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Kawai K, Iwamoto K, Miyata S, Okada I, Ando M, Fujishiro H, Ando M, Noda A, Ozaki N. LPS and its relationship with subjective-objective discrepancies of sleep onset latency in patients with psychiatric disorders. Sci Rep 2023; 13:22637. [PMID: 38114534 PMCID: PMC10730694 DOI: 10.1038/s41598-023-49261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
Subjective-objective discrepancies in sleep onset latency (SOL), which is often observed among psychiatric patients, is attributed partly to the definition of sleep onset. Recently, instead of SOL, latency to persistent sleep (LPS), which is defined as the duration from turning out the light to the first consecutive minutes of non-wakefulness, has been utilized in pharmacological studies. This study aimed to determine the non-awake time in LPS that is most consistent with subjective sleep onset among patients with psychiatric disorders. We calculated the length of non-awake time in 30-s segments from lights-out to 0.5-60 min. The root mean square error was then calculated to determine the most appropriate length. The analysis of 149 patients with psychiatric disorders showed that the optimal non-awake time in LPS was 12 min. On the other hands, when comorbid with moderate or severe obstructive sleep apnea (OSA), the optimal length was 19.5 min. This study indicates that 12 min should be the best fit for the LPS non-awake time in patients with psychiatric disorders. When there is comorbidity with OSA, however, a longer duration should be considered. Measuring LPS minimizes discrepancies in SOL and provides important clinical information.
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Affiliation(s)
- Keita Kawai
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan.
| | - Seiko Miyata
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Ippei Okada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Motoo Ando
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akiko Noda
- Department of Biomedical Sciences, Chubu University Graduate School of Life and Health Sciences, Kasugai, Aichi, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
- Pathophysiology of Mental Disorders, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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2
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Jordan DG, Slavish DC, Dietch J, Messman B, Ruggero C, Kelly K, Taylor DJ. Investigating sleep, stress, and mood dynamics via temporal network analysis. Sleep Med 2023; 103:1-11. [PMID: 36709723 PMCID: PMC10006381 DOI: 10.1016/j.sleep.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE/BACKGROUND Prior research has emphasized the bidirectional relationships between sleep, stress, and affective states, such as depression. Given the inherent variability and fluctuations associated with sleep, assessing how sleep and affective variables function within a dynamic system may help further uncover possible causes and consequences of sleep disturbances, as well as find candidate targets for intervention. To this end, we examined dynamic relationships between self-reported stress, depressed mood, and clinically-relevant sleep parameters via temporal network analysis. METHODS Participants were 401 nurses (92% female, 78% White, Mage = 39.47 years) who completed 14 days of sleep diaries incorporating self-reported stress and depression, as well as total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. RESULTS AND CONCLUSIONS Overall, total sleep time emerged as a highly influential variable in the context of "outstrength centrality," meaning total sleep time had numerous outward connections with other variables (e.g., stress and sleep efficiency). The high outstrength centrality of total sleep time suggests this variable is a source of activation within this dynamic system. Conversely, stress showed high "instrength centrality," suggesting this variable was highly impacted by other variables in the system, such as depressed mood and sleep efficiency. These findings emphasize the importance of assessing unfolding sleep processes within a naturalistic setting, and implicate the role of total sleep time in fueling depressed mood and stress. Discussion emphasizes implications of these results for understanding the connections between sleep, stress, and depression as well as clinical relevance of these findings.
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3
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Moore PT. Infra-low frequency neurofeedback and insomnia as a model of CNS dysregulation. Front Hum Neurosci 2022; 16:959491. [PMID: 36211128 PMCID: PMC9534730 DOI: 10.3389/fnhum.2022.959491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
This paper will review what is conventionally known of sleep homeostasis and focus on insomnia as a primary manifestation of brain dysregulation, whether as a solitary symptom or as part of a larger syndrome such as post-traumatic stress disorder, PTSD. It will discuss in brief behavioral/mindfulness treatments that have been used to treat neurologic diseases, as this is germane to the phenomenology of neurofeedback (NF). It will explore how neurofeedback may work at the subconscious level and cover the current clinical experience of the effectiveness of this technique in the treatment of insomnia. It will conclude with a case presentation.
