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Leclair-Visonneau L, Feemster JC, Bibi N, Gossard TR, Jagielski JT, Strainis EP, Carvalho DZ, Timm PC, Bliwise DL, Boeve BF, Silber MH, McCarter SJ, St. Louis EK. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med 2024; 20:279-291. [PMID: 37823585 PMCID: PMC10835777 DOI: 10.5664/jcsm.10862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
STUDY OBJECTIVES Accurate diagnosis of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is crucial due to its injury potential and neurological prognosis. We aimed to analyze visual and automated REM sleep without atonia (RSWA) diagnostic thresholds applicable in varying clinical presentations in a contemporary cohort of patients with iRBD using submentalis (SM) and individual bilateral flexor digitorum superficialis (FDS) and anterior tibialis electromyography limb recordings during polysomnography. METHODS We analyzed RSWA in 20 patients with iRBD and 20 age-, REM-, apnea-hypopnea index-matched controls between 2017 and 2022 for phasic burst durations, density of phasic, tonic, and "any" muscle activity (number of 3-second mini-epochs containing phasic or tonic muscle activity divided by the total number of REM sleep 3-second mini-epochs), and automated Ferri REM atonia index (RAI). Group RSWA metrics were comparatively analyzed. Receiver operating characteristic curves determined optimized area under the curve (AUC) and maximized specificity and sensitivity diagnostic iRBD RSWA thresholds. RESULTS All mean RSWA metrics were higher in patients with iRBD than in controls (P < .05), except for selected anterior tibialis measures. Optimized, maximal specificity AUC diagnostic cutoffs for coprimary outcomes were: SM "any" 6.5%, 14.0% (AUC = 92.5%) and combined SM+FDS "any" 15.1%, 27.4% (AUC = 95.8%), while SM burst durations were 0.72, and 0.72 seconds (AUC 90.2%) and FDS RAI = 0.930, 0.888 (AUC 92.8%). CONCLUSIONS This study provides evidence for current quantitative RSWA diagnostic thresholds in chin and individual 4 limb muscles applicable in different iRBD clinical settings and confirms the key value of SM or SM+FDS to assure accurate iRBD diagnosis. Evolving iRBD recognition underscores the necessity of continuous assessment with future large, prospective, well-harmonized, multicenter polysomnographic analyses. CITATION Leclair-Visonneau L, Feemster JC, Bibi N, et al. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med. 2024;20(2):279-291.
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Affiliation(s)
- Laurène Leclair-Visonneau
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical Neurophysiology, CHU de Nantes, Nantes, France
- Nantes Université, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
| | - John C. Feemster
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Noor Bibi
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Thomas R. Gossard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Jack T. Jagielski
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Emma P. Strainis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Diego Z. Carvalho
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Paul C. Timm
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Donald L. Bliwise
- Emory Sleep Center and Department of Neurology, Emory University, Atlanta, Georgia
| | - Bradley F. Boeve
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Michael H. Silber
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Stuart J. McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Erik K. St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical and Translational Science, Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin
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Singh O, Carvalho DZ, Espay AJ, Benarroch EE, Grewal SS, Pagani-Estévez GL. Spinal cord stimulation for gait impairment in Parkinson Disease: scoping review and mechanistic considerations. Pain Med 2023; 24:S11-S17. [PMID: 37833048 DOI: 10.1093/pm/pnad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/20/2023] [Accepted: 06/27/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Advanced Parkinson's Disease (PD) is associated with Parkinson's Disease gait impairment (PDg), which increases the risk for falls and is often treatment-refractory. Subthalamic nucleus (STN) and globus pallidus pars interna (GPi) deep brain stimulation (DBS) often fails to improve axial symptoms like PDg. Spinal cord stimulation (SCS) has been suggested to improve PDg. SCS may benefit PDg by disrupting pathologic beta-oscillations and hypersynchrony in cortico-striatal-thalamic circuits to override excessive inhibition of brainstem locomotor regions. SCS may potentially improve locomotion by acting at any of these levels, either alone or in combination. METHODS We conducted a comprehensive literature search and scoping review, identifying 106 patients in whom SCS was evaluated for PDg. RESULTS Among the identified patients, 63% carried a pain diagnosis. Overall, the most common stimulation location was thoracic (78%), most commonly T9-T10. Burst (sub-perception) was the most common stimulation modality (59%). Prior treatment with DBS was used in 25%. Motor outcomes were assessed by the Unified Parkinson Disease Rating Scale (UPDRS) III-motor, UPDRS, the Timed Up and Go (TUG), and/or 10-/20-meter walking tests.Among these patients, 95 (90%) had PDg amelioration and improved motor outcomes. CONCLUSIONS Despite small sample sizes, patient heterogeneity, and unblinded evaluations complicating interpretations of efficacy and safety, SCS may be beneficial for at least a subset of PDg. Further research is required to clarify the role of SCS for PDg and the patients most suitable to benefit from this intervention.
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Affiliation(s)
- Omesh Singh
- Department of Physical Medicine and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, OH 45219, United States
| | - Diego Z Carvalho
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
- Center for Sleep Medicine, Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Alberto J Espay
- James J and Joan A Gardner Center for Parkinson Disease and Movement Disorders, University of Cincinnati Medical Center, Cincinnati, OH 45219, United States
| | | | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Gabriel L Pagani-Estévez
- Interventional and Surgical Pain Management, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45219, United States
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Pagani-Estévez GL, Holland MT, Tippmann-Peikert M, Benarroch EE, Silber MH, Carvalho DZ. Potential therapeutic benefit of spinal cord stimulation in restless legs syndrome: scoping review and mechanistic considerations. Pain Med 2023; 24:S18-S23. [PMID: 37833049 DOI: 10.1093/pm/pnad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Restless legs syndrome (RLS) is a prevalent sensorimotor disorder that can dramatically impair sleep quality, daytime function, and quality of life. Although many patients benefit from standard pharmacological therapy, some patients suffer from insufficient treatment response or medication intolerance. Novel treatment approaches are therefore necessary. OBJECTIVE Given the overlap between RLS and pain syndromes in both pathophysiological mechanisms and certain treatment options, we aimed to perform a scoping review of the available evidence on spinal cord stimulation (SCS) for RLS and discuss potential mechanistic implications. METHODS We identified a total of 16 cases of patients with RLS who underwent SCS, all from case reports or case series. DISCUSSION The published evidence is insufficient to assess SCS efficacy in patients with RLS, but SCS remains a promising investigational therapy in RLS on the basis of its potential mitigatory effects in the central hyperexcitability of the sensorimotor cortex through neuromodulation of spinal, subcortical, and cortical areas. A call for further research in this field is presented, with suggestions for future directions and trial designs.
