Central chemosensitivity and breathing asleep in unilateral medullary lesion patients: comparisons to animal data

The rostro-ventrolateral medulla (RVLM) is a site of chemosensitivity in animals; such site(s) have not been defined in humans. We studied the effect of unilateral focal lesions in the rostrolateral medulla (RLM) of man, on the ventilatory CO(2) sensitivity and during awake and sleep breathing. Nine patients with RLM lesions (RLM group), and six with lesions elsewhere (non-RLM group) were studied. The ventilatory CO(2) sensitivity was lower in the RLM compared with the non-RLM group (mean (S.D.), RLM, 1.4 (0.9), non-RLM 3.0 (0.6) L min(-1) mmHg(-1)). In both groups resting breathing was normal. During sleep all RLM patients had frequent arousals, four had significant sleep disordered breathing (SDB), only one non-RLM patient had SDB. Our findings in humans resemble those in animals with focal RVLM lesions. This review provides evidence that in humans there is an area of chemosensitivity in the RLM. We propose that in humans, dorsal displacement of the RVLM area of chemosensitivity in animals, arises from development of the olive plus the consequences of the evolution of the cerebellum/inferior peduncle.

The relationship between sleep and epilepsy

Seizures occur extensively during sleep or on awakening in a substantial proportion of patients with epilepsy. Interictal epileptiform discharges are also influenced by sleep and sleep deprivation. Continuous spike-waves in slow-wave sleep are the hallmark of Landau-Kleffner syndrome and ESES (Electrical Status in Slow Sleep). Sleep deprivation is known to influence not only the occurrence but also the symptomatology of epileptic seizures. Sleep architecture and daytime alertness are influenced by seizures and antiepileptic medications. This review examines the clinical and basic science aspects of this relationship between sleep and epilepsy.

Sleep patterns and sleep disruptions in kindergarten children

Assessed sleep patterns and sleep disruptions in kindergarten children and investigated the relation between sleep measures derived from objective and subjective evaluation methods. The sleep patterns of 59 normal kindergarten children (mean age = 5.5 years) were monitored for 4 to 5 consecutive nights by means of activity monitors (actigraph) and by means of parental daily sleep logs. The correlation between the actigraphic measures and the daily parental logs indicated that parents were accurate reporters of sleep schedule measures. However, parents were less accurate in assessing sleep quality measures, significantly underestimating the number of night-wakings and overestimating the quality of their children's sleep. Fragmented sleep was found, by means of activity monitoring, in 41% of the children.

Inspired CO(2) and O(2) in sleeping infants rebreathing from bedding: relevance for sudden infant death syndrome

Some infants sleep facedown for long periods with no ill effects, whereas others become hypoxemic. Rebreathing of expired air has been determined by CO(2) measurement; however, O(2) levels under such conditions have not been determined. To evaluate this and other factors influencing inspired gas concentrations, we studied 21 healthy infants during natural sleep while facedown on soft bedding. We measured gas exchange with the environment and bedding, ventilatory response to rebreathing, and concentrations of inspired CO(2) and O(2). Two important factors influencing inspired gas concentrations were 1) a variable seal between bedding and infants' faces and 2) gas gradients in the bedding beneath the infants, with O(2)-poor and CO(2)-rich air nearest to the face, fresher air distal to the face, and larger tidal volumes being associated with fresher inspired air. Minute ventilation increased significantly while rebreathing because of an increase in tidal volume, not frequency. The measured drop in inspired O(2) was significantly greater than the accompanying rise in inspired CO(2). This appears to be due to effects of the respiratory exchange ratio and differential tissue solubilities of CO(2) and O(2) during unsteady conditions.

