Sleep in a sitting position: effect of triazolam on sleep stages and EEG power spectra

Effects of moderate alcohol consumption and hypobaric hypoxia: implications for passengers' sleep, oxygen saturation and heart rate on long-haul flights

BACKGROUND

Passengers on long-haul flights frequently consume alcohol. Inflight sleep exacerbates the fall in blood oxygen saturation (SpO2) caused by the decreased oxygen partial pressure in the cabin. We investigated the combined influence of alcohol and hypobaric hypoxia on sleep, SpO2 and heart rate.

METHODS

Two groups of healthy individuals spent either two nights with a 4-hour sleep opportunity (00:00-04:00 hours) in the sleep laboratory (n=23; 53 m above sea level) or in the altitude chamber (n=17; 753 hPa corresponding to 2438 m above sea level, hypobaric condition). Participants consumed alcohol before one of the nights (mean±SE blood alcohol concentration 0.043±0.003%). The order of the nights was counterbalanced. Two 8-hour recovery nights (23:00-07:00 hours) were scheduled between conditions. Polysomnography, SpO2 and heart rate were recorded.

RESULTS

The combined exposure to alcohol and hypobaric condition decreased SpO2 to a median (25th/75th percentile) of 85.32% (82.86/85.93) and increased heart rate to a median (25th/75th percentile) of 87.73 bpm (85.89/93.86) during sleep compared with 88.07% (86.50/88.49) and 72.90 bpm (70.90/78.17), respectively, in the non-alcohol hypobaric condition, 94.97% (94.59/95.33) and 76.97 bpm (65.17/79.52), respectively, in the alcohol condition and 95.88% (95.72/96.36) and 63.74 bpm (55.55/70.98), respectively, in the non-alcohol condition of the sleep laboratory group (all p<0.0001). Under the combined exposure SpO2 was 201.18 min (188.08/214.42) below the clinical hypoxia threshold of 90% SpO2 compared with 173.28 min (133.25/199.03) in the hypobaric condition and 0 min (0/0) in both sleep laboratory conditions. Deep sleep (N3) was reduced to 46.50 min (39.00/57.00) under the combined exposure compared with both sleep laboratory conditions (alcohol: 84.00 min (62.25/92.75); non-alcohol: 67.50 min (58.50/87.75); both p<0.003).

CONCLUSIONS

The combination of alcohol and inflight hypobaric hypoxia reduced sleep quality, challenged the cardiovascular system and led to extended duration of hypoxaemia (SpO2 <90%).

[Sleep in a performance artist: Eight days and seven nights sitting inside a metal sculpture]

