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Krone LB, Fehér KD, Rivero T, Omlin X. Brain stimulation techniques as novel treatment options for insomnia: A systematic review. J Sleep Res 2023; 32:e13927. [PMID: 37202368 PMCID: PMC10909439 DOI: 10.1111/jsr.13927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/15/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Despite the success of cognitive behavioural therapy for insomnia and recent advances in pharmacotherapy, many patients with insomnia do not sufficiently respond to available treatments. This systematic review aims to present the state of science regarding the use of brain stimulation approaches in treating insomnia. To this end, we searched MEDLINE, Embase and PsycINFO from inception to 24 March 2023. We evaluated studies that compared conditions of active stimulation with a control condition or group. Outcome measures included standardized insomnia questionnaires and/or polysomnography in adults with a clinical diagnosis of insomnia. Our search identified 17 controlled trials that met inclusion criteria, and assessed a total of 967 participants using repetitive transcranial magnetic stimulation, transcranial electric stimulation, transcutaneous auricular vagus nerve stimulation or forehead cooling. No trials using other techniques such as deep brain stimulation, vestibular stimulation or auditory stimulation met the inclusion criteria. While several studies report improvements of subjective and objective sleep parameters for different repetitive transcranial magnetic stimulation and transcranial electric stimulation protocols, important methodological limitations and risk of bias limit their interpretability. A forehead cooling study found no significant group differences in the primary endpoints, but better sleep initiation in the active condition. Two transcutaneous auricular vagus nerve stimulation trials found no superiority of active stimulation for most outcome measures. Although modulating sleep through brain stimulation appears feasible, gaps in the prevailing models of sleep physiology and insomnia pathophysiology remain to be filled. Optimized stimulation protocols and proof of superiority over reliable sham conditions are indispensable before brain stimulation becomes a viable treatment option for insomnia.
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Affiliation(s)
- Lukas B. Krone
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
- Centre for Experimental NeurologyUniversity of BernBernSwitzerland
- Department of Physiology Anatomy and Genetics, Sir Jules Thorn Sleep and Circadian Neuroscience InstituteUniversity of OxfordOxfordUK
- The Kavli Institute for Nanoscience DiscoveryUniversity of OxfordOxfordUK
| | - Kristoffer D. Fehér
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
- Geneva University Hospitals (HUG), Division of Psychiatric SpecialtiesUniversity of GenevaGenevaSwitzerland
| | - Tania Rivero
- Medical LibraryUniversity Library of Bern, University of BernBernSwitzerland
| | - Ximena Omlin
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
- Geneva University Hospitals (HUG), Division of Psychiatric SpecialtiesUniversity of GenevaGenevaSwitzerland
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2
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Züst MA, Mikutta C, Omlin X, DeStefani T, Wunderlin M, Zeller CJ, Fehér KD, Hertenstein E, Schneider CL, Teunissen CE, Tarokh L, Klöppel S, Feige B, Riemann D, Nissen C. The Hierarchy of Coupled Sleep Oscillations Reverses with Aging in Humans. J Neurosci 2023; 43:6268-6279. [PMID: 37586871 PMCID: PMC10490476 DOI: 10.1523/jneurosci.0586-23.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/29/2023] [Revised: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023] Open
Abstract
A well orchestrated coupling hierarchy of slow waves and spindles during slow-wave sleep supports memory consolidation. In old age, the duration of slow-wave sleep and the number of coupling events decrease. The coupling hierarchy deteriorates, predicting memory loss and brain atrophy. Here, we investigate the dynamics of this physiological change in slow wave-spindle coupling in a frontocentral electroencephalography position in a large sample (N = 340; 237 females, 103 males) spanning most of the human life span (age range, 15-83 years). We find that, instead of changing abruptly, spindles gradually shift from being driven by slow waves to driving slow waves with age, reversing the coupling hierarchy typically seen in younger brains. Reversal was stronger the lower the slow-wave frequency, and starts around midlife (age range, ∼40-48 years), with an established reversed hierarchy between 56 and 83 years of age. Notably, coupling strength remains unaffected by age. In older adults, deteriorating slow wave-spindle coupling, measured using the phase slope index (PSI) and the number of coupling events, is associated with blood plasma glial fibrillary acidic protein levels, a marker for astrocyte activation. Data-driven models suggest that decreased sleep time and higher age lead to fewer coupling events, paralleled by increased astrocyte activation. Counterintuitively, astrocyte activation is associated with a backshift of the coupling hierarchy (PSI) toward a "younger" status along with increased coupling occurrence and strength, potentially suggesting compensatory processes. As the changes in coupling hierarchy occur gradually starting at midlife, we suggest there exists a sizable window of opportunity for early interventions to counteract undesirable trajectories associated with neurodegeneration.SIGNIFICANCE STATEMENT Evidence accumulates that sleep disturbances and cognitive decline are bidirectionally and causally linked, forming a vicious cycle. Improving sleep quality could break this cycle. One marker for sleep quality is a clear hierarchical structure of sleep oscillations. Previous studies showed that sleep oscillations decouple in old age. Here, we show that, rather, the hierarchical structure gradually shifts across the human life span and reverses in old age, while coupling strength remains unchanged. This shift is associated with markers for astrocyte activation in old age. The shifting hierarchy resembles brain maturation, plateau, and wear processes. This study furthers our comprehension of this important neurophysiological process and its dynamic evolution across the human life span.