Intrinsic near-24-h pacemaker period determines limits of circadian entrainment to a weak synchronizer in humans

Endogenous circadian clocks are robust regulators of physiology and behavior. Synchronization or entrainment of biological clocks to environmental time is adaptive and important for physiological homeostasis and for the proper timing of species-specific behaviors. We studied subjects in the laboratory for up to 55 days each to determine the ability to entrain the human clock to a weak circadian synchronizing stimulus [scheduled activity-rest cycle in very dim (approximately 1.5 lux in the angle of gaze) light-dark cycle] at three approximately 24-h periods: 23.5, 24.0, and 24.6 h. These studies allowed us to test two competing hypotheses as to whether the period of the human circadian pacemaker is near to or much longer than 24 h. We report here that imposition of a sleep-wake schedule with exposure to the equivalent of candle light during wakefulness and darkness during sleep is usually sufficient to maintain circadian entrainment to the 24-h day but not to a 23.5- or 24.6-h day. Our results demonstrate functionally that, in normally entrained sighted adults, the average intrinsic circadian period of the human biological clock is very close to 24 h. Either exposure to very dim light and/or the scheduled sleep-wake cycle itself can entrain this near-24-h intrinsic period of the human circadian pacemaker to the 24-h day.

Dynamic control of auditory activity during sleep: correlation between song response and EEG

The song nucleus high vocal center (HVC) sends neural signals for song production and receives auditory input. By using electroencephalography (EEG) to objectively identify wake/sleep state, we show that HVC auditory responses change with physiological states. Comparison of EEG and HVC records revealed that HVC response to auditory stimuli is greatest during slow-wave sleep. During slow-wave sleep, HVC neurons responded preferentially to the bird's own song. Strikingly, both spontaneous and forced waking during sleep caused HVC auditory responses to cease within milliseconds of an EEG-measured state change. State-dependent phenomena in downstream nuclei, such as robustus archistriatalis, are likely to be derivatives of those in HVC.

5-HT(2A) receptor-like protein is present in small neurons located in rat mesopontine cholinergic nuclei, but absent from cholinergic neurons

The cholinergic neurons of the pedunculopontine and laterodorsal tegmental nuclei (PPN and LDN) increase their activity during wakefulness and REM sleep and interact with brainstem neurons containing serotonin (5-HT) and other amines. To determine whether mesopontine neurons that contain nitric oxide synthase (NOS), a marker for cholinergic cells, express 5-HT(2A) receptors, dual immunostaining for 5-HT(2A) receptor-like protein and NOS was employed with either peroxidase or fluorescent secondary probes. Within the PPN and LDN, different cells expressed 5-HT(2A) receptors and NOS. In addition to the lack of co-localization, the 5-HT(2A) receptor-expressing cells were smaller and less numerous than the adjacent NOS neurons. We propose that 5-HT(2A) receptor-expressing cells are local inhibitory interneurons whose one function is to ensure the reciprocal patterns of activity in subpopulations of mesopontine cholinergic and aminergic neurons.

Sudden withdrawal of carbamazepine increases cardiac sympathetic activity in sleep

OBJECTIVE

To evaluate the cardiac autonomic effects of abrupt withdrawal of carbamazepine (CBZ) during sleep in patients with epilepsy.

BACKGROUND

The pathophysiology of sudden unexpected death in epilepsy (SUDEP) is uncertain, with ictal or peri-ictal cardiorespiratory compromise appearing probable. Risk factors for SUDEP include multiple antiepileptic drugs (AED), poor compliance, and abrupt AED withdrawal. The spectral analysis of the beat-to-beat heart rate variability (HRV) displays two main components: low frequency (LF), representing sympathetic and parasympathetic influence and high frequency (HF), representing parasympathetic influence. The LF/HF ratio is commonly regarded as an indicator of sympathovagal balance.

METHOD

Twelve patients with medically intractable seizures underwent abrupt withdrawal of CBZ to facilitate seizure recording during controlled circuit TV-EEG monitoring. Continuous EKG recording was begun 24 hours before CBZ reduction. Spectral analysis of the HRV was performed during selected samples of non-REM sleep before and after CBZ reduction. Analyses were made at least 6 hours after from (complex) partial and 12 hours from generalized seizures.

RESULTS

The mean LF/HF ratio before withdrawal of CBZ was 2.15 compared with a ratio of 2.65 on day 4 after withdrawal, an increase of 19% (geometric mean; 95% CI, 2% to 34%; Wilcoxon test, z = 2.36; p = 0.018). The ratio increased in 10 patients compared with a decrease in only one patient.