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Affiliation(s)
- Gabriel L Pagani-Estévez
- Department of Interventional and Surgical Pain Management, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45220, United States
| | - Marshall T Holland
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Maja Tippmann-Peikert
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
- Center for Sleep Medicine, Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | | | - Michael H Silber
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
- Center for Sleep Medicine, Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Diego Z Carvalho
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
- Center for Sleep Medicine, Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
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Carvalho DZ, St Louis EK. Sleepwalking Into a Risky Path: Expanding the Concerns for Parasomnias in the Elderly. Mayo Clin Proc 2023; 98:1436-1438. [PMID: 37793720 DOI: 10.1016/j.mayocp.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/22/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Diego Z Carvalho
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN.
| | - Erik K St Louis
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
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Jagielski JT, Bibi N, Gay PC, Junna MR, Carvalho DZ, Williams JA, Morgenthaler TI. Evaluating an under-mattress sleep monitor compared to a peripheral arterial tonometry home sleep apnea test device in the diagnosis of obstructive sleep apnea. Sleep Breath 2023; 27:1433-1441. [PMID: 36441446 DOI: 10.1007/s11325-022-02751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVES To evaluate whether or not the apnea-hypopnea index (AHI) from a peripheral arterial tonometry (PAT) home sleep apnea test (HSAT) is equivalent to the AHI provided by the mean of one, three, or seven nights from the Withings Sleep Analyzer (WSA) under-mattress device. METHODS We prospectively enrolled patients with suspected OSA in whom a PAT-HSAT was ordered. Eligible patients used the WSA for seven to nine nights. PAT data were scored using the device's intrinsic machine learning algorithms to arrive at the AHI using both 3% and 4% desaturation criteria for hypopnea estimations (PAT3%-AHI and PAT4%-AHI, respectively). These were then compared with the WSA-estimated AHI (WSA-AHI). RESULTS Of 61 patients enrolled, 35 completed the study with valid PAT and WSA data. Of the 35 completers 16 (46%) had at least moderately severe OSA (PAT3%-AHI ≥ 15). The seven-night mean WSA-AHI was 2.13 (95%CI = - 0.88, 5.14) less than the PAT3%-AHI, but 5.64 (95%CI = 2.54, 8.73) greater than the PAT4%-AHI. The accuracy and area under the receiver operating curve (AUC) using the PAT3%-AHI ≥ 15 were 77% and 0.87 and for PAT4%-AHI ≥ 15 were 77% and 0.85, respectively. The one-, three-, or seven-night WSA-AHI were not equivalent to either the 3% or 4% PAT-AHI (equivalency threshold of ± 2.5 using the two one-sided t-test method). CONCLUSIONS The WSA derives estimates of the AHI unobtrusively over many nights, which may prove to be a valuable clinical tool. However, the WSA-AHI over- or underestimates the PAT-AHI in clinical use, and the appropriate use of the WSA in clinical practice will require further evaluation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04778748.
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Affiliation(s)
- Jack T Jagielski
- Neurology Clinical Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Noor Bibi
- Neurology Clinical Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Peter C Gay
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mithri R Junna
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Diego Z Carvalho
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Julie A Williams
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy I Morgenthaler
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA.
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic Center for Sleep Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
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Carvalho DZ, McCarter SJ, St Louis EK, Przybelski SA, Johnson Sparrman KL, Somers VK, Boeve BF, Petersen RC, Jack CR, Graff-Radford J, Vemuri P. Association of Polysomnographic Sleep Parameters With Neuroimaging Biomarkers of Cerebrovascular Disease in Older Adults With Sleep Apnea. Neurology 2023; 101:e125-e136. [PMID: 37164654 PMCID: PMC10351545 DOI: 10.1212/wnl.0000000000207392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/23/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Our objective was to determine whether polysomnographic (PSG) sleep parameters are associated with neuroimaging biomarkers of cerebrovascular disease (CVD) related to white matter (WM) integrity in older adults with obstructive sleep apnea (OSA). METHODS From the population-based Mayo Clinic Study of Aging, we identified participants without dementia who underwent at least 1 brain MRI and PSG. We quantified 2 CVD biomarkers: WM hyperintensities (WMHs) from fluid-attenuated inversion recovery (FLAIR)-MRI, and fractional anisotropy of the genu of the corpus callosum (genu FA) from diffusion MRI. For this cross-sectional analysis, we fit linear models to assess associations between PSG parameters (NREM stage 1 percentage, NREM stage 3 percentage [slow-wave sleep], mean oxyhemoglobin saturation, and log of apnea-hypopnea index [AHI]) and CVD biomarkers (log of WMH and log of genu FA), respectively, while adjusting for age (at MRI), sex, APOE ε4 status, composite cardiovascular and metabolic conditions (CMC) score, REM stage percentage, sleep duration, and interval between MRI and PSG. RESULTS We included 140 participants with FLAIR-MRI (of which 103 had additional diffusion MRI). The mean ± SD age was 72.7 ± 9.6 years at MRI with nearly 60% being men. The absolute median (interquartile range [IQR]) interval between MRI and PSG was 1.74 (0.9-3.2) years. 90.7% were cognitively unimpaired (CU) during both assessments. For every 10-point decrease in N3%, there was a 0.058 (95% CI 0.006-0.111, p = 0.030) increase in the log of WMH and 0.006 decrease (95% CI -0.012 to -0.0002, p = 0.042) in the log of genu FA. After matching for age, sex, and N3%, participants with severe OSA had higher WMH (median [IQR] 0.007 [0.005-0.015] vs 0.006 [0.003-0.009], p = 0.042) and lower genu FA (median [IQR] 0.57 [0.55-0.63] vs 0.63 [0.58-0.65], p = 0.007), when compared with those with mild/moderate OSA. DISCUSSION We found that reduced slow-wave sleep and severe OSA were associated with higher burden of WM abnormalities in predominantly CU older adults, which may contribute to greater risk of cognitive impairment, dementia, and stroke. Our study supports the association between sleep depth/fragmentation and intermittent hypoxia and CVD biomarkers. Longitudinal studies are required to assess causation.
