1
|
Montupil J, Cardone P, Staquet C, Bonhomme A, Defresne A, Martial C, Alnagger NL, Gosseries O, Bonhomme V. The nature of consciousness in anaesthesia. BJA OPEN 2023; 8:100224. [PMID: 37780201 PMCID: PMC10539891 DOI: 10.1016/j.bjao.2023.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Abstract
Neuroscientists agree on the value of locating the source of consciousness within the brain. Anaesthesiologists are no exception, and have their own operational definition of consciousness based on phenomenological observations during anaesthesia. The full functional correlates of consciousness are yet to be precisely identified, however rapidly evolving progress in this scientific domain has yielded several theories that attempt to model the generation of consciousness. They have received variable support from experimental observations, including those involving anaesthesia and its ability to reversibly modulate different aspects of consciousness. Aside from the interest in a better understanding of the mechanisms of consciousness, exploring the functional tenets of the phenomenological consciousness states of general anaesthesia has the potential to ultimately improve patient management. It could facilitate the design of specific monitoring devices and approaches, aiming at reliably detecting each of the possible states of consciousness during an anaesthetic procedure, including total absence of mental content (unconsciousness), and internal awareness (sensation of self and internal thoughts) with or without conscious perception of the environment (connected or disconnected consciousness, respectively). Indeed, it must be noted that unresponsiveness is not sufficient to infer absence of connectedness or even absence of consciousness. This narrative review presents the current knowledge in this field from a system-level, underlining the contribution of anaesthesia studies in supporting theories of consciousness, and proposing directions for future research.
Collapse
Affiliation(s)
- Javier Montupil
- Anesthesia and Perioperative Neuroscience Laboratory, Liege, Belgium
- Department of Anesthesia and Intensive Care Medicine, Liege, Belgium
- University Department of Anesthesia and Intensive Care Medicine, Citadelle Regional Hospital, Liege, Belgium
| | - Paolo Cardone
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
- Centre du Cerveau, Liege University Hospital, Liege, Belgium
| | - Cécile Staquet
- Anesthesia and Perioperative Neuroscience Laboratory, Liege, Belgium
- Department of Anesthesia and Intensive Care Medicine, Liege, Belgium
| | - Arthur Bonhomme
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Aline Defresne
- Anesthesia and Perioperative Neuroscience Laboratory, Liege, Belgium
- Department of Anesthesia and Intensive Care Medicine, Liege, Belgium
- University Department of Anesthesia and Intensive Care Medicine, Citadelle Regional Hospital, Liege, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
- Centre du Cerveau, Liege University Hospital, Liege, Belgium
| | - Naji L.N. Alnagger
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
- Centre du Cerveau, Liege University Hospital, Liege, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
- Centre du Cerveau, Liege University Hospital, Liege, Belgium
| | - Vincent Bonhomme
- Anesthesia and Perioperative Neuroscience Laboratory, Liege, Belgium
- Department of Anesthesia and Intensive Care Medicine, Liege, Belgium
| |
Collapse
|
2
|
Zhang XW, Chen L, Chen CF, Cheng J, Zhang PP, Wang LC. Dexmedetomidine modulates neuronal activity of horizontal limbs of diagonal band via α2 adrenergic receptor in mice. BMC Anesthesiol 2023; 23:327. [PMID: 37784079 PMCID: PMC10544551 DOI: 10.1186/s12871-023-02278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Dexmedetomidine (DEX) is widely used in clinical sedation which has little effect on cardiopulmonary inhibition, however the mechanism remains to be elucidated. The basal forebrain (BF) is a key nucleus that controls sleep-wake cycle. The horizontal limbs of diagonal bundle (HDB) is one subregions of the BF. The purpose of this study was to examine whether the possible mechanism of DEX is through the α2 adrenergic receptor of BF (HDB). METHODS In this study, we investigated the effects of DEX on the BF (HDB) by using whole cell patch clamp recordings. The threshold stimulus intensity, the inter-spike-intervals (ISIs) and the frequency of action potential firing in the BF (HDB) neurons were recorded by application of DEX (2 µM) and co-application of a α2 adrenergic receptor antagonist phentolamine (PHEN) (10 µM). RESULTS DEX (2 µM) increased the threshold stimulus intensity, inhibited the frequency of action potential firing and enlarged the inter-spike-interval (ISI) in the BF (HDB) neurons. These effects were reversed by co-application of PHEN (10 µM). CONCLUSION Taken together, our findings revealed DEX decreased the discharge activity of BF (HDB) neuron via α2 adrenergic receptors.
Collapse
Affiliation(s)
- Xia-Wei Zhang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, 230032, Hefei, China
| | - Lei Chen
- Departments of Pharmacy, The First Affiliated Hospital of Anhui University of Chinese Medicine, 230031, Hefei, China
| | - Chang-Feng Chen
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, 230032, Hefei, China
| | - Juan Cheng
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, 230032, Hefei, China
| | - Ping-Ping Zhang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, 230032, Hefei, China
| | - Lie-Cheng Wang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, 230032, Hefei, China.
| |
Collapse
|
3
|
Cardone P, Bodart O, Kirsch M, Sanfilippo J, Virgillito A, Martial C, Simon J, Wannez S, Sanders RD, Laureys S, Massimini M, Vandewalle G, Bonhomme V, Gosseries O. Depth of sedation with dexmedetomidine increases transcranial magnetic stimulation-evoked potential amplitude non-linearly. Br J Anaesth 2023; 131:715-725. [PMID: 37596183 DOI: 10.1016/j.bja.2023.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Cortical excitability is higher in unconsciousness than in wakefulness, but it is unclear how this relates to anaesthesia. We investigated cortical excitability in response to dexmedetomidine, the effects of which are not fully known. METHODS We recorded transcranial magnetic stimulation (TMS) and EEG in frontal and parietal cortex of 20 healthy subjects undergoing dexmedetomidine sedation in four conditions (baseline, light sedation, deep sedation, recovery). We used the first component (0-30 ms) of the TMS-evoked potential (TEP) to measure cortical excitability (amplitude), slope, and positive and negative peak latencies (collectively, TEP indices). We used generalised linear mixed models to test the effect of condition, brain region, and responsiveness on TEP indices. RESULTS Compared with baseline, amplitude in the frontal cortex increased by 6.52 μV (P<0.001) in light sedation, 4.55 μV (P=0.003) in deep sedation, and 5.03 μV (P<0.001) in recovery. Amplitude did not change in the parietal cortex. Compared with baseline, slope increased in all conditions (P<0.02) in the frontal but not parietal cortex. The frontal cortex showed 5.73 μV higher amplitude (P<0.001), 0.63 μV ms-1 higher slope (P<0.001), and 2.2 ms shorter negative peak latency (P=0.001) than parietal areas. Interactions between dexmedetomidine and region had effects over amplitude (P=0.004) and slope (P=0.009), with both being higher in light sedation, deep sedation, and recovery compared with baseline. CONCLUSIONS Transcranial magnetic stimulation-evoked potential amplitude changes non-linearly as a function of depth of sedation by dexmedetomidine, with a region-specific paradoxical increase. Future research should investigate other anaesthetics to elucidate the link between cortical excitability and depth of sedation.
Collapse
Affiliation(s)
- Paolo Cardone
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium
| | - Olivier Bodart
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium; Department of Neurology, University of Liège, Liège, Belgium
| | - Murielle Kirsch
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Anaesthesia and Intensive Care Medicine, University of Liège, Liège, Belgium
| | - Julien Sanfilippo
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium
| | | | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium
| | - Jessica Simon
- Psychology and Neuroscience of Cognition, University of Liège, Liège, Belgium
| | - Sarah Wannez
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Camperdown, Australia; Department of Anaesthetics & Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium; Joint International Research Unit on Consciousness, CERVO Brain Research Centre, CIUSS, University Laval, Québec City, QC, Canada
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; IRCCS Fondazione Don Gnocchi, Milan, Italy
| | - Gilles Vandewalle
- Sleep and Chronobiology Lab, GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium
| | - Vincent Bonhomme
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Anaesthesia and Intensive Care Medicine, University of Liège, Liège, Belgium; University Department of Anaesthesia and Intensive Care Medicine, Centre Hospitalier Régional de la Citadelle (CHR Citadelle), Liège, Belgium.
