabilistic sequence learning task that enabled us to separately measure two processes of procedural learning, namely general skill learning and statistical learning. Using raw RT measures, in between-group comparisons, we found a U-shaped trajectory with children and older adults exhibiting greater general skill learning compared to adolescents and younger adults. However, when we controlled for differences in average RTs (either by using ratio scores or focusing on a subsample of participants with similar average speed), only children (but not older adults) demonstrated superior general skill learning consistently across analyses. Testing the relationship between average RTs and general skill learning within age groups shed light on further age-related differences, suggesting that general skill learning measures are more affected by average speed in some age groups. Consistent with previous studies of learning probabilistic regularities, statistical learning showed a gradual decline across the lifespan, and learning performance seemed to be independent of average speed, regardless of the age group. Overall, our results suggest that children are superior learners in various aspects of procedural learning, including both general skill and statistical learning. Our study also highlights the importance to test, and control for, the effect of average speed on other RT measures of cognitive functions, which can fundamentally affect the interpretation of group differences in developmental, aging and clinical psychology and neuroscience studies.

Sleep and the extraction of hidden regularities: A systematic review and the importance of temporal rules

As part of its role in memory consolidation, sleep has been repeatedly identified as critical for the extraction of regularities from wake experiences. However, many null results have been published as well, with no clear consensus emerging regarding the conditions that yield this sleep effect. Here, we systematically review the role of sleep in the extraction of hidden regularities, specifically those involving associative relations embedded in newly learned information. We found that the specific behavioral task used in a study had far more impact on whether a sleep effect was discovered than either the category of the cognitive processes targeted, or the particular experimental design employed. One emerging pattern, however, was that the explicit detection of hidden rules is more likely to happen when the rules are of a temporal nature (i.e., event A at time t predicts a later event B) than when they are non-temporal. We discuss this temporal rule sensitivity in reference to the compressed memory replay occurring in the hippocampus during slow-wave-sleep, and compare this effect to what happens when the extraction of regularities depends on prior knowledge and relies on structures other than the hippocampus.

Role of normal sleep and sleep apnea in human memory processing

A fundamental problem in the field of obstructive sleep apnea (OSA) and memory is that it has historically minimized the basic neurobiology of sleep's role in memory. Memory formation has been classically divided into phases of encoding, processing/consolidation, and retrieval. An abundance of evidence suggests that sleep plays a critical role specifically in the processing/consolidation phase, but may do so differentially for memories that were encoded using particular brain circuits. In this review, we discuss some of the more established evidence for sleep's function in the processing of declarative, spatial navigational, emotional, and motor/procedural memories and more emerging evidence highlighting sleep's importance in higher order functions such as probabilistic learning, transitive inference, and category/gist learning. Furthermore, we discuss sleep's capacity for memory augmentation through targeted/cued memory reactivation. OSA - by virtue of its associated sleep fragmentation, intermittent hypoxia, and potential brain structural effects - is well positioned to specifically impact the processing/consolidation phase, but testing this possibility requires experimental paradigms in which memory encoding and retrieval are separated by a period of sleep with and without the presence of OSA. We argue that such paradigms should focus on the specific types of memory tasks for which sleep has been shown to have a significant effect. We discuss the small number of studies in which this has been done, in which OSA nearly uniformly negatively impacts offline memory processing. When periods of offline processing are minimal or absent and do not contain sleep, as is the case in the broad literature on OSA and memory, the effects of OSA on memory are far less consistent.

Children retain implicitly learned phonological sequences better than adults: a longitudinal study

Whereas adults often rely on explicit memory, children appear to excel in implicit memory, which plays an important role in the acquisition of various cognitive skills, such as those involved in language. The current study aimed to test the assertion of an age-dependent shift in implicit versus explicit learning within a theoretical framework that explains the link between implicit sequence memory and word-form acquisition, using the Hebb repetition paradigm. We conducted a one-year, multiple-session longitudinal study in which we presented auditory sequences of syllables, co-presented with pictures of aliens, for immediate serial recall by a group of children (8-9 years) and by an adult group. The repetition of one Hebb sequence was explicitly announced, while the repetition of another Hebb sequence was unannounced and, therefore, implicit. Despite their overall inferior recall performance, the children showed better offline retention of the implicit Hebb sequence, compared with adults who showed a significant decrement across the delays. Adults had gained more explicit knowledge of the implicit sequence than children, but this could not explain the age-dependent decline in the delayed memory for it. There was no significant age-effect for delayed memory of the explicit Hebb sequence, with both age groups showing retention. Overall performance by adults was positively correlated with measures of post-learning awareness. Performance by children was positively correlated with vocabulary knowledge. We conclude that children outperform adults in the retention over time of implicitly learned phonological sequences that will gradually consolidate into novel word-forms. The findings are discussed in the light of maturational differences for implicit versus explicit memory systems that also play a role in language acquisition. A video abstract of this article can be viewed at: https://youtu.be/G5nOfJB72t4.