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Affiliation(s)
- Diego Z Carvalho
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN.
| | - Stuart J McCarter
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Erik K St Louis
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Scott A Przybelski
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Kohl L Johnson Sparrman
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Virend K Somers
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Jonathan Graff-Radford
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
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Berry B, Varatharajah Y, Kremen V, Kucewicz M, Guragain H, Brinkmann B, Duque J, Carvalho DZ, Stead M, Sieck G, Worrell G. Phase-Amplitude Coupling Localizes Pathologic Brain with Aid of Behavioral Staging in Sleep. Life (Basel) 2023; 13:life13051186. [PMID: 37240831 DOI: 10.3390/life13051186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/28/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Low frequency brain rhythms facilitate communication across large spatial regions in the brain and high frequency rhythms are thought to signify local processing among nearby assemblies. A heavily investigated mode by which these low frequency and high frequency phenomenon interact is phase-amplitude coupling (PAC). This phenomenon has recently shown promise as a novel electrophysiologic biomarker, in a number of neurologic diseases including human epilepsy. In 17 medically refractory epilepsy patients undergoing phase-2 monitoring for the evaluation of surgical resection and in whom temporal depth electrodes were implanted, we investigated the electrophysiologic relationships of PAC in epileptogenic (seizure onset zone or SOZ) and non-epileptogenic tissue (non-SOZ). That this biomarker can differentiate seizure onset zone from non-seizure onset zone has been established with ictal and pre-ictal data, but less so with interictal data. Here we show that this biomarker can differentiate SOZ from non-SOZ interictally and is also a function of interictal epileptiform discharges. We also show a differential level of PAC in slow-wave-sleep relative to NREM1-2 and awake states. Lastly, we show AUROC evaluation of the localization of SOZ is optimal when utilizing beta or alpha phase onto high-gamma or ripple band. The results suggest an elevated PAC may reflect an electrophysiology-based biomarker for abnormal/epileptogenic brain regions.
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Affiliation(s)
- Brent Berry
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Yogatheesan Varatharajah
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Biomedical and Electrical/Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Vaclav Kremen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University, 160 00 Prague, Czech Republic
| | - Michal Kucewicz
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hari Guragain
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin Brinkmann
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Juliano Duque
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Computing and Mathematics, FFCLRP, University of São Paulo, Ribeirão Preto 14040-901, SP, Brazil
| | | | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Gary Sieck
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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Gossard TR, Teigen LN, Yoo S, Timm PC, Jagielski J, Bibi N, Feemster JC, Steele T, Carvalho DZ, Junna MR, Lipford MC, Tippmann Peikert M, LeClair-Visonneau L, McCarter SJ, Boeve BF, Silber MH, Hirsch J, Sharp RR, St. Louis EK. Patient values and preferences regarding prognostic counseling in isolated REM sleep behavior disorder. Sleep 2023; 46:zsac244. [PMID: 36259668 PMCID: PMC9832520 DOI: 10.1093/sleep/zsac244] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/19/2022] [Indexed: 11/27/2022] Open
Abstract
STUDY OBJECTIVES Isolated REM sleep behavior disorder (iRBD) carries a high lifetime risk for phenoconversion to a defined neurodegenerative disease (NDD) including Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. We aimed to examine iRBD patient values and preferences regarding prognostic counseling. METHODS One hundred thirteen iRBD patient participants enrolled in the Mayo Clinic iRBD Patient Registry were sent an email survey concerning their values and preferences concerning NDD prognostic counseling and their experiences following diagnosis with iRBD. RESULTS Of 81 respondents (71.7% response rate), the majority were men (74.0%) with an average age of 65.7 (±9.7) years. Responses indicated a strong preference toward receiving prognostic information about possible future NDD development. 92.5% of respondents felt knowledge concerning personal NDD risk was important, while 87.6% indicated prognostic discussions were important to maintaining trust in their physician. 95.7% indicated a desire for more information, while only 4.3% desired less information regarding their NDD prognostic risk. Most respondents strongly agreed that prognostic information was important to discuss with their family and friends and inform future life planning, and most expressed interest in learning more about future neuroprotective therapies and symptomatic treatments for parkinsonism and dementia. CONCLUSIONS Most iRBD patients indicated strong preferences for disclosure of NDD prognostic risk and indicated that prognostic information was important for family discussions and future life planning. Future broader surveys and qualitative studies of clinic-based and ultimately community dwelling iRBD patients' values and preferences are needed to guide appropriately tailored and individualized prognostic counseling approaches following iRBD diagnosis.