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium.
| |
Collapse
|
4
|
Fan S, Cheng X, Zhang P, Wang Y, Wang L, Cheng J. The α 2 Adrenoceptor Agonist and Sedative/Anaesthetic Dexmedetomidine Excites Diverse Neuronal Types in the Ventrolateral Preoptic Area of Male Mice. ASN Neuro 2023; 15:17590914231191016. [PMID: 37499170 PMCID: PMC10388635 DOI: 10.1177/17590914231191016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
SUMMARY STATEMENT Dexmedetomidine is an important ICU sedative. The mechanism of dexmedetomidine is not fully understood. Activating NA(-) and NA(+) neurons in the VLPO by dexmedetomidine using polysomnography and electrophysiological recording, this may explain the unique sedative properties with rapid arousal.
Collapse
Affiliation(s)
- Sumei Fan
- Department of Anatomy and Histoembryology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Xinqi Cheng
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pingping Zhang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Yuanyin Wang
- School of Stomatology, Anhui Medical University, Hefei, China
| | - Liecheng Wang
- Department of Anatomy and Histoembryology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Juan Cheng
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| |
Collapse
|
5
|
Carnovale C, Perrotta C, Baldelli S, Cattaneo D, Montrasio C, Barbieri SS, Pompilio G, Vantaggiato C, Clementi E, Pozzi M. Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects. Cardiovasc Res 2022; 119:647-667. [PMID: 35895876 PMCID: PMC10153433 DOI: 10.1093/cvr/cvac110] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/14/2022] Open
Abstract
A bidirectional relationship exists between hypertension and psychiatric disorders, including unipolar and bipolar depression, anxiety, post-traumatic stress disorder (PTSD), psychosis, schizophrenia, mania, and dementia/cognitive decline. Repurposing of antihypertensive drugs to treat mental disorders is thus being explored. A systematic knowledge of the mechanisms of action and clinical consequences of the use of antihypertensive agents on neuropsychiatric functions has not been achieved yet. In this article, we review the putative role of antihypertensive agents in psychiatric disorders, discuss the targets and mechanisms of action, and examine how and to what extent specific drug classes/molecules may trigger, worsen, or mitigate psychiatric symptoms. In addition, we review pharmacokinetics (brain penetration of drugs) and pharmacogenetics data that add important information to assess risks and benefits of antihypertensive drugs in neuropsychiatric settings. The scientific literature shows robust evidence of a positive effect of α1 blockers on PTSD symptoms, nightmares and sleep quality, α2 agonists on core symptoms, executive function and quality of life in Attention-Deficit/Hyperactivity Disorder, PTSD, Tourette's syndrome, and β blockers on anxiety, aggression, working memory, and social communication. Renin-angiotensin system modulators exert protective effects on cognition, depression, and anxiety, and the loop diuretic bumetanide reduced the core symptoms of autism in a subset of patients. There is no evidence of clear benefits of calcium channel blockers in mood disorders in the scientific literature. These findings are mainly from preclinical studies; clinical data are still insufficient or of anecdotal nature, and seldom systematic. The information herewith provided can support a better therapeutic approach to hypertension, tailored to patients with, or with high susceptibility to, psychiatric illness. It may prompt clinical studies exploring the potential benefit of antihypertensive drugs in selected patients with neuropsychiatric comorbidities that include outcomes of neuropsychiatric interest and specifically assess undesirable effects or interactions.
Collapse
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, 20157 Milano, Italy
| | - Cristiana Perrotta
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, 20157 Milano, Italy
| | - Sara Baldelli
- Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, 20157 Milano, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, 20157 Milano, Italy
| | - Cristina Montrasio
- Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, 20157 Milano, Italy
| | - Silvia S Barbieri
- Unit of Brain-Heart axis: cellular and molecular mechanisms - Centro Cardiologico Monzino IRCCS, 20138 Milano, Italy
| | - Giulio Pompilio
- Unit of Vascular Biology and Regenerative Medicine - Centro Cardiologico Monzino IRCCS, 20138, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, 20157 Milano, Italy.,Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| |
Collapse
|
6
|
Osorio-Forero A, Cherrad N, Banterle L, Fernandez LMJ, Lüthi A. When the Locus Coeruleus Speaks Up in Sleep: Recent Insights, Emerging Perspectives. Int J Mol Sci 2022; 23:ijms23095028. [PMID: 35563419 PMCID: PMC9099715 DOI: 10.3390/ijms23095028] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/03/2022] Open
Abstract
For decades, numerous seminal studies have built our understanding of the locus coeruleus (LC), the vertebrate brain’s principal noradrenergic system. Containing a numerically small but broadly efferent cell population, the LC provides brain-wide noradrenergic modulation that optimizes network function in the context of attentive and flexible interaction with the sensory environment. This review turns attention to the LC’s roles during sleep. We show that these roles go beyond down-scaled versions of the ones in wakefulness. Novel dynamic assessments of noradrenaline signaling and LC activity uncover a rich diversity of activity patterns that establish the LC as an integral portion of sleep regulation and function. The LC could be involved in beneficial functions for the sleeping brain, and even minute alterations in its functionality may prove quintessential in sleep disorders.
Collapse
|
7
|
Mann C, Wegner J, Weeß HG, Staubach P. Pathobiology of Second-Generation Antihistamines Related to Sleep in Urticaria Patients. BIOLOGY 2022; 11:biology11030433. [PMID: 35336805 PMCID: PMC8945773 DOI: 10.3390/biology11030433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
Background: Standard treatment options for urticaria are second-generation antihistamines; however, their effect on sleep is uncertain. This study measures the influence of different antihistamines on the biologic sleep pattern of urticaria patients and the relevance of sleep in urticaria patients. Methods: Ten patients with chronic spontaneous urticaria (CSU) and uncontrolled symptoms under a single dose of second-generation antihistamines were included. Two nights were monitored: the first night after 5 days on single dosage and the second night after 5 days on fourfold dosage. Patient-rated questionnaires were used and sleep was monitored using polygraphy. Results: The patients’ rated daytime sleepiness decreased (p = 0.0319), as did their insomnia severity (p = 0.0349). The urticaria control (UCT) improved (p = 0.0007), as did the quality of life (p < 0.0001). There was no significant change of nightly pruritus (p = 0.1173), but there was an improvement of daytime pruritus (p = 0.0120). A significant increase in rapid eye movement (REM) sleep was seen (p = 0.0002) (from a mean of 3.9% to 14.3%). The deep sleep state (N3) also improved (8.7% to 12.3%) (p = 0.1172). Conclusion: This study has demonstrated an improvement of the sleep pattern in CSU patients under up-dosed second-generation antihistamines, without increased daytime sleepiness, alongside an improvement of urticaria symptoms and quality of life.
Collapse
Affiliation(s)
- Caroline Mann
- Department of Dermatology, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (J.W.); (P.S.)