CONCLUSION

Abrupt withdrawal of CBZ leads to enhanced sympathetic activity in sleep as evidenced by increased LF/HF ratios. Increased sympathetic activity in the setting of seizure-induced hypoxia could predispose to SUDEP.

Insomnia related to dysthymia: polysomnographic and psychometric comparison with normal controls and acute therapeutic trials with trazodone

Utilizing polysomnography (PSG) and psychometry, objective and subjective sleep and awakening quality was investigated in 11 patients (mean age 50 +/- 14) with nonorganic insomnia (F 51.0) related to dysthymia (F 34.1) as compared with 11 age- and sex-matched normal controls. Patients demonstrated decreased sleep efficiency and sleep stage S2 as well as increased sleep latency to S1, S2 and S3, wakefulness within the total sleep period, number of awakenings, S1 and REM sleep. There was no intergroup difference in REM latency. Subjective sleep quality and the total score of the Self-Assessment Scale for Sleep and Awakening Quality (SSA) were deteriorated as were evening and morning well-being, mood, affectivity and drowsiness. Noopsychic measures showed deteriorated numerical memory, fine motor activity and reaction time variability. In a placebo-controlled crossover design study, the acute effects of 100 mg trazodone, a serotonin reuptake inhibitor with a sedative action due to 5HT(2) and alpha(1) receptor blockade, were investigated in the patients. As compared with placebo, trazodone induced an increase in slow-wave sleep (S3 + 4), a lengthening of REM latency, a decrease in REM sleep and a normalization of the periodic leg movement (PLM) index. In the morning, there was a minimal increase in somatic complaints and a decrease in critical flicker frequency and systolic blood pressure. In conclusion, our study demonstrated that dysthymia induced significant changes in objective and subjective sleep and awakening quality, which were counteracted by 100 mg trazodone, thus suggesting a key-lock principle in the treatment of nonorganic insomnia related to dysthymia with this drug.

Modulation of Purkinje cell response to glutamate during the sleep-waking cycle

The hypothesis that corticocerebellar responsiveness is modified by the behavioral state was tested in freely moving rats by evaluating the responses of extracellularly recorded Purkinje cells located in the cerebellar posterior vermis to microiontophoretically applied glutamate (8-80 nA for 3-5 s every 30-32 s) during the spontaneous sleep-waking cycle. Rats were chronically implanted for polygraphic recordings so that responses of Purkinje cells to glutamate could be related to the states of quiet waking, slow-wave sleep and paradoxical sleep. Analysis on a population of 33 neurons subjected to alternate periods of sleep and waking showed that the mean response to glutamate was significantly reduced to 75+/-18% during slow-wave sleep with respect to waking. This effect occurred independently on changes of basal firing rate which in sleep was slightly, although significantly, reduced to 94+/-12%. Independence of glutamate response modulation from changes of baseline firing was also observed in a different data set obtained from 19 Purkinje cells which were recorded during a continuous slow-wave sleep period that allowed several consecutive drug applications. In this condition responses to glutamate progressively decreased as sleep proceeded while spontaneous activity remained stable after a slight decrease at the transition from waking to sleep. Spectral analysis performed on the electroencephalogram signal, in particular on epochs centered around each glutamate pulse, revealed that for both data sets the reduction of neuronal responsiveness was related to the intensity of slow-wave sleep and more precisely to the delta and slow oscillation (0.6-4.2 Hz) content of the power spectrum of the electroencephalogram. Spontaneous and glutamate-evoked activity were also evaluated in 23 Purkinje cells during transition from slow-wave sleep to paradoxical sleep. In particular, during paradoxical sleep spontaneous activity became irregular so that for 44 out of 90 glutamate responses quantification was unreliable. The remaining 46 responses were characterized by high variability in amplitude even within the same episode of paradoxical sleep. With respect to the preceding slow-wave sleep values, 17/46 responses increased, 14/46 decreased and 15/46 remained within the 15% limit, giving a mean value of 132%. These data indicate that Purkinje cell response to glutamate is modulated during the spontaneous sleep-waking cycle. We speculate that this modulation depends upon the action of the neuromodulatory systems which diffusely project to the cerebellum, whose function would be to adapt the performance of the cerebellar circuits to changes of the animal state. On the other hand, the phasic changes in amplitude of Purkinje cell response during paradoxical sleep could be due to the interaction between the effects of glutamate application and those exerted by endogenous signals possibly related to the phasic events of this sleep stage.