Sleep in extreme situations has been little studied. The artist Abraham Poincheval (AP) is known for his performances in confined spaces. For his show at the Perrotin Gallery in Paris, he was enclosed for 8days and 7nights in a metal sculpture of his body in a seated position, with his head facing a work by Hans Hartung at the end of a cone system placed in front of his eyes which occluded all other visual stimuli. The interior of the metal structure was not padded and there was no head support. His sleep and internal temperature were continuously recorded using polysomnography (Grael, Compumedics) and an orally swallowed temperature sensitive capsule (Bodycap) with temperature sampling every 2min. AP slept an average of 355.1min/24h, composed of light slow-wave sleep (N1: 47.1min, N2: 192.2min), deep slow-wave sleep (N3: 100.4min), and REM sleep 4,3 % (15.4min). Sleep, although mostly nocturnal, was split into periods of no more than 20min. Deep sleep was therefore remarkably resistant to the uncomfortable experimental conditions, while REM sleep was markedly impaired, lasting only a few short minutes and followed by rapid awakening. This is probably due to the head position within the sculpture which was unsupported, so REM sleep with its inherent muscle atonia led to involuntary head flexion and was impossible to sustain for long. The thermal minimum was between 5:17 a.m. and 6:35 a.m. The amplitude of the core temperature decreased by more than 30 % between the beginning and the end of the protocol. Despite the immobility induced by the confined experimental conditions, there was no desynchronization of circadian rhythms. The sleep time was surprisingly long given the conditions, and slow-wave sleep was relatively preserved with an amount typically found in normal subjects while REM sleep was markedly impaired. Slow-wave sleep is clearly preserved underlying its central role in physical and mental homeostasis. REM sleep is clearly more fragile. The reduction in REM sleep linked to position has been found in a study of sleep in the sitting position in airplanes where loss of muscle tonus in the neck fragments REM sleep. Techniques for selective REM sleep deprivation also use muscle atonia: one of the initial techniques of selective REM sleep deprivation relied on muscle atonia in REM causing a cat to fall from a small perch into water. In man, the lack of head support is clearly a source of REM fragmentation. However in the case of this study, we cannot exclude an effect of other factors, notably the meditative techniques used by the performer to maintain attention on the painting, described as a dream state punctuated by visual hallucinations. Surprisingly, despite physical isolation within the sculpture, AP's biological rhythms remained stable. However, the conditions were not those of complete isolation: noise, the presence of the public in the gallery who occasionally talked to AP through the sculpture, and variations in light during the day were all temporal cues. In addition, a heatwave during the performance raised the temperature in the room with reduced total sleep time on the hottest night. Although the phase of the circadian rhythm measured by the internal temperature did not change, the amplitude fell which is compatible with reduced physical activity. In conclusion, under physically constraining and uncomfortable sleep conditions, deep sleep is maintained while REM sleep is starkly reduced. From a homeostatic point of view, this means that over a short period of time, in a survival situation, energy recovery through deep slow-wave sleep takes priority over REM sleep.

Effect of Seat Angle when Sleeping in a Car on Quality of Sleep and Its Impact on Calculation Performance the Following Day

The number of occasions to stay in a car overnight is increasing during disasters; however, the effects on sleep and the impact on daytime functioning are not well understood. We investigated the effect of seat angle when sleeping in a car and its impact on calculation performance the following day. Fifteen healthy males participated in three trials (sleeping in a car with the front seat angled at 45° and 60° in a laboratory and sleeping at home); sleep and calculation performance the following day were compared. Increased wake after sleep onset and decreased slow-wave sleep were observed in the 60° trial, that is, near-vertical, compared with the others. Subjective sleep quality and calculation performance in the 45° and 60° trials were poorer than those in the home trial. The effect of seat angle on sleep was confirmed objectively, but not subjectively, suggesting that a large seat angle might cause sleep impairment.

Sleep-Induced Hypoxia under Flight Conditions: Implications and Countermeasures for Long-Haul Flight Crews and Passengers

PURPOSE

Recuperation during sleep on board of commercial long-haul flights is a safety issue of utmost importance for flight crews working extended duty periods. We intended to explore how sleep and blood oxygenation (in wake versus sleep) are affected by the conditions in an airliner at cruising altitude.

METHODS

Healthy participants' sleep was compared between 4-h sleep opportunities in the sleep laboratory (n = 23; sleep lab, ie, 53 m above sea level) and in an altitude chamber (n = 20; flight level, ie, 753 hPa, corresponding to 2438 m above sea level). A subgroup of 12 participants underwent three additional conditions in the altitude chamber: 1) 4-h sleep at ground level, 2) 4-h sleep at flight level with oxygen partial pressure equivalent to ground level, 3) 4-h monitored wakefulness at flight level. Sleep structure and blood oxygenation were analysed with mixed ANOVAs.

RESULTS

Total sleep time at flight level compared to in the sleep laboratory was shorter (Δ mean ± standard error -11.1 ± 4.2 min) and included less N3 sleep (Δ -17.6 ± 5.4 min), while blood oxygenation was decreased. Participants spent 69.7% (± 8.3%) of the sleep period time but only 13.2% (± 3.0%) of monitored wakefulness in a hypoxic state (<90% oxygen saturation). Oxygen enrichment of the chamber prevented oxygen desaturation.