- Correspondence:
| | - Joanna Wegner
- Department of Dermatology, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (J.W.); (P.S.)
| | - Hans-Günter Weeß
- Division of Sleep Medicine, Center for Psychiatry, Psychosomatic and Psychotherapy, Pfalzklinikum Klingenmünster, 76889 Klingenmünster, Germany;
| | - Petra Staubach
- Department of Dermatology, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (J.W.); (P.S.)
| |
Collapse
|
8
|
Liu D, Huang J, Gao S, Jin H, He J. A temporo-spatial pharmacometabolomics method to characterize pharmacokinetics and pharmacodynamics in the brain microregions by using ambient mass spectrometry imaging. Acta Pharm Sin B 2022; 12:3341-3353. [PMID: 35967273 PMCID: PMC9366215 DOI: 10.1016/j.apsb.2022.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/10/2022] [Accepted: 03/20/2022] [Indexed: 11/01/2022] Open
|
9
|
Zhang X, Chang L, Pan SD, Yan FX. Dexmedetomidine Improves Non-rapid Eye Movement Stage 2 Sleep in Children in the Intensive Care Unit on the First Night After Laparoscopic Surgery. Front Pediatr 2022; 10:871809. [PMID: 35573948 PMCID: PMC9091560 DOI: 10.3389/fped.2022.871809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous studies have reported that children who were admitted to the ICU experienced a significant decrease in sleep quality compared to home. We investigated the effects of dexmedetomidine as an adjunct to sufentanil on the sleep in children admitted to the ICU on the first night after major surgery. METHODS This is a prospective study From January to February 2022. Clinical trial number: ChiCTR2200055768, http://www.chictr.org.cn. Fifty-four children aged 1-10 years old children undergoing major laparoscopic surgery were recruited and randomly assigned to either the DEX group, in which intravenous dexmedetomidine (0.3 ug/kg/h) and sufentanil (0.04 ug/kg/h) were continuously infused intravenously for post-operative analgesia; or the SUF group, in which only sufentanil (0.04 ug/kg/h) was continuously infused. Patients were monitored with polysomnography (PSG) on the first night after surgery for 12 h. PSG, sleep architecture, physiologic variables and any types of side effects related to anesthesia and analgesia were recorded. The differences between the two groups were assessed using the chi-square and Wilcoxon rank-sum tests. RESULTS Fifty-four children completed data collection, of which thirty-four were 1-6 years old and twenty were aged >6 years. Compared to the SUF group, subjects in the DEX group aged 1-6 years displayed increased stage 2 sleep duration (P = 0.02) and light sleep duration (P = 0.02). Subjects aged >6 years in the DEX group also displayed increased stage 2 sleep duration (P = 0.035) and light sleep duration (P = 0.018), but decreased REM sleep percentage (P = 0). Additionally, the heart rate and blood pressure results differed between age groups, with the heart rates of subjects aged >6 years in DEX group decreasing at most time points compared to SUF group (P < 0.05). CONCLUSION Dexmedetomidine prolonged N2 sleep and light sleep duration in the pediatric ICU after surgery but had different effects on the heart rate and blood pressure of subjects in different age groups.
Collapse
Affiliation(s)
- Xian Zhang
- Department of Anesthesiology, Capital Institute of Pediatrics Affiliated Children's Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Li Chang
- Department of Respiratory Medicine, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
| | - Shou-Dong Pan
- Department of Anesthesiology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
| | - Fu-Xia Yan
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| |
Collapse
|
10
|
Mooney KL, Brooks Peterson M, Skirko JR, Friedman NR. The Quest for a DISE Protocol. Otolaryngol Head Neck Surg 2021; 167:590-599. [PMID: 34399647 DOI: 10.1177/01945998211036645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this quality initiative project was to modify our existing institutional drug-induced sleep endoscopy (DISE) protocol so that the surgeon could consistently determine obstructive breathing patterns while minimizing children's discomfort. METHODS A quality initiative study utilizing the well-described plan-do-study-act (PDSA) process was conducted at a tertiary hospital for children with polysomnogram-documented obstructive sleep apnea who were undergoing DISE. A 4-point Likert measurement tool was created. Change in each Likert rating with subsequent PDSA cycle was tested with the Wilcoxon rank sum test (Mann-Whitney), and change across all PDSA cycles was tested with the Kruskal-Wallis equality-of-populations rank test. RESULTS After a series of 4 PDSA cycles with 81 children, the DISE protocol was streamlined from 14 to 9 steps. There was significant improvement for all aspects of the DISE, with a final overall median rating of 1 (excellent) for intravenous (IV) placement, scope insertion, and anesthesiologist and surgeon satisfaction (P < .01). DISCUSSION For sleep surgeons, DISE is quickly becoming what bronchoscopy is to the airway surgeon. Utilizing inhalational agents to obtain IV access and insert the flexible scope in the rapid "on-off" fashion optimizes DISE success regardless of the primary sedation medication and allows ample time for these agents to dissipate. IMPLICATIONS FOR PRACTICE Adoption of a DISE protocol that includes nasal premedication and inhalational volatile gases for IV and scope insertion at the onset provides a more predictable level of sedation that is well tolerated by the patient, enabling the otolaryngologist to create an obstructive sleep apnea treatment plan.
Collapse
Affiliation(s)
- Kristin L Mooney
- Department of Surgery, Children's Hospital Colorado, Broomfield, Colorado, USA
| | - Melissa Brooks Peterson
- Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, Colorado, USA.,Division of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jonathan R Skirko
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Norman R Friedman
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| |
Collapse
|
11
|
Bouchereau E, Sharshar T, Legouy C. Delayed awakening in neurocritical care. Rev Neurol (Paris) 2021; 178:21-33. [PMID: 34392974 DOI: 10.1016/j.neurol.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
Delayed awakening is defined as a persistent disorder of arousal or consciousness 48 to 72h after sedation interruption in critically ill patients. Delayed awakening is either a component of coma or delirium. It results in longer hospital stays and increased mortality. It is therefore a diagnostic, therapeutic and prognostic emergency. In severe brain injured patients, delayed awakening may be related to the primary neurological injury or to secondary systemic insults related to organ failure associated with intensive care. In the present review, we propose diagnostic, therapeutic and prognostic algorithms for managing delayed awaking in neuro-ICU brain injured patients.
Collapse
Affiliation(s)
- E Bouchereau
- G.H.U Paris Psychiatry & Neurosciences, department of Neurocritical care, Service d'Anesthésie-Réanimation Neurochirurgicale, 1, rue Cabanis, 75674 Paris Cedex 14, France; INSERM U1266, FHU NeuroVasc, Institut de Psychiatrie et Neuroscience de Paris, Paris, France
| | - T Sharshar
- G.H.U Paris Psychiatry & Neurosciences, department of Neurocritical care, Service d'Anesthésie-Réanimation Neurochirurgicale, 1, rue Cabanis, 75674 Paris Cedex 14, France; INSERM U1266, FHU NeuroVasc, Institut de Psychiatrie et Neuroscience de Paris, Paris, France.
| | - C Legouy
- G.H.U Paris Psychiatry & Neurosciences, department of Neurocritical care, Service d'Anesthésie-Réanimation Neurochirurgicale, 1, rue Cabanis, 75674 Paris Cedex 14, France
| |
Collapse
|
12
|
Tanaka R, Tanaka S, Hayashi K, Iida K, Sawa T, Kawamata M. The histamine H 1 receptor antagonist hydroxyzine enhances sevoflurane and propofol anesthesia: A quantitative EEG study. Clin Neurophysiol 2021; 132:2054-2061. [PMID: 34284240 DOI: 10.1016/j.clinph.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/26/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine the anesthesia-promoting effects of hydroxyzine on electroencephalograms during sevoflurane anesthesia and during propofol anesthesia. METHODS We analyzed 40 patients scheduled for elective surgery under sevoflurane anesthesia (n = 20) or propofol anesthesia (n = 20). Anesthesia was adjusted at a bispectral index value of 50-60, and then 0.5 mg/kg of hydroxyzine was administered intravenously. We analyzed frontal electroencephalograms before and after hydroxyzine injection with power spectral and bicoherence analyses, which are suitable for assessing the anesthetic depth induced by γ-aminobutyric acid (GABA)ergic anesthetics. RESULTS Hydroxyzine increased the α bicoherence peaks in both sevoflurane anesthesia (mean difference, 11.2%; 95% confidence interval (CI), 7.6 to 14.8; P < 0.001) and propofol anesthesia (mean difference, 5.6%; 95% CI, 1.7 to 9.4; P = 0.008). Hydroxyzine increased the averaged δ bicoherence values in both sevoflurane anesthesia (mean difference, 5.5%; 95% CI, 2.1 to 8.8; P = 0.003) and propofol anesthesia (mean difference, 3.9%; 95% CI, 1.0 to 6.8; P = 0.011). CONCLUSIONS Hydroxyzine enhances both sevoflurane anesthesia and propofol anesthesia probably by facilitation of GABAergic neural circuit mechanisms. SIGNIFICANCE The findings provide a new insight into the role of histaminergic neurons during general anesthesia in humans.