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Affiliation(s)
- Marc Alain Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- Private Clinic Meiringen, 3860 Meiringen, Switzerland
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, United Kingdom
| | - Ximena Omlin
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Tatjana DeStefani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Céline Jacqueline Zeller
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Kristoffer Daniel Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- Division of Psychiatric Specialties, Geneva University Hospitals (HUG), 1201 Geneva, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Charlotte Elisabeth Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Leila Tarokh
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, 79104 Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, 79104 Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- Division of Psychiatric Specialties, Geneva University Hospitals (HUG), 1201 Geneva, Switzerland
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3
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Fehér KD, Omlin X, Tarokh L, Schneider CL, Morishima Y, Züst MA, Wunderlin M, Koenig T, Hertenstein E, Ellenberger B, Ruch S, Schmidig F, Mikutta C, Trinca E, Senn W, Feige B, Klöppel S, Nissen C. Feasibility, efficacy, and functional relevance of automated auditory closed-loop suppression of slow-wave sleep in humans. J Sleep Res 2023:e13846. [PMID: 36806335 DOI: 10.1111/jsr.13846] [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: 10/26/2022] [Revised: 12/22/2022] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
Slow-wave sleep (SWS) is a fundamental physiological process, and its modulation is of interest for basic science and clinical applications. However, automatised protocols for the suppression of SWS are lacking. We describe the development of a novel protocol for the automated detection (based on the whole head topography of frontal slow waves) and suppression of SWS (through closed-loop modulated randomised pulsed noise), and assessed the feasibility, efficacy and functional relevance compared to sham stimulation in 15 healthy young adults in a repeated-measure sleep laboratory study. Auditory compared to sham stimulation resulted in a highly significant reduction of SWS by 30% without affecting total sleep time. The reduction of SWS was associated with an increase in lighter non-rapid eye movement sleep and a shift of slow-wave activity towards the end of the night, indicative of a homeostatic response and functional relevance. Still, cumulative slow-wave activity across the night was significantly reduced by 23%. Undisturbed sleep led to an evening to morning reduction of wake electroencephalographic theta activity, thought to reflect synaptic downscaling during SWS, while suppression of SWS inhibited this dissipation. We provide evidence for the feasibility, efficacy, and functional relevance of a novel fully automated protocol for SWS suppression based on auditory closed-loop stimulation. Future work is needed to further test for functional relevance and potential clinical applications.
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Affiliation(s)
- Kristoffer D Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Division of Psychiatric Specialties, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Ximena Omlin
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Division of Psychiatric Specialties, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Leila Tarokh
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Yosuke Morishima
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Social Neuroscience and Social Psychology, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Thomas Koenig
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Simon Ruch
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital and University of Tübingen, Tübingen, Germany
| | - Flavio Schmidig
- Cognitive Neuroscience of Memory and Consciousness, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Privatklinik Meiringen, Meiringen, Switzerland
| | - Ersilia Trinca
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Walter Senn
- Institute of Physiology, University of Bern, Bern, Switzerland
| | - Bernd Feige
- University of Freiburg Medical Center, Freiburg, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Division of Psychiatric Specialties, Geneva University Hospitals (HUG), Geneva, Switzerland
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4
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Reid MJ, Omlin X, Espie CA, Sharman R, Tamm S, Kyle SD. The effect of sleep continuity disruption on multimodal emotion processing and regulation: a laboratory-based, randomised, controlled experiment in good sleepers. J Sleep Res 2023; 32:e13634. [PMID: 35578403 DOI: 10.1111/jsr.13634] [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: 01/10/2022] [Revised: 03/11/2022] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
Previous research shows that experimental sleep deprivation alters emotion processing, suggesting a potential mechanism linking sleep disruption to mental ill-health. Extending previous work, we experimentally disrupted sleep continuity in good sleepers and assessed next-day emotion processing and regulation using tasks with established sensitivity to depression. In a laboratory-based study, 51 good sleepers (37 female; mean [SD] age 24 [3.63] years), were randomised to 1 night of uninterrupted sleep (n = 24) or sleep continuity disruption (n = 27). We assessed emotion perception, attention, and memory the following day. Participants also completed an emotion regulation task and measures of self-reported affect, anxiety, sleepiness, overnight declarative memory consolidation, and psychomotor vigilance. Confirming the effects of the manipulation, sleep continuity disruption led to a marked decrease in polysomnography-defined total sleep time (229.98 versus 434.57 min), increased wake-time after sleep onset (260.66 versus 23.84 min), and increased sleepiness (d = 0.81). Sleep continuity disruption led to increased anxiety (d = 0.68), decreased positive affect (d = -0.62), reduced overnight declarative memory consolidation (d = -1.08), and reduced psychomotor vigilance (longer reaction times [d = 0.64] and more lapses [d = 0.74]), relative to control. However, contrary to our hypotheses, experimental sleep disruption had no effect on perception of, or bias for, emotional facial expressions, emotional memory for words, or emotion regulation following worry induction. In conclusion, 1 night of sleep continuity disruption had no appreciable effect on objective measures of emotion processing or emotion regulation in response to worry induction, despite clear effects on memory consolidation, vigilance, and self-reported affect and anxiety.
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Affiliation(s)
- Matthew J Reid
- Sleep and Circadian Neuroscience Institute, The University of Oxford, Oxford, UK.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ximena Omlin
- Sleep and Circadian Neuroscience Institute, The University of Oxford, Oxford, UK
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, The University of Oxford, Oxford, UK
| | - Rachel Sharman
- Sleep and Circadian Neuroscience Institute, The University of Oxford, Oxford, UK
| | - Sandra Tamm
- Department of Psychiatry, The University of Oxford, Oxford, UK.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, The University of Oxford, Oxford, UK
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Maurer LF, Espie CA, Omlin X, Emsley R, Kyle SD. The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomised controlled mechanistic trial. Sleep 2021; 45:6360382. [PMID: 34463762 DOI: 10.1093/sleep/zsab223] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep restriction therapy (SRT) effectively treats insomnia but mechanisms are poorly understood. Theoretical models suggest that potentiation of sleep pressure and reduction of arousal are key mechanisms of action. To our knowledge this has never been directly tested. We designed a randomised controlled trial with embedded mechanistic measurement to investigate if SRT causally modifies multidimensional assessments of sleep pressure and arousal. METHODS Participants aged 25-55 who met DSM-5 diagnostic criteria for insomnia disorder were randomised to four weeks of SRT or time in bed regularisation (TBR), a control intervention that involves prescription of a regular but not reduced time in bed. Sleep pressure was assessed through daily diary appraisal of morning and evening sleepiness, weekly Epworth sleepiness scale (ESS) scores, psychomotor vigilance, and NREM delta power (0.75-4.5Hz) from ambulatory polysomnographic recordings. Arousal was assessed through daily diary appraisal of cognitive arousal, the pre-sleep arousal scale (PSAS), and NREM beta power (15-32Hz). Outcomes were assessed at baseline (2-week period prior to randomisation), during the intervention phase (1-4 weeks post-randomisation), and at 12-week follow-up. We performed intention-to-treat analyses using linear mixed models. For continuous daily measures, the treatment period was split into early (weeks 1-2) and late (weeks 3-4) treatment. RESULTS Fifty-six participants (39 females, mean age=40.78±9.08) were assigned to SRT (n=27) or TBR (n=29). The SRT group showed enhanced sleep pressure relative to TBR, reflected in (1) enhanced sleepiness in the evening during early (d=1.17) and late treatment (d=0.92), and in the morning during early treatment (d=0.47); (2) higher daytime sleepiness on the ESS at weeks-1 and -2 (d=0.54, d=0.45); and (3) reduced psychomotor vigilance at week-1 (d=0.34). The SRT group also showed reduced arousal relative to TBR, reflected in lower levels of daily-monitored cognitive arousal during early treatment (d=0.53) and decreased PSAS total score at week-4 and week-12 (ds≥0.39). Power spectral analysis of all night NREM sleep revealed an increase in relative, but not absolute, EEG delta power at week-1 and week-4 (ds≥0.52) and a decrease of relative EEG beta power at week-4 (d=0.11). CONCLUSION For the first time we show that SRT increases sleep pressure and decreases arousal during acute implementation, providing support for mechanism-of-action.