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Affiliation(s)
- Thomas R Gossard
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | - Luke N Teigen
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | - Seeley Yoo
- Mayo Center for Sleep Medicine, Minnesota, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | | | - Noor Bibi
- Mayo Center for Sleep Medicine, Minnesota, USA
| | - John C Feemster
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Tyler Steele
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Diego Z Carvalho
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | | | - Melissa C Lipford
- Mayo Center for Sleep Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Maja Tippmann Peikert
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | | | | | | | - Michael H Silber
- Mayo Center for Sleep Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Jessica Hirsch
- Biomedical Ethics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Erik K St. Louis
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin, USA
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9
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Carvalho DZ, St. Louis EK, Przybelski SA, Morgenthaler TI, Machulda MM, Boeve BF, Petersen RC, Jack CR, Graff-Radford J, Vemuri P, Mielke MM. Sleepiness in Cognitively Unimpaired Older Adults Is Associated With CSF Biomarkers of Inflammation and Axonal Integrity. Front Aging Neurosci 2022; 14:930315. [PMID: 35898322 PMCID: PMC9309557 DOI: 10.3389/fnagi.2022.930315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Sleepiness has been associated with cognitive decline and dementia in the elderly. Older adults with excessive daytime sleepiness appear to be more vulnerable to longitudinal amyloid PET accumulation before the onset of the dementia. However, it remains unclear whether sleepiness is similarly associated with other biomarkers of Alzheimer’s disease (AD), axonal integrity, and inflammation, which may also contribute to neurodegeneration and cognitive decline. Methods In this cross-sectional analysis, we identified 260 cognitively unimpaired adults (>60 years) from the Mayo Clinic Study of Aging, a population-based cohort from Olmsted County (MN), who underwent CSF quantification of AD biomarkers (Aβ42, p-tau, p-tau/Aβ42) in addition to at least one of the following biomarkers [neurofilament light chain (NfL) interleukin-6 (IL-6), IL-10, and tumor necrosis factor-α (TNF-α)]. We fit linear regression models to assess associations between sleepiness, as measured by the Epworth Sleepiness Scale (ESS), and CSF biomarkers, controlling for age, sex, APOε4 status, body mass index, hypertension, dyslipidemia, and prior diagnosis of obstructive sleep apnea. Results Higher ESS scores were associated with higher CSF IL-6 and NfL, but not with the other CSF biomarkers. For every ESS score point increase, there was a 0.009 ([95% CI 0.001–0.016], p = 0.033) increase in the log of IL-6 and 0.01 ([95% CI 0.002–0.018], p = 0.016) increase in the log of NfL. A sensitivity analysis showed an association between ESS scores and log of p-tau/Aβ42 only in participants with an abnormal ratio (>0.023), highly predictive of amyloid positivity. For every ESS score point increase, there was a 0.006 ([95% CI 0.001–0.012], p = 0.021) increase in the log of CSF p-tau/Aβ42. Conclusion Sleepiness was associated with greater CSF IL-6 and NfL levels, which could contribute to neurodegeneration or alternatively cause sleepiness. Higher NfL levels may result from sleep disruption and/or contribute to sleepiness via disturbed connectivity or damage to wake-promoting centers. Associations between sleepiness and p-tau/Aβ42 in participants with abnormal ratio suggest that amyloid positivity contributes to vulnerability to sleep disturbance, which may further amyloid accumulation in a feed-forward loop process. Prospective studies of these markers are needed to determine cause-effect relationships between these associations.
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Affiliation(s)
- Diego Z. Carvalho
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Diego Z. Carvalho,
| | - Erik K. St. Louis
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Scott A. Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Timothy I. Morgenthaler
- Center for Sleep Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mary M. Machulda
- Department of Psychology, Mayo Clinic, Rochester, MN, United States
| | - Bradley F. Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Ronald C. Petersen
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Clifford R. Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Michelle M. Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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10
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Moore JL, Carvalho DZ, St Louis EK, Bazil C. Sleep and Epilepsy: a Focused Review of Pathophysiology, Clinical Syndromes, Co-morbidities, and Therapy. Neurotherapeutics 2021; 18:170-180. [PMID: 33786803 PMCID: PMC8116418 DOI: 10.1007/s13311-021-01021-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 10/21/2022] Open
Abstract
A healthy brain requires balancing of waking and sleeping states. The normal changes in waking and sleeping states result in neurophysiological conditions that either increase or decrease the tendency of seizures and interictal discharges to occur. This article reviews the manifold and complex relationships between sleep and epilepsy and discusses treatment of the sleep-related epilepsies. Several forms of epilepsy predominantly or exclusively manifest during sleep and seizures tend to arise especially from light NREM sleep. Diagnostic interictal epileptiform discharges on the electroencephalogram are also most likely to be activated during deep NREM sleep stage N3. Epileptiform discharges and antiepileptic medications may in turn detrimentally impact sleep. Co-morbid sleep disorders also have the potential to worsen seizure control. Sleep has an important key association with sudden unexpected death in epilepsy (SUDEP). Further research is necessary to understand the complex relationships between sleep and epileptic disorders and their treatments.
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Affiliation(s)
- J Layne Moore
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Diego Z Carvalho
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
- Departments of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Erik K St Louis
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA.
- Departments of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA.
| | - Carl Bazil
- Division of Epilepsy and Sleep, Columbia University, New York, NY, USA
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Moore JL, Carvalho DZ, St Louis EK, Bazil C. Correction to: Sleep and Epilepsy: a Focused Review of Pathophysiology, Clinical Syndromes, Co-morbidities, and Therapy. Neurotherapeutics 2021; 18:655. [PMID: 33847908 PMCID: PMC8116396 DOI: 10.1007/s13311-021-01060-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- J Layne Moore
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Diego Z Carvalho
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
- Departments of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Erik K St Louis
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA.
- Departments of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA.
| | - Carl Bazil
- Division of Epilepsy and Sleep, Columbia University, New York, NY, USA
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Carvalho DZ, St. Louis EK, Schwarz CG, Bradley BF, Lowe VJ, Przybelski SA, Reddy A, Mielke MM, Knopman DS, Petersen RC, Jack CR, Vemuri P. 0355 Neurobiological Correlates of Sleepiness in Middle Aged and Older Adults: A FDG-PET Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sleepiness has been associated with functional and cognitive decline, and may present with excessive daytime sleepiness (EDS) and/or increased sleep duration. We investigated whether sleepiness and changes in sleep patterns are associated with FDG-PET levels in wake-promoting regions.
Methods
From the Mayo Clinic Study of Aging cohort, we identified 373 cognitively-unimpaired middle-aged and older adults (mean +/- s.d. 66.1 +/- 13.2 yo) who underwent FDG-PET. EDS was defined as ESS score >=10. Changes in sleep patterns (sleeping more, less, or no change) were assessed using question #16 of the Beck Depression Inventory-2. We used probabilistic maps to create regions of interest (ROIs): the locus coeruleus (LC), posterior lateral hypothalamus (PLH), and the basal forebrain divided in 1) medial septum/diagonal band of Broca (MS/DB) and 2) nucleus basalis of Meynert (nbM). FDG-PET levels were referenced to the pons (SUVR). In this cross-sectional analysis, we fit linear models to assess the association between EDS and changes in sleeping patterns with FDG SUVR in in each ROI, while controlling for age, sex, education, BMI, witnessed apneas, and cardiovascular risk factors.
Results
10.5% had EDS, 15% reported sleeping more and 21% reported sleeping less than usual. 30.7% of participants with EDS reported sleeping more, 25.6% less, and 43.5% the same. EDS was associated with an elevation in FDG-PET SUVR in the MS/DB region (.035 [95% CI .008; .063], p=.012), while sleeping more was associated with a decrease in FDG-PET SUVR in the same region (-.027 [95%CI -.052; -.002], p=.036). Sleeping less was associated with an increase in FDG-PET SUVR in the PLH (.021 [95% CI .005; .03], p=.019). No associations were found in other ROIs.