CONCLUSION

Sleep - but not wakefulness - under flight conditions induces hypobaric hypoxia which may contribute to impaired sleep. The results caution against the assumption of equivalent crew recovery in-flight and on the ground but hold promise for oxygen enrichment as a countermeasure. The present results have implications for flight safety and possible long-term consequences for health in crews.

Effect of Time (Season, Surgical Starting Time, Waiting Time) on Patients with Gastric Cancer

Purpose

The purpose of the present study was to evaluate the effect of time (season, surgical starting time in the daytime, preoperative waiting time) on patients with gastric cancer.

Methods

A retrospective collection of medical records of patients who underwent gastrectomy at a single clinical center from January 2013 to December 2018 was performed. Medical records were collected, and short-term outcomes and long-term survival were analyzed by different time groups.

Results

A total of 586 patients were included in this study. In terms of surgical starting time, the midday group had a shorter operation time (p=0.017) but more complications (p=0.048) than the non-midday group. No significant difference was found based on the season of gastrectomy. The long preoperative waiting group had a shorter postoperative hospital stay than the short waiting group (p=0.026). No significant difference was found between the short-waiting group and long-waiting group in overall survival for all clinical stages. Age (p=0.040, HR=1.017, 95% CI=1.001-1.033), BMI (p<0.001, HR=0.879, 95% CI=0.844-0.953) and clinical stage (p<0.001, HR=2.053, 95% CI=1.619-2.603) were independent prognostic factors predicting overall survival; however, season of gastrectomy, surgical starting time and preoperative waiting time were not identified as independent prognostic factors.

Conclusion

Surgical starting time at the midday could cause more complications, and surgeons should be careful when the surgical starting time is midday.

Automated driving: A biomechanical approach for sleeping positions

Occupants of autonomous vehicle have frequently indicated the desire to sleep or rest while driving, yet little has been known regarding the suitable design criteria for a biomechanically reasoned in-vehicle sleeping position. This study was aimed at evaluating the biomechanical quality of different backrest and seat pan angle combinations, and at predicting the most favourable sleeping positions based on vehicle restriction. More specifically, the interface pressure distribution and subjective suitability rating of 23 subjects was assessed in a total of nine (3 × 3) combinations of seat pan (20°, 30°, 40°) and backrest (145°, 155°, 165°) angles. Biomechanical quality was evaluated with an interface pressure score (IPS) based on sensitivity weighted pressures and the total contact area. Two-way repeated measures ANOVA revealed that IPS significantly improves with increasing seat pan angle whereas backrest angles of 155° or 165° lead to significant better IPS compared to flatter ones (145°). The overall highest IPS was observed for a 40°-seat pan angle in combination with a 155°-backrest angle. Subjective suitability rating revealed that people prefer a combination of 165° backrest angle with a seat pan of 20°; however, eight of nine combinations can be considered as suitable for sleeping. Therefore, the combination of a 40°-seat pan angle and 155° backrest is recommended by the present study for an in-vehicle sleeping position due to the increased biomechanical quality.

What works for jetlag? A systematic review of non-pharmacological interventions

Jetlag is a combination of travel fatigue and circadian misalignment resulting from air travel across time zones. Routinely recommended interventions based on circadian science include timely exposure to light and darkness (scheduled sleep), but the real-world effectiveness of these and other non-circadian strategies is unknown. We systematically reviewed the evidence for non-pharmacological interventions for jetlag. PubMed, EMBASE, Scopus, and Web of Science were searched. Studies reviewed 1) involved human participants undergoing air travel with a corresponding shift in the external light-dark cycle; 2) administered a non-pharmacological intervention; 3) had a control or comparison group; and 4) examined outcomes such as jetlag symptoms, sleep, cognitive/physical performance, mood, fatigue, or circadian markers. Thirteen studies used light exposure, physical activity, diet, chiropractic treatment, or a multifaceted intervention to counteract jetlag. Nine studies found no significant change in the outcomes, three reported mixed findings, and one was positive. The null findings are likely due to poorly designed circadian interventions and neglect of contributors to travel fatigue. Higher quality studies that schedule darkness as well as light, in the periods before, during, and after flight are needed to reduce the circadian component of jetlag. Interventions should also address the stressors that contribute to travel fatigue.