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Affiliation(s)
- Leonie F Maurer
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience, University of Oxford, Sir William Dunn School of Pathology, Oxford, United Kingdom
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience, University of Oxford, Sir William Dunn School of Pathology, Oxford, United Kingdom.,Big Health Inc., San Francisco, USA.,Big Health Inc., London, UK
| | - Ximena Omlin
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience, University of Oxford, Sir William Dunn School of Pathology, Oxford, United Kingdom
| | - Richard Emsley
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience, University of Oxford, Sir William Dunn School of Pathology, Oxford, United Kingdom
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Maurer LF, Espie CA, Omlin X, Reid MJ, Sharman R, Gavriloff D, Emsley R, Kyle SD. Isolating the role of time in bed restriction in the treatment of insomnia: a randomized, controlled, dismantling trial comparing sleep restriction therapy with time in bed regularization. Sleep 2020; 43. [DOI: 10.1093/sleep/zsaa096] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Abstract
Study Objectives
Sleep restriction therapy (SRT) is one of the most effective treatments for insomnia. Restriction of time in bed (TIB) is assumed to be the central mechanism through which SRT improves sleep consolidation and reduces insomnia symptoms. This hypothesis has never been directly tested. We designed a randomized, controlled, dismantling trial in order to isolate the role of TIB restriction in driving both clinical and polysomnographic sleep outcomes.
Methods
Participants aged 25–55 who met diagnostic criteria for insomnia disorder were block-randomized (1:1) to 4 weeks of SRT or time in bed regularization (TBR), a treatment that involves the prescription of a regular but not reduced TIB. The primary outcome was assessed with the insomnia severity index (ISI) at baseline, 4-, and 12-weeks post-randomization. Secondary outcomes included sleep continuity (assessed via polysomnography, actigraphy, and diary) and quality of life. We performed intention-to-treat analyses using linear mixed models.
Results
Fifty-six participants (39 females, mean age = 40.78 ± 9.08) were assigned to SRT (n = 27) or TBR (n = 29). Daily monitoring of sleep via diaries and actigraphy confirmed large group differences in TIB (d range = 1.63–1.98). At 4-weeks post-randomization, the adjusted mean difference for the ISI was −4.49 (d = −1.40) and −4.35 at 12 weeks (d = −1.36), indicating that the SRT group reported reduced insomnia severity relative to TBR. Robust treatment effects in favor of SRT were also found for objective and self-reported sleep continuity variables (d range = 0.40–0.92) and sleep-related quality of life (d = 1.29).
Conclusions
For the first time, we demonstrate that TIB restriction is superior to the regularization of TIB on its own. Our results underscore the centrality of the restriction component in reducing insomnia symptoms and consolidating sleep.
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Affiliation(s)
- Leonie Franziska Maurer
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Colin Alexander Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ximena Omlin
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Matthew James Reid
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Rachel Sharman
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Dimitri Gavriloff
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Simon David Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Omlin X, Reid MJ, Sharman R, Schneider J, Espie CA, Kyle SD. 0548 Overnight Memory Consolidation in Insomnia versus Normal and Experimentally Disrupted Sleep. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.545] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Healthy sleep is assumed to play an important role in the consolidation of newly acquired memories. Evidence suggest that periods of sleep after learning facilitates memory consolidation relative to wakefulness. Insomnia is associated with cognitive impairment but few studies have assessed overnight memory consolidation. We compared overnight consolidation in people with insomnia to a group of good sleepers who were randomised to either a normal night of sleep (uninterrupted sleep, US) or one night of sleep continuity disruption via forced awakenings (FA).
Methods
51 good sleepers (37 female; mean age: 24 years, SD: 3.63), randomised to either one night of US (n=24) or one night of FA (n=27), were compared to 27 participants meeting criteria for insomnia disorder (23 female; mean age: 53 years, SD: 8.34) who were assessed at baseline as part of a randomised controlled trial of digital cognitive-behavioural therapy. Overnight memory consolidation (difference in correctly recalled word pairs between evening and morning recall) was assessed using the same word-pair task and protocol in the two lab-based studies.
Results
Overnight memory consolidation was significantly lower in the insomnia (mean: 5.4, SD: 5.8, p=0.001) and the FA (mean: 6.7, SD: 4.1, p<0.001) group compared to the US group (mean: 11.6, SD: 5.3). However, when adjusted for age only the FA group, but not the insomnia group, showed significantly lower memory performance than the US group.
Conclusion
While our findings suggest that overnight memory consolidation is impaired in insomnia relative to normal sleep we cannot rule out an age-related explanation given the difference in ages between the study samples. Future work will assess whether overnight consolidation improves following cognitive behavioural therapy.