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4
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Grimaldi D, Reid KJ, Papalambros NA, Braun RI, Malkani RG, Abbott SM, Ong JC, Zee PC. Autonomic dysregulation and sleep homeostasis in insomnia. Sleep 2021; 44:6029088. [PMID: 33295989 DOI: 10.1093/sleep/zsaa274] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/24/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is common in older adults, and is associated with poor health, including cognitive impairment and cardio-metabolic disease. Although the mechanisms linking insomnia with these comorbidities remain unclear, age-related changes in sleep and autonomic nervous system (ANS) regulation might represent a shared mechanistic pathway. In this study, we assessed the relationship between ANS activity with indices of objective and subjective sleep quality in older adults with insomnia. METHODS Forty-three adults with chronic insomnia and 16 age-matched healthy sleeper controls were studied. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), objective sleep quality by electroencephalogram spectral components derived from polysomnography, and ANS activity by measuring 24-h plasma cortisol and norepinephrine (NE). RESULTS Sleep cycle analysis displayed lower slow oscillatory (SO: 0.5-1.25 Hz) activity in the first cycle in insomnia compared to controls. In insomnia, 24-h cortisol levels were higher and 24-h NE levels were lower than controls. In controls, but not in insomnia, there was a significant interaction between NE level during wake and SO activity levels across the sleep cycles, such that in controls but not in insomnia, NE level during wake was positively associated with the amount of SO activity in the first cycle. In insomnia, lower 24-h NE level and SO activity in the first sleep cycle were associated with poorer subjective sleep quality. CONCLUSION Dysregulation of autonomic activity may be an underlying mechanism that links objective and subjective measures of sleep quality in older adults with insomnia, and potentially contribute to adverse health outcomes.
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Affiliation(s)
- Daniela Grimaldi
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kathryn J Reid
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Nelly A Papalambros
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Rosemary I Braun
- Biostatistics Division, Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL, USA.,Department of Physics and Astronomy, Northwestern University, Evanston, IL, USA
| | - Roneil G Malkani
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sabra M Abbott
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jason C Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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5
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Hong JK, Lee HJ, Chung S, Yoon IY. Differences in sleep measures and waking electroencephalography of patients with insomnia according to age and sex. J Clin Sleep Med 2021; 17:1175-1182. [PMID: 33590824 DOI: 10.5664/jcsm.9156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep characteristics are known to be different according to age and sex. The objective of this study was to investigate differences in sleep parameters and quantitative electroencephalography of patients with insomnia according to age and sex. METHODS Patients with insomnia disorder ages 40-79 years were recruited. Each participant was assessed with the Pittsburgh Sleep Quality Index, 4-day wrist actigraphy, and quantitative electroencephalography derived from a 64-channel electroencephalogram system. These variables were compared between age groups (40-64 years vs 65-79 years) and sexes. RESULTS Among 173 participants, 61 (35%) were ages 65-79 years and 64 (35%) were males. The older group reported shorter (P = .009) total sleep time than the middle-aged group based on the Pittsburgh Sleep Quality Index, while women slept longer than men based on actigraphy (P = .040). Regarding electroencephalography, women had higher relative beta power than men (P = .006). Older patients showed slower dominant occipital frequency than younger patients (P = .008). The age effect was more noticeable on both clinical variables and quantitative electroencephalography for women. Compared with younger women, older women reported shorter total sleep time in the Pittsburgh Sleep Quality Index (P = .025), underestimated their sleep time (Pittsburgh Sleep Quality Index total sleep time/actigraphic total sleep time, P = .034), and showed reduced alpha power in the frontal area (P = .009). CONCLUSIONS Clinicians should be aware of the age and sex difference on manifestation of insomnia, which may further impact an individual's behaviors, such as staying in bed for a longer time or seeking sleep aids.
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Affiliation(s)
- Jung Kyung Hong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Joo Lee
- Department of Psychiatry, Ulsan University Hospital, Ulsan, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Seoul National University College of Medicine, Seoul, Korea
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6
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Duan D, Gu C, Polotsky VY, Jun JC, Pham LV. Effects of Dinner Timing on Sleep Stage Distribution and EEG Power Spectrum in Healthy Volunteers. Nat Sci Sleep 2021; 13:601-612. [PMID: 34017207 PMCID: PMC8131073 DOI: 10.2147/nss.s301113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/13/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Eating time and sleep habits are important modifiable behaviors that affect metabolic health, but the relationship between food intake and sleep remains incompletely understood. Observational data suggest that late food intake is associated with impaired sleep quality. We examined the effect of routine dinner (RD, 5 hours before bedtime) vs late dinner (LD, 1 hour before bedtime) on sleep architecture in healthy volunteers. PARTICIPANTS AND METHODS This was a post hoc analysis of a randomized crossover study of RD vs LD with a fixed sleep opportunity in a laboratory setting. On each of the two visits, 20 healthy adult volunteers (10 women) received an isocaloric meal followed by overnight polysomnography. Sleep architecture over the course of the night was assessed using visual sleep staging and EEG spectral power analysis and was compared between RD and LD. We modeled the proportions of spectral power in alpha, beta, delta, and theta bands as functions of dinner timing, time of night, and their interaction with mixed-effect spline regression. RESULTS Conventional sleep stages were similar between the 2 visits. LD caused a 2.5% initial increase in delta power and a reciprocal 2.7% decrease in combined alpha and beta power (p<0.0001). These effects diminished as sleep continued with a reversal of these patterns in the latter part of the night. CONCLUSION Contrary to the existing literature, shifting dinner timing from 5 hours before sleep to 1 hour before sleep in healthy volunteers did not result in significant adverse changes in overnight sleep architecture. In fact, LD was associated with deeper sleep in the beginning of the night and lighter sleep in the latter part of the night in healthy volunteers. This novel manifestation of postprandial hypersomnia may have therapeutic potential in patients with sleep disorders.