Intact implicit statistical learning in borderline personality disorder

Wide-spread neuropsychological deficits have been identified in borderline personality disorder (BPD). Previous research found impairments in decision making, declarative memory, working memory and executive functions; however, no studies have focused on implicit learning in BPD yet. The aim of our study was to investigate implicit statistical learning by comparing learning performance of 19 BPD patients and 19 healthy, age-, education- and gender-matched controls on a probabilistic sequence learning task. Moreover, we also tested whether participants retain the acquired knowledge after a delay period. To this end, participants were retested on a shorter version of the same task 24h after the learning phase. We found intact implicit statistical learning as well as retention of the acquired knowledge in this personality disorder. BPD patients seem to be able to extract and represent regularities implicitly, which is in line with the notion that implicit learning is less susceptible to illness compared to the more explicit processes.

Overnight Motor Skill Learning Outcomes in Obstructive Sleep Apnea: Effect of Continuous Positive Airway Pressure

STUDY OBJECTIVE

To determine the effectiveness of continuous positive airway pressure (CPAP) therapy in alleviating known impairments in the overnight consolidation of motor skill learning in patients with obstructive sleep apnea (OSA).

METHODS

Twenty-five patients with untreated moderate-severe OSA, 13 first-night CPAP users, 17 compliant CPAP users, and 14 healthy control patients were trained on a motor sequence learning task (Sequential Finger Tapping Task, SFTT) and were subsequently tested prior to and after polysomnographic recorded sleep. Measures of subjective sleepiness (Karolinska Sleepiness Scale) and sustained attention (Psychomotor Vigilance Task) were also completed before and after sleep.

RESULTS

Typical analyses of overnight improvement on the SFTT show significantly greater overnight gains in motor task speed in controls (+11.6 ± 4.7%, p = 0.007) and compliant CPAP users (+8.9 ± 4.3%, p = 0.008) compared to patients with OSA (-4.86 ± 4.5%). Additional analyses suggest that these improvements in motor performance occurred prior to the sleep episode, as all groups significantly improved (15% to 22%) over a 10-min presleep rest period. Thereafter, performance in all groups significantly deteriorated over sleep (6% to 16%) with trends toward patients with OSA showing greater losses in performance compared to control patients and compliant CPAP users. No between-group differences in subjective sleepiness and sustained attention were found presleep and postsleep.

CONCLUSIONS

The current data suggest impairments in overnight motor learning in patients with OSA may be a combination of deficient stabilization of memory over a sleep episode as well as increased vulnerability to time on task fatigue effects. Compliant CPAP usage possibly offsets both of these impediments to learning outcomes by improving both sleep quality and subsequent daytime function.

Declarative and Non-declarative Memory Consolidation in Children with Sleep Disorder

Healthy sleep is essential in children’s cognitive, behavioral, and emotional development. However, remarkably little is known about the influence of sleep disorders on different memory processes in childhood. Such data could give us a deeper insight into the effect of sleep on the developing brain and memory functions and how the relationship between sleep and memory changes from childhood to adulthood. In the present study we examined the effect of sleep disorder on declarative and non-declarative memory consolidation by testing children with sleep-disordered breathing (SDB) which is characterized by disrupted sleep structure. We used a story recall task to measure declarative memory and Alternating Serial Reaction time (ASRT) task to assess non-declarative memory. This task enables us to measure two aspects of non-declarative memory, namely general motor skill learning and sequence-specific learning. There were two sessions: a learning phase and a testing phase, separated by a 12 h offline period with sleep. Our data showed that children with SDB exhibited a generally lower declarative memory performance both in the learning and testing phase; however, both the SDB and control groups exhibited retention of the previously recalled items after the offline period. Here we showed intact non-declarative consolidation in SDB group in both sequence-specific and general motor skill. These findings suggest that sleep disorders in childhood have a differential effect on different memory processes (online vs. offline) and give us insight into how sleep disturbances affects developing brain.

Sleep and memory consolidation: motor performance and proactive interference effects in sequence learning

That post-training sleep supports the consolidation of sequential motor skills remains debated. Performance improvement and sensitivity to proactive interference are both putative measures of long-term memory consolidation. We tested sleep-dependent memory consolidation for visuo-motor sequence learning using a proactive interference paradigm. Thirty-three young adults were trained on sequence A on Day 1, then had Regular Sleep (RS) or were Sleep Deprived (SD) on the night after learning. After two recovery nights, they were tested on the same sequence A, then had to learn a novel, potentially competing sequence B. We hypothesized that proactive interference effects on sequence B due to the prior learning of sequence A would be higher in the RS condition, considering that proactive interference is an indirect marker of the robustness of sequence A, which should be better consolidated over post-training sleep. Results highlighted sleep-dependent improvement for sequence A, with faster RTs overnight for RS participants only. Moreover, the beneficial impact of sleep was specific to the consolidation of motor but not sequential skills. Proactive interference effects on learning a new material at Day 4 were similar between RS and SD participants. These results suggest that post-training sleep contributes to optimizing motor but not sequential components of performance in visuo-motor sequence learning.