Support
The research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) and the Dr Mortimer and Theresa Sackler Foundation. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
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Affiliation(s)
- X Omlin
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM
| | - M J Reid
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM
| | - R Sharman
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM
| | - J Schneider
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM
| | - C A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM
| | - S D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM
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Kyle SD, Hurry MED, Emsley R, Marsden A, Omlin X, Juss A, Spiegelhalder K, Bisdounis L, Luik AI, Espie CA, Sexton CE. The effects of digital cognitive behavioral therapy for insomnia on cognitive function: a randomized controlled trial. Sleep 2020; 43:5777024. [DOI: 10.1093/sleep/zsaa034] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/07/2020] [Indexed: 11/14/2022] Open
Abstract
AbstractStudy ObjectivesWe sought to examine the impact of digital cognitive behavioral therapy (dCBT) for insomnia on both self-reported cognitive impairment and objective cognitive performance.MethodsThe Defining the Impact of Sleep improvement on Cognitive Outcomes (DISCO) trial was an online, two-arm, single-blind, randomized clinical trial of dCBT versus wait-list control. Participants were aged 25 years and older, met DSM-5 diagnostic criteria for insomnia disorder, and reported difficulties with concentration or memory. Assessments were carried out online at baseline, and 10 and 24 weeks post-randomization. The primary outcome measure was self-reported cognitive impairment, assessed with the British Columbia Cognitive Complaints Inventory (BC-CCI). Secondary outcomes included tests of cognitive performance, insomnia symptoms, cognitive failures, fatigue, sleepiness, depression, and anxiety.ResultsFour hundred and ten participants with insomnia were recruited and assigned to dCBT (N = 205) or wait-list control (N = 205). At 10 weeks post-randomization the estimated adjusted mean difference for the BC-CCI was −3.03 (95% CI: −3.60, −2.47; p < 0.0001, d = −0.86), indicating that participants in the dCBT group reported less cognitive impairment than the control group. These effects were maintained at 24 weeks (d = −0.96) and were mediated, in part, via reductions in insomnia severity and increased sleep efficiency. Treatment effects in favor of dCBT, at both 10 and 24 weeks, were found for insomnia severity, sleep efficiency, cognitive failures, fatigue, sleepiness, depression, and anxiety. We found no between-group differences in objective tests of cognitive performance.ConclusionsOur study shows that dCBT robustly decreases self-reported cognitive impairment at post-treatment and these effects are maintained at 6 months.
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Affiliation(s)
- Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Madeleine E D Hurry
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Antonia Marsden
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Ximena Omlin
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Amender Juss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Lampros Bisdounis
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Big Health Ltd, London, UK
| | - Claire E Sexton
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, UK
- Global Brain Health Institute, Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA
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9
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van Sluijs R, Wilhelm E, Rondei Q, Omlin X, Crivelli F, Straumann D, Jäger L, Riener R, Achermann P. Gentle rocking movements during sleep in the elderly. J Sleep Res 2020; 29:e12989. [PMID: 32061115 PMCID: PMC7757236 DOI: 10.1111/jsr.12989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/05/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
Vestibular stimulation in the form of rocking movements could be a promising non‐pharmacological intervention for populations with reduced sleep quality, such as the elderly. We hypothesized that rocking movements influence sleep by promoting comfort. We assessed whether gentle rocking movements can facilitate the transition from wake to sleep, increase sleep spindle density and promote deep sleep in elderly people. We assessed self‐reported comfort using a pilot protocol including translational movements and movements along a pendulum trajectory with peak linear accelerations between 0.10 and 0.20 m/s2. We provided whole‐night stimulation using the settings rated most comfortable during the pilot study (movements along a pendulum trajectory with peak linear acceleration of 0.15 m/s2). Sleep measures (polysomnography) of two baseline and two movement nights were compared. In our sample (n = 19; eight female; mean age: 66.7 years, standard deviation: 3 years), vestibular stimulation using preferred stimulation settings did not improve sleep. A reduction of delta power was observed, suggesting reduced sleep depth during rocking movements. Sleep fragmentation was similar in both conditions. We did not observe a sleep‐promoting effect using settings optimized to be comfortable. This finding could imply that comfort is not the underlying mechanism. At frequencies below 0.3 Hz, the otoliths cannot distinguish tilt from translation. Translational movement trajectories, such as used in previous studies reporting positive effects of rocking, could have caused sensory confusion due to a mismatch between vestibular and other sensory information. We propose that this sensory confusion might be essential to the sleep‐promoting effect of rocking movements described in other studies.
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Affiliation(s)
- Rachel van Sluijs
- Department of Health Science and Technology, Sensory-Motor Systems Laboratory, Institute of Robotic and Intelligent Systems, Swiss Federal Institute of Technology, Zurich, Switzerland.,Sleep & Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland
| | - Elisabeth Wilhelm
- Department of Health Science and Technology, Sensory-Motor Systems Laboratory, Institute of Robotic and Intelligent Systems, Swiss Federal Institute of Technology, Zurich, Switzerland.,Sleep & Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland
| | - Quincy Rondei
- Department of Health Science and Technology, Sensory-Motor Systems Laboratory, Institute of Robotic and Intelligent Systems, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Ximena Omlin
- Department of Health Science and Technology, Sensory-Motor Systems Laboratory, Institute of Robotic and Intelligent Systems, Swiss Federal Institute of Technology, Zurich, Switzerland.,Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Francesco Crivelli
- Department of Health Science and Technology, Sensory-Motor Systems Laboratory, Institute of Robotic and Intelligent Systems, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | - Lukas Jäger
- Department of Health Science and Technology, Sensory-Motor Systems Laboratory, Institute of Robotic and Intelligent Systems, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Robert Riener
- Department of Health Science and Technology, Sensory-Motor Systems Laboratory, Institute of Robotic and Intelligent Systems, Swiss Federal Institute of Technology, Zurich, Switzerland.,Sleep & Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Peter Achermann
- Sleep & Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, The KEY Institute for Brain Mind Research, University Hospital of Psychiatry, Zurich, Switzerland.,Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
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10
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Mitchell LJ, Bisdounis L, Ballesio A, Omlin X, Kyle SD. The impact of cognitive behavioural therapy for insomnia on objective sleep parameters: A meta-analysis and systematic review. Sleep Med Rev 2019; 47:90-102. [PMID: 31377503 DOI: 10.1016/j.smrv.2019.06.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 01/10/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/24/2022]
Abstract
It is well-established that cognitive behavioural therapy for insomnia (CBT-I) improves self-reported sleep disturbance, however the impact on objective sleep is less clear. This meta-analysis aimed to quantify the impact of multi-component CBT-I on objective measures of sleep, indexed via polysomnography (PSG) and actigraphy. Fifteen studies met inclusion criteria. Following appraisal for risk of bias, extracted data were meta-analysed using random-effects models. The quality of the literature was generally high, although reporting of methodological detail varied markedly between studies. Meta-analyses found no evidence that CBT-I reliably improves PSG-defined sleep parameters. Actigraphy evidence was more mixed; with a small effect for reduction in sleep onset latency (Hedge's g = -0.28 [95% confidence interval (CI) -0.51 to -0.05], p = 0.018) and a moderate effect for reduction in total sleep time (TST) (Hedge's g = -0.51 [95% CI -0.75 to -0.26], p < 0.001). In contrast, and consistent with recent meta-analyses, CBT-I was associated with robust improvements in diary measures of sleep initiation and maintenance (Hedge's g range = 0.50 to 0.79) but not TST. While the literature is small and still developing, the sleep benefits of CBT-I are more clearly expressed in the subjective versus objective domain.