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Affiliation(s)
- Daisy Duan
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chenjuan Gu
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan C Jun
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luu V Pham
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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7
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de Zambotti M, Goldstone A, Forouzanfar M, Javitz H, Claudatos S, Colrain IM, Baker FC. The falling asleep process in adolescents. Sleep 2021; 43:5686157. [PMID: 31872251 DOI: 10.1093/sleep/zsz312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/03/2019] [Indexed: 01/25/2023] Open
Abstract
STUDY OBJECTIVES To investigate the pre-sleep psychophysiological state and the arousal deactivation process across the sleep onset (SO) transition in adolescents. METHODS Data were collected from a laboratory overnight recording in 102 healthy adolescents (48 girls, 12-20 years old). Measures included pre-sleep self-reported cognitive/somatic arousal, and cortical electroencephalographic (EEG) and electrocardiographic activity across the SO transition. RESULTS Adolescent girls, compared with boys, reported higher pre-sleep cognitive activation (p = 0.025) and took longer to fall asleep (p < 0.05), as defined with polysomnography. Girls also showed a less smooth progression from wake-to-sleep compared with boys (p = 0.022). In both sexes, heart rate (HR) dropped at a rate of ~0.52 beats per minute in the 5 minutes preceding SO, and continued to drop, at a slower rate, during the 5 minutes following SO (p < 0.05). Older girls had a higher HR overall in the pre-sleep period and across SO, compared to younger girls and boys (p < 0.05). The EEG showed a progressive cortical synchronization, with increases in Delta relative power and reductions in Alpha, Sigma, Beta1, and Beta2 relative powers (p < 0.05) in the approach to sleep, in both sexes. Delta relative power was lower and Theta, Alpha, and Sigma relative powers were higher in older compared to younger adolescents at bedtime and across SO (p < 0.05). CONCLUSIONS Our findings show the dynamics of the cortical-cardiac de-arousing process across the SO transition in a non-clinical sample of healthy adolescents. Findings suggest a female-specific vulnerability to inefficient sleep initiation, which may contribute to their greater risk for developing insomnia.
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Affiliation(s)
| | - Aimee Goldstone
- Center for Health Sciences, SRI International, Menlo Park, CA
| | | | - Harold Javitz
- Center for Health Sciences, SRI International, Menlo Park, CA
| | | | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA.,Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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8
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Daytime Neurophysiological Hyperarousal in Chronic Insomnia: A Study of qEEG. J Clin Med 2020; 9:jcm9113425. [PMID: 33114486 PMCID: PMC7694040 DOI: 10.3390/jcm9113425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The hyperarousal model demonstrates that instability of sleep-wake regulation leads to insomnia symptoms and various neurophysiological hyperarousal states. Previous studies have shown that hyperarousal states that appear in chronic insomnia patients are not limited to sleep at nighttime but are stable characteristics that extend into the daytime. However, this phenomenon is mainly measured at bedtime, so it hard to determine whether it is maintained throughout a 24 h cycle or if it just appears at bedtime. Methods: We examined the resting state qEEG (quantitative electroencephalogram) and ECG (electrocardiogram) of chronic insomnia patients (n = 24) compared to good sleepers (n = 22) during the daytime. Results: As compared with controls, participants with insomnia showed a clearly high beta band activity in eyes closed condition at all brain areas. They showed a low frequency band at the frontal area; high frequency bands at the central and parietal areas were found in eyes open condition. Significantly higher heart rates were also found in the chronic insomnia group. Conclusion: These findings suggest that chronic insomnia patients were in a state of neurophysiological hyperarousal during the middle of the day due to abnormal arousal regulation.
