Arterial spin-labeled (ASL) perfusion in children with Sturge-Weber syndrome: a retrospective cross-sectional study

PURPOSE

Sturge-Weber syndrome (SWS) is a developmental disorder with venous hypertension and associated tissue responses including pial angiomatosis, cortical calcifications, and cerebral atrophy. Arterial spin-labeled (ASL) perfusion is an advanced MR sequence which can assess perfusion, without the need for contrast. We systematically evaluated the potential benefits of using ASL in Sturge-Weber syndrome, to determine the extent of intracranial perfusion abnormality and stage of disease, relevant for prognostication and surgical planning.

METHODS

Two pediatric neuroradiologists retrospectively evaluated ASL perfusion imaging of 31 children with confirmed SWS and recorded the presence of hyper-perfusion, hypo-perfusion, or normal perfusion. The presence and distribution of ASL abnormality were compared against the presence and side of atrophy/calcification and pial angiomatosis on standard MR sequences.

RESULTS

Thirty-one children (52% female, median age 16.7 months) with SWS had ASL imaging. Seven (23%) had hyper-perfusion, 15 (48%) had hypo-perfusion, and 9 (29%) had no perfusion abnormalities. ASL perfusion abnormality matched the location of SWS findings on conventional imaging in 86% (19/22). ASL demonstrated statistically significant increased perfusion in the early stage of the disease and decreased perfusion when there was atrophy. The parietal lobe was involved in 86% of cases.

CONCLUSION

ASL perfusion imaging is an advanced technique which may contribute to earlier diagnosis and more accurate prognostication of Sturge-Weber syndrome, helping guide management and potential surgical planning.

The Effects of Commercially-Relevant Disturbances on Sleep Behaviour in Laying Hens

Ensuring the welfare of commercially kept animals is a legal and ethical responsibility. Sleep behaviour can be sensitive to environmental perturbations and may be useful in assessing welfare state. The objective of this study was to use behavioural and electrophysiological (EEG) measures to observe the effects of 24 h stressors followed by periods of no stressors on laying hen sleep behaviour, and to investigate the use of sleep behaviour as a means of welfare assessment in commercial poultry. Ten laying hens surgically implanted with EEG devices to record their brain activity over four batches were used. Hens were subjected to undisturbed, disturbed and recovery periods for 24 h. Disturbed periods consisted of either feed deprivation, increased ambient temperature (28 °C) or simulated footpad pain via injection of Freund's adjuvant into the footpad. Sleep state was scored using behaviour data from infrared cameras and EEG data. Over all periods, hens engaged in both SWS (average 60%) and REM sleep (average 12%) during the lights-off period. Feed deprivation and footpad pain had little to no effect on sleep states, while increased ambient temperature significantly reduced REM sleep (to near elimination, p < 0.001) and SWS (p = 0.017). During the lights-on period, footpad pain increased the proportion of time spent resting (p = 0.008) and in SWS (p < 0.001), with feed deprivation or increased ambient temperature (p > 0.05) having no effect. Increasing ambient temperatures are likely to affect sleep and welfare in commercially-kept laying hens in the face of global climate change.

Technical Acoustic Measurements Combined with Clinical Parameters for the Differential Diagnosis of Nonalcoholic Steatohepatitis

Background and aim: Diagnosing nonalcoholic steatohepatitis (NASH) is challenging. This study intended to explore the diagnostic value of multiple technical acoustic measurements in the diagnosis of NASH, and to establish a diagnostic model combining technical acoustic measurements with clinical parameters to improve the diagnostic efficacy of NASH. Methods: We consecutively enrolled 75 patients with clinically suspected nonalcoholic fatty liver disease (NAFLD) who underwent percutaneous liver biopsy in our hospital from June 2020 to December 2021. All cases underwent multiple advanced acoustic measurements for liver such as shear wave dispersion (SWD), shear wave speed (SWS), attenuation imaging (ATI), normalized local variance (NLV), and liver-kidney intensity ratio (Ratio) examination before liver biopsies. A nomogram prediction model combining the technical acoustic measurements and clinical parameters was established and the model is proposed to improve the diagnostic performance of NASH. Results: A total of 75 cases were included in this study. The classification of pathological grade for NASH was as follows: normal liver, (n = 15, 20%), nonalcoholic fatty liver (NAFL), (n = 44, 58.7%), and NASH, (n = 16, 21.3%). There were statistically significant differences in SWS (p = 0.002), acoustic coefficient (AC) (p = 0.018), NLV (p = 0.033), age (p = 0.013) and fasting blood glucose (Glu) (p = 0.049) between NASH and non-NASH. A nomogram model which includes SWS, AC, NLV, age and Glu was built to predict NASH, and the calibration curves showed good calibrations in both training and validation sets. The AUCs of the combined nomogram model for the training set and validation set were 0.8597 and 0.7794, respectively. Conclusion: There were statistically significant differences in SWS, AC, NLV, age and Glu between NASH and non-NASH. A nomogram model which includes SWS, AC, NLV, age and Glu was built to predict NASH. The predictive model has a higher diagnostic performance than a single factor model in the diagnosis of NASH and has good clinical application prospects.

The Effects of Mild Disturbances on Sleep Behaviour in Laying Hens

The positive welfare of commercial animals presents many benefits, making the accurate assessment of welfare important. Assessments frequently use behaviour to determine welfare state; however, nighttime behaviours are often ignored. Sleep behaviour may offer new insights into welfare assessments. This study aimed to establish a baseline for sleep behaviour in laying hens and to then apply mild short-term disturbances and observe the subsequent effects. Twelve laying hens were divided into four batches and were surgically implanted with electroencephalogram (EEG) devices to record their brain activity. The batches were subjected to undisturbed, disturbed and recovery types of nights. Disturbed nights consisted of systematic sequences of disturbance application (wind, 90 dB noise or 20 lux light) applied one at a time for 5 min every 30 min from 21:00 to 03:00 (lights off period: 19:00-05:00). Sleep state was scored using EEG data and behaviour data from infrared cameras. Over all the types of night hens engaged in both SWS (58%) and REM sleep (18%) during lights off. When applied, the disturbances were effective at altering the amounts of wakefulness and SWS (Time × Type of Night, p < 0.001, p = 0.017, respectively), whereas REM sleep was unaltered (p = 0.540). There was no evidence of carry-over effects over the following day or night. Laying hens may be resilient to short-term sleep disruption by compensating for this in the same night, suggesting that these disturbances do not impact their long-term welfare (i.e., over days). Sleep behaviour potentially offers a unique means of assessing an aspect of animal welfare that, to date, has been poorly studied.