The REM sleep-memory consolidation hypothesis

It has been hypothesized that REM (rapid eye movement) sleep has an important role in memory consolidation. The evidence for this hypothesis is reviewed and found to be weak and contradictory. Animal studies correlating changes in REM sleep parameters with learning have produced inconsistent results and are confounded by stress effects. Humans with pharmacological and brain lesion-induced suppression of REM sleep do not show memory deficits, and other human sleep-learning studies have not produced consistent results. The time spent in REM sleep is not correlated with learning ability across humans, nor is there a positive relation between REM sleep time or intensity and encephalization across species. Although sleep is clearly important for optimum acquisition and performance of learned tasks, a major role in memory consolidation is unproven.

Sleep, learning, and dreams: off-line memory reprocessing

Converging evidence and new research methodologies from across the neurosciences permit the neuroscientific study of the role of sleep in off-line memory reprocessing, as well as the nature and function of dreaming. Evidence supports a role for sleep in the consolidation of an array of learning and memory tasks. In addition, new methodologies allow the experimental manipulation of dream content at sleep onset, permitting an objective and scientific study of this dream formation and a renewed search for the possible functions of dreaming and the biological processes subserving it.

The role of sleep in learning and memory

Sleep has been implicated in the plastic cerebral changes that underlie learning and memory. Indications that sleep participates in the consolidation of fresh memory traces come from a wide range of experimental observations. At the network level, reactivations during sleep of neuronal assemblies recently challenged by new environmental circumstances have been reported in different experimental designs. These neuronal assemblies are proposed to be involved in the processing of memory traces during sleep. However, despite this rapidly growing body of experimental data, evidence for the influence of sleep discharge patterns on memory traces remains fragmentary. The underlying role of sleep in learning and memory has yet to be precisely characterized.

Hypothalamic regulation of sleep

The recent discovery linking narcolepsy, a sleep disorder characterized by very short REM sleep latency, with a neuropeptide that regulates feeding and energy metabolism, provides a way to understand how several behaviors may be disrupted as a result of a defect in this peptide. In this chapter we review the evidence linking hypocretin and sleep, including our own studies, and propose that a defect in the lateral hypothalamus that also involves the hypocretin neurons is likely to produce a disturbance in sleep, mood, appetite, and rhythms.

Arousal response to hypoxia in newborn mice

We examined the arousal response to 5% O(2) in newborn mice at several ages before and after peripheral chemoreceptor resetting, namely, at 3, 12, and 48 h (n=22 in each group). Breathing was measured by whole-body flow barometric plethysmography. Sleep and arousal were determined behaviourally. We found that: (1) the arousal response was present in all age groups; (2) the arousal response occurred during the hypoxic ventilatory decline in all age groups, showing that mechanoreceptor input was not sufficient to trigger arousal; and (3) arousal latency was shorter after than before chemoreceptor resetting, suggesting a contribution of chemoreceptors to arousal. We conclude that arousal may contribute to the hypoxic ventilatory response in the early postnatal period in mice and that it should be taken into consideration in studies of ventilatory control maturation in newborns.