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Affiliation(s)
- Laura J Mitchell
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lampros Bisdounis
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, Italy
| | - Ximena Omlin
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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11
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Maurer LF, Espie CA, Omlin X, Kyle SD. 0385 Daytime Impairment during Sleep Restriction Therapy for Insomnia: Results from a Randomised-Controlled Trial. Sleep 2019. [DOI: 10.1093/sleep/zsz067.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Reid MJ, Omlin X, Notebaert L, Espie C, Kyle S. 0119 The Effect Of Sleep Continuity Disruption On Threat-related Attentional Bias: Randomised Controlled Experiment In Good Sleepers. Sleep 2019; 42:A49-A50. [DOI: 10.1093/sleep/zsz067.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Affiliation(s)
- Matthew James Reid
- University of Oxford, Sleep and Circadian Neuroscience Institute, Department of Clinical Neurosciences, oxford, United Kingdom
| | - Ximena Omlin
- University of Oxford, Sleep and Circadian Neuroscience Institute, Department of Clinical Neurosciences, Oxford, United Kingdom
| | | | - Colin Espie
- University of Oxford, Sleep and Circadian Neuroscience Institute, Department of Clinical Neurosciences, Oxford, United Kingdom
| | - Simon Kyle
- University of Oxford, Sleep and Circadian Neuroscience Institute, Department of Clinical Neurosciences, Oxford, United Kingdom
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13
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Malafeev A, Laptev D, Bauer S, Omlin X, Wierzbicka A, Wichniak A, Jernajczyk W, Riener R, Buhmann J, Achermann P. Automatic Human Sleep Stage Scoring Using Deep Neural Networks. Front Neurosci 2018; 12:781. [PMID: 30459544 PMCID: PMC6232272 DOI: 10.3389/fnins.2018.00781] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [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: 07/18/2018] [Accepted: 10/09/2018] [Indexed: 11/20/2022] Open
Abstract
The classification of sleep stages is the first and an important step in the quantitative analysis of polysomnographic recordings. Sleep stage scoring relies heavily on visual pattern recognition by a human expert and is time consuming and subjective. Thus, there is a need for automatic classification. In this work we developed machine learning algorithms for sleep classification: random forest (RF) classification based on features and artificial neural networks (ANNs) working both with features and raw data. We tested our methods in healthy subjects and in patients. Most algorithms yielded good results comparable to human interrater agreement. Our study revealed that deep neural networks (DNNs) working with raw data performed better than feature-based methods. We also demonstrated that taking the local temporal structure of sleep into account a priori is important. Our results demonstrate the utility of neural network architectures for the classification of sleep.
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Affiliation(s)
- Alexander Malafeev
- Chronobiology and Sleep Research, Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - Dmitry Laptev
- Information Science and Engineering, Institute for Machine Learning, ETH Zurich, Zurich, Switzerland
| | - Stefan Bauer
- Information Science and Engineering, Institute for Machine Learning, ETH Zurich, Zurich, Switzerland
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Ximena Omlin
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
| | - Aleksandra Wierzbicka
- Sleep Disorders Center, Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology in Warsaw, Warsaw, Poland
| | - Adam Wichniak
- Third Department of Psychiatry and Sleep Disorders Center, Institute of Psychiatry and Neurology in Warsaw, Warsaw, Poland
| | - Wojciech Jernajczyk
- Sleep Disorders Center, Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology in Warsaw, Warsaw, Poland
| | - Robert Riener
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
- University Hospital Balgrist (SCI Center), Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Joachim Buhmann
- Information Science and Engineering, Institute for Machine Learning, ETH Zurich, Zurich, Switzerland
| | - Peter Achermann
- Chronobiology and Sleep Research, Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
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14
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Malafeev A, Omlin X, Wierzbicka A, Wichniak A, Jernajczyk W, Riener R, Achermann P. Automatic artefact detection in single‐channel sleep
EEG
recordings. J Sleep Res 2018. [DOI: 10.1111/jsr.12679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alexander Malafeev
- Institute of Pharmacology and Toxicology, Chronobiology and Sleep Research University of Zurich, Zurich Zurich Switzerland
- Neuroscience Center Zurich University of Zurich and ETH Zurich Zurich Switzerland
| | - Ximena Omlin
- Neuroscience Center Zurich University of Zurich and ETH Zurich Zurich Switzerland
- Sensory‐Motor Systems Lab ETH Zurich Zurich Switzerland
| | - Aleksandra Wierzbicka
- Sleep Disorders Center Department of Clinical Neurophysiology Institute of Psychiatry and Neurology in Warsaw Warsaw Poland
| | - Adam Wichniak
- Third Department of Psychiatry and Sleep Disorders Center Institute of Psychiatry and Neurology in Warsaw Warsaw Poland
| | - Wojciech Jernajczyk
- Sleep Disorders Center Department of Clinical Neurophysiology Institute of Psychiatry and Neurology in Warsaw Warsaw Poland
| | - Robert Riener
- Sensory‐Motor Systems Lab ETH Zurich Zurich Switzerland
- Medical Faculty University of Zurich Zurich Switzerland
- Zurich Center for Interdisciplinary Sleep Research University of Zurich, Zurich Zurich Switzerland
| | - Peter Achermann
- Institute of Pharmacology and Toxicology, Chronobiology and Sleep Research University of Zurich, Zurich Zurich Switzerland
- Neuroscience Center Zurich University of Zurich and ETH Zurich Zurich Switzerland
- Zurich Center for Interdisciplinary Sleep Research University of Zurich, Zurich Zurich Switzerland
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15