Collapse
Affiliation(s)
- Ryusuke Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan.
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan
| | - Kazuko Hayashi
- Department of Anesthesiology, Kyoto Chubu Medical Center, Japan; Department of Anesthesiology, Kyoto Prefectural University of Medicine, Japan
| | - Keisuke Iida
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan
| |
Collapse
|
13
|
Robea MA, Ciobica A, Curpan AS, Plavan G, Strungaru S, Lefter R, Nicoara M. Preliminary Results Regarding Sleep in a Zebrafish Model of Autism Spectrum Disorder. Brain Sci 2021; 11:brainsci11050556. [PMID: 33924776 PMCID: PMC8146635 DOI: 10.3390/brainsci11050556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022] Open
Abstract
Autism spectrum disorder (ASD) is one of the most salient developmental neurological diseases and remarkable similarities have been found between humans and model animals of ASD. A common method of inducing ASD in zebrafish is by administrating valproic acid (VPA), which is an antiepileptic drug that is strongly linked with developmental defects in children. In the present study we replicated and extended the findings of VPA on social behavior in zebrafish by adding several sleep observations. Juvenile zebrafish manifested hyperactivity and an increase in ASD-like social behaviors but, interestingly, only exhibited minimal alterations in sleep. Our study confirmed that VPA can generate specific ASD symptoms, indicating that the zebrafish is an alternative model in this field of research.
Collapse
Affiliation(s)
- Madalina Andreea Robea
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iasi, Bd. Carol I, 20A, 700505 Iasi, Romania; (M.A.R.); (A.-S.C.); (G.P.); (M.N.)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iasi, Bd. Carol I, 20A, 700505 Iasi, Romania; (M.A.R.); (A.-S.C.); (G.P.); (M.N.)
- Correspondence:
| | - Alexandrina-Stefania Curpan
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iasi, Bd. Carol I, 20A, 700505 Iasi, Romania; (M.A.R.); (A.-S.C.); (G.P.); (M.N.)
| | - Gabriel Plavan
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iasi, Bd. Carol I, 20A, 700505 Iasi, Romania; (M.A.R.); (A.-S.C.); (G.P.); (M.N.)
| | - Stefan Strungaru
- Department of Interdisciplinary Research in Science, “Alexandru Ioan Cuza” University of Iasi, Bd. Carol I Avenue, 11, 700505 Iasi, Romania;
| | - Radu Lefter
- Center of Biomedical Research, Romanian Academy, Bd. Carol I, No 8, 700505 Iasi, Romania;
| | - Mircea Nicoara
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iasi, Bd. Carol I, 20A, 700505 Iasi, Romania; (M.A.R.); (A.-S.C.); (G.P.); (M.N.)
| |
Collapse
|
14
|
Locus Coeruleus Acid-Sensing Ion Channels Modulate Sleep-Wakefulness and State Transition from NREM to REM Sleep in the Rat. Neurosci Bull 2021; 37:684-700. [PMID: 33638800 DOI: 10.1007/s12264-020-00625-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/18/2020] [Indexed: 12/11/2022] Open
Abstract
The locus coeruleus (LC) is one of the essential chemoregulatory and sleep-wake (S-W) modulating centers in the brain. LC neurons remain highly active during wakefulness, and some implicitly become silent during rapid eye movement (REM) sleep. LC neurons are also involved in CO2-dependent modulation of the respiratory drive. Acid-sensing ion channels (ASICs) are highly expressed in some brainstem chemosensory breathing regulatory areas, but their localization and functions in the LC remain unknown. Mild hypercapnia increases the amount of non-REM (NREM) sleep and the number of REM sleep episodes, but whether ASICs in the LC modulate S-W is unclear. Here, we investigated the presence of ASICs in the LC and their role in S-W modulation and the state transition from NREM to REM sleep. Male Wistar rats were surgically prepared for chronic polysomnographic recordings and drug microinjections into the LC. The presence of ASIC-2 and ASIC-3 in the LC was immunohistochemically characterized. Microinjections of amiloride (an ASIC blocker) and APETx2 (a blocker of ASIC-2 and -3) into the LC significantly decreased wakefulness and REM sleep, but significantly increased NREM sleep. Mild hypercapnia increased the amount of NREM and the number of REM episodes. However, APETx2 microinjection inhibited this increase in REM frequency. These results suggest that the ASICs of LC neurons modulate S-W, indicating that ASICs could play an important role in vigilance-state transition. A mild increase in CO2 level during NREM sleep sensed by ASICs could be one of the determinants of state transition from NREM to REM sleep.
Collapse
|
15
|
Lee JM, Cho YJ, Ahn EJ, Choi GJ, Kang H. Pharmacological strategies to prevent postoperative delirium: a systematic review and network meta-analysis. Anesth Pain Med (Seoul) 2021; 16:28-48. [PMID: 33445233 PMCID: PMC7861905 DOI: 10.17085/apm.20079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background Postoperative delirium (POD) is a condition of cerebral dysfunction and a common complication after surgery. This study aimed to compare and determine the relative efficacy of pharmacological interventions for preventing POD using a network meta-analysis. Methods We performed a systematic and comprehensive search to identify and analyze all randomized controlled trials until June 29, 2020, comparing two or more pharmacological interventions, including placebo, to prevent or reduce POD. The primary outcome was the incidence of POD. We performed a network meta-analysis and used the surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of the pharmacological interventions evaluated. Results According to the SUCRA value, the incidence of POD decreased in the following order: the combination of propofol and acetaminophen (86.1%), combination of ketamine and dexmedetomidine (86.0%), combination of diazepam, flunitrazepam, and pethidine (84.8%), and olanzapine (75.6%) after all types of anesthesia; combination of propofol and acetaminophen (85.9%), combination of ketamine and dexmedetomidine (83.2%), gabapentin (82.2%), and combination of diazepam, flunitrazepam, and pethidine (79.7%) after general anesthesia; and ketamine (87.1%), combination of propofol and acetaminophen (86.0%), and combination of dexmedetomidine and acetaminophen (66.3%) after cardiac surgery. However, only the dexmedetomidine group showed a lower incidence of POD than the control group after all types of anesthesia and after general anesthesia. Conclusions Dexmedetomidine reduced POD compared with the control group. The combination of propofol and acetaminophen and the combination of ketamine and dexmedetomidine seemed to be effective in preventing POD. However, further studies are needed to determine the optimal pharmacological intervention to prevent POD.
Collapse
Affiliation(s)
- Jun Mo Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ye Jin Cho
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Jin Ahn
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Geun Joo Choi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea.,The Institute of Evidence Based Clinical Medicine, Chung-Ang University, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea.,The Institute of Evidence Based Clinical Medicine, Chung-Ang University, Seoul, Korea
| |
Collapse
|
16
|
Ballesteros JJ, Briscoe JB, Ishizawa Y. Neural signatures of α2-Adrenergic agonist-induced unconsciousness and awakening by antagonist. eLife 2020; 9:57670. [PMID: 32857037 PMCID: PMC7455241 DOI: 10.7554/elife.57670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/09/2020] [Indexed: 12/29/2022] Open
Abstract
How the brain dynamics change during anesthetic-induced altered states of consciousness is not completely understood. The α2-adrenergic agonists are unique. They generate unconsciousness selectively through α2-adrenergic receptors and related circuits. We studied intracortical neuronal dynamics during transitions of loss of consciousness (LOC) with the α2-adrenergic agonist dexmedetomidine and return of consciousness (ROC) in a functionally interconnecting somatosensory and ventral premotor network in non-human primates. LOC, ROC and full task performance recovery were all associated with distinct neural changes. The early recovery demonstrated characteristic intermediate dynamics distinguished by sustained high spindle activities. Awakening by the α2-adrenergic antagonist completely eliminated this intermediate state and instantaneously restored awake dynamics and the top task performance while the anesthetic was still being infused. The results suggest that instantaneous functional recovery is possible following anesthetic-induced unconsciousness and the intermediate recovery state is not a necessary path for the brain recovery.