Central and baroreflex control of heart rate during the wake-sleep cycle in rat

Spontaneous fluctuations in Heart Period (HP) and Mean Arterial Pressure (MAP) make it possible to evaluate baroreceptor-heart rate reflex sensitivity (BRS). 30-s sequences of HP and MAP beat-to-beat values were considered in the different wake-sleep states (Wake, W; Quiet Sleep, QS; Active Sleep, AS) in rats to assess whether 1) BRS changes between states and 2) the different indexes supply consistent BRS measures. BRS indexes were calculated according to validated literature procedures as regression coefficients of HP vs. MAP 1) within all ramps of increasing or decreasing MAP of four beats or more, with HP and MAP changing in the same direction (baroreflex-mediated fluctuations, BRSp), 2) within all such ramps irrespective of the relative direction of HP and MAP changes (baroreflex + non-baroreflex, i.e. non-homeostatic centrally driven, fluctuations, BRSA). HP vs. MAP regression coefficient along the entire 30-s sequence (bHPMAP) was also calculated.

RESULTS

BRSp did not change among states, BRSA decreased from QS to W to AS, bHPMAP decreased from QS to W and became negative in AS.

CONCLUSIONS

1) as indicated by BRSp, baroreflex sensitivity is state independent, 2) BRSp to BRS(A) to bHPMAP are increasingly affected by non-baroreflex fluctuations, BRSp being most apt to measure BRS, 3) non-homeostatic MAP and HP fluctuations increase from QS to W and prevail in AS. These potentially harmful fluctuations are normally buffered by baroreflexes: in the case of baroreflex impairment, circulatory risk may arise in conditions like AS, when they prevail.

Role of school schedule, age, and parental socioeconomic status on sleep duration and sleepiness of Parisian children

The aim of the study was to assess the duration and quality of sleep of prepubertal (Tanner Scale level 1) physically and mentally healthy children as a function of school schedule (4 versus 4.5 days per week), age and grade (median age of 9.5 years for 4th grade versus median age of 10.5 years for 5th grade), school district (wealthy versus nonwealthy) in Paris, France, and parental socioeconomic status (high, medium, or low). We studied 51 girl and 44 boy volunteer pupils with written parental consent. The study lasted 2 weeks during the month of March. During the first study week, the children attended school 4.5 days, and during the second week, they attended school only 4 days without difference in the length of the school day. A sleep log was used to ascertain time of lights off for sleep and lights on at awakening, nighttime sleep duration, and self-rated sleep quality. A visual analog scale (VAS) was also used by pupils to self-rate the level of perceived sleepiness at four specific times of the school day. Conventional statistical methods (e.g., t and chi2 tests) were used to examine differences in mean values. Sleep duration, self-rated sleepiness, and subjective sleep quality were comparable (P > .05) by gender, school schedule, school district, and parental socioeconomic status. Overall, the sleep of this sample of Parisian children around 10 years of age was rather stable in its duration and timing, suggesting flexibility to adjust to the different school schedules.

Normal ranges for the variability in heart rate in young infants while sleeping

OBJECTIVE

Measurements of the variability in heart rate are increasingly used as markers of cardiac autonomic activity. We sought to establish the development this variability in healthy young infants while sleeping.

PATIENTS

We carried out polygraphic studies with electrocardiographic recording in 587 healthy infants aged from 5 to 26 weeks.

METHODS

We determined several variables over a period of 400 minutes sleeping: mean RR interval, 5 time-domain (SDNN, SDNNi, SDANNi, RMSSD, and pNN50) and 5 frequency-domain indexes (spectral power over 3 regions of interest, total power and low-to-high frequency ratio). Frequency-domain indexes were also assessed separately for the periods of quiet sleep and those of rapid eye movement sleep.

RESULTS

Our data showed a significant correlation between the indexes of heart rate variability and the mean RR interval, the breathing rate, and the corrected age of the infants. We also demonstrated the importance of the maturation of the sleeping patterns.

CONCLUSION

These data in a large cohort of healthy infants confirm a progressive maturation of the autonomic nervous system during sleep, and may be used to examine the influence of physiological and pathophysiological factors on autonomic control during polygraphic studies.