Skin temperature, sleep, and vigilance

A large number of studies have shown a close association between the 24-hour rhythms in core body temperature and sleep propensity. More recently, studies have have begun to elucidate an intriguing association of sleep with skin temperature as well. The present chapter addresses the association of sleep and alertness with skin temperature. It discusses whether the association could reflect common underlying drivers of both sleep propensity and skin vasodilation; whether it could reflect efferents of sleep-regulating brain circuits to thermoregulatory circuits; and whether skin temperature could provide afferent input to sleep-regulating brain circuits. Sleep regulation and concomitant changes in skin temperature are systematically discussed and three parallel factors suggested: a circadian clock mechanism, a homeostatic hourglass mechanism, and a third set of sleep-permissive and wake-promoting factors that gate the effectiveness of signals from the clock and hourglass in the actual induction of sleep or maintenance of alert wakefulness. The chapter moreover discusses how the association between skin temperature and arousal can change with sleep deprivation and insomnia. Finally it addresses whether the promising laboratory findings on the effects of skin temperature manipulations on vigilance can be applied to improve sleep in everyday life.

Effects of oral temazepam on slow waves during non-rapid eye movement sleep in healthy young adults: A high-density EEG investigation

Slow waves are characteristic waveforms that occur during non-rapid eye movement (NREM) sleep that play an integral role in sleep quality and brain plasticity. Benzodiazepines are commonly used medications that alter slow waves, however, their effects may depend on the time of night and measure used to characterize slow waves. Prior investigations have utilized minimal scalp derivations to evaluate the effects of benzodiazepines on slow waves, and thus the topography of changes to slow waves induced by benzodiazepines has yet to be fully elucidated. This study used high-density electroencephalography (hdEEG) to evaluate the effects of oral temazepam on slow wave activity, incidence, and morphology during NREM sleep in 18 healthy adults relative to placebo. Temazepam was associated with significant decreases in slow wave activity and incidence, which were most prominent in the latter portions of the sleep period. However, temazepam was also associated with a decrease in the magnitude of high-amplitude slow waves and their slopes in the first NREM sleep episode, which was most prominent in frontal derivations. These findings suggest that benzodiazepines produce changes in slow waves throughout the night that vary depending on cortical topography and measures used to characterize slow waves. Further research that explores the relationships between benzodiazepine-induced changes to slow waves and the functional effects of these waveforms is indicated.

Effects of oral temazepam on sleep spindles during non-rapid eye movement sleep: A high-density EEG investigation

Benzodiazepines are commonly used medications that alter sleep spindles during non-rapid eye movement (NREM) sleep, however the topographic changes to these functionally significant waveforms have yet to be fully elucidated. This study utilized high-density electroencephalography (hdEEG) to investigate topographic changes in sleep spindles and spindle-range activity caused by temazepam during NREM sleep in 18 healthy adults. After an accommodation night, sleep for all participants was recorded on two separate nights after taking either placebo or oral temazepam 15 mg. Sleep was monitored using 256-channel hdEEG. Spectral analysis and spindle waveform detection of sleep EEG data were performed for each participant night. Global and topographic data were subsequently compared between temazepam and placebo conditions. Temazepam was associated with significant increases in spectral power from 10.33 to 13.83 Hz. Within this frequency band, temazepam broadly increased sleep spindle duration, and topographically increased spindle amplitude and density in frontal and central-posterior regions, respectively. Higher frequency sleep spindles demonstrated increased spindle amplitude and a paradoxical decrease in spindle density in frontal and centroparietal regions. Further analysis demonstrated temazepam both slowed the average frequency of spindle waveforms and increased the relative proportion of spindles at peak frequencies in frontal and centroparietal regions. These findings suggest that benzodiazepines have diverse effects on sleep spindles that vary by frequency and cortical topography. Further research that explores the relationships between topographic and frequency-dependent changes in pharmacologically-induced sleep spindles and the functional effects of these waveforms is indicated.