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9
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Hein M, Lanquart JP, Loas G, Hubain P, Linkowski P. Alterations of neural network organization during REM sleep in women: implication for sex differences in vulnerability to mood disorders. Biol Sex Differ 2020; 11:22. [PMID: 32334638 PMCID: PMC7183628 DOI: 10.1186/s13293-020-00297-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background Sleep plays an important role in vulnerability to mood disorders. However, despite the existence of sex differences in vulnerability to mood disorders, no study has yet investigated the sex effect on sleep network organization and its potential involvement in vulnerability to mood disorders. The aim of our study was to empirically investigate the sex effect on network organization during REM and slow-wave sleep using the effective connectivity measured by Granger causality. Methods Polysomnographic data from 44 healthy individuals (28 men and 16 women) recruited prospectively were analysed. To obtain the 19 × 19 connectivity matrix of all possible pairwise combinations of electrodes by Granger causality method from our EEG data, we used the Toolbox MVGC multivariate Granger causality. The computation of the network measures was realized by importing these connectivity matrices into EEGNET Toolbox. Results In men and women, all small-world coefficients obtained are compatible with a small-world network organization during REM and slow-wave sleep. However, compared to men, women present greater small-world coefficients during REM sleep as well as for all EEG bands during this sleep stage, which indicates the presence of a small-world network organization less marked during REM sleep as well as for all EEG bands during this sleep stage in women. In addition, in women, these small-world coefficients during REM sleep as well as for all EEG bands during this sleep stage are positively correlated with the presence of subclinical symptoms of depression. Conclusions Thus, the highlighting of these sex differences in network organization during REM sleep indicates the presence of differences in the global and local processing of information during sleep between women and men. In addition, this small-world network organization less marked during REM sleep appears to be a marker of vulnerability to mood disorders specific to women, which opens up new perspectives in understanding sex differences in the occurrence of mood disorders.
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Affiliation(s)
- Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium.
| | - Jean-Pol Lanquart
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium
| | - Gwénolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium
| | - Paul Linkowski
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium
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10
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Howlett RDM, Lustig KA, MacDonald KJ, Cote KA. Hyperarousal Is Associated with Socioemotional Processing in Individuals with Insomnia Symptoms and Good Sleepers. Brain Sci 2020; 10:brainsci10020112. [PMID: 32093215 PMCID: PMC7071480 DOI: 10.3390/brainsci10020112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 12/26/2022] Open
Abstract
Despite complaints of difficulties in waking socioemotional functioning by individuals with insomnia, only a few studies have investigated emotion processing performance in this group. Additionally, the role of sleep in socioemotional processing has not been investigated extensively nor using quantitative measures of sleep. Individuals with insomnia symptoms (n = 14) and healthy good sleepers (n = 15) completed two nights of at-home polysomnography, followed by an afternoon of in-lab performance testing on tasks measuring the processing of emotional facial expressions. The insomnia group self-reported less total sleep time, but no other group differences in sleep or task performance were observed. Greater beta EEG power throughout the night was associated with higher intensity ratings of happy, fearful and sad faces for individuals with insomnia, yet blunted sensitivity and lower accuracy for good sleepers. Thus, the presence of hyperarousal differentially impacted socioemotional processing of faces in individuals with insomnia symptoms and good sleepers.
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Affiliation(s)
| | | | | | - Kimberly A. Cote
- Correspondence: ; Tel.: +1-905-688-5550 (ext. 4806); Fax: +1-905-688-6922
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11
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Hein M, Lanquart JP, Mungo A, Hubain P, Loas G. Impact of number of sleep ultradian cycles on polysomnographic parameters related to REM sleep in major depression: Implications for future sleep research in psychiatry. Psychiatry Res 2020; 285:112818. [PMID: 32035377 DOI: 10.1016/j.psychres.2020.112818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/18/2020] [Accepted: 01/25/2020] [Indexed: 12/22/2022]
Abstract
Given the contradictory data on REMS alterations in major depression, the aim of this study was to empirically demonstrate that based on the number of sleep ultradian cycles, it was possible to highlight different subtypes of major depression characterized by specific patterns of REMS alterations. Demographic and polysomnographic data from 211 individuals (30 healthy controls and 181 untreated major depressed individuals) recruited from the sleep laboratory database were analyzed. Major depressed individuals with sleep ultradian cycles <4 showed alterations consistent with REMS deficiency (non-shortened REM latency as well as decrease in REMS percentage, REMS duration and REMS/NREMS ratio) whereas major depressed individuals with sleep ultradian cycles >4 showed alterations consistent with REMS disinhibition (shortened REM latency as well as increase in REMS percentage, REMS duration and REMS/NREMS ratio). Regarding major depressed individuals with 4 sleep ultradian cycles, their REMS alterations were intermediate to those present in major depressed individuals with sleep ultradian cycles <4 and >4. Thus, in major depressed individuals, the highlighting of this heterogeneity of REMS alterations based on the number of sleep ultradian cycles seems to suggest the involvement of distinct pathophysiological mechanisms and could open new perspectives for future sleep research in psychiatry.