Collapse
Affiliation(s)
- Jesus Javier Ballesteros
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Jessica Blair Briscoe
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Yumiko Ishizawa
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| |
Collapse
|
17
|
Dexmedetomidine Activation of Dopamine Neurons in the Ventral Tegmental Area Attenuates the Depth of Sedation in Mice. Anesthesiology 2020; 133:377-392. [DOI: 10.1097/aln.0000000000003347] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background
Dexmedetomidine induces a sedative response that is associated with rapid arousal. To elucidate the underlying mechanisms, the authors hypothesized that dexmedetomidine increases the activity of dopaminergic neurons in the ventral tegmental area, and that this action contributes to the unique sedative properties of dexmedetomidine.
Methods
Only male mice were used. The activity of ventral tegmental area dopamine neurons was measured by a genetically encoded Ca2+ indicator and patch-clamp recording. Dopamine neurotransmitter dynamics in the medial prefrontal cortex and nucleus accumbens were measured by a genetically encoded dopamine sensor. Ventral tegmental area dopamine neurons were inhibited or activated by a chemogenetic approach, and the depth of sedation was estimated by electroencephalography.
Results
Ca2+ signals in dopamine neurons in the ventral tegmental area increased after intraperitoneal injection of dexmedetomidine (40 μg/kg; dexmedetomidine, 16.917 [14.882; 21.748], median [25%; 75%], vs. saline, –0.745 [–1.547; 0.359], normalized data, P = 0.001; n = 6 mice). Dopamine transmission increased in the medial prefrontal cortex after intraperitoneal injection of dexmedetomidine (40 μg/kg; dexmedetomidine, 10.812 [9.713; 15.104], median [25%; 75%], vs. saline, –0.498 [–0.664; –0.355], normalized data, P = 0.001; n = 6 mice) and in the nucleus accumbens (dexmedetomidine, 8.543 [7.135; 11.828], median [25%; 75%], vs. saline, –0.329 [–1.220; –0.047], normalized data, P = 0.001; n = 6 mice). Chemogenetic inhibition or activation of ventral tegmental area dopamine neurons increased or decreased slow waves, respectively, after intraperitoneal injection of dexmedetomidine (40 μg/kg; delta wave: two-way repeated measures ANOVA, F[2, 33] = 8.016, P = 0.002; n = 12 mice; theta wave: two-way repeated measures ANOVA, F[2, 33] = 22.800, P < 0.0001; n = 12 mice).
Conclusions
Dexmedetomidine activates dopamine neurons in the ventral tegmental area and increases dopamine concentrations in the related forebrain projection areas. This mechanism may explain rapid arousability upon dexmedetomidine sedation.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Collapse
|
18
|
Gu Y, Yang F, Zhang Y, Zheng J, Wang J, Li B, Ma T, Cui X, Lu K, Ma H. The effects of different doses of dexmedetomidine on the requirements for propofol for loss of consciousness in patients monitored via the bispectral index: a double-blind, placebo-controlled trial. BMC Anesthesiol 2020; 20:96. [PMID: 32334510 PMCID: PMC7183661 DOI: 10.1186/s12871-020-01013-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The α2-adrenergic agonist dexmedetomidine (DEX) is a sedative and can be used as an adjunct to hypnotics. The study sought to evaluate the effects of different doses of DEX on the requirements for propofol for loss of consciousness (LOC) in patients monitored via the bispectral index (BIS). METHODS In this randomized, double-blind, three arm parallel group design and placebo-controlled trial, 73 patients aged between 18 and ~ 65 years with a BMI range of 18.0-24.5 kg·m- 2 and an American Society of Anesthesiologists (ASA) grade I or II who were scheduled for general anesthesia at the General Hospital of Ningxia Medical University were included in this study. Anesthesiologists and patients were blinded to the syringe contents. All patients were randomly assigned in a 1:1:1 ratio to receive a 0.5 μg·kg- 1 DEX infusion (0.5 μg·kg- 1 DEX group; n = 24), a 1.0 μg·kg- 1 DEX infusion (1.0 μg·kg- 1 DEX group; n = 25) or a saline infusion (control group; n = 24) for 10 min. Propofol at a concentration of 20 mg·kg- 1·h- 1 was then infused at the end of the DEX or saline infusion. The propofol infusion was stopped when the patient being infused lost consciousness. The primary endpoint were propofol requirements for LOC and BIS value at LOC. RESULTS The data from 73 patients were analyzed. The propofol requirements for LOC was reduced in the DEX groups compared with the control group (1.12 ± 0.33 mg·kg- 1 for the 0.5 μg·kg- 1 DEX group vs. 1.79 ± 0.39 mg·kg- 1 for the control group; difference, 0.68 mg·kg- 1 [95% CI, 0.49 to 0.87]; P = 0.0001) (0.77 ± 0.27 mg·kg- 1 for the 1.0 μg·kg- 1 DEX group vs. 1.79 ± 0.39 mg·kg- 1 for the control group; difference, 1.02 mg·kg- 1 [95% CI, 0.84 to 1.21]; P = 0.0001). The propofol requirements for LOC was lower in the 1.0 μg·kg- 1 DEX group than the 0.5 μg·kg- 1 DEX group (0.77 ± 0.27 mg·kg- 1 vs. 1.12 ± 0.33 mg·kg- 1, respectively; difference, 0.34 mg·kg- 1 [95% CI, 0.16 to 0.54]; P = 0.003). At the time of LOC, the BIS value was higher in the DEX groups than in the control group (67.5 ± 3.5 for group 0.5 μg·kg- 1 DEX vs. 60.5 ± 3.8 for the control group; difference, 7.04 [95% CI, 4.85 to 9.23]; P = 0.0001) (68.4 ± 4.1 for group 1.0 μg·kg- 1 DEX vs. 60.5 ± 3.8 for the control group; difference, 7.58 [95% CI, 5.41 to 9.75]; P = 0.0001). CONCLUSION The study showed that DEX (both 0.5 and 1.0 μg·kg- 1 DEX) reduced the propofol requirements for LOC. DEX pre-administration increased the BIS value for LOC induced by propofol. CLINICAL TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (trial ID: NCT02783846 on May 26, 2016).