Impact of acetazolamide and CPAP on cortical activity in obstructive sleep apnea patients

STUDY OBJECTIVES

1) To investigate the impact of acetazolamide, a drug commonly prescribed for altitude sickness, on cortical oscillations in patients with obstructive sleep apnea syndrome (OSAS). 2) To examine alterations in the sleep EEG after short-term discontinuation of continuous positive airway pressure (CPAP) therapy.

DESIGN

Data from two double-blind, placebo-controlled randomized cross-over design studies were analyzed.

SETTING

Polysomnographic recordings in sleep laboratory at 490 m and at moderate altitudes in the Swiss Alps: 1630 or 1860 m and 2590 m.

PATIENTS

Study 1: 39 OSAS patients. Study 2: 41 OSAS patients.

INTERVENTIONS

Study 1: OSAS patients withdrawn from treatment with CPAP. Study 2: OSAS patients treated with autoCPAP. Treatment with acetazolamide (500-750 mg) or placebo at moderate altitudes.

MEASUREMENTS AND RESULTS

An evening dose of 500 mg acetazolamide reduced slow-wave activity (SWA; approximately 10%) and increased spindle activity (approximately 10%) during non-REM sleep. In addition, alpha activity during wake after lights out was increased. An evening dose of 250 mg did not affect these cortical oscillations. Discontinuation of CPAP therapy revealed a reduction in SWA (5-10%) and increase in beta activity (approximately 25%).

CONCLUSIONS

The higher evening dose of 500 mg acetazolamide showed the "spectral fingerprint" of Benzodiazepines, while 250 mg acetazolamide had no impact on cortical oscillations. However, both doses had beneficial effects on oxygen saturation and sleep quality.

Sleep, vigilance, and thermosensitivity

The regulation of sleep and wakefulness is well modeled with two underlying processes: a circadian and a homeostatic one. So far, the parameters and mechanisms of additional sleep-permissive and wake-promoting conditions have been largely overlooked. The present overview focuses on one of these conditions: the effect of skin temperature on the onset and maintenance of sleep, and alertness. Skin temperature is quite well suited to provide the brain with information on sleep-permissive and wake-promoting conditions because it changes with most if not all of them. Skin temperature changes with environmental heat and cold, but also with posture, environmental light, danger, nutritional status, pain, and stress. Its effect on the brain may thus moderate the efficacy by which the clock and homeostat manage to initiate or maintain sleep or wakefulness. The review provides a brief overview of the neuroanatomical pathways and physiological mechanisms by which skin temperature can affect the regulation of sleep and vigilance. In addition, current pitfalls and possibilities of practical applications for sleep enhancement are discussed, including the recent finding of impaired thermal comfort perception in insomniacs.

Characteristic EEG differences between voluntary recumbent sleep onset in bed and involuntary sleep onset in a driving simulator

OBJECTIVE

To investigate the differences in electroencephalographic (EEG) characteristics for voluntary sleep onset in bed sleeping and involuntary sleep onset in driving.

METHODS

EEG measurement and analysis on 20 human subjects were conducted during recumbent bed sleeping as well as involuntary sleeping during a simulated driving platform. Each experiment was conducted on separate days.

RESULTS

Vertex and spindle waves showed differing morphology under each condition. Vertex sharpness during recumbent sleep onset was significantly sharper than involuntary sleep onset during simulated driving. Sharpness of vertices from night-driving was significantly sharper than with day-driving. Triple conjoined vertex waves only occurred with voluntary recumbent sleep onset. A conjoined vertex spindle waveform was statistically associated with sleep onset whilst driving.