Effect of sleep loss on pain-New conceptual and mechanistic avenues

Introduction

Sleep disturbances increase pain sensitivity in clinical and preclinical settings, but the precise mechanisms are unknown. This represents a major public health issue because of the growing sleep deficiency epidemic fueled by modern lifestyle. To understand the neural pathways at the intersection between sleep and pain processes, it is critical to determine the precise nature of the sleep disruptions that increase pain and the specific component of the pain response that is targeted.

Methods

We performed a review of the literature about sleep disturbances and pain sensitivity in humans and rodents by taking into consideration the targeted sleep stage (REMS, non-NREMS, or both), the amount of sleep lost, and the different types of sleep disruptions (partial or total sleep loss, duration, sleep fragmentation or interruptions), and how these differences might affect distinct components of the pain response.

Results

We find that the effects of sleep disturbances on pain are highly conserved among species. The major driver for pain hypersensitivity appears to be the total amount of sleep lost, while REMS loss by itself does not seem to have a direct effect on pain sensitivity. Sleep loss caused by extended wakefulness preferentially increases pain perception, whereas interrupted and limited sleep strongly dysregulates descending controls such as DNIC, especially in women.

Discussion

We discuss the possible mechanisms involved, including an increase in inflammatory processes, a loss of nociceptive inhibitory pathways, and a defect in the cognitive processing of noxious input.

Instability of non-REM sleep in older women evaluated by sleep-stage transition and envelope analyses

Study objective

Traditionally, age-related deterioration of sleep architecture in older individuals has been evaluated by visual scoring of polysomnographic (PSG) recordings with regard to total sleep time and latencies. In the present study, we additionally compared the non-REM sleep (NREM) stage and delta, theta, alpha, and sigma wave stability between young and older subjects to extract features that may explain age-related changes in sleep.

Methods

Polysomnographic recordings were performed in 11 healthy older (72.6 ± 2.4 years) and 9 healthy young (23.3 ± 1.1 years) females. In addition to total sleep time, the sleep stage, delta power amplitude, and delta, theta, alpha, and sigma wave stability were evaluated by sleep stage transition analysis and a novel computational method based on a coefficient of variation of the envelope (CVE) analysis, respectively.

Results

In older subjects, total sleep time and slow-wave sleep (SWS) time were shorter whereas wake after sleep onset was longer. The number of SWS episodes was similar between age groups, however, sleep stage transition analysis revealed that SWS was less stable in older individuals. NREM sleep stages in descending order of delta power were: SWS, N2, and N1, and delta power during NREM sleep in older subjects was lower than in young subjects. The CVE of the delta-band is an index of delta wave stability and showed significant differences between age groups. When separately analyzed for each NREM stage, different CVE clusters in NREM were clearly observed between young and older subjects. A lower delta CVE and amplitude were also observed in older subjects compared with young subjects in N2 and SWS. Additionally, lower CVE values in the theta, alpha and sigma bands were also characteristic of older participants.

Conclusion

The present study shows a decrease of SWS stability in older subjects together with a decrease in delta wave amplitude. Interestingly, the decrease in SWS stability coincided with an increase in short-term delta, theta, sigma, and alpha power stability revealed by lower CVE. Loss of electroencephalograms (EEG) variability might be a useful marker of brain age.

Associations Between Late Pregnancy Dietary Inflammatory Index (DII) and Offspring Bone Mass: A Meta-Analysis of the Southampton Women's Survey (SWS) and the Avon Longitudinal Study of Parents and Children (ALSPAC)

Systemic inflammation is associated with reduced bone mineral density and may be influenced by pro-inflammatory diets. We undertook an observational analysis of associations between late pregnancy energy-adjusted dietary inflammatory index (E-DII) scores and offspring bone outcomes in childhood. E-DII scores (higher scores indicating pro-inflammatory diets) were derived from food frequency questionnaires in late pregnancy in two prospective mother-offspring cohorts: the Southampton Women's Survey (SWS) and the Avon Longitudinal Study of Parents and Children (ALSPAC). The mean (SD) offspring age at dual-energy X-ray absorptiometry (DXA) scanning was 9.2 (0.2) years. Linear regression was used to assess associations between E-DII and bone outcomes, adjusting for offspring sex and age at DXA and maternal age at childbirth, educational level, pre-pregnancy body mass index (BMI), parity, physical activity level, and smoking in pregnancy. Associations were synthesized using fixed-effect meta-analysis. Beta coefficients represent the association per unit E-DII increment. In fully adjusted models (total n = 5910) late pregnancy E-DII was negatively associated with offspring whole body minus head bone area (BA: β = -3.68 [95% confidence interval -6.09, -1.27] cm2 /unit), bone mineral content (BMC: β = -4.16 [95% CI -6.70, -1.62] g/unit), and areal bone mineral density (aBMD: β = -0.0012 [95% CI -0.0020, -0.0004] g.cm-2 /unit), but there was only a weak association with BMC adjusted for BA (β = -0.48 [95% CI -1.11, 0.15] g/unit) at 9 years. Adjustment for child height partly or, for weight, fully attenuated the associations. Higher late pregnancy E-DII scores (representing a more pro-inflammatory diet) are negatively associated with offspring bone measures, supporting the importance of maternal and childhood diet on longitudinal offspring bone health. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

GNA11-mutated Sturge-Weber Syndrome has distinct neurologic and dermatologic features

BACKGROUND

Sturge-Weber syndrome (SWS) is a neurocutaneous disorder characterized by clinical manifestations involving the brain, eye and skin. SWS is commonly caused by somatic mutations in G protein subunit Alpha Q (GNAQ). Subunit Alpha 11 (GNA11) mutations have been reported in 5 cases. It is not clear if their phenotypic features differ.

METHODS

Within two European multidisciplinary centers we looked for patients with clinical characteristics of SWS and a GNA11 mutation. Clinical and radiological data was collected retrospectively and prospectively.

RESULTS

We identified three patients with SWS associated with a somatic GNA11 mutation. They had disseminated capillary malformation (CM) and hyper- or hypotrophy of an extremity. At birth, the CMs of the face, trunk and limbs were pink and patchy, and slowly darkened with age evolving to purple color. Two of the patients had glaucoma. All had neurological symptoms and moderate brain atrophy at a lower degree of severity than classically associated with SWS. Susceptibility-Weighted Images (SWI) and contrast-enhanced (CE) Fluid Attenuated Inversion Recovery (FLAIR) MR views demonstrated best sensitivity to reveal the pial angiomas.