Conclusion
Our results suggest that sleepiness and changes in sleep patterns in cognitively-unimpaired middle-aged and older adults were associated with measurable metabolic changes in areas of the brain involved in sleep and wakefulness. Further research should clarify whether these findings could represent different phenotypes of sleepiness with potential diagnostic and prognostic implications.
Support
NIA/NIH
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13
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Carvalho DZ, St Louis EK, Schwarz CG, Lowe VJ, Boeve BF, Przybelski SA, Reddy A, Mielke MM, Knopman DS, Petersen RC, Jack CR, Vemuri P. Witnessed apneas are associated with elevated tau-PET levels in cognitively unimpaired elderly. Neurology 2020; 94:e1793-e1802. [PMID: 32217775 DOI: 10.1212/wnl.0000000000009315] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/13/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To assess whether informant-reported apneas during sleep (witnessed apneas) in cognitively unimpaired (CU) elderly persons are associated with higher levels of brain tau. METHODS From the population-based Mayo Clinic Study of Aging, we identified 292 CU elderly ≥65 years of age with both AV-1451 tau-PET and Pittsburgh compound B (PiB)-PET scans and whose bed partners and close relatives had completed a questionnaire that assessed whether participants had witnessed apneas during sleep. For this cross-sectional analysis, we selected the entorhinal and inferior temporal cortices as our regions of interest (ROIs) because they are highly susceptible to tau accumulation. PET signal was scaled to the cerebellum crus to calculate standardized uptake value ratio (SUVR). We fit linear models to assess the association between regional tau and witnessed apneas while controlling for age, sex, years of education, body mass index, hypertension, hyperlipidemia, diabetes, reduced sleep, excessive daytime sleepiness, and global PiB. RESULTS Forty-three participants (14.7%) were found to have witnessed apneas during sleep. The report of witnessed apneas was associated with higher tau-PET SUVR elevation in our ROIs: 0.049 SUVR (95% confidence interval [CI] 0.010-0.087, p = 0.015) in the entorhinal cortex and 0.037 SUVR (95% CI 0.006-0.067, p = 0.019) in the inferior temporal cortex after controlling for confounders. CONCLUSION We identified a significant association between witnessed apneas in CU elderly and elevated tau-PET signal in tau-susceptible brain regions. These results suggest a plausible mechanism that could contribute to cognitive impairment and the development of Alzheimer disease. Longitudinal observations are necessary to determine direction of causality.
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Affiliation(s)
- Diego Z Carvalho
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN.
| | - Erik K St Louis
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Christopher G Schwarz
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Val J Lowe
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Scott A Przybelski
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Ashritha Reddy
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
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Carvalho DZ, St Louis EK, Knopman DS, Boeve BF, Lowe VJ, Roberts RO, Mielke MM, Przybelski SA, Machulda MM, Petersen RC, Jack CR, Vemuri P. Association of Excessive Daytime Sleepiness With Longitudinal β-Amyloid Accumulation in Elderly Persons Without Dementia. JAMA Neurol 2019. [PMID: 29532057 DOI: 10.1001/jamaneurol.2018.0049] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Aging is associated with excessive daytime sleepiness (EDS), which has been linked to cognitive decline in the elderly. However, whether EDS is associated with the pathologic processes of Alzheimer disease remains unclear. Objective To investigate whether EDS at baseline is associated with a longitudinal increase in regional β-amyloid (Aβ) accumulation in a cohort of elderly individuals without dementia. Design, Setting, and Participants This prospective analysis included participants enrolled in the Mayo Clinic Study of Aging, a longitudinal population-based study in Olmsted County, Minnesota. Of 2900 participants, 2172 (74.9%) agreed to undergo carbon 11-labeled Pittsburgh compound B positron emission tomography (PiB-PET). We included 283 participants 70 years or older without dementia who completed surveys assessing sleepiness at baseline and had at least 2 consecutive PiB-PET scans from January 1, 2009, through July 31, 2016, after excluding 45 (13.7%) who had a comorbid neurologic disorder. Main Outcomes and Measures Excessive daytime sleepiness was defined as an Epworth Sleepiness Scale score of at least 10. The difference in Aβ levels between the 2 consecutive scans (ΔPiB) in Aβ-susceptible regions (prefrontal, anterior cingulate, posterior cingulate-precuneus, and parietal) was determined. Multiple linear regression models were fit to explore associations between baseline EDS and ΔPiB while adjusting for baseline age, sex, presence of the apolipoprotein E ε4 allele, educational level, baseline PiB uptake, global PiB positivity (standardized uptake value ratio ≥1.4), physical activity, cardiovascular comorbidities (obesity, hypertension, hyperlipidemia, and diabetes), reduced sleep duration, respiratory symptoms during sleep, depression, and interval between scans. Results Of the initial 283 participants, mean (SD) age was 77.1 (4.8) years; 204 (72.1%) were men and 79 (27.9%) were women. Sixty-three participants (22.3%) had EDS. Baseline EDS was significantly associated with increased regional Aβ accumulation in the anterior cingulate (B coefficient = 0.031; 95% CI, 0.001-0.061; P = .04), posterior cingulate-precuneus (B coefficient = 0.038; 95% CI, 0.006-0.069; P = .02), and parietal (B coefficient = 0.033; 95% CI, 0.001-0.065; P = .04) regions. Association of EDS with longitudinal Aβ accumulation was stronger in participants with baseline global PiB positivity in the anterior cingulate (B coefficient = 0.065; 95% CI, 0.010-0.118; P = .02) and cingulate-precuneus (B coefficient = 0.068; 95% CI, 0.009-0.126; P = .02) regions. Conclusions and Relevance Baseline EDS was associated with increased longitudinal Aβ accumulation in elderly persons without dementia, suggesting that those with EDS may be more vulnerable to pathologic changes associated with Alzheimer disease. Further work is needed to elucidate whether EDS is a clinical marker of greater sleep instability, synaptic or network overload, or neurodegeneration of wakefulness-promoting centers. Early identification of patients with EDS and treatment of underlying sleep disorders could reduce Aβ accumulation in this vulnerable group.