CONCLUSIONS

This study has identified distinctive differences in EEG graphoelements during the sleep onset phase of recumbent and simulated driving conditions suggesting that EEG graphoelements are affected by cortical processes and vary according to the prevalent sleep condition.

SIGNIFICANCE

This study could provide a further basis for developing safety alerting devices for the detection of sleep onset in the hope of improving driving safety.

Extract of Ganoderma lucidum potentiates pentobarbital-induced sleep via a GABAergic mechanism

Ganoderma lucidum has been used for the treatment of a variety of diseases. For the first time here we report a detailed study on the mechanisms and effects of G. lucidum aqueous extract (GLE) on sleep and its sedative activity. GLE showed no effects on sleep architecture in normal rats at doses of 80 and 120 mg/kg. However, GLE significantly decreased sleep latency, increased sleeping time, non-REM sleep time and light sleep time in pentobarbital-treated rats. Suppression of locomotor activity in normal mice induced by GLE was also observed. Flumazenil, a benzodiazepine receptor antagonist, at a dose of 3.5 mg/kg showed a significant antagonistic effect on the shortening in sleep latency, increase in sleeping time, non-REM sleep time or light sleep time in pentobarbital-treated rat induced by GLE. Significant effect was also observed with GLE on delta activity during non-REM sleep and flumazenil did not block this effect. In conclusion, GLE may be a herb having benzodiazepine-like hypnotic activity at least in part.

Effects of kava-kava extract on the sleep-wake cycle in sleep-disturbed rats

RATIONALE

Kava-kava extract may be useful as an herbal medicine for treatment of insomnia and anxiety.

OBJECTIVES

The present study was undertaken to investigate the effects of kava-kava extract on the sleep-wake cycle in comparison with that of flunitrazepam using sleep-disturbed rats.

METHODS

Electrodes for measurement of electroencephalogram (EEG) and electromyogram (EMG) were implanted into the frontal cortex and the dorsal neck muscle of rats. EEG and EMG were recorded with an electroencephalogram. SleepSign ver.2.0 was used for EEG and EMG analysis. Total times of wakefulness, non-rapid eye movement (non-REM) and REM sleep were measured from 09:00 to 15:00.

RESULTS

A significant shortening of the sleep latency in sleep-disturbed rats was observed following the administration of kava-kava extract at a dose of 300 mg/kg, while no effects were observed on the total waking and non-REM sleep time. On the other hand, flunitrazepam showed a significant shortening in sleep latency, decrease in total waking time and increase in total non-REM sleep time. Although the effects of flunitrazepam were antagonized by the benzodiazepine receptor antagonist flumazenil, the effect of kava-kava extract was not antagonized by flumazenil. Kava-kava extract showed a significant increase in delta activity during non-REM sleep in sleep-disturbed rats, whereas a significant decrease in delta power during non-REM sleep was observed with flunitrazepam. Flumazenil caused no significant effect on the changes in delta activity induced by both kava-kava extract and flunitrazepam.

CONCLUSIONS

Kava-kava extract is an herbal medicine having not only hypnotic effects, but also sleep quality-enhancement effects.

Modulation of rhythmic brain activity by diazepam: GABA(A) receptor subtype and state specificity

The inhibitory neurotransmitter gamma-aminobutyric acid (GABA) is involved in the generation of various brain rhythmic activities that can be modulated by benzodiazepines. Here, we assessed the contribution of alpha(2)GABA type A (GABA(A)) receptors to the effects of benzodiazepines on sleep and waking oscillatory patterns by combining pharmacological and genetic tools. The effects of diazepam on the electroencephalogram were compared between alpha(2)(H101R) knock-in mice in which the alpha(2)GABA(A) receptor was rendered diazepam-insensitive, and their wild-type controls. The suppression of delta activity typically induced by diazepam in non-rapid eye movement (REM) sleep was significantly stronger in wild-type control mice than in alpha(2)(H101R) mice. Moreover, electroencephalogram frequency activity above 16-18 Hz was enhanced in wild-type mice both in non-REM sleep and waking. This effect was absent in alpha(2)(H101R) mice. Theta activity was enhanced after diazepam both in REM sleep and in waking in wild-type mice. In alpha(2)(H101R) mice, this effect was markedly reduced in REM sleep whereas it persisted in waking. These findings suggest that alpha(2)GABA(A) receptors, which are expressed in hypothalamic and pontine nuclei and in the hippocampus, are localized in distinct neural circuits relevant for the modulation of rhythmic brain activities by benzodiazepines.