CONCLUSIONS

We differentiate two distinct clinical/radiological phenotypes of SWS; GNAQ- and GNA11-SWS. The classical GNAQ-SWS is characterized by a homogeneous dark-red CM commonly associated with underlying soft tissue hypertrophy. The CM in GNA11-SWS is more reticulate and darkens with time; neurological picture is milder. SWI and post contrast FLAIR sequences appear to be necessary to demonstrate the leptomeningeal angiomatosis. Yet, anti-epileptic medication or future targeted therapies may be useful, like in classic SWS.

Cueing emotional memories during slow wave sleep modulates next-day activity in the orbitofrontal cortex and the amygdala

Emotional memories are preferentially consolidated during sleep, through the process of memory reactivation. Targeted memory reactivation (TMR) has been shown to boost memory consolidation during sleep, but its neural correlates remain unclear, particularly for emotional memories. Here, we aimed to examine how TMR of emotional material during slow wave sleep (SWS) impacts upon neural processing during a subsequent arousal rating task. Participants were trained on a spatial memory task including negative and neutral pictures paired with semantically matching sounds. The picture-sound pairs were rated for emotional arousal before and after the spatial memory task. Then, half of the sounds from each emotional category (negative and neutral) were cued during SWS. The next day, participants were retested on both the arousal rating and the spatial memory task inside an MRI scanner, followed by another retest session a week later. Memory consolidation and arousal processing did not differ between cued and non-cued items of either emotional category. We found increased responses to emotional stimuli in the amygdala and orbitofrontal cortex (OFC), and a cueing versus emotion interaction in the OFC, whereby cueing neutral stimuli led to an increase in OFC activity, while cueing negative stimuli led to decreased OFC activation. Interestingly, the effect of cueing on amygdala activation was modulated by time spent in REM sleep. We conclude that SWS TMR impacts OFC activity, while REM sleep plays a role in mediating the effect of such cueing on amygdala.

Exposure to relaxing words during sleep promotes slow-wave sleep and subjective sleep quality

Our thoughts alter our sleep, but the underlying mechanisms are still unknown. We propose that mental processes are active to a greater or lesser extent during sleep and that this degree of activation affects our sleep depth. We examined this notion by activating the concept of "relaxation" during sleep using relaxation-related words in 50 healthy participants. In support of our hypothesis, playing relaxing words during non-rapid eye movement sleep extended the time spent in slow-wave sleep, increased power in the slow-wave activity band after the word cue, and abolished an asymmetrical sleep depth during the word presentation period. In addition, participants reported a higher sleep quality and elevated subjective alertness. Our results support the notion that the activation of mental concepts during sleep can influence sleep depth. They provide a basis for interventions using targeted activations to promote sleep depth and sleep quality to foster well-being and health.

Racial disparities in sleep-related cardiac function in young, healthy adults: Implications for cardiovascular-related health

STUDY OBJECTIVES

Considerable evidence shows that individuals from marginalized racial/ethnic groups in the US experience greater rates of sleep disturbance and cardiovascular complications. Because sleep is a modifiable factor that is critically involved in cardiovascular health, improved understanding of the association between sleep and cardiovascular health during early adulthood can prevent cardiovascular disparities. This study examined racial/ethnic differences in cardiovascular function during sleep using heart-rate and heart-rate-variability analyses.

METHODS

Participants in this laboratory-based sleep study included healthy, "good sleepers" who were in early adulthood and resided in the US at the time of participation [14 non-Hispanic Black (NHB; age=30.9(6.6), 57% female), 12 Asian (Asian, age=26.0(5.2), 42% female), and 24 non-Hispanic white (NHW; age=24.6(5.8), 79% female)].

RESULTS

After adjusting for demographic factors and an apnea-hypopnea index, we found significantly higher heart rate within NREM Stage 2 (N2) (b=-22.6, p=.04) and REM sleep (b=-25.8, p=.048) and lower heart rate variability during N2 sleep (b=-22.6, p=.04) among NHB individuals compared to NHW individuals. Further, NHB and Asian participants demonstrated significantly lower percent of time in slow wave sleep (SWS) compared to NHW participants (NHB: b=-22.6, p=.04; Asian: b=-22.6, p=.04). Individuals' percent of time in SWS significantly mediated differences in heart rate during N2 [indirect=0.94, 95% CI (0.03, 2.68)] and REM sleep [indirect=1.02, 95% CI (0.04, 3.04)].

CONCLUSIONS

Our results showed disparities in sleep-related cardiovascular function in early adulthood that are mediated by SWS. These data suggest targeting sleep health in early adulthood might help reduce cardiovascular disease burden on individuals from marginalized groups.

Childhood DNA methylation as a marker of early life rapid weight gain and subsequent overweight

BACKGROUND

High early postnatal weight gain has been associated with childhood adiposity; however, the mechanism remains unknown. DNA methylation is a hypothesised mechanism linking early life exposures and subsequent disease. However, epigenetic changes associated with high early weight gain have not previously been investigated. Our aim was to investigate the associations between early weight gain, peripheral blood DNA methylation, and subsequent overweight/obese. Data from the UK Avon Longitudinal study of Parents and Children (ALSPAC) cohort were used to estimate associations between early postnatal weight gain and epigenome-wide DNA CpG site methylation (Illumina 450 K Methylation Beadchip) in blood in childhood (n = 125) and late adolescence (n = 96). High weight gain in the first year (a change in weight z-scores > 0.67), both unconditional (rapid weight gain) and conditional on birthweight (rapid thrive), was related to individual CpG site methylation and across regions using the meffil pipeline, with and without adjustment for cell type proportions, and with 5% false discovery rate correction. Variation in methylation at high weight gain-associated CpG sites was then examined with regard to body composition measures in childhood and adolescence. Replication of the differentially methylated CpG sites was sought using whole-blood DNA samples from 104 children from the UK Southampton Women's Survey.

RESULTS

Rapid infant weight gain was associated with small (+ 1% change) increases in childhood methylation (age 7) for two distinct CpG sites (cg01379158 (NT5M) and cg11531579 (CHFR)). Childhood methylation at one of these CpGs (cg11531579) was also higher in those who experienced rapid weight gain and were subsequently overweight/obese in adolescence (age 17). Rapid weight gain was not associated with differential DNA methylation in adolescence. Childhood methylation at the cg11531579 site was also suggestively associated with rapid weight gain in the replication cohort.