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Herzig D, Eser P, Omlin X, Riener R, Wilhelm M, Achermann P. Reproducibility of Heart Rate Variability Is Parameter and Sleep Stage Dependent. Front Physiol 2018; 8:1100. [PMID: 29367845 PMCID: PMC5767731 DOI: 10.3389/fphys.2017.01100] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 08/30/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022] Open
Abstract
Objective: Measurements of heart rate variability (HRV) during sleep have become increasingly popular as sleep could provide an optimal state for HRV assessments. While sleep stages have been reported to affect HRV, the effect of sleep stages on the variance of HRV parameters were hardly investigated. We aimed to assess the variance of HRV parameters during the different sleep stages. Further, we tested the accuracy of an algorithm using HRV to identify a 5-min segment within an episode of slow wave sleep (SWS, deep sleep). Methods: Polysomnographic (PSG) sleep recordings of 3 nights of 15 healthy young males were analyzed. Sleep was scored according to conventional criteria. HRV parameters of consecutive 5-min segments were analyzed within the different sleep stages. The total variance of HRV parameters was partitioned into between-subjects variance, between-nights variance, and between-segments variance and compared between the different sleep stages. Intra-class correlation coefficients of all HRV parameters were calculated for all sleep stages. To identify an SWS segment based on HRV, Pearson correlation coefficients of consecutive R-R intervals (rRR) of moving 5-min windows (20-s steps). The linear trend was removed from the rRR time series and the first segment with rRR values 0.1 units below the mean rRR for at least 10 min was identified. A 5-min segment was placed in the middle of such an identified segment and the corresponding sleep stage was used to assess the accuracy of the algorithm. Results: Good reproducibility within and across nights was found for heart rate in all sleep stages and for high frequency (HF) power in SWS. Reproducibility of low frequency (LF) power and of LF/HF was poor in all sleep stages. Of all the 5-min segments selected based on HRV data, 87% were accurately located within SWS. Conclusions: SWS, a stable state that, in contrast to waking, is unaffected by internal and external factors, is a reproducible state that allows reliable determination of heart rate, and HF power, and can satisfactorily be detected based on R-R intervals, without the need of full PSG. Sleep may not be an optimal condition to assess LF power and LF/HF power ratio.
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Affiliation(s)
- David Herzig
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Bern University Hospital (Inselspital), University of Bern, Bern, Switzerland
| | - Prisca Eser
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Bern University Hospital (Inselspital), University of Bern, Bern, Switzerland
| | - Ximena Omlin
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Matthias Wilhelm
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Bern University Hospital (Inselspital), University of Bern, Bern, Switzerland
| | - Peter Achermann
- Institute of Pharmacology and Toxicology, Zurich Center for Interdisciplinary Sleep Research and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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16
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Kyle SD, Hurry MED, Emsley R, Luik AI, Omlin X, Spiegelhalder K, Espie CA, Sexton CE. Effects of digital Cognitive Behavioural Therapy for Insomnia on cognitive function: study protocol for a randomised controlled trial. Trials 2017; 18:281. [PMID: 28623947 PMCID: PMC5474001 DOI: 10.1186/s13063-017-2012-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/23/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The daytime effects of insomnia pose a significant burden to patients and drive treatment seeking. In addition to subjective deficits, meta-analytic data show that patients experience reliable objective impairments across several cognitive domains. While Cognitive Behavioural Therapy for Insomnia (CBT-I) is an effective and scalable treatment, we know little about its impact upon cognitive function. Trials of CBT-I have typically used proxy measures for cognitive functioning, such as fatigue or work performance scales, and no study has assessed self-reported impairment in cognitive function as a primary outcome. Moreover, only a small number of studies have assessed objective cognitive performance, pre-to-post CBT-I, with mixed results. This study specifically aims to (1) investigate the impact of CBT-I on cognitive functioning, assessed through both self-reported impairment and objective performance measures, and (2) examine whether change in sleep mediates this impact. METHODS/DESIGN We propose a randomised controlled trial of 404 community participants meeting criteria for Insomnia Disorder. In the DISCO trial (D efining the I mpact of improved S leep on CO gnitive function (DISCO)) participants will be randomised to digital automated CBT-I delivered by a web and/or mobile platform (in addition to treatment as usual (TAU)) or to a wait-list control (in addition to TAU). Online assessments will take place at 0 (baseline), 10 (post-treatment), and 24 (follow-up) weeks. At week 25, all participants allocated to the wait-list group will be offered digital CBT-I, at which point the controlled element of the trial will be complete. The primary outcome is self-reported cognitive impairment at post-treatment (10 weeks). Secondary outcomes include objective cognitive performance, insomnia severity, sleepiness, fatigue, and self-reported cognitive failures and emotional distress. All main analyses will be carried out on completion of follow-up assessments and will be based on the intention-to-treat principle. Further analyses will determine to what extent observed changes in self-reported cognitive impairment and objective cognitive performance are mediated by changes in sleep. The trial is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) based at Oxford University Hospitals NHS Trust and University of Oxford, and by the NIHR Oxford Health BRC. DISCUSSION This study will be the first large-scale examination of the impact of digital CBT-I on self-reported cognitive impairment and objective cognitive performance. TRIAL REGISTRATION ISRCTN, ID: ISRCTN89237370 . Registered on 17 October 2016.