Diazepam-induced changes on sleep and the EEG spectrum in mice: role of the alpha3-GABA(A) receptor subtype

Benzodiazepines reduce EEG slow-wave activity in non-REM sleep by potentiating GABAergic neurotransmission at GABAA receptors via a modulatory binding site. However, the mechanisms of action underlying the effects of benzodiazepines on sleep and the sleep EEG are still unknown. Slow waves during sleep are generated by the corticothalamic system and synchronized by the inhibitory GABAergic neurons of the reticular thalamic nucleus. This region contains exclusively alpha3-containing GABAA receptors. We investigated the role of these receptors in the mediation of diazepam effects on the sleep EEG by studying point-mutated mice in which the alpha3-GABAA receptor is diazepam-insensitive [alpha3(H126R)]. Sleep was recorded for 12 h after i.p. injection of 3 mg/kg diazepam or vehicle at light onset in alpha3(H126R) and wild-type controls (n = 13-17 per genotype). The main effect was a marked reduction of slow-wave activity (EEG power density in 0.75-4.00 Hz) in non-REM sleep and a concomitant increase in frequencies above 15.00 Hz in non-REM sleep and waking in both genotypes. Neither effect of diazepam differed significantly between the genotypes. Despite the exclusive expression of alpha3-containing GABAA receptors in the reticular thalamic nucleus, these receptors do not seem to be critical for the mediation of the effects of diazepam on the sleep EEG.

Body posture affects electroencephalographic activity and psychomotor vigilance task performance in sleep-deprived subjects

OBJECTIVE

This study examined the effects of posture on electroencephalographic (EEG) activity and psychomotor vigilance task (PVT) performance in 16 sleep-deprived volunteers.

METHODS

EEG data were collected while participants completed 10 min PVTs under two counterbalanced sitting/standing conditions during 28 h of continuous wakefulness.

RESULTS

In both the sitting and standing conditions, theta activity progressively increased as a function of sleep loss, but standing upright significantly attenuated this effect, suggesting that alertness was improved by the more upright posture. The PVT results showed that cognitive psychomotor performance was maintained at nearly well-rested levels by standing upright, whereas reaction time and attention noticeably deteriorated when participants were seated.

CONCLUSIONS

These results suggest that an upright posture increases EEG arousal and sustained attention, indicating that postural manipulations can be useful for counteracting fatigue in sleep-deprived individuals.

Diazepam-induced changes in sleep: role of the alpha 1 GABA(A) receptor subtype

Ligands acting at the benzodiazepine (BZ) site of gamma-aminobutyric acid type A (GABA(A)) receptors currently are the most widely used hypnotics. BZs such as diazepam (Dz) potentiate GABA(A) receptor activation. To determine the GABA(A) receptor subtypes that mediate the hypnotic action of Dz wild-type mice and mice that harbor Dz-insensitive alpha1 GABA(A) receptors [alpha1 (H101R) mice] were compared. Sleep latency and the amount of sleep after Dz treatment were not affected by the point mutation. An initial reduction of rapid eye movement (REM) sleep also occurred equally in both genotypes. Furthermore, the Dz-induced changes in the sleep and waking electroencephalogram (EEG) spectra, the increase in power density above 21 Hz in non-REM sleep and waking, and the suppression of slow-wave activity (SWA; EEG power in the 0.75- to 4.0-Hz band) in non-REM sleep were present in both genotypes. Surprisingly, these effects were even more pronounced in alpha1(H101R) mice and sleep continuity was enhanced by Dz only in the mutants. Interestingly, Dz did not affect the initial surge of SWA at the transitions to sleep, indicating that the SWA-generating mechanisms are not impaired by the BZ. We conclude that the REM sleep inhibiting action of Dz and its effect on the EEG spectra in sleep and waking are mediated by GABA(A) receptors other than alpha1, i.e., alpha2, alpha3, or alpha5 GABA(A) receptors. Because alpha1 GABA(A) receptors mediate the sedative action of Dz, our results provide evidence that the hypnotic effect of Dz and its EEG "fingerprint" can be dissociated from its sedative action.