CONCLUSIONS

This study identified associations between rapid weight gain in infancy and small increases in childhood methylation at two CpG sites, one of which was replicated and was also associated with subsequent overweight/obese. It will be important to determine whether loci are markers of early rapid weight gain across different, larger populations. The mechanistic relevance of these differentially methylated sites requires further investigation.

Hypnotic Suggestions Increase Slow-Wave Parameters but Decrease Slow-Wave Spindle Coupling

PURPOSE

Sleep, in particular slow-wave sleep, is beneficial for memory consolidation. In two recent studies, a hypnotic suggestion to sleep more deeply increased the amount of slow-wave sleep in both a nap and a night design. In spite of these increases in slow-wave sleep, no beneficial effect on declarative memory consolidation was found. As coupling of slow-waves and sleep spindles is assumed to be critical for declarative memory consolidation during sleep, we hypothesized that the missing memory benefit after increased SWS could be related to a decrease in slow-wave/spindle coupling.

PARTICIPANTS AND METHODS

Data from 33 highly hypnotizable subjects were retrieved from a nap (n = 14) and a night (n = 19) study with a similar design and procedure. After an adaptation session, subjects slept in the sleep laboratory for two experimental sessions with polysomnography. Prior to sleep, a paired-associate learning task was conducted. Next, subjects either listened to a hypnotic suggestion to sleep more deeply or to a control text in a randomized order according to a within-subject design. After sleep, subjects performed the recall of the memory task. Here, we conducted a fine-grained analysis of the sleep data on slow-waves, spindles and their coupling.

RESULTS

In line with our hypothesis, listening to a hypnosis tape decreased the percentage of spindles coupled to slow-waves. Slow-wave parameters were consistently increased, but sleep spindles remained unaffected by the hypnotic suggestion.

CONCLUSION

Our results suggest that selectively enhancing slow-waves without affecting sleep spindles might not be sufficient to improve memory consolidation during sleep.

Time-frequency analysis and fuzzy-based detection of heat-stressed sleep EEG spectra

Nowadays, sleep disorders are contemplated as the major issue in the human lives. The current work aims at extraction of time-frequency information from recorded dataset and provides an efficient sleep stage detection method. Recordings of brain signal namely electroencephalogram (EEG), electrooculogram (EOG), and electromyogram (EMG) were carried out under defined clinical condition for the classification of sleep EEG. Subsequent upon the extraction of various features from the raw EEG data, neuro-fuzzy system is trained to classify the sleep stages into three major classes namely awake, slow wave sleep (SWS), and rapid eye movement sleep (REM). This classification would enable medical professionals to diagnose sleep related disorders accurately. The results obtained clearly indicate that the mean performance for SWS stage is profound as compared to REM and awake stage. Specificity and sensitivity of the proposed method are obtained as 95.4% and 80%, respectively. The average accuracy of the system employing neuro-fuzzy approach is found to be 90.6% in which SWS stage was best detected among the other stages of sleep EEG.Graphical abstract.

Sleep architecture is related to the season of PSG recording in 8-month-old infants

To date, little is known about the impact of season on infant sleep. In higher latitudes, the duration of daily light time varies substantially between different seasons, and environmental light is one potential factor affecting sleep. In this cohort study, one-night polysomnography (PSG) was performed on 72 healthy 8-month-old infants in 2012 and 2013 to study the effect of season on the sleep architecture of young infants in Finland. The children were divided into four subgroups, according to the amount of light during their birth season and the amount of light during the season of the PSG recordings, corresponding to spring, summer, autumn, and winter. We found that the season of birth did not have an impact on the infants' sleep architecture at 8 months of age, but the season of the PSG recording did have an effect on several sleep variables. In the PSGs conducted during the spring, there was less N3 sleep and more N2 sleep than in the PSGs conducted during the autumn. In addition, there was more fragmented sleep during spring than autumn. According to our data, the season has an effect on the sleep architecture of young infants and should, therefore, be considered when evaluating the PSG findings of young infants. The exact mechanisms behind this novel finding remain unclear, however. The findings imply that infants` sleep is affected by the season or light environment, as is the case in adult sleep. Since potential explanatory factors, such as direct natural or artificial light exposure and the melatonin levels of the infants, were not controlled, more research is needed in the future to better understand this phenomenon.

Passive Coping Strategies During Repeated Social Defeat Are Associated With Long-Lasting Changes in Sleep in Rats

Exposure to severe stress has immediate and prolonged neuropsychiatric consequences and increases the risk of developing Posttraumatic Stress Disorder (PTSD). Importantly, PTSD develops in only a subset of individuals after exposure to a traumatic event, with the understanding of this selective vulnerability being very limited. Individuals who go on to develop PTSD after a traumatic experience typically demonstrate sleep disturbances including persistent insomnia and recurrent trauma-related nightmares. We previously established a repeated social defeat paradigm in which rats segregate into either passively or actively coping subpopulations, and we found that this distinction correlates with measures of vulnerability or resilience to stress. In this study, we examined differences between these two behavioral phenotypes in sleep changes resulting from repeated social defeat stress. Our data indicate that, compared to control and actively coping rats, passively coping rats have less slow-wave sleep (SWS) for at least 2 weeks after the end of a series of exposures to social defeat. Furthermore, resilient rats show less exaggerated motor activation at awakenings from rapid eye movement (REM) sleep and less fragmentation of REM sleep compared to control and passively coping rats. Together, these data associate a passive coping strategy in response to repeated social defeat stress with persisting sleep disturbances. Conversely, an active coping strategy may be associated with resilience to sleep disturbances. These findings may have both prognostic and therapeutic applications to stress-associated neuropsychiatric disorders, including PTSD.

Is Sleep Disruption a Cause or Consequence of Alzheimer's Disease? Reviewing Its Possible Role as a Biomarker

In recent years, the idea that sleep is critical for cognitive processing has gained strength. Alzheimer's disease (AD) is the most common form of dementia worldwide and presents a high prevalence of sleep disturbances. However, it is difficult to establish causal relations, since a vicious circle emerges between different aspects of the disease. Nowadays, we know that sleep is crucial to consolidate memory and to remove the excess of beta-amyloid and hyperphosphorilated tau accumulated in AD patients' brains. In this review, we discuss how sleep disturbances often precede in years some pathological traits, as well as cognitive decline, in AD. We describe the relevance of sleep to memory consolidation, focusing on changes in sleep patterns in AD in contrast to normal aging. We also analyze whether sleep alterations could be useful biomarkers to predict the risk of developing AD and we compile some sleep-related proposed biomarkers. The relevance of the analysis of the sleep microstructure is highlighted to detect specific oscillatory patterns that could be useful as AD biomarkers.