Positron emission tomography with deoxyglucose-F18 imaging of sleep

Positron emission tomography with deoxyglucose-F18 was obtained during nighttime sleep in 36 normal volunteers, 12 studied in rapid eye movement sleep (REM period 2), 12 in nonREM sleep, and 12 while awake with eyes closed. Metabolic rate was higher throughout the cortex in REM than nonREM sleep, with differences most marked in the cingulate and frontal cortex, thalamus, and visual association areas. Whole-brain metabolic rates in the waking condition were intermediate between those in REM and nonREM sleep. Metabolism in the primary visual cortex and parts of the lateral temporal lobe was relatively constant in the REM/nonREM conditions. REM sleep did not differ from either the nonREM or waking conditions in hemispheric lateralization of metabolic activity. Compared with REM sleep, nonREM sleep was associated with significantly lower metabolic rates in the temporal and occipital regions, as well as the thalamus.

Retinal circadian rhythms in humans

Circadian rhythms in the retina may reflect intrinsic rhythms in the eye. Previous reports on circadian variability in electrophysiological human retinal measures have been scanty, and the results have been somewhat inconsistent. We studied the circadian variation of the electrooculography (EOG), electroretinography (ERG), and visual threshold (VTH) in subjects undergoing a 36h testing period. We used an ultrashort sleep-wake cycle to balance effects of sleep and light-dark across circadian cycles. Twelve healthy volunteers (10 males, 2 females; mean age 26.3 years, standard deviation [SD] 8.0 years, range 19-40 years) participated in the study. The retinal functions and oral temperature were measured every 90 min. The EOG was measured in the light, whereas the ERG and the VTH were measured in the dark. Sleep was inferred from activity detected by an Actillume monitor. The EOG peak-to-peak responses followed a circadian rhythm, with the peak occurring late in the morning (acrophase 12:22). The ERG b-wave implicit time peaked in the early morning (acrophase 06:46). No statistically significant circadian rhythms could be demonstrated in the ERG a-wave implicit time or peak-to-peak amplitude. The VTH rhythm peaked in the early morning (acrophases 07:59 for blue and 07:32 for red stimuli). All retinal rhythms showed less-consistent acrophases than the temperature and sleep rhythms. This study demonstrated several different circadian rhythms in retinal electrophysiological and psychophysical measures of healthy subjects. As the retinal rhythms had much poorer signal-to-noise ratios than the temperature rhythm, these measures cannot be recommended as circadian markers.

Circadian clues to sleep onset mechanisms

Thermoregulatory processes have long been implicated in initiation of human sleep. A meta-analysis of studies carried out under the controlled conditions of a constant routine protocol followed by nocturnal sleep revealed that heat loss, indirectly measured by the distal-proximal skin temperature gradient, was the best predictor variable for sleep onset latency (compared with core body temperature or its rate of change, heart rate, melatonin onset, and subjective sleepiness ratings). The cognitive signal of "lights out" induced relaxation, with a consequent shift in heat redistribution from the core to the periphery (as measured by an abrupt increase in skin temperatures and a rapid fall in heart rate). These thermoregulatory changes took place before sleep onset: sleep itself had minor further effects. Thus, when the confounding, long-lasting masking effects of lying down are controlled for, circadian thermoregulation initiates sleep, but does not appear to play a major role in its maintenance.

Sleep, performance, circadian rhythms, and light-dark cycles during two space shuttle flights

Sleep, circadian rhythm, and neurobehavioral performance measures were obtained in five astronauts before, during, and after 16-day or 10-day space missions. In space, scheduled rest-activity cycles were 20-35 min shorter than 24 h. Light-dark cycles were highly variable on the flight deck, and daytime illuminances in other compartments of the spacecraft were very low (5.0-79.4 lx). In space, the amplitude of the body temperature rhythm was reduced and the circadian rhythm of urinary cortisol appeared misaligned relative to the imposed non-24-h sleep-wake schedule. Neurobehavioral performance decrements were observed. Sleep duration, assessed by questionnaires and actigraphy, was only approximately 6.5 h/day. Subjective sleep quality diminished. Polysomnography revealed more wakefulness and less slow-wave sleep during the final third of sleep episodes. Administration of melatonin (0.3 mg) on alternate nights did not improve sleep. After return to earth, rapid eye movement (REM) sleep was markedly increased. Crewmembers on these flights experienced circadian rhythm disturbances, sleep loss, decrements in neurobehavioral performance, and postflight changes in REM sleep.