Collapse
Affiliation(s)
- Yang Gu
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China.,Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, China
| | - Fan Yang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yonghai Zhang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Junwei Zheng
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Jie Wang
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Bin Li
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Tao Ma
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Xiang Cui
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Kaimei Lu
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Hanxiang Ma
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China.
| |
Collapse
|
19
|
Murillo-Rodríguez E, Arankowsky-Sandoval G, Pertwee RG, Parker L, Mechoulam R. Sleep and neurochemical modulation by cannabidiolic acid methyl ester in rats. Brain Res Bull 2020; 155:166-173. [DOI: 10.1016/j.brainresbull.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023]
|
20
|
Nami M, Mehrabi S, Kamali AM, Kazemiha M, Carvalho J, Derman S, Lakey-Betia J, Vasquez V, Kosagisharaf R. A New Hypothesis on Anxiety, Sleep Insufficiency, and Viral Infections; Reciprocal Links to Consider in Today's "World vs. COVID-19" Endeavors. Front Psychiatry 2020; 11:585893. [PMID: 33250794 PMCID: PMC7674554 DOI: 10.3389/fpsyt.2020.585893] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/24/2020] [Indexed: 12/19/2022] Open
Abstract
In today's ever-growing concerns about the coronavirus disease (COVID-19) pandemic, many experience sleep insufficiencies, such as difficulty falling or staying asleep, sleep-related behavioral symptoms, and out-of-phase circadian rhythmicity despite the lack of history of earlier such symptoms. Meanwhile, the disruption in sleep bioparameters is experienced more in people with a history of sleep disorders. The behavioral sleep disorders in the current situations are prevalent given the today's amount of anxiety everyone is feeling about COVID-19. On the other hand, evidences indicated that the cross-link between impaired sleep efficiency and disrupted innate immunity makes people susceptible to viral infections. The present brief review highlights the links between psychosocial stress, sleep insufficiency, and susceptibility to viral infections in relevance to COVID-19 situation. The stress management measures, including addressing sleep-related disorders and sleep hygiene, will have a notable impact by harnessing immune response and thus reducing the susceptibility to viral infections.
Collapse
Affiliation(s)
- Mohammad Nami
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,Dana Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran.,Academy of Health, Senses Cultural Foundation, Sacramento, CA, United States.,Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama City, Panama.,Sleep Disorders Laboratory, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samrad Mehrabi
- Sleep Disorders Laboratory, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Division of Pulmonology, Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali-Mohammad Kamali
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,Dana Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
| | - Milad Kazemiha
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,Dana Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
| | | | - Sabri Derman
- Sleep Disorders Unit, American Hospital, Koc Foundation, Istanbul, Turkey
| | - Johant Lakey-Betia
- Centre for Biodiversity and Drug Discovery, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama City, Panama
| | - Velmarini Vasquez
- Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama City, Panama
| | - Rao Kosagisharaf
- Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama City, Panama
| |
Collapse
|
21
|
Abstract
The neural mechanisms of sleep, a fundamental biological behavior from invertebrates to humans, have been a long-standing mystery and present an enormous challenge. Gradually, perspectives on the neurobiology of sleep have been more various with the technical innovations over the recent decades, and studies have now identified many specific neural circuits that selectively regulate the initiation and maintenance of wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep. The cholinergic system in basal forebrain (BF) that fire maximally during waking and REM sleep is one of the key neuromodulation systems related to waking and REM sleep. Here we outline the recent progress of the BF cholinergic system in sleep-wake cycle. The intricate local connectivity and multiple projections to other cortical and subcortical regions of the BF cholinergic system elaborately presented here form a conceptual framework for understanding the coordinating effects with the dissecting regions. This framework also provides evidences regarding the relationships between the general anesthesia and wakefulness/sleep cycle focusing on the neural circuitry of unconsciousness induced by anesthetic drugs.
Collapse
|
22
|
Scammell TE, Jackson AC, Franks NP, Wisden W, Dauvilliers Y. Histamine: neural circuits and new medications. Sleep 2019; 42:5099478. [PMID: 30239935 PMCID: PMC6335869 DOI: 10.1093/sleep/zsy183] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Indexed: 12/12/2022] Open
Abstract
Histamine was first identified in the brain about 50 years ago, but only in the last few years have researchers gained an understanding of how it regulates sleep/wake behavior. We provide a translational overview of the histamine system, from basic research to new clinical trials demonstrating the usefulness of drugs that enhance histamine signaling. The tuberomammillary nucleus is the sole neuronal source of histamine in the brain, and like many of the arousal systems, histamine neurons diffusely innervate the cortex, thalamus, and other wake-promoting brain regions. Histamine has generally excitatory effects on target neurons, but paradoxically, histamine neurons may also release the inhibitory neurotransmitter GABA. New research demonstrates that activity in histamine neurons is essential for normal wakefulness, especially at specific circadian phases, and reducing activity in these neurons can produce sedation. The number of histamine neurons is increased in narcolepsy, but whether this affects brain levels of histamine is controversial. Of clinical importance, new compounds are becoming available that enhance histamine signaling, and clinical trials show that these medications reduce sleepiness and cataplexy in narcolepsy.
Collapse
Affiliation(s)
- Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Alexander C Jackson
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT
| | - Nicholas P Franks
- Department of Life Sciences and UK Dementia Research Institute, Imperial College London, UK
| | - William Wisden
- Department of Life Sciences and UK Dementia Research Institute, Imperial College London, UK
| | - Yves Dauvilliers
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac, Université Montpellier, INSERM, Montpellier, France
| |
Collapse
|
23
|
Ma Y, Miracca G, Yu X, Harding EC, Miao A, Yustos R, Vyssotski AL, Franks NP, Wisden W. Galanin Neurons Unite Sleep Homeostasis and α2-Adrenergic Sedation. Curr Biol 2019; 29:3315-3322.e3. [PMID: 31543455 PMCID: PMC6868514 DOI: 10.1016/j.cub.2019.07.087] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/24/2019] [Accepted: 07/30/2019] [Indexed: 12/18/2022]
Abstract
Our urge to sleep increases with time spent awake, until sleep becomes inescapable. The sleep following sleep deprivation is longer and deeper, with an increased power of delta (0.5–4 Hz) oscillations, a phenomenon termed sleep homeostasis [1, 2, 3, 4]. Although widely expressed genes regulate sleep homeostasis [1, 4, 5, 6, 7, 8, 9, 10] and the process is tracked by somnogens and phosphorylation [1, 3, 7, 11, 12, 13, 14], at the circuit level sleep homeostasis has remained mysterious. Previously, we found that sedation induced with α2-adrenergic agonists (e.g., dexmedetomidine) and sleep homeostasis both depend on the preoptic (PO) hypothalamus [15, 16]. Dexmedetomidine, increasingly used for long-term sedation in intensive care units [17], induces a non-rapid-eye-movement (NREM)-like sleep but with undesirable hypothermia [18, 19]. Within the PO, various neuronal subtypes (e.g., GABA/galanin and glutamate/NOS1) induce NREM sleep [20, 21, 22] and concomitant body cooling [21, 22]. This could be because NREM sleep’s restorative effects depend on lower body temperature [23, 24]. Here, we show that mice with lesioned PO galanin neurons have reduced sleep homeostasis: in the recovery sleep following sleep deprivation there is a diminished increase in delta power, and the mice catch up little on lost sleep. Furthermore, dexmedetomidine cannot induce high-power delta oscillations or sustained hypothermia. Some hours after dexmedetomidine administration to wild-type mice there is a rebound in delta power when they enter normal NREM sleep, reminiscent of emergence from torpor. This delta rebound is reduced in mice lacking PO galanin neurons. Thus, sleep homeostasis and dexmedetomidine-induced sedation require PO galanin neurons and likely share common mechanisms. This is the first identification of a cell type underlying sleep homeostasis Preoptic galanin neurons are essential for sleep homeostasis Galanin neurons mediate the sedative and hypothermic actions of dexmedetomidine Dexmedetomidine causes an EEG delta power rebound dependent on galanin neurons
Collapse
Affiliation(s)
- Ying Ma
- Department of Life Sciences, Imperial College, London SW7 2AZ, UK
| | - Giulia Miracca
- Department of Life Sciences, Imperial College, London SW7 2AZ, UK
| | - Xiao Yu
- Department of Life Sciences, Imperial College, London SW7 2AZ, UK
| | - Edward C Harding
- Department of Life Sciences, Imperial College, London SW7 2AZ, UK
| | - Andawei Miao
- Department of Life Sciences, Imperial College, London SW7 2AZ, UK; UK Dementia Research Institute, Imperial College, London SW7 2AZ, UK
| | - Raquel Yustos
- Department of Life Sciences, Imperial College, London SW7 2AZ, UK
| | - Alexei L Vyssotski
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich 8057, Switzerland
| | - Nicholas P Franks
- Department of Life Sciences, Imperial College, London SW7 2AZ, UK; UK Dementia Research Institute, Imperial College, London SW7 2AZ, UK.
| | - William Wisden
- Department of Life Sciences, Imperial College, London SW7 2AZ, UK; UK Dementia Research Institute, Imperial College, London SW7 2AZ, UK.
| |
Collapse
|
24
|
Abstract
Over the past decade, basic sleep research investigating the circuitry controlling sleep and wakefulness has been boosted by pharmacosynthetic approaches, including chemogenetic techniques using designed receptors exclusively activated by designer drugs (DREADD). DREADD offers a series of tools that selectively control neuronal activity as a way to probe causal relationship between neuronal sub-populations and the regulation of the sleep-wake cycle. Following the path opened by optogenetics, DREADD tools applied to discrete neuronal sub-populations in numerous brain areas quickly made their contribution to the discovery and the expansion of our understanding of critical brain structures involved in a wide variety of behaviors and in the control of vigilance state architecture.