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Affiliation(s)
- Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium.
| | - Jean-Pol Lanquart
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Anaïs Mungo
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Gwenolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
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12
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Reducing bedtime physiological arousal levels using immersive audio-visual respiratory bio-feedback: a pilot study in women with insomnia symptoms. J Behav Med 2019; 42:973-983. [PMID: 30790211 DOI: 10.1007/s10865-019-00020-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 02/14/2019] [Indexed: 02/02/2023]
Abstract
Hyperarousal is a critical component of insomnia, particularly at bedtime when individuals are trying to fall asleep. The current study evaluated the effect of a novel, acute behavioral experimental manipulation (combined immersive audio-visual relaxation and biofeedback) in reducing bedtime physiological hyperarousal in women with insomnia symptoms. After a clinical/adaptation polysomnographic (PSG) night, sixteen women with insomnia symptoms had two random-order PSG nights: immersive audio-visual respiratory bio-feedback across the falling asleep period (manipulation night), and no pre-sleep arousal manipulation (control night). While using immersive audio-visual respiratory bio-feedback, overall heart rate variability was increased and heart rate (HR) was reduced (by ~ 5 bpm; p < 0.01), reflecting downregulation of autonomic pre-sleep arousal, relative to no-manipulation. HR continued to be lower during sleep, and participants had fewer awakenings and sleep stage transitions on the manipulation night relative to the control night (p < 0.05). The manipulation did not affect sleep onset latency or other PSG parameters. Overall, this novel behavioral approach targeting the falling asleep process emphasizes the importance of pre-sleep hyperarousal as a potential target for improving sleep and nocturnal autonomic function during sleep in insomnia.
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13
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Issuriya A, Kumarnsit E, Reakkamnuan C, Samerphob N, Sathirapanya P, Cheaha D. Dexamethasone induces alterations of slow wave oscillation, rapid eye movement sleep and high-voltage spindle in rats. Acta Neurobiol Exp (Wars) 2019. [DOI: 10.21307/ane-2019-023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Hein M, Senterre C, Lanquart JP, Montana X, Loas G, Linkowski P, Hubain P. Hyperarousal during sleep in untreated, major depressed subjects with prodromal insomnia: A polysomnographic study. Psychiatry Res 2017; 258:387-395. [PMID: 28860016 DOI: 10.1016/j.psychres.2017.08.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/22/2022]
Abstract
In primary insomnia, specific dynamics of hyperarousal are evident during the night. Similarly, in major depression, many elements also favor of the presence of hyperarousal. Thus, it would be interesting to investigate if hyperarousal presents the same dynamic in major depression. Polysomnographic data from 30 healthy controls, 66 patients with major depression and prodromal insomnia, and 86 primary insomnia sufferers recruited from the sleep laboratory database were studied for whole night and thirds of the night. Insomnia sufferers and patients with depression exhibit a similar polysomnographic pattern both for whole night (increased sleep latency and WASO and reduced SWS and REM) and thirds of night (increased WASO at first and last thirds, reduced SWS in first third, and reduced in REM in first and last third). No alterations were detected during the second third of the night. Just as in primary insomnia, the hyperarousal phenomenon is found mainly in major depression with prodromal insomnia during the sleep-onset period and the first and last thirds of the night, but lesser during the second third of the night. These specific dynamics of hyperarousal may aid in the understanding of the particular relationship between insomnia and depression.
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Affiliation(s)
- Matthieu Hein
- Erasme hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium.
| | - Christelle Senterre
- School of Public Health SPU-ESP, Department of Biostatistics, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - Jean-Pol Lanquart
- Erasme hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - Xavier Montana
- Erasme hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - Gwénolé Loas
- Erasme hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - Paul Linkowski
- Erasme hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - Philippe Hubain
- Erasme hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium
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Hein M, Senterre C, Lanquart JP, Montana X, Loas G, Linkowski P, Hubain P. Hyperarousal during sleep in untreated primary insomnia sufferers: A polysomnographic study. Psychiatry Res 2017; 253:71-78. [PMID: 28364590 DOI: 10.1016/j.psychres.2017.03.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 01/28/2023]
Abstract
Because some evidence favors the hyperarousal model of insomnia, we sought to learn more about the dynamics of this phenomenon during sleep. Polysomnographic data from 30 normative subjects and 86 untreated primary insomnia sufferers recruited from the database of the sleep laboratory were studied for whole nights and in terms of thirds of the night. Untreated primary insomnia sufferers had an increased sleep latency and excess of WASO, together with a deficit in REM and NREM sleep during the entire night. In terms of thirds of the night, they presented a major excess of WASO during the first and last thirds of the night but an excess of lesser importance during the middle third. A deficit in SWS was found during the first third of the night, but for REM, the deficit was present during both the first and last thirds. Primary insomnia sufferers had no SWS or REM deficit during the second third of the night. We found that the hyperarousal phenomenon occurs mainly during the sleep-onset period of the first and last thirds of the night and is less important during the middle third. These results open new avenues for understanding the pathophysiology of primary insomnia.
