Sleep-dependent motor sequence memory consolidation in individuals with periodic limb movements

Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches?

AIMS

Although clonazepam (CLO) and melatonin (MLT) are the most frequently used treatments for REM sleep behavior disorder, the polysomnographic features associated with their use are little known. The aim of this study was to evaluate polysomnographic and clinical parameters of patients with idiopathic/isolated REM sleep behavior disorder (iRBD) treated chronically with CLO, sustained-release MLT, alone or in combination, and in a group of drug-free iRBD patients.

METHODS

A total of 96 patients were enrolled: 43 drug-free, 21 with CLO (0.5-2 mg), 20 with sustained-release MLT (1-4 mg), and 12 taking a combination of them (same doses). Clinical variables and polysomnography were collected.

RESULTS

Although clinical improvement was reported in all groups, MLT impacted sleep architecture more than the other treatments, with significant and large increase in N3 stage, moderate reduction in N2 and REM sleep, and moderate increase in REM latency. CLO moderately increased the percentage of both REM sleep and especially N2, while reducing N1 and wakefulness. Patients treated with both CLO and MLT did not show major changes in sleep architecture.

CONCLUSION

These results suggest that the administration of MLT or CLO impacts (positively) on sleep parameters of iRBD patients. However, there is a need to better stratify patients, in order to treat them in a targeted manner, depending on the patient's individual sleep architecture and expected differential effects of these agents.

Learning Monologues at Bedtime Improves Sleep Quality in Actors and Non-Actors

Several studies show that pre-sleep learning determines changes in subsequent sleep, including improvements of sleep quality. Our aims were to confirm this finding using a more ecological task (learning a theatrical monologue) and to investigate whether the effect is modulated by expertise. Using a mixed design, we compared polysomnographic recordings of baseline sleep (BL, 9-h TIB) to those of post-training sleep (TR, with the same TIB but preceded by the training session), in one group of actors (N = 11) and one of non-actors (N = 11). In both groups, TR appears reorganized and re-compacted by the learning session, as shown, among others, by a significant decrease of WASO%, awakenings, arousals, and state transitions and by a trend towards an increased number of complete cycles and total cycle time. Concerning memory performance, the number of synonyms produced was significantly higher in the morning relative to immediate recall. No between-groups differences emerged either for sleep or memory variables. Our data confirm pre-sleep learning's beneficial effect on sleep quality in an ecological context. While expertise appears not to influence memory-related sleep mechanisms, results on morning recall support the recent view that sleep's role in memory processes consists in trace "transformation" for adaptive purposes, rather than rote consolidation.

Sleep continuity, stability and organization in good and bad sleepers

The relationship between objective and subjective sleep quality is still debated. Here, we investigate differences in objective sleep parameters in habitual subjective good sleepers and bad sleepers with the aim of evaluating sleep continuity, stability and organization as possible determinants of subjective sleep quality. In total, 38 subjects (good sleepers, N = 18; bad sleepers, N = 20) underwent two nights of sleep recording. Traditional sleep parameters displayed no between-groups differences. Conversely, bad sleepers showed lower sleep continuity (awakenings frequency), stability (e.g. arousals and state transitions frequency) and organization (e.g. number of sleep cycles and time spent in cycles). Our findings point to the involvement of these measures in determining habitual sleep quality perception and suggest the possibility to include them in standard sleep assessments.

The effect of complex cognitive training on subsequent night sleep

Using a nap design, we have recently shown that training at a complex cognitive task at bedtime improves objective sleep quality by reducing sleep fragmentation. In order to extend our findings to nighttime sleep, here we assess the impact of a multi-componential cognitive task at bedtime on the subsequent sleep episode of subjects reporting habitual bad sleep, allegedly characterized by high sleep fragmentation. In a within-subjects design, 20 subjective bad sleepers underwent polysomnographic recording in three conditions: (a) baseline sleep (BL); (b) post-training sleep (TR), preceded by a complex ecological task, i.e. a modified version of the word game Ruzzle; (c) post-active control sleep (AC), preceded by a control task. Sleep in TR was more organized (higher number of cycles and longer time spent in cycles) and showed lower microarousal frequency than in AC and BL. As for sleep continuity (total and brief awakening frequency) and other stability measures (state transition and functional uncertainty period frequency, time in functional uncertainty), both TR and AC showed significant improvements compared with BL. Arousal frequency was also reduced in TR relative to BL. Our results show a clear impact of cognitive training on subsequent night sleep, basically consisting of an increase in sleep continuity, stability and organization. In our sample of bad sleepers, these post-training changes end up representing a notable sleep improvement, also consistently reflected in subjective sleep quality perception. Therefore, ecological pre-sleep cognitive training should be further studied as an easily accessible complementary approach in standard therapies for sleep-disordered populations.

Sleep changes following intensive cognitive activity

Studies over the last 40 years have mainly investigated sleep structure changes as a result of wake duration, in the frame of the classical sleep regulation theories. However, wake intervals of the same duration can profoundly differ in their intensity, which actually reflects the degree of cognitive and physical activity. Data on how sleep can be modified by wake intensity changes (initially sparse and of little consistence) have become much more substantial, especially in the frame of the intense research debate on sleep-memory relationships. Our aim is to examine the vast repertoire of sleep modifications that depend on waking cognitive manipulations, highlighting the sleep features that appear most affected. By systematically addressing this issue, we want to set the basis for future research exploring both the specific nature of the mechanisms involved and the applicative psychosocial and clinical fall-outs, in terms of possible behavioural interventions for sleep quality improvement.

Oral Delivery of Honokiol Microparticles for Nonrapid Eye Movement Sleep

Honokiol (HNK) is a small-molecule lignin extracted from Magnolia Officinalis, demonstrating high potency in promoting nonrapid eye movement (NREM) sleep by modulating the benzodiazepine site of the GABA_A receptor. However, the clinical use of HNK in the treatment of insomnia is restricted by its extremely low oral bioavailability. In the present work, enhanced oral bioavailability of HNK was achieved by loading it into poly lactide-glycolide acid microparticles (HNK-MP). After oral administration, HNK-MP demonstrated 15-fold increase of AUC_0-12 h in comparison to free HNK. The maximum blood concentration ( C_max) of HNK in HNK-MP-treated rats was 3.6 μg/mL at 2 h after oral administration, which was 6.5-fold of that in free HNK-treated rats. Oral administration of HNK-MP (20 mg/kg) efficiently increased NREM sleep by 60% by enhancing the transition from wakefulness to NREM sleep in rats. The biosafety of HNK-MP was assessed in vivo, and no damage occurred in the gastrointestinal tract. The present study provides a promising oral HNK formulation for the treatment of insomnia.