Collapse
|
25
|
Yu X, Ma Y, Harding EC, Yustos R, Vyssotski AL, Franks NP, Wisden W. Genetic lesioning of histamine neurons increases sleep-wake fragmentation and reveals their contribution to modafinil-induced wakefulness. Sleep 2019; 42:zsz031. [PMID: 30722053 PMCID: PMC6519916 DOI: 10.1093/sleep/zsz031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 11/12/2022] Open
Abstract
Acute chemogenetic inhibition of histamine (HA) neurons in adult mice induced nonrapid eye movement (NREM) sleep with an increased delta power. By contrast, selective genetic lesioning of HA neurons with caspase in adult mice exhibited a normal sleep-wake cycle overall, except at the diurnal start of the lights-off period, when they remained sleepier. The amount of time spent in NREM sleep and in the wake state in mice with lesioned HA neurons was unchanged over 24 hr, but the sleep-wake cycle was more fragmented. Both the delayed increase in wakefulness at the start of the night and the sleep-wake fragmentation are similar phenotypes to histidine decarboxylase knockout mice, which cannot synthesize HA. Chronic loss of HA neurons did not affect sleep homeostasis after sleep deprivation. However, the chronic loss of HA neurons or chemogenetic inhibition of HA neurons did notably reduce the ability of the wake-promoting compound modafinil to sustain wakefulness. Thus, part of modafinil's wake-promoting actions arise through the HA system.
Collapse
Affiliation(s)
- Xiao Yu
- Department of Life Sciences, Imperial College London, UK
| | - Ying Ma
- Department of Life Sciences, Imperial College London, UK
| | | | - Raquel Yustos
- Department of Life Sciences, Imperial College London, UK
| | - Alexei L Vyssotski
- Institute of Neuroinformatics, University of Zürich/ETH Zürich, Zürich, Switzerland
| | - Nicholas P Franks
- Department of Life Sciences, Imperial College London, UK
- UK Dementia Research Institute at Imperial College London, UK
| | - William Wisden
- Department of Life Sciences, Imperial College London, UK
- UK Dementia Research Institute at Imperial College London, UK
| |
Collapse
|
26
|
Chazot PL, Johnston L, Mcauley E, Bonner S. Histamine and Delirium: Current Opinion. Front Pharmacol 2019; 10:299. [PMID: 31024298 PMCID: PMC6467166 DOI: 10.3389/fphar.2019.00299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/11/2019] [Indexed: 12/14/2022] Open
Abstract
Delirium is a very common, but refractory clinical state, notably present in intensive care and in the growing aging community. It is characterized by fluctuating disturbances in a number of key behavioral features, namely cognition, mood, attention, arousal, and self-awareness. Histamine is arguably the most pleotropic neurotransmitter in the human brain, and this review provides a rationale, and proposes that this neuroactive amine plays a role in modulating the characteristic features of delirium. While centrally permeable H1 and H2 histamine receptor antagonists have pro-delirium potential, we propose that centrally permeable H3 histamine receptor antagonists may provide an exciting new strategy to combat delirium. The Histamine H4 receptor may also have an indirect inflammatory neuroglial role which requires further exploration.
Collapse
Affiliation(s)
- Paul L. Chazot
- Department of Biosciences, Durham University, Durham, United Kingdom
| | - Laura Johnston
- Department of Biosciences, Durham University, Durham, United Kingdom
| | - Edel Mcauley
- Intensive Care, South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Stephen Bonner
- Intensive Care, South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, United Kingdom
| |
Collapse
|
27
|
van der Meer HG, Taxis K, Teichert M, Griens F, Pont LG, Wouters H. Anticholinergic and sedative medication use in older community-dwelling people: A national population study in the Netherlands. Pharmacoepidemiol Drug Saf 2019; 28:315-321. [PMID: 30747477 PMCID: PMC6593836 DOI: 10.1002/pds.4698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/18/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
Purpose To identify the proportion of older adults with a high anticholinergic/sedative load and to identify patient subgroups based on type of central nervous system (CNS)‐active medication used. Methods A cross‐sectional study of a nationwide sample of patients with anticholinergic/sedative medications dispensed by 1779 community pharmacies in the Netherlands (90% of all community pharmacies) in November 2016 was conducted. Patients aged older than 65 years with a high anticholinergic/sedative load defined as having a drug burden index (DBI) greater than 1 were included. Proportion of patients with a high anticholinergic/sedative load was calculated by dividing the number of individuals in our study population by the 2.4 million older patients using medications dispensed from study pharmacies. Patient subgroups based on type of CNS‐active medications used were identified with latent class analysis. Results Overall, 8.7% (209 472 individuals) of older adults using medications had a DBI greater than 1. Latent class analysis identified four patient subgroups (classes) based on the following types of CNS‐active medications used: “combined psycholeptic/psychoanaleptic medication” (class 1, 57.9%), “analgesics” (class 2, 17.9%), “antiepileptic medication” (class 3, 17.8%), and “anti‐Parkinson medication” (class 4, 6.3%). Conclusions A large proportion of older adults in the Netherlands had a high anticholinergic/sedative load. Four distinct subgroups using specific CNS‐active medication were identified. Interventions aiming at reducing the overall anticholinergic/sedative load should be tailored to these subgroups.
Collapse
Affiliation(s)
- Helene G van der Meer
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Katja Taxis
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Fabiënne Griens
- Foundation for Pharmaceutical Statistics, The Hague, the Netherlands
| | - Lisa G Pont
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Hans Wouters
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands.,Department General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
28
|
Dijk DJ, Landolt HP. Sleep Physiology, Circadian Rhythms, Waking Performance and the Development of Sleep-Wake Therapeutics. Handb Exp Pharmacol 2019; 253:441-481. [PMID: 31254050 DOI: 10.1007/164_2019_243] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Disturbances of the sleep-wake cycle are highly prevalent and diverse. The aetiology of some sleep disorders, such as circadian rhythm sleep-wake disorders, is understood at the conceptual level of the circadian and homeostatic regulation of sleep and in part at a mechanistic level. Other disorders such as insomnia are more difficult to relate to sleep regulatory mechanisms or sleep physiology. To further our understanding of sleep-wake disorders and the potential of novel therapeutics, we discuss recent findings on the neurobiology of sleep regulation and circadian rhythmicity and its relation with the subjective experience of sleep and the quality of wakefulness. Sleep continuity and to some extent REM sleep emerge as determinants of subjective sleep quality and waking performance. The effects of insufficient sleep primarily concern subjective and objective sleepiness as well as vigilant attention, whereas performance on higher cognitive functions appears to be better preserved albeit at the cost of increased effort. We discuss age-related, sex and other trait-like differences in sleep physiology and sleep need and compare the effects of existing pharmacological and non-pharmacological sleep- and wake-promoting treatments. Successful non-pharmacological approaches such as sleep restriction for insomnia and light and melatonin treatment for circadian rhythm sleep disorders target processes such as sleep homeostasis or circadian rhythmicity. Most pharmacological treatments of sleep disorders target specific signalling pathways with no well-established role in either sleep homeostasis or circadian rhythmicity. Pharmacological sleep therapeutics induce changes in sleep structure and the sleep EEG which are specific to the mechanism of action of the drug. Sleep- and wake-promoting therapeutics often induce residual effects on waking performance and sleep, respectively. The need for novel therapeutic approaches continues not at least because of the societal demand to sleep and be awake out of synchrony with the natural light-dark cycle, the high prevalence of sleep-wake disturbances in mental health disorders and in neurodegeneration. Novel approaches, which will provide a more comprehensive description of sleep and allow for large-scale sleep and circadian physiology studies in the home environment, hold promise for continued improvement of therapeutics for disturbances of sleep, circadian rhythms and waking performance.