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Affiliation(s)
- Matthieu Hein
- Erasme Hospital, Free University of Brussels, Department of Psychiatry and Sleep Laboratory, Brussels, Belgium.
| | - Christelle Senterre
- School of Public Health SPU-ESP, Free University of Brussels, Department of Biostatistics, Brussels, Belgium
| | - Jean-Pol Lanquart
- Erasme Hospital, Free University of Brussels, Department of Psychiatry and Sleep Laboratory, Brussels, Belgium
| | - Xavier Montana
- Erasme Hospital, Free University of Brussels, Department of Psychiatry and Sleep Laboratory, Brussels, Belgium
| | - Gwénolé Loas
- Erasme Hospital, Free University of Brussels, Department of Psychiatry and Sleep Laboratory, Brussels, Belgium
| | - Paul Linkowski
- Erasme Hospital, Free University of Brussels, Department of Psychiatry and Sleep Laboratory, Brussels, Belgium
| | - Philippe Hubain
- Erasme Hospital, Free University of Brussels, Department of Psychiatry and Sleep Laboratory, Brussels, Belgium
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Hyperarousal and Beyond: New Insights to the Pathophysiology of Insomnia Disorder through Functional Neuroimaging Studies. Brain Sci 2017; 7:brainsci7030023. [PMID: 28241468 PMCID: PMC5366822 DOI: 10.3390/brainsci7030023] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 01/04/2023] Open
Abstract
Neuroimaging studies have produced seemingly contradictory findings in regards to the pathophysiology of insomnia. Although most study results are interpreted from the perspective of a "hyperarousal" model, the aggregate findings from neuroimaging studies suggest a more complex model is needed. We provide a review of the major findings from neuroimaging studies, then discuss them in relation to a heuristic model of sleep-wake states that involves three major factors: wake drive, sleep drive, and level of conscious awareness. We propose that insomnia involves dysregulation in these factors, resulting in subtle dysregulation of sleep-wake states throughout the 24 h light/dark cycle.
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Riedner BA, Goldstein MR, Plante DT, Rumble ME, Ferrarelli F, Tononi G, Benca RM. Regional Patterns of Elevated Alpha and High-Frequency Electroencephalographic Activity during Nonrapid Eye Movement Sleep in Chronic Insomnia: A Pilot Study. Sleep 2016; 39:801-12. [PMID: 26943465 DOI: 10.5665/sleep.5632] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 11/26/2015] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVES To examine nonrapid eye movement (NREM) sleep in insomnia using high-density electroencephalography (EEG). METHODS All-night sleep recordings with 256 channel high-density EEG were analyzed for 8 insomnia subjects (5 females) and 8 sex and age-matched controls without sleep complaints. Spectral analyses were conducted using unpaired t-tests and topographical differences between groups were assessed using statistical non-parametric mapping. Five minute segments of deep NREM sleep were further analyzed using sLORETA cortical source imaging. RESULTS The initial topographic analysis of all-night NREM sleep EEG revealed that insomnia subjects had more high-frequency EEG activity (> 16 Hz) compared to good sleeping controls and that the difference between groups was widespread across the scalp. In addition, the analysis also showed that there was a more circumscribed difference in theta (4-8 Hz) and alpha (8-12 Hz) power bands between groups. When deep NREM sleep (N3) was examined separately, the high-frequency difference between groups diminished, whereas the higher regional alpha activity in insomnia subjects persisted. Source imaging analysis demonstrated that sensory and sensorimotor cortical areas consistently exhibited elevated levels of alpha activity during deep NREM sleep in insomnia subjects relative to good sleeping controls. CONCLUSIONS These results suggest that even during the deepest stage of sleep, sensory and sensorimotor areas in insomnia subjects may still be relatively active compared to control subjects and to the rest of the sleeping brain.
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Affiliation(s)
- Brady A Riedner
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison, WI
| | - Michael R Goldstein
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison, WI.,University of Arizona, Department of Psychology, Tucson, AZ
| | - David T Plante
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison, WI
| | - Meredith E Rumble
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison, WI
| | - Fabio Ferrarelli
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison, WI
| | - Giulio Tononi
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison, WI
| | - Ruth M Benca
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison, WI
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Spindle Oscillations in Sleep Disorders: A Systematic Review. Neural Plast 2016; 2016:7328725. [PMID: 27034850 PMCID: PMC4806273 DOI: 10.1155/2016/7328725] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/27/2016] [Indexed: 01/03/2023] Open
Abstract
Measurement of sleep microarchitecture and neural oscillations is an increasingly popular technique for quantifying EEG sleep activity. Many studies have examined sleep spindle oscillations in sleep-disordered adults; however reviews of this literature are scarce. As such, our overarching aim was to critically review experimental studies examining sleep spindle activity between adults with and without different sleep disorders. Articles were obtained using a systematic methodology with a priori criteria. Thirty-seven studies meeting final inclusion criteria were reviewed, with studies grouped across three categories: insomnia, hypersomnias, and sleep-related movement disorders (including parasomnias). Studies of patients with insomnia and sleep-disordered breathing were more abundant relative to other diagnoses. All studies were cross-sectional. Studies were largely inconsistent regarding spindle activity differences between clinical and nonclinical groups, with some reporting greater or less activity, while many others reported no group differences. Stark inconsistencies in sample characteristics (e.g., age range and diagnostic criteria) and methods of analysis (e.g., spindle bandwidth selection, visual detection versus digital filtering, absolute versus relative spectral power, and NREM2 versus NREM3) suggest a need for greater use of event-based detection methods and increased research standardization. Hypotheses regarding the clinical and empirical implications of these findings, and suggestions for potential future studies, are also discussed.