Neuropathy target esterase (NTE/PNPLA6) and organophosphorus compound-induced delayed neurotoxicity (OPIDN)

Systemic inhibition of neuropathy target esterase (NTE) with certain organophosphorus (OP) compounds produces OP compound-induced delayed neurotoxicity (OPIDN), a distal degeneration of axons in the central nervous system (CNS) and peripheral nervous system (PNS), thereby providing a powerful model for studying a spectrum of neurodegenerative diseases. Axonopathies are important medical entities in their own right, but in addition, illnesses once considered primary neuronopathies are now thought to begin with axonal degeneration. These disorders include Alzheimer's disease, Parkinson's disease, and motor neuron diseases such as amyotrophic lateral sclerosis (ALS). Moreover, conditional knockout of NTE in the mouse CNS produces vacuolation and other degenerative changes in large neurons in the hippocampus, thalamus, and cerebellum, along with degeneration and swelling of axons in ascending and descending spinal cord tracts. In humans, NTE mutations cause a variety of neurodegenerative conditions resulting in a range of deficits including spastic paraplegia and blindness. Mutations in the Drosophila NTE orthologue SwissCheese (SWS) produce neurodegeneration characterized by vacuolization that can be partially rescued by expression of wild-type human NTE, suggesting a potential therapeutic approach for certain human neurological disorders. This chapter defines NTE and OPIDN, presents an overview of OP compounds, provides a rationale for NTE research, and traces the history of discovery of NTE and its relationship to OPIDN. It then briefly describes subsequent studies of NTE, including practical applications of the assay; aspects of its domain structure, subcellular localization, and tissue expression; abnormalities associated with NTE mutations, knockdown, and conventional or conditional knockout; and hypothetical models to help guide future research on elucidating the role of NTE in OPIDN.

Sleep-Wake Cycle in Young and Older Mice

Sleep plays a key role in multiple cognitive functions and sleep pattern changes with aging. Human studies revealed that aging decreases sleep efficiency and reduces the total sleep time, the time spent in slow-wave sleep (SWS), and the delta power (1–4 Hz) during sleep; however, some studies of sleep and aging in mice reported opposing results. The aim of our work is to estimate how features of sleep–wake state in mice during aging could correspond to age-dependent changes observed in human. In this study, we investigated the sleep/wake cycle in young (3 months old) and older (12 months old) C57BL/6 mice using local-field potentials (LFPs). We found that older adult mice sleep more than young ones but only during the dark phase of sleep-wake cycle. Sleep fragmentation and sleep during the active phase (dark phase of cycle), homologous to naps, were higher in older mice. Older mice show a higher delta power in frontal cortex, which was accompanied with similar trend for age differences in slow wave density. We also investigated regional specificity of sleep–wake electrographic activities and found that globally posterior regions of the cortex show more rapid eye movement (REM) sleep whereas somatosensory cortex displays more often SWS patterns. Our results indicate that the effects of aging on the sleep–wake activities in mice occur mainly during the dark phase and the electrode location strongly influence the state detection. Despite some differences in sleep–wake cycle during aging between human and mice, some features of mice sleep share similarity with human sleep during aging.

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

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

Individual Differences in Slow-Wave-Sleep Predict Acquisition of Full Cognitive Maps

Accumulating evidence suggests that sleep, and particularly Slow-Wave-Sleep (SWS), helps the implicit and explicit extraction of regularities within memories that were encoded in a previous wake period. Sleep following training on virtual navigation was also shown to improve performance in subsequent navigation tests. Some studies propose that this sleep-effect on navigation is based on explicit recognition of landmarks; however, it is possible that SWS-dependent extraction of implicit spatiotemporal regularities contributes as well. To examine this possibility, we administered a novel virtual navigation task in which participants were required to walk through a winding corridor and then choose one of five marked doors to exit. Unknown to participants, the markings on the correct door reflected the corridor’s shape (from a bird’s eye view). Detecting this regularity negates the need to find the exit by trial and error. Participants performed the task twice a day for a week, while their overnight sleep was monitored. We found that the more time participants spent in SWS across the week, the better they were able to implicitly extract the hidden regularity. In contrast, the few participants that explicitly realized the regularity did not rely on SWS to do so. Moreover, the SWS effect was strictly at the trait-level: Baseline levels of SWS prior to the experimental week could predict success just as well, but day-to-day variations in SWS did not predict day-to-day improvements. We propose that our findings indicate SWS facilitates implicit integration of new information into cognitive maps, possibly through compressed memory replay.

Effects of early morning nap sleep on associative memory for neutral and emotional stimuli

Emotional events are preferentially retained in episodic memory. This effect is commonly attributed to enhanced consolidation and has been linked specifically to rapid eye movement (REM) sleep physiology. While several studies have demonstrated an enhancing effect of REM sleep on emotional item memory, it has not been thoroughly explored whether this effect extends to the retention of associative memory. Moreover, it is unclear how non-rapid eye movement (NREM) sleep contributes to these effects. The present study thus examined associative recognition of emotional and non-emotional material across an early morning nap (N = 23) and sustained wakefulness (N = 23). Nap group subjects demonstrated enhanced post-sleep associative memory performance, which was evident across both valence categories. Subsequent analyses revealed significant correlations between NREM spindle density and pre-sleep memory performance. Moreover, NREM spindle density was positively correlated with post-sleep neutral associative memory performance but not with post-sleep emotional associative memory. Accordingly, only neutral associative memory, but not emotional associative memory, was significantly correlated with spindle density after an additional night of sleep (+24 h). These results illustrate a temporally persistent relationship between spindle density and memory for neutral associations, whereas post-sleep emotional associative memory appears to be disengaged from NREM-sleep-dependent processes.

Plasticity during Sleep Is Linked to Specific Regulation of Cortical Circuit Activity

Sleep is thought to be involved in the regulation of synaptic plasticity in two ways: by enhancing local plastic processes underlying the consolidation of specific memories and by supporting global synaptic homeostasis. Here, we briefly summarize recent structural and functional studies examining sleep-associated changes in synaptic morphology and neural excitability. These studies point to a global down-scaling of synaptic strength across sleep while a subset of synapses increases in strength. Similarly, neuronal excitability on average decreases across sleep, whereas subsets of neurons increase firing rates across sleep. Whether synapse formation and excitability is down or upregulated across sleep appears to partly depend on the cell's activity level during wakefulness. Processes of memory-specific upregulation of synapse formation and excitability are observed during slow wave sleep (SWS), whereas global downregulation resulting in elimination of synapses and decreased neural firing is linked to rapid eye movement sleep (REM sleep). Studies of the excitation/inhibition balance in cortical circuits suggest that both processes are connected to a specific inhibitory regulation of cortical principal neurons, characterized by an enhanced perisomatic inhibition via parvalbumin positive (PV+) cells, together with a release from dendritic inhibition by somatostatin positive (SOM+) cells. Such shift towards increased perisomatic inhibition of principal cells appears to be a general motif which underlies the plastic synaptic changes observed during sleep, regardless of whether towards up or downregulation.