Collapse
Affiliation(s)
- Derk-Jan Dijk
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | - Hans-Peter Landolt
- Institute of Pharmacology and Toxicology, Sleep and Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland
| |
Collapse
|
29
|
Cortical Excitability and Activation of TrkB Signaling During Rebound Slow Oscillations Are Critical for Rapid Antidepressant Responses. Mol Neurobiol 2018; 56:4163-4174. [PMID: 30288695 PMCID: PMC6505519 DOI: 10.1007/s12035-018-1364-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/25/2018] [Indexed: 12/15/2022]
Abstract
Rapid antidepressant effects of ketamine become most evident when its psychotomimetic effects subside, but the neurobiological basis of this “lag” remains unclear. Laughing gas (N2O), another NMDA-R (N-methyl-d-aspartate receptor) blocker, has been reported to bring antidepressant effects rapidly upon drug discontinuation. We took advantage of the exceptional pharmacokinetic properties of N2O to investigate EEG (electroencephalogram) alterations and molecular determinants of antidepressant actions during and immediately after NMDA-R blockade. Effects of the drugs on brain activity were investigated in C57BL/6 mice using quantitative EEG recordings. Western blot and qPCR were used for molecular analyses. Learned helplessness (LH) was used to assess antidepressant-like behavior. Immediate-early genes (e.g., bdnf) and phosphorylation of mitogen-activated protein kinase—markers of neuronal excitability—were upregulated during N2O exposure. Notably, phosphorylation of BDNF receptor TrkB and GSK3β (glycogen synthase kinase 3β) became regulated only gradually upon N2O discontinuation, during a brain state dominated by slow EEG activity. Subanesthetic ketamine and flurothyl-induced convulsions (reminiscent of electroconvulsive therapy) also evoked slow oscillations when their acute pharmacological effects subsided. The correlation between ongoing slow EEG oscillations and TrkB-GSK3β signaling was further strengthened utilizing medetomidine, a hypnotic-sedative agent that facilitates slow oscillations directly through the activation of α2-adrenergic autoreceptors. Medetomidine did not, however, facilitate markers of neuronal excitability or produce antidepressant-like behavioral changes in LH. Our results support a hypothesis that transient cortical excitability and the subsequent regulation of TrkB and GSK3β signaling during homeostatic emergence of slow oscillations are critical components for rapid antidepressant responses.
Collapse
|
30
|
Role of Histamine in Modulating the Immune Response and Inflammation. Mediators Inflamm 2018; 2018:9524075. [PMID: 30224900 PMCID: PMC6129797 DOI: 10.1155/2018/9524075] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/15/2018] [Accepted: 07/04/2018] [Indexed: 01/04/2023] Open
Abstract
Inflammatory mediators, including cytokines, histamine, bradykinin, prostaglandins, and leukotrienes, impact the immune system, usually as proinflammatory factors. Other mediators act as regulatory components to establish homeostasis after injury or prevent the inflammatory process. Histamine, a biogenic vasoactive amine, causes symptoms such as allergies and has a pleiotropic effect that is dependent on its interaction with its four histamine receptors. In this review, we discuss the dualistic effects of histamine: how histamine affects inflammation of the immune system through the activation of intracellular pathways that induce the production of inflammatory mediators and cytokines in different immune cells and how histamine exerts regulatory functions in innate and adaptive immune responses. We also evaluate the interactions between these effects.
Collapse
|
31
|
Cooper JM, Halter KA, Prosser RA. Circadian rhythm and sleep-wake systems share the dynamic extracellular synaptic milieu. Neurobiol Sleep Circadian Rhythms 2018; 5:15-36. [PMID: 31236509 PMCID: PMC6584685 DOI: 10.1016/j.nbscr.2018.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/06/2018] [Accepted: 04/10/2018] [Indexed: 01/23/2023] Open
Abstract
The mammalian circadian and sleep-wake systems are closely aligned through their coordinated regulation of daily activity patterns. Although they differ in their anatomical organization and physiological processes, they utilize overlapping regulatory mechanisms that include an assortment of proteins and molecules interacting within the extracellular space. These extracellular factors include proteases that interact with soluble proteins, membrane-attached receptors and the extracellular matrix; and cell adhesion molecules that can form complex scaffolds connecting adjacent neurons, astrocytes and their respective intracellular cytoskeletal elements. Astrocytes also participate in the dynamic regulation of both systems through modulating neuronal appositions, the extracellular space and/or through release of gliotransmitters that can further contribute to the extracellular signaling processes. Together, these extracellular elements create a system that integrates rapid neurotransmitter signaling across longer time scales and thereby adjust neuronal signaling to reflect the daily fluctuations fundamental to both systems. Here we review what is known about these extracellular processes, focusing specifically on areas of overlap between the two systems. We also highlight questions that still need to be addressed. Although we know many of the extracellular players, far more research is needed to understand the mechanisms through which they modulate the circadian and sleep-wake systems.
Collapse
Key Words
- ADAM, A disintegrin and metalloproteinase
- AMPAR, AMPA receptor
- Astrocytes
- BDNF, brain-derived neurotrophic factor
- BMAL1, Brain and muscle Arnt-like-1 protein
- Bmal1, Brain and muscle Arnt-like-1 gene
- CAM, cell adhesion molecules
- CRY, cryptochrome protein
- Cell adhesion molecules
- Circadian rhythms
- Cry, cryptochrome gene
- DD, dark-dark
- ECM, extracellular matrix
- ECS, extracellular space
- EEG, electroencephalogram
- Endo N, endoneuraminidase N
- Extracellular proteases
- GFAP, glial fibrillary acidic protein
- IL, interleukin
- Ig, immunoglobulin
- LC, locus coeruleus
- LD, light-dark
- LH, lateral hypothalamus
- LRP-1, low density lipoprotein receptor-related protein 1
- LTP, long-term potentiation
- MMP, matrix metalloproteinases
- NCAM, neural cell adhesion molecule protein
- NMDAR, NMDA receptor
- NO, nitric oxide
- NST, nucleus of the solitary tract
- Ncam, neural cell adhesion molecule gene
- Nrl, neuroligin gene
- Nrx, neurexin gene
- P2, purine type 2 receptor
- PAI-1, plasminogen activator inhibitor-1
- PER, period protein
- PPT, peduculopontine tegmental nucleus
- PSA, polysialic acid
- Per, period gene
- REMS, rapid eye movement sleep
- RSD, REM sleep disruption
- SCN, suprachiasmatic nucleus
- SWS, slow wave sleep
- Sleep-wake system
- Suprachiasmatic nucleus
- TNF, tumor necrosis factor
- TTFL, transcriptional-translational negative feedback loop
- VIP, vasoactive intestinal polypeptide
- VLPO, ventrolateral preoptic
- VP, vasopressin
- VTA, ventral tegmental area
- dNlg4, drosophila neuroligin-4 gene
- nNOS, neuronal nitric oxide synthase gene
- nNOS, neuronal nitric oxide synthase protein
- tPA, tissue-type plasminogen activator
- uPA, urokinase-type plasminogen activator
- uPAR, uPA receptor
Collapse
|