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Corsi-Cabrera M, Rojas-Ramos OA, del Río-Portilla Y. Waking EEG signs of non-restoring sleep in primary insomnia patients. Clin Neurophysiol 2015; 127:1813-21. [PMID: 26675627 DOI: 10.1016/j.clinph.2015.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/17/2015] [Accepted: 08/10/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Subjective feelings of insufficient and non-restorative sleep are core symptoms of primary insomnia. Sleep has a restorative effect on next-day waking EEG activity, whereas sleep loss has non-restorative effects in good sleepers. We proposed to explore waking EEG activity in primary insomniacs the evening before, and the morning after, a night of sleep, in order to detect signs of morning hyper-arousal and non-restoring sleep that might explain the subjective feelings despite the absence of objective signs in polysomnography. METHOD Pre-sleep (10 pm) and post-sleep (10 am) waking EEG activity was analyzed in 10 non-medicated primary insomniacs and matched control subjects. Beta and Gamma absolute power and EEG temporal coupling were obtained. Participants also evaluated subjective sleep quantity and quality. RESULTS Insomnia patients evaluated their sleep as non-restorative and insufficient. Compared to pre-sleep, during post-sleep control subjects exhibited significantly decreased Beta and Gamma power and reduced synchronization among anterior and posterior regions, consistent with restoring effects of sleep. Insomnia patients showed no beneficial effects of sleep on these EEG parameters. CONCLUSION Insomniacs are hyper-aroused during morning wakefulness and they do not benefit from preceding sleep. SIGNIFICANCE Our study adds new knowledge to our understanding of the physiopathology of insomnia.
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Affiliation(s)
- María Corsi-Cabrera
- Sleep Laboratory, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico.
| | - Olga A Rojas-Ramos
- Sleep Laboratory, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico; Departament of Psychophysiology, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico
| | - Yolanda del Río-Portilla
- Sleep Laboratory, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico; Departament of Psychophysiology, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico
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Decreased delta sleep ratio and elevated alpha power predict vulnerability to depression during interferon-alpha treatment. Acta Neuropsychiatr 2015; 27:14-24. [PMID: 25434651 DOI: 10.1017/neu.2014.30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Although poor sleep accompanies depression, it is unknown which specific sleep abnormalities precede depression. This is similarly the case for depression developing during interferon-α (IFN-α) therapy. Because vulnerability becomes evident in those who slept poorly before IFN-α, we prospectively determined which specific aspect of sleep could predict subsequent depression. METHODS Two nights of polysomnography with quantitative electroencephalogram (EEG) were obtained in 24 adult, euthymic subjects--all subsequently treated with IFN-α for hepatitis C. Every 2 weeks, a Beck Depression Inventory-II (BDI-II) score was obtained, and the maximal increase in BDI-II from pre-treatment baseline--excluding the sleep question--was determined. RESULTS The delta sleep ratio (DSR; an index of early-night restorative delta power) was inversely associated with BDI-II increases (p<0.01), as was elevated alpha power (8-12 Hz; p<0.001). Both delta (0.5-4 Hz) and alpha power exhibited high between-night correlations (r=0.83 and 0.92, respectively). In mixed-effect repeated-measure analyses, there was an interaction between alpha power and DSR (p<0.001)--subjects with low alpha power and elevated DSR were resilient to developing depression. Most other sleep parameters--including total sleep time and percentage of time in slow wave sleep--were not associated with subsequent changes in depression. CONCLUSIONS Both high DSR and low alpha power may be specific indices of resilience. As most other aspects of sleep were not associated with resilience or vulnerability, sleep interventions to prevent depression may need to specifically target these specific sleep parameters.