Sleep Changes in Adolescents Following Procedural Task Training

Recent research has suggested that some of the inter-individual variation in sleep spindle activity is due to innate learning ability. Sleep spindles have also been observed to vary following learning in both young and older adults. We examined the effect of procedural task acquisition on sleep stages and on sleep spindles in an adolescent sample. Participants were 32 adolescents (17 females) between the ages of 12 and 19 years. Spindle activity was examined in three different frequency ranges: 11.00–13.50 Hz (slow), 13.51–16.00 Hz (fast), and 16.01–18.50 Hz (superfast). No changes in spindle density were observed after successful learning of the pursuit rotor task. This result was in contrast to a number of studies reporting spindle density increases following successful learning. In the present study, participants who successfully learned the task showed no changes in their sleep stage proportions, but participants who were not successful showed a decrease in the proportion of stage 2 and increases in both SWS and REM sleep. We suggest that these changes in the sleep stages are consistent with the two stage model of sleep and memory proposed by Smith et al. (2004a).

An Adenosine-Mediated Glial-Neuronal Circuit for Homeostatic Sleep

Sleep homeostasis reflects a centrally mediated drive for sleep, which increases during waking and resolves during subsequent sleep. Here we demonstrate that mice deficient for glial adenosine kinase (AdK), the primary metabolizing enzyme for adenosine (Ado), exhibit enhanced expression of this homeostatic drive by three independent measures: (1) increased rebound of slow-wave activity; (2) increased consolidation of slow-wave sleep; and (3) increased time constant of slow-wave activity decay during an average slow-wave sleep episode, proposed and validated here as a new index for homeostatic sleep drive. Conversely, mice deficient for the neuronal adenosine A1 receptor exhibit significantly decreased sleep drive as judged by these same indices. Neuronal knock-out of AdK did not influence homeostatic sleep need. Together, these findings implicate a glial-neuronal circuit mediated by intercellular Ado, controlling expression of homeostatic sleep drive. Because AdK is tightly regulated by glial metabolic state, our findings suggest a functional link between cellular metabolism and sleep homeostasis.

SIGNIFICANCE STATEMENT

The work presented here provides evidence for an adenosine-mediated regulation of sleep in response to waking (i.e., homeostatic sleep need), requiring activation of neuronal adenosine A1 receptors and controlled by glial adenosine kinase. Adenosine kinase acts as a highly sensitive and important metabolic sensor of the glial ATP/ADP and AMP ratio directly controlling intracellular adenosine concentration. Glial equilibrative adenosine transporters reflect the intracellular concentration to the extracellular milieu to activate neuronal adenosine receptors. Thus, adenosine mediates a glial-neuronal circuit linking glial metabolic state to neural-expressed sleep homeostasis. This indicates a metabolically related function(s) for this glial-neuronal circuit in the buildup and resolution of our need to sleep and suggests potential therapeutic targets more directly related to sleep function.

EEG Bands of Wakeful Rest, Slow-Wave and Rapid-Eye-Movement Sleep at Different Brain Areas in Rats

Accumulating evidence reveals that neuronal oscillations with various frequency bands in the brain have different physiological functions. However, the frequency band divisions in rats were typically based on empirical spectral distribution from limited channels information. In the present study, functionally relevant frequency bands across vigilance states and brain regions were identified using factor analysis based on 9 channels EEG signals recorded from multiple brain areas in rats. We found that frequency band divisions varied both across vigilance states and brain regions. In particular, theta oscillations during REM sleep were subdivided into two bands, 5–7 and 8–11 Hz corresponding to the tonic and phasic stages, respectively. The spindle activities of SWS were different along the anterior-posterior axis, lower oscillations (~16 Hz) in frontal regions and higher in parietal (~21 Hz). The delta and theta activities co-varied in the visual and auditory cortex during wakeful rest. In addition, power spectra of beta oscillations were significantly decreased in association cortex during REM sleep compared with wakeful rest. These results provide us some new insights into understand the brain oscillations across vigilance states, and also indicate that the spatial factor should not be ignored when considering the frequency band divisions in rats.

Non-truncating LIFR mutation: causal for prominent congenital pain insensitivity phenotype with progressive vertebral destruction?

We present a Qatari family with two children who displayed a characteristic phenotype of congenital marked pain insensitivity with hypohidrosis and progressive aseptic destruction of joints and vertebrae resembling that of hereditary sensory and autonomic neuropathies (HSANs). The patients, aged 10 and 14, remained of uncertain genetic diagnosis until whole genome sequencing was pursued. Genome sequencing identified a novel homozygous C65S mutation in the LIFR gene that is predicted to markedly destabilize and alter the structure of a particular domain and consequently to affect the functionality of the whole multi-domain LIFR protein. The C65S mutant LIFR showed altered glycosylation and an elevated expression level that might be attributed to a slow turnover of the mutant form. LIFR mutations have been reported in Stüve-Wiedemann syndrome (SWS), a severe autosomal recessive skeletal dysplasia often resulting in early death. Our patients share some clinical features of rare cases of SWS long-term survivors; however, they also phenocopy HSAN due to the marked pain insensitivity phenotype and progressive bone destruction. Screening for LIFR mutations might be warranted in genetically unresolved HSAN phenotypes.

Correlations between adolescent processing speed and specific spindle frequencies

Sleep spindles are waxing and waning thalamocortical oscillations with accepted frequencies of between 11 and 16 Hz and a minimum duration of 0.5 s. Our research has suggested that there is spindle activity in all of the sleep stages, and thus for the present analysis we examined the link between spindle activity (Stage 2, rapid eye movement (REM) and slow wave sleep (SWS)) and waking cognitive abilities in 32 healthy adolescents. After software was used to filter frequencies outside the desired range, slow spindles (11.00–13.50 Hz), fast spindles (13.51–16.00 Hz) and spindle-like activity (16.01–18.50 Hz) were observed in Stage 2, SWS and REM sleep. Our analysis suggests that these specific EEG frequencies were significantly related to processing speed, which is one of the subscales of the intelligence score, in adolescents. The relationship was prominent in SWS and REM sleep. Further, the spindle-like activity (16.01–18.50 Hz) that occurred during SWS was strongly related to processing speed. Results suggest that the ability of adolescents to respond to tasks in an accurate, efficient and timely manner is related to their sleep quality. These findings support earlier research reporting relationships between learning, learning potential and sleep spindle activity in adults and adolescents.