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Affiliation(s)
- Simon D. Kyle
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
| | - Madeleine E. D. Hurry
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
- Oxford Nuffield Department of Clinical Neurosciences, Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford, UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Annemarie I. Luik
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
- Big Health Ltd., London, UK
| | - Ximena Omlin
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Colin A. Espie
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
- Big Health Ltd., London, UK
| | - Claire E. Sexton
- Oxford Nuffield Department of Clinical Neurosciences, Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford, UK
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17
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Abstract
For centuries, rocking has been used to promote sleep in babies or toddlers. Recent research suggested that relaxation could play a role in facilitating the transition from waking to sleep during rocking. Breathing techniques are often used to promote relaxation. However, studies investigating head motions and body rotations showed that vestibular stimulation might elicit a vestibulo-respiratory response, leading to an increase in respiration frequency. An increase in respiration frequency would not be considered to promote relaxation in the first place. On the other hand, a coordination of respiration to rhythmic vestibular stimulation has been observed. Therefore, this study aimed to investigate the effect of different movement frequencies and amplitudes on respiration frequency. Furthermore, we tested whether subjects adapt their respiration to movement frequencies below their spontaneous respiration frequency at rest, which could be beneficial for relaxation. Twenty-one healthy subjects (24–42 years, 12 males) were investigated using an actuated bed, moving along a lateral translation. Following movement frequencies were applied: +30%, +15%, -15%, and -30% of subjects’ rest respiration frequency during baseline (no movement). Furthermore, two different movement amplitudes were tested (Amplitudes: 15 cm, 7.5 cm; movement frequency: 0.3 Hz). In addition, five subjects (25–28 years, 2 males) were stimulated with their individual rest respiration frequency. Rocking movements along a lateral translation caused a vestibulo-respiratory adaptation leading to an increase in respiration frequency. The increase was independent of the applied movement frequencies or amplitudes but did not occur when stimulating with subjects’ rest respiration frequency. Furthermore, no synchronization of the respiration frequency to the movement frequency was observed. In particular, subjects did not lower their respiration frequency below their resting frequency. Hence, it was not feasible to influence respiration in a manner that might be considered beneficial for relaxation.
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Affiliation(s)
- Ximena Omlin
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
- * E-mail:
| | | | | | | | - Peter Achermann
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Neuroscience Center, University and ETH Zurich, Zurich, Switzerland
- Zurich Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Neuroscience Center, University and ETH Zurich, Zurich, Switzerland
- Zurich Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
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18
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Crivelli F, Omlin X, Rauter G, von Zitzewitz J, Achermann P, Riener R. Somnomat: a novel actuated bed to investigate the effect of vestibular stimulation. Med Biol Eng Comput 2015; 54:877-89. [PMID: 26706035 DOI: 10.1007/s11517-015-1423-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 10/26/2013] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
Rocking movements are known to affect human sleep. Previous studies have demonstrated that the transition from wake to sleep can be facilitated by rocking movements, which might be related to relaxation. However, it is not yet known which movements would have the greatest effect. Thus, a 6-degree-of-freedom tendon-based robotic bed was developed, for systematic evaluation of vestibular stimuli. The applicability of the device was evaluated with 25 subjects. Six movement axes were tested and analyzed for differences in promoting relaxation. Relaxation was assessed by electroencephalogram, electrocardiogram, respiration and a questionnaire. The developed device fulfilled all needed requirements proving the applicability of this technology. Movements had no significant effects on the electroencephalogram and electrocardiogram. Respiration frequency was significantly lower for baseline measurements without movement (median 0.183-0.233 Hz) compared to movement conditions (median 0.283-0.300 Hz). Questionnaire ratings showed a trend (p = 0.057) toward higher relaxation for movements along the vertical axis (z-axis) (median 4.67; confidence interval 4.33-5.67) compared to the roll-axis (median 4.33; confidence interval 3.67-5.00). Movements along the vertical axis (z-axis), therefore, appear most promising in promoting relaxation, though no effects were found in electroencephalogram and electrocardiogram variables. This lack of effect might be attributed to the short exposure to the movements and the large inter-individual variability and individual preferences among subjects.
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Affiliation(s)
| | - Ximena Omlin
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland.
| | - Georg Rauter
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Joachim von Zitzewitz
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland.,International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain-Mind Institute, EPFL, Lausanne, Switzerland
| | - Peter Achermann
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
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19
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Abstract
Rapid recognition of voluntary motions is crucial in human-computer interaction, but few studies compare the predictive abilities of different sensing technologies. This paper thus compares performances of different technologies when predicting targets of human reaching motions: electroencephalography (EEG), electrooculography, camera-based eye tracking, electromyography (EMG), hand position, and the user's preferences. Supervised machine learning is used to make predictions at different points in time (before and during limb motion) with each individual sensing modality. Different modalities are then combined using an algorithm that takes into account the different times at which modalities provide useful information. Results show that EEG can make predictions before limb motion onset, but requires subject-specific training and exhibits decreased performance as the number of possible targets increases. EMG and hand position give high accuracy, but only once the motion has begun. Eye tracking is robust and exhibits high accuracy at the very onset of limb motion. Several advantages of combining different modalities are also shown, including advantages of combining measurements with contextual data. Finally, some recommendations are given for sensing modalities with regard to different criteria and applications. The information could aid human-computer interaction designers in selecting and evaluating appropriate equipment for their applications.
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Affiliation(s)
- Domen Novak
- Sensory-Motor Systems Lab, ETH Zurich, CH-8092 Zurich, Switzerland.
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20
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Novak D, Omlin X, Leins-Hess R, Riener R. Effectiveness of different sensing modalities in predicting targets of reaching movements. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:4255-4258. [PMID: 24110672 DOI: 10.1109/embc.2013.6610485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Human motion recognition is essential for many biomedical applications, but few studies compare the abilities of multiple sensing modalities. This paper thus evaluates the effectiveness of different modalities when predicting targets of human reaching movements. Electroencephalography, electrooculography, camera-based eye tracking, electromyography, hand tracking and the user's preferences are used to make predictions at different points in time. Prediction accuracies are calculated based on data from 10 subjects in within-subject crossvalidation. Results show that electroencephalography can make predictions before limb motion onset, but its accuracy decreases as the number of potential targets increases. Electromyography and hand tracking give high accuracy, but only after motion onset. Eye tracking is robust and gives high accuracy at limb motion onset. Combining multiple modalities can increase accuracy, though not always. While many studies have evaluated individual sensing modalities, this study provides quantitative data on many modalities at different points of time in a single setting. The information could help biomedical engineers choose the most appropriate equipment for a particular application.
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21
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Abstract
While gait rehabilitation robots have become increasingly common to automate treadmill training, their efficacy is still controversial. Current robots lack the ability to react compliantly to the user's voluntary effort and cognitive intention. Bio-cooperative control concepts allow integrating the patient into the control loop as part of the plant rather than seeing him as a source of disturbance. Closed loop control is thereby performed on a physiological and psychological level. In this paper, we review the concept of bio-cooperative control implemented with neurological patients during robot-assisted gait rehabilitation. We highlight its clinical importance and review our work on control strategies that allow bio-cooperative control. We finish by discussing the future potential of bio-cooperative control in rehabilitation robotics.