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Affiliation(s)
| | | | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Rosebud O Roberts
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Scott A Przybelski
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Sun H, Paixao L, Oliva JT, Goparaju B, Carvalho DZ, van Leeuwen KG, Akeju O, Thomas RJ, Cash SS, Bianchi MT, Westover MB. Brain age from the electroencephalogram of sleep. Neurobiol Aging 2018; 74:112-120. [PMID: 30448611 DOI: 10.1016/j.neurobiolaging.2018.10.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 12/18/2022]
Abstract
The human electroencephalogram (EEG) of sleep undergoes profound changes with age. These changes can be conceptualized as "brain age (BA)," which can be compared to chronological age to reflect the degree of deviation from normal aging. Here, we develop an interpretable machine learning model to predict BA based on 2 large sleep EEG data sets: the Massachusetts General Hospital (MGH) sleep lab data set (N = 2532; ages 18-80); and the Sleep Heart Health Study (SHHS, N = 1974; ages 40-80). The model obtains a mean absolute deviation of 7.6 years between BA and chronological age (CA) in healthy participants in the MGH data set. As validation, a subset of SHHS containing longitudinal EEGs 5.2 years apart shows an average of 5.4 years increase in BA. Participants with significant neurological or psychiatric disease exhibit a mean excess BA, or "brain age index" (BAI = BA-CA) of 4 years relative to healthy controls. Participants with hypertension and diabetes have a mean excess BA of 3.5 years. The findings raise the prospect of using the sleep EEG as a potential biomarker for healthy brain aging.
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Affiliation(s)
- Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jefferson T Oliva
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Bioinspired Computing Laboratory, Computer Science Department, University of São Paulo, Brazil
| | - Balaji Goparaju
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Diego Z Carvalho
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kicky G van Leeuwen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; University of Twente, Enschede, the Netherlands
| | - Oluwaseun Akeju
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert J Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Matt T Bianchi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Dolatshahi M, Carvalho DZ, Cole A, Cash S. T06. Outcome of brain responsive neurostimulation in refractory epilepsy cases from a single tertiary epilepsy centre. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Sun H, Paixao LC, Carvalho DZ, Cash SS, Bianchi MT, Westover MB. S141. Predicting brain age from the electroencephalogram of sleep. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Carvalho DZ, Townley RA, Burkle CM, Rabinstein AA, Wijdicks EFM. Propofol Frenzy: Clinical Spectrum in 3 Patients. Mayo Clin Proc 2017; 92:1682-1687. [PMID: 29101936 DOI: 10.1016/j.mayocp.2017.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/07/2017] [Accepted: 08/22/2017] [Indexed: 02/04/2023]
Abstract
Postsedation neuroexcitation is sometimes attributed to intravenous injection of the sedative-hypnotic drug propofol. The movements associated with these events have strongly suggested convulsive activity, but they rarely have been comprehensively evaluated. We present video recordings of 3 healthy young patients who underwent elective surgery under conscious sedation and emerged from sedation with transient but repetitive violent motor activity and impaired consciousness. These manifestations required considerable mobilization of multiple health care workers to protect the patient from inflicting harm. All patients received propofol, and all fully recovered without adverse sequelae. We postulate that these movements are propofol related. Importantly, we found no evidence of seizures clinically or electrographically.
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Carvalho DZ, St. Louis EK, Boeve BF, Knopman DS, Lowe VJ, Roberts RO, Mielke MM, Przybelski SA, Petersen RC, Jack CR, Vemuri P. 0273 BASELINE EXCESSIVE DAYTIME SLEEPINESS ASSOCIATED WITH AN INCREASE IN BRAIN METABOLISM IN NON-DEMENTED ELDERLY: A LONGITUDINAL FDG-PET STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Carvalho DZ, St Louis EK, Boeve BF, Mielke MM, Przybelski SA, Knopman DS, Machulda MM, Roberts RO, Geda YE, Petersen RC, Jack CR, Vemuri P. Excessive daytime sleepiness and fatigue may indicate accelerated brain aging in cognitively normal late middle-aged and older adults. Sleep Med 2016; 32:236-243. [PMID: 28065685 DOI: 10.1016/j.sleep.2016.08.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/30/2016] [Accepted: 08/04/2016] [Indexed: 12/29/2022]
Abstract
Excessive daytime sleepiness (EDS) and fatigue increases with age. The aim of this study was to investigate the association between EDS and fatigue with cortical thickness and hippocampal volume in cognitively normal, late middle-aged and older adults. We performed a cross-sectional observational study of 1374 cognitively-normal subjects aged 50 years and older who had a structural MRI. Regional cortical thickness and hippocampal volume were measured. Multiple linear regression models were fit to explore associations between EDS and fatigue and structural MRI measures in different brain regions, adjusting for multiple covariates. EDS was defined as Epworth Sleepiness Scale ≥10. Fatigue severity was assessed with the Beck Depression Inventory-2. 208 participants had EDS, 27 had significant fatigue, and 11 had both. Participants with EDS or fatigue had significantly lower cognitive scores, more disturbed sleep, and medical comorbidities. The presence of EDS was associated with both global and regional atrophy, whereas fatigue was more associated with frontal and temporal changes. Cortical thinning predicted by EDS and fatigue was maximal in the temporal region with average reduction of 34.2 μm (95% CI, -54.1, -14.3; P = 0.001) and 90.2 μm (95% CI, -142.1, -38.2; P = 0.001), respectively. Fatigue was also associated with hippocampal volume reduction of -374.2 mm3 (95% CI, -670.8, -77.7; P = 0.013). Temporal cortical thinning predicted by presence of EDS and fatigue was equivalent to more than 3.5 and 9 additional years of aging, respectively. EDS and fatigue were associated with cortical thickness reduction primarily in regions with increased age-susceptibility, which may indicate accelerated brain aging.
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Affiliation(s)
| | | | | | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Rosebud O Roberts
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Yonas E Geda
- Department of Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Mayo Clinic, Scottsdale, AZ, USA; Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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Carvalho DZ, Boes CJ. Absent quadriceps reflex with distant toe flexor response: An underrecognized neurological sign. Clin Neurol Neurosurg 2016; 149:44-5. [PMID: 27458829 DOI: 10.1016/j.clineuro.2016.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/22/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
As opposed to finger flexion response upon tapping the styloid process with absent brachioradialis reflex (inverted brachioradialis reflex), toe flexion response upon patellar percussion with absent quadriceps reflex is a quite underrecognized neurological sign, and has been reported only once in the literature. Similar to the inverted brachioradialis reflex, this sign can also be useful for neurological localization. We hereby report a patient presenting with signs and symptoms of lumbar radiculopathy in the setting of an anterior epidural mass compressing the cauda equina at L2-L4, without evidence of myelopathy. Upon examination, the patient had bilateral absent quadriceps reflexes with a right toe flexor response when the right patella was percussed. An absent quadriceps reflex with distant toe flexor response is proposed as a lower extremity equivalent of the inverted brachioradialis reflex, likely localizing to L3-L4 levels. Spindle hypersensitivity due to lack of reciprocal inhibition from antagonist muscles is hypothesized as a possible underlying mechanism. Further observations should help clarify the most common underlying etiology (radicular vs. radiculomyelopathy). Neurologists should be able to recognize this sign, as it can be helpful for neurological localization.