The EEG as an index of neuromodulator balance in memory and mental illness

There is a strong correlation between signature EEG frequency patterns and the relative levels of distinct neuromodulators. These associations become particularly evident during the sleep-wake cycle. The monoamine-acetylcholine balance hypothesis is a theory of neurophysiological markers of the EEG and a detailed description of the findings that support this proposal are presented in this paper. According to this model alpha rhythm reflects the relative predominance of cholinergic muscarinic signals and delta rhythm that of monoaminergic receptor effects. Both high voltage synchronized rhythms are likely mediated by inhibitory Gαi/o-mediated transduction of inhibitory interneurons. Cognitively, alpha and delta EEG measures are proposed to indicate automatic and flexible strategies, respectively. Sleep is associated with marked changes in relative neuromodulator levels corresponding to EEG markers of distinct stages. Sleep studies on memory consolidation present some of the strongest evidence yet for the respective roles of monoaminergic and cholinergic projections in declarative and non-declarative memory processes, a key theoretical premise for understanding the data. Affective dysregulation is reflected in altered EEG patterns during sleep.

Sleep characteristics in the quail Coturnix coturnix

As mammals, birds exhibit two sleep phases, slow wave sleep (SWS) and REM (Rapid Eye Movement) sleep characterized by presenting different electrophysiological patterns of brain activity. During SWS a high amplitude slow wave pattern in brain activity is observed. This activity is substituted by a low amplitude fast frequency pattern during REM sleep. Common quail (Coturnix coturnix) is an animal model that has provided information related to different physiological mechanisms present in man. There are reports related to its electrophysiological brain activity, however the sleep characteristics that have been described are not. The objectives of this study is describing the sleep characteristics throughout the nychthemeral cycle of the common quail and consider this bird species as an avian model to analyze the regulatory mechanisms of sleep. Experiments were carried out in implanted exemplars of C. coturnix. Under general anesthesia induced by ether inhalation, stainless steel electrodes were placed to register brain activity from the anterior and posterior areas during 24 continuous hours throughout the sleep-wake cycle. Ocular and motor activities were visually monitored. Quail showed four electrophysiologically and behaviorally different states of vigilance: wakefulness (53.28%), drowsiness (14.27%), slow wave sleep (30.47%) and REM sleep (1.98%). The animals presented 202 REM sleep episodes throughout the nychthemeral cycle. Sleep distribution was polyphasic; however sleep amount was significantly greater during the period corresponding to the night. The number of nocturnal REM sleep episodes was significantly greater than that of diurnal one.

CONCLUSION

The quail C. coturnix shows a polyphasic distribution of sleep; however the amount of this state of vigilance is significantly greater during the nocturnal period.

Morning blood pressure is associated with sleep quality in obese adolescents

OBJECTIVE

To examine relationships among blood pressure (BP), adiposity, and sleep quality with the use of overnight polysomnography in obese adolescents.

STUDY DESIGN

Overnight polysomnogram and morning BP measurements were performed in obese (body mass index [BMI] >95th percentile) nondiabetic adolescents (eligible age range 12-18 years, n = 49). Subjects were stratified into 2 groups, one with normal BP, and one with elevated BP, and demographic and clinical characteristics were compared between the groups. Multiple linear regression analysis was used to assess the effects of sleep quality on BP.

RESULTS

Participants (n = 27) had a normal morning BP, and 22 (44.9%) had elevated morning BP. There were no differences in age (P = .53), sex (P = .44), race (P = .58), or BMI (P = .56) between the 2 BP groups. The group with elevated BP spent shorter percentages of time in rapid eye movement (REM; P = .006) and slow-wave sleep (SWS; P = .024). Multiple linear regression analysis showed that a lower percentage of both REM and SWS was associated with increased morning BP after we adjusted for pubertal stage, sex, race, and BMI.

CONCLUSION

Lack of deeper stages of sleep, REM sleep, and SWS is associated with greater morning BP in obese adolescents, independent of BMI. Poor sleep quality should be considered in the work-up of obese youth with hypertension. Intervention studies are needed to evaluate whether improving the quality of sleep will decrease BP elevation.

Single unit activity of the suprachiasmatic nucleus and surrounding neurons during the wake-sleep cycle in mice

The suprachiasmatic nucleus (SCN) of the mammalian hypothalamus contains a circadian clock for timing of diverse neuronal, endocrine, and behavioral rhythms, such as the cycle of sleep and wakefulness. Using extracellular single unit recordings, we have determined, for the first time, the discharge activity of individual SCN neurons during the complete wake-sleep cycle in non-anesthetized, head restrained mice. SCN neurons (n=79) were divided into three types according to their regular (type I; n=38) or irregular (type II; n=19) discharge activity throughout the wake-sleep cycle or their quiescent activity during waking and irregular discharge activity during sleep (type III; n=22). The type I and II neurons displayed a long-duration action potential, while the type III neurons displayed either a short-duration or long-duration action potential. The type I neurons discharged exclusively as single isolated spikes, whereas the type II and III neurons fired as single isolated spikes, clusters, or bursts. The type I and II neurons showed wake-active, wake/paradoxical (or rapid eye movement) sleep-active, or state-unrelated activity profiles and were, respectively, mainly located in the ventral or dorsal region of the SCN. In contrast, the type III neurons displayed sleep-active discharge profiles and were mainly located in the lateral region of the SCN. The majority of type I and II neurons tested showed an increase in discharge rate following application of light to the animal's eyes. Of the 289 extra-SCN neurons recorded, those displaying sleep-active discharge profiles were mainly located dorsal to the SCN, whereas those displaying wake-active discharge profiles were mainly located lateral or dorsolateral to the SCN. This study shows heterogeneity of mouse SCN and surrounding anterior hypothalamic neurons and suggests differences in their topographic organization and roles in mammalian circadian rhythms and the regulation of sleep and wakefulness.