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Koenig A, Novak D, Omlin X, Pulfer M, Perreault E, Zimmerli L, Mihelj M, Riener R. Real-time closed-loop control of cognitive load in neurological patients during robot-assisted gait training. IEEE Trans Neural Syst Rehabil Eng 2011; 19:453-64. [PMID: 21827971 DOI: 10.1109/tnsre.2011.2160460] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cognitively challenging training sessions during robot-assisted gait training after stroke were shown to be key requirements for the success of rehabilitation. Despite a broad variability of cognitive impairments amongst the stroke population, current rehabilitation environments do not adapt to the cognitive capabilities of the patient, as cognitive load cannot be objectively assessed in real-time. We provided healthy subjects and stroke patients with a virtual task during robot-assisted gait training, which allowed modulating cognitive load by adapting the difficulty level of the task. We quantified the cognitive load of stroke patients by using psychophysiological measurements and performance data. In open-loop experiments with healthy subjects and stroke patients, we obtained training data for a linear, adaptive classifier that estimated the current cognitive load of patients in real-time. We verified our classification results via questionnaires and obtained 88% correct classification in healthy subjects and 75% in patients. Using the pre-trained, adaptive classifier, we closed the cognitive control loop around healthy subjects and stroke patients by automatically adapting the difficulty level of the virtual task in real-time such that patients were neither cognitively overloaded nor under-challenged.
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Affiliation(s)
- Alexander Koenig
- Sensory-Motor Systems Lab, Department of Mechanical Engineering and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland.
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Koenig A, Omlin X, Zimmerli L, Sapa M, Krewer C, Bolliger M, Müller F, Riener R. Psychological state estimation from physiological recordings during robot-assisted gait rehabilitation. ACTA ACUST UNITED AC 2011; 48:367-85. [PMID: 21674389 DOI: 10.1682/jrrd.2010.03.0044] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Robot-assisted treadmill training is an established intervention used to improve walking ability in patients with neurological disorders. Although it has been shown that attention to the task is a key factor for successful rehabilitation, the psychological state of patients during robot-assisted gait therapy is often neglected. We presented 17 nondisabled subjects and 10 patients with neurological disorders a virtual-reality task with varying difficulty levels to induce feelings of being bored, excited, and overstressed. We developed an approach to automatically estimate and classify a patient's psychological state, i.e., his or her mental engagement, in real time during gait training. We used psychophysiological measurements to obtain an objective measure of the current psychological state. Automatic classification was performed by a neural network. We found that heart rate, skin conductance responses, and skin temperature can be used as markers for psychological states in the presence of physical effort induced by walking. The classifier achieved a classification error of 1.4% for nondisabled subjects and 2.1% for patients with neurological disorders. Using our new method, we processed the psychological state data in real time. Our method is a first step toward real-time auto-adaptive gait training with potential to improve rehabilitation results by optimally challenging patients at all times during exercise.
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Affiliation(s)
- Alexander Koenig
- Sensory-Motor Systems Laboratory, ETH Zurich, Tannenstrasse 1, E4, 8092 Zurich, Switzerland.
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Koenig A, Omlin X, Bergmann J, Zimmerli L, Bolliger M, Müller F, Riener R. Controlling patient participation during robot-assisted gait training. J Neuroeng Rehabil 2011; 8:14. [PMID: 21429200 PMCID: PMC3076234 DOI: 10.1186/1743-0003-8-14] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [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: 07/15/2010] [Accepted: 03/23/2011] [Indexed: 11/29/2022] Open
Abstract
Background The overall goal of this paper was to investigate approaches to controlling active participation in stroke patients during robot-assisted gait therapy. Although active physical participation during gait rehabilitation after stroke was shown to improve therapy outcome, some patients can behave passively during rehabilitation, not maximally benefiting from the gait training. Up to now, there has not been an effective method for forcing patient activity to the desired level that would most benefit stroke patients with a broad variety of cognitive and biomechanical impairments. Methods Patient activity was quantified in two ways: by heart rate (HR), a physiological parameter that reflected physical effort during body weight supported treadmill training, and by a weighted sum of the interaction torques (WIT) between robot and patient, recorded from hip and knee joints of both legs. We recorded data in three experiments, each with five stroke patients, and controlled HR and WIT to a desired temporal profile. Depending on the patient's cognitive capabilities, two different approaches were taken: either by allowing voluntary patient effort via visual instructions or by forcing the patient to vary physical effort by adapting the treadmill speed. Results We successfully controlled patient activity quantified by WIT and by HR to a desired level. The setup was thereby individually adaptable to the specific cognitive and biomechanical needs of each patient. Conclusion Based on the three successful approaches to controlling patient participation, we propose a metric which enables clinicians to select the best strategy for each patient, according to the patient's physical and cognitive capabilities. Our framework will enable therapists to challenge the patient to more activity by automatically controlling the patient effort to a desired level. We expect that the increase in activity will lead to improved rehabilitation outcome.
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Affiliation(s)
- Alexander Koenig
- Sensory-Motor Systems Lab, Department of Mechanical Engineering and Process Engineering, ETH Zurich, Switzerland.
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Koenig AC, Somaini L, Pulfer M, Holenstein T, Omlin X, Wieser M, Riener R. Model-based Heart rate prediction during Lokomat walking. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2009:1758-61. [PMID: 19963765 DOI: 10.1109/iembs.2009.5333096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We implemented a model for prediction of heart rate during Lokomat walking. Using this model, we can predict potential overstressing of the patient and adapt the physical load accordingly. Current models for treadmill based heart rate control neglect the fact that the interaction torques between Lokomat and human can have a significant effect on heart rate. Tests with five healthy subjects lead to a model of sixth order with walking speed and power expenditure as inputs and heart rate prediction as output. Recordings with five different subjects were used for model validation. Future work includes model identification and predictive heart rate control with spinal cord injured and stroke patients.
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Affiliation(s)
- Alexander C Koenig
- Sensory Motor Systems Lab, ETH Zurich, Institute of Robotics and Intelligent Systems, Department of Mechanical Engineering and Process Engineering, ETH Zurich, Switzerland.
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