Functional neuroanatomy of human sleep states after zolpidem and placebo: a H215O-PET study

Changes in the functional organization of the brain during the course of sleep and waking are reflected by different patterns of regional cerebral blood flow (rCBF). To investigate the effect of the hypnotic zolpidem, a benzodiazepine receptor agonist, drug or placebo were administered to eight young, healthy men prior to bedtime. The subjects were sleep-deprived to promote sleep during the 4-h recording period in the positron emission tomography scanner. Intravenous injections of labelled water were administered during pre-drug wakefulness, and during Stage 2, Stage 4 and rapid eye movement (REM) sleep, each injection being followed by an emission scan. Statistical parametric mapping was used to investigate the effects of treatment and sleep states. During sleep (combined Stages 2 and 4, and REM sleep) relative rCBF was lower after zolpidem than after placebo in the basal ganglia and insula, and higher in the parietal cortex. A 'multiple study' analysis of REM sleep revealed that rCBF in the anterior cingulum was lower after zolpidem than after placebo, whereas rCBF in the occipital and parietal cortex, parahippocampal gyrus and cerebellum was higher. When the pooled data (drug and placebo) of Stages 2 and 4 were compared with wakefulness, rCBF was lower in prefrontal cortex and insula, and higher in the occipital and parietal cortex. The results indicate that some differences in rCBF from wakefulness to non-REM sleep are further augmented by zolpidem.

The effects of body posture on resting electroencephalographic activity in sleep-deprived subjects

OBJECTIVE

This study examined the effects of posture on the resting electroencephalographic (EEG) activity of sleep-deprived volunteers.

METHODS

EEG data were collected under two conditions at 13 separate time points. Testing was performed while subjects remained in a normal seated position and then repeated while subjects stood upright.

RESULTS

Results indicated that delta and theta activity progressively increased as a function of sleep loss, and that standing upright attenuated this effect.

CONCLUSIONS

These results suggest that an upright posture increases EEG arousal and may be useful for counteracting fatigue in sleep-deprived individuals.

Effect of unilateral somatosensory stimulation prior to sleep on the sleep EEG in humans

The hypothesis that local activation of brain regions during wakefulness affects the EEG recorded from these regions during sleep was tested by applying vibratory stimuli to one hand prior to sleep. Eight subjects slept in the laboratory for five consecutive nights. During a 6-h period prior to night 3, either the left or the right hand was vibrated intermittently (20 min on-8 min off), while prior to night 5 the same treatment was applied to the contralateral hand. The sleep EEG was recorded from frontal, central, parietal and occipital derivations and subjected to spectral analysis. The interhemispheric asymmetry index (IAI) was calculated for spectral power in nonREM sleep in the frequency range 0.25-25.0 Hz for 0.5-Hz or 1-Hz bins. In the first hour of sleep following right-hand stimulation, the IAI of the central derivation was increased relative to baseline, which corresponds to a shift of power towards the left hemisphere. This effect was most prominent in the delta range, was limited to the first hour of sleep and was restricted to the central derivation situated over the somatosensory cortex. No significant changes were observed following left-hand stimulation. Although the effect was small, it is consistent with the hypothesis that the activation of specific neuronal populations during wakefulness may have repercussions on their electrical activity pattern during subsequent sleep.