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Carvalho DZ, Schönwald SV, Schumacher-Schuh AF, Braga CW, Souza DO, Oses JP, Donis KC, Rieder CR. Overnight S100B in Parkinson's Disease: A glimpse into sleep-related neuroinflammation. Neurosci Lett 2015; 608:57-63. [PMID: 26453767 DOI: 10.1016/j.neulet.2015.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/15/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
Abstract
Calcium-binding protein B (S100B), a primary product of astrocytes, is a proposed marker of Parkinson's Disease (PD) pathophysiology, diagnosis and progression. However, it has also been implicated in sleep disruption, which is very common in PD. To explore the relationship between S100B, disease severity, sleep symptoms and polysomnography (PSG) findings, overnight changes in serum S100B levels were investigated for the first time in PD. 17 fully treated, non-demented, moderately advanced PD patients underwent PSG and clinical assessment of sleep symptoms. Serum S100B samples were collected immediately before and after the PSG. Results are shown as median [interquartile range]. Night and morning S100B levels were similar, but uncorrelated (rs=-0.277, p=0.28). Morning S100B levels, as opposed to night levels, positively correlated with the Unified Parkinson's Disease rating scale (UPDRS) subsections I and II (rs=0.547, p=0.023; rs=0.542, p=0.025). Compared to those with overnight S100B reduction, patients with overnight S100B elevation had higher H&Y scores (2.5 [0.87] vs. 2 [0.25], p=0.035) and worse total Pittsburgh Sleep Quality Index (PSQI) and Parkinson's Disease Sleep Scores (10 [3.2] vs. 8 [4.5], p=0.037; 92.9 [39] vs. 131.4 [28], p=0.034). Correlation between morning S100B levels and total UPDRS score was strengthened after controlling for total PSQI score (rs=0.531, p=0.034; partial rs=0.699, p=0.004, respectively). Overnight S100B variation and morning S100B were associated with PD severity and perceived sleep disruption. S100B is proposed as a putative biomarker for sleep-related neuroinflammation in PD. Noradrenergic-astrocytic dysfunction is hypothesized as a possible mechanism underlying these findings.
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Affiliation(s)
- D Z Carvalho
- Clinical Neurophysiology Laboratory, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - S V Schönwald
- Clinical Neurophysiology Laboratory, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Sleep and Movement Disorders Clinics, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - A F Schumacher-Schuh
- Sleep and Movement Disorders Clinics, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - C W Braga
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - D O Souza
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - J P Oses
- Laboratory of Clinical Neurosciences, Postgraduate Program in Health and Behavior, Center for Life and Health Sciences, Universidade Católica de Pelotas (UCPel), Porto Alegre, RS, Brazil
| | - K C Donis
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - C R Rieder
- Sleep and Movement Disorders Clinics, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Department of Neurology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Carvalho DZ, Hughes JD, Liebo GB, Bendel EC, Bjarnason H, Klaas JP. Venous Congestive Myelopathy due to Chronic Inferior Vena Cava Thrombosis Treated with Endovascular Stenting: Case Report and Review of the Literature. J Vasc Interv Neurol 2015; 8:49-53. [PMID: 25825633 PMCID: PMC4367808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Impaired inferior vena cava (IVC) outflow can lead to collateralization of blood to the valveless epidural venous plexus, causing epidural venous engorgement and venous congestion. Herein we describe a case of chronic IVC thrombosis presenting as venous congestive myelopathy treated with angioplasty and endovascular stenting. The pathophysiological mechanisms of cord injury are hypothesized, and IVC stenting application is evaluated. METHODS Case report and review of the literature. RESULTS IVC outflow obstruction has only rarely been associated with neurologic dysfunction, with reports of lumbosacral nerve root compression in the cases of IVC agenesis, compression, or occlusion. Although endovascular angioplasty with stenting is emerging as a leading treatment option for chronic IVC thrombosis, its use to treat neurologic complications is limited to one case report for intractable sciatica. Our case is the first description of IVC thrombosis presenting with venous congestive myelopathy, and treated successfully with IVC stenting. CONCLUSION Venous congestive myelopathy should be seen as a broader clinical condition, including not only typical dural arteriovenous fistulas, but also disorders of venous outflow. Therefore, identifying a rare, but potentially treatable, etiology is important to avoid permanent neurologic deficits. IVC stenting is proposed as a novel and effective treatment approach.
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Affiliation(s)
| | | | - Greta B. Liebo
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Emily C. Bendel
- Department of Vascular & Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Haraldur Bjarnason
- Department of Vascular & Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - James P. Klaas
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Lopez MR, Cheng JY, Kanner AM, Carvalho DZ, Diamond JA, Wallace DM. Insomnia symptoms in South Florida military veterans with epilepsy. Epilepsy Behav 2013; 27:159-64. [PMID: 23434722 DOI: 10.1016/j.yebeh.2013.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/10/2013] [Accepted: 01/12/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the high prevalence of insomnia in veterans with epilepsy, it remains understudied. Our aim was to identify the associations of insomnia with epilepsy, comorbidities, and treatment-related variables in South Florida veterans. METHODS We performed a cross-sectional analysis of veterans attending an epilepsy clinic over 18 months. Participants completed standardized assessments of seizure and sleep. Insomnia was defined as 1) difficulty with sleep onset, maintenance, or premature awakenings with daytime consequences or 2) sedative-hypnotic use on most nights of the previous month. RESULTS One hundred sixty-five veterans (87% male, age 56 ± 15 years) were included: 66 reporting insomnia (40%). In logistic regression analysis, insomnia was significantly associated with post-traumatic seizure etiology, lamotrigine prescription, and mood and psychotic disorders. Female gender and levetiracetam treatment were associated with lower odds for insomnia. CONCLUSION Insomnia was associated with post-traumatic epilepsy, mood/psychotic comorbidities, and antiepileptic regimen. Insomnia represents an under-recognized opportunity to improve comprehensive epilepsy care.