Systemic administration and local microinjection into the central nervous system of the 5-HT(7) receptor agonist LP-211 modify the sleep-wake cycle in the rat

The effects of LP-211, a selective serotonin 5-HT7 receptor agonist were studied in adult rats implanted for chronic sleep recordings. Intraperitoneal administration of LP-211 (2.5-10mg/kg) during the light phase of the light-dark cycle significantly increased wakefulness (W) and reduced rapid-eye-movement sleep (REMS) and the number of REM periods during the 6-h recording period. Direct infusion of LP-211 into the dorsal raphe nucleus (DRN) (2-6 mM), locus coeruleus nucleus (LC) (4 mM), basal forebrain (horizontal limb of the diagonal band of Broca) (HDB) (2 mM) or laterodorsal tegmental nucleus (LDT) (4 mM) induced also a decrease of REMS. Additionally, microinjection of the 5-HT7 receptor ligand into the HDB (2 mM) augmented W. Presently, there is no satisfactory explanation for the effect of 5-HT7 receptor activation on W and REMS occurrence. Additional studies are required to characterize the neurotransmitter systems responsible for the actions of LP-211 on the behavioral states.

Mechanisms underlying obesity resistance associated with high spontaneous physical activity

Obesity resistance due to elevated orexin signaling is accompanied by high levels of spontaneous physical activity (SPA). The behavioral and neural mechanisms underlying this observation have not been fully worked out. We determined the contribution of hypothalamic orexin receptors (OXRs) to SPA stimulated by orexin A (OXA), whether OXA-stimulated SPA was secondary to arousal and whether voluntary wheel running led to compensations in 24-h SPA. We further tested whether orexin action on dopamine one receptors (DA1R) in the substantia nigra (SN) plays an important role in the generation of SPA. To test this, SPA response was determined in lean and obese rats with cannulae targeted toward the rostral lateral hypothalamus (rLH) or SN. Sleep/wake states were also measured in rats with rLH cannula and electroencephalogram/electromyogram radiotelemetry transmitters. SPA in lean rats was more sensitive to antagonism of the OX1R and in the early response to the orexin 2 agonist. OXA increased arousal equally in lean and obese rodents, which is discordant from the greater SPA response in lean rats. Obesity-resistant rats ran more and wheel running was directly related to 24-h SPA levels. The OX1R antagonist, SB-334867-A, and the DA1R antagonist, SCH3390, in SN more effectively reduced SPA stimulated by OXA in obesity-resistant rats. These data suggest OXA-stimulated SPA is not secondary to enhanced arousal, propensity for SPA parallels inclination to run and that orexin action on dopaminergic neurons in SN may participate in the mediation of SPA and running wheel activity.

Slow wave sleep induced by GABA agonist tiagabine fails to benefit memory consolidation

STUDY OBJECTIVES

Slow wave sleep (SWS) plays a pivotal role in consolidating memories. Tiagabine has been shown to increase SWS in favor of REM sleep without impacting subjective sleep. However, it is unknown whether this effect is paralleled by an improved sleep-dependent consolidation of memory.

DESIGN

This double-blind within-subject crossover study tested sensitivity of overnight retention of declarative neutral and emotional materials (word pairs, pictures) as well as a procedural memory task (sequence finger tapping) to oral administration of placebo or 10 mg tiagabine (at 22:30).

PARTICIPANTS

Fourteen healthy young men aged 21.9 years (range 18-28 years).

MEASUREMENTS AND RESULTS

Tiagabine significantly increased the time spent in SWS and decreased REM sleep compared to placebo. Tiagabine also enhanced slow wave activity (0.5-4.0 Hz) and density of < 1 Hz slow oscillations during NREM sleep. Fast (12-15 Hz) and slow (9-12 Hz) spindle activity, in particular that occurring phase-locked to the slow oscillation cycle, was decreased following tiagabine. Despite signs of deeper and more SWS, overnight retention of memory tested after sleep the next evening (19:30) was generally not improved after tiagabine, but on average even lower than after placebo, with this impairing effect reaching significance for procedural sequence finger tapping.

CONCLUSIONS

Our data show that increasing slow wave sleep with tiagabine does not improve memory consolidation. Possibly this is due to functional differences from normal slow wave sleep, i.e., the concurrent suppressive influence of tiagabine on phase-locked spindle activity.

Sleep architecture in ziprasidone-treated bipolar depression: a pilot study

OBJECTIVES

This study investigated the effect of ziprasidone augmentation therapy on sleep architecture in bipolar depression.

METHODS

We conducted a double-blind, randomized, placebo-controlled clinical pilot trial of ziprasidone versus placebo in Diagnostic and Statistical Manual of Mental Disorders, fourth edition bipolar disorder with current major depressive episode. The effects during acute (2-5 days) and continuation treatment (28-31 days) were measured. Main outcomes were sleep architecture variables including rapid eye movement sleep (REM) and slow wave sleep (SWS) measured by polysomnography. Secondary outcomes included subjective sleep quality measures and illness severity measures including the 17-item Hamilton Depression Rating Scale (HAMD-17), Montgomery Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAMA) and Clinical Global Illness Severity (CGI-S) scores.

RESULTS

The completer analysis comprised of 14 patients (ziprasidone, N = 8 and placebo, N = 6). Latency to REM, duration of SWS, duration of stage 2 sleep, total sleep time, onset to sleep latency, number of awakenings and overall sleep efficiency significantly improved in ziprasidone-treated participants over placebo. CGI-S and HAMA scores also significantly improved. No significant difference between treatment groups was seen on the HAMD-17, MADRS or in self-reported sleep quality. Increase in SWS duration significantly correlated with improvement in CGI-S, however, this finding did not withstand Bonferroni correction.

CONCLUSION

Adjunctive ziprasidone treatment alters sleep architecture in patients with bipolar depression, which may partially explain its mechanism of action and merits further investigation.

The sleep cycle modelled as a cortical phase transition

We present a mean-field model of the cortex that attempts to describe the gross changes in brain electrical activity for the cycles of natural sleep. We incorporate within the model two major sleep modulatory effects: slow changes in both synaptic efficiency and in neuron resting voltage caused by the ∼90-min cycling in acetylcholine, together with even slower changes in resting voltage caused by gradual elimination during sleep of somnogens (fatigue agents) such as adenosine. We argue that the change from slow-wave sleep (SWS) to rapid-eye-movement (REM) sleep can be understood as a first-order phase transition from a low-firing, coherent state to a high-firing, desychronized cortical state. We show that the model predictions for changes in EEG power, spectral distribution, and correlation time at the SWS-to-REM transition are consistent not only with those observed in clinical recordings of a sleeping human subject, but also with the on-cortex EEG patterns recently reported by Destexhe et al. [J. Neurosci.19(11), (1999) 4595-4608] for the sleeping cat.