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Affiliation(s)
- M R Lopez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Schönwald SV, Carvalho DZ, de Santa-Helena EL, Lemke N, Gerhardt GJL. Topography-specific spindle frequency changes in obstructive sleep apnea. BMC Neurosci 2012; 13:89. [PMID: 22985414 PMCID: PMC3496607 DOI: 10.1186/1471-2202-13-89] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 06/28/2012] [Indexed: 11/25/2022] Open
Abstract
Background Sleep spindles, as detected on scalp electroencephalography (EEG), are considered to be markers of thalamo-cortical network integrity. Since obstructive sleep apnea (OSA) is a known cause of brain dysfunction, the aim of this study was to investigate sleep spindle frequency distribution in OSA. Seven non-OSA subjects and 21 patients with OSA (11 mild and 10 moderate) were studied. A matching pursuit procedure was used for automatic detection of fast (≥13Hz) and slow (<13Hz) spindles obtained from 30min samples of NREM sleep stage 2 taken from initial, middle and final night thirds (sections I, II and III) of frontal, central and parietal scalp regions. Results Compared to non-OSA subjects, Moderate OSA patients had higher central and parietal slow spindle percentage (SSP) in all night sections studied, and higher frontal SSP in sections II and III. As the night progressed, there was a reduction in central and parietal SSP, while frontal SSP remained high. Frontal slow spindle percentage in night section III predicted OSA with good accuracy, with OSA likelihood increased by 12.1%for every SSP unit increase (OR 1.121, 95% CI 1.013 - 1.239, p=0.027). Conclusions These results are consistent with diffuse, predominantly frontal thalamo-cortical dysfunction during sleep in OSA, as more posterior brain regions appear to maintain some physiological spindle frequency modulation across the night. Displaying changes in an opposite direction to what is expected from the aging process itself, spindle frequency appears to be informative in OSA even with small sample sizes, and to represent a sensitive electrophysiological marker of brain dysfunction in OSA.
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Affiliation(s)
- Suzana V Schönwald
- Sleep Laboratory, Division of Pulmonary Medicine, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350/sala 2050, Porto Alegre, RS, 90035-003, Brazil
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Wallace DM, Shafazand S, Carvalho DZ, Nahab FB, Sengun C, Russell A, Moore HP, Singer C. Sleep-related falling out of bed in Parkinson's disease. J Clin Neurol 2012; 8:51-7. [PMID: 22523513 PMCID: PMC3325432 DOI: 10.3988/jcn.2012.8.1.51] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 05/18/2011] [Accepted: 05/18/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Sleep-related falling out of bed (SFOB), with its potential for significant injury, has not been a strong focus of investigation in Parkinson's disease (PD) to date. We describe the demographic and clinical characteristics of PD patients with and without SFOB. METHODS We performed a retrospective analysis of 50 consecutive PD patients, who completed an REM sleep behavior disorder screening questionnaire (RBDSQ), questionnaires to assess for RBD clinical mimickers and questions about SFOB and resulting injuries. Determination of high risk for RBD was based on an RBDSQ score of 5 or greater. RESULTS Thirteen patients reported history of SFOB (26%). Visual hallucinations, sleep-related injury, quetiapine and amantadine use were more common in those patients reporting SFOB. Twenty-two patients (44%) fulfilled criteria for high risk for RBD, 12 of which (55%) reported SFOB. Five patients reported injuries related to SFOB. SFOB patients had higher RBDSQ scores than non-SFOB patients (8.2±3.0 vs. 3.3±2.0, p<0.01). For every one unit increase in RBDSQ score, the likelihood of SFOB increased two-fold (OR 2.4, 95% CI 1.3-4.2, p<0.003). CONCLUSIONS SFOB may be a clinical marker of RBD in PD and should prompt confirmatory polysomnography and pharmacologic treatment to avoid imminent injury. Larger prospective studies are needed to identify risk factors for initial and recurrent SFOB in PD.
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Affiliation(s)
- D M Wallace
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Wallace DM, Shafazand S, Ramos AR, Carvalho DZ, Gardener H, Lorenzo D, Wohlgemuth WK. Insomnia characteristics and clinical correlates in Operation Enduring Freedom/Operation Iraqi Freedom veterans with post-traumatic stress disorder and mild traumatic brain injury: an exploratory study. Sleep Med 2011; 12:850-9. [PMID: 21925943 DOI: 10.1016/j.sleep.2011.06.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/20/2011] [Accepted: 06/01/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is limited data on chronic insomnia in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, in whom post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co-exist. Our aim was to compare sleep characteristics of three groups of OEF/OIF veterans: (1) healthy sleepers (HS), (2) those with insomnia associated with PTSD and mTBI (PTSD-mTBI), and (3) those with insomnia associated with PTSD alone. METHODS Consecutive veterans with insomnia complaints (> 6 months) were recruited over 6 months from the Miami VA Post Deployment clinic. Participants completed a sleep disorders clinical interview, medical history, and questionnaires about insomnia, sleepiness, pain, fatigue, depression, PTSD, and health-related quality of life. They underwent polysomnography (PSG) with 2 weeks of actigraphy (ACT) and sleep diaries. RESULTS There were no differences in demographics or most questionnaire responses between PTSD and PTSD-mTBI groups. Subjective daytime sleepiness was significantly greater in PTSD-mTBI subjects compared with HS and PTSD participants. Significant co-morbid sleep disorders were noted in insomnia patients. PSG and ACT wake after sleep onset was significantly shorter in PTSD-mTBI subjects as compared with PTSD participants. CONCLUSION Insomnia patients with PTSD-mTBI were subjectively sleepier despite spending less time awake during the night than PTSD subjects, possibly as a consequence of head trauma.
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Affiliation(s)
- D M Wallace
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Schönwald SV, Carvalho DZ, Dellagustin G, de Santa-Helena EL, Gerhardt GJ. Quantifying chirp in sleep spindles. J Neurosci Methods 2011; 197:158-64. [DOI: 10.1016/j.jneumeth.2011.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 01/20/2011] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
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