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Poor sleep predicts symptoms of depression and disability retirement due to depression. J Affect Disord 2015; 172:381-9. [PMID: 25451441 DOI: 10.1016/j.jad.2014.10.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Disturbed sleep is associated with mood disorders. Both depression and insomnia may increase the risk of disability retirement. The longitudinal links among insomnia, depression and work incapacity are poorly known. METHODS We examined association of self-reported sleep quality with incident symptoms of depression and disability retirement due to depressive disorders in a longitudinal population-based sample of twins (n=12,063 individuals). These adults were categorized by their sleep quality in 1975 and 1981, excluding individuals with depressed mood in 1975/1981. The outcomes were the Beck Depression Inventory (BDItot) and its subscale Negative Attitudes Towards Self (BDINATS) in 1990 as dichotomized measures, and the incidence of disability retirement due to depressive disorder during 1991-2004. RESULTS Onset of poor sleep between 1975 and 1981 predicted incident depression (BDItot OR=4.5, 95% CI: 2.7-7.4, BDINATS OR=2.0, 95% CI: 1.4-2.7), while persistent poor sleep showed somewhat weaker effects (BDItot; OR=2.5, 95% CI: 1.0-6.0, BDINATS OR=1.9, 95% CI: 1.1-3.3). Among those with few recent stressful life events, onset of poor sleep predicted strongly depression (BDINATS OR=9.5, 95% CI: 3.7-24.2). Likewise onset of poor sleep by 1981 increased the risk of disability retirement due to depression (OR=2.9, 95% CI: 1.8-4.9) with a similar risk among those with persistent poor sleep (OR=2.7, 95% CI: 1.3-5.7). LIMITATIONS Lack of baseline diagnostic interviews; sleep quality based on self-report. CONCLUSIONS Poor sleep is of importance in etiology of depression and disability retirement due to depression. This emphasizes the importance of early detection and treatment of sleep disturbances.
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Robillard R, Hermens DF, Naismith SL, White D, Rogers NL, Ip TK, Mullin SJ, Alvares GA, Guastella AJ, Smith KL, Rong Y, Whitwell B, Southan J, Glozier N, Scott EM, Hickie IB. Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders. J Psychiatry Neurosci 2015; 40:28-37. [PMID: 25203899 PMCID: PMC4275328 DOI: 10.1503/jpn.130247] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The nature of sleep-wake abnormalities in individuals with mental disorders remains unclear. The present study aimed to examine the differences in objective ambulatory measures of the sleep-wake and activity cycles across young people with anxiety, mood or psychotic disorders. METHODS Participants underwent several days of actigraphy monitoring. We divided participants into 5 groups (control, anxiety disorder, unipolar depression, bipolar disorder, psychotic disorder) according to primary diagnosis. RESULTS We enrolled 342 participants aged 12-35 years in our study: 41 healthy controls, 56 with anxiety disorder, 135 with unipolar depression, 80 with bipolar disorder and 30 with psychotic disorders. Compared with the control group, sleep onset tended to occur later in the anxiety, depression and bipolar groups; sleep offset occurred later in all primary diagnosis groups; the sleep period was longer in the anxiety, bipolar and psychosis groups; total sleep time was longer in the psychosis group; and sleep efficiency was lower in the depression group, with a similar tendency for the anxiety and bipolar groups. Sleep parameters were significantly more variable in patient subgroups than in controls. Cosinor analysis revealed delayed circadian activity profiles in the anxiety and bipolar groups and abnormal circadian curve in the psychosis group. LIMITATIONS Although statistical analyses controlled for age, the sample included individuals from preadolescence to adulthood. Most participants from the primary diagnosis subgroups were taking psychotropic medications, and a large proportion had other comorbid mental disorders. CONCLUSION Our findings suggest that delayed and disorganized sleep offset times are common in young patients with various mental disorders. However, other sleep-wake cycle disturbances appear to be more prominent in broad diagnostic categories.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ian B. Hickie
- Correspondence to: I.B. Hickie, Brain & Mind Research Institute, University of Sydney, Level 4, 94 Mallett St., Camperdown NSW 2050 Australia;
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Primeau MM, Tal JZ, O’Hara R. Depression. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sleep changes in the disorder of insomnia: A meta-analysis of polysomnographic studies. Sleep Med Rev 2014; 18:195-213. [DOI: 10.1016/j.smrv.2013.04.001] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/12/2013] [Accepted: 04/02/2013] [Indexed: 11/20/2022]
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Spectral analysis of the sleep onset period in primary insomnia. Clin Neurophysiol 2014; 125:979-87. [DOI: 10.1016/j.clinph.2013.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/21/2013] [Accepted: 10/13/2013] [Indexed: 11/18/2022]
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Maes J, Verbraecken J, Willemen M, De Volder I, van Gastel A, Michiels N, Verbeek I, Vandekerckhove M, Wuyts J, Haex B, Willemen T, Exadaktylos V, Bulckaert A, Cluydts R. Sleep misperception, EEG characteristics and Autonomic Nervous System activity in primary insomnia: A retrospective study on polysomnographic data. Int J Psychophysiol 2014; 91:163-71. [DOI: 10.1016/j.ijpsycho.2013.10.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 11/29/2022]
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Chen MC, Chang C, Glover GH, Gotlib IH. Increased insula coactivation with salience networks in insomnia. Biol Psychol 2014; 97:1-8. [PMID: 24412227 DOI: 10.1016/j.biopsycho.2013.12.016] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/10/2013] [Accepted: 12/30/2013] [Indexed: 11/28/2022]
Abstract
Insomnia is among the most prevalent and costly of all sleep-related disorders. To characterize the neural mechanisms underlying subjective dysfunction in insomnia, we examined brain activity in 17 female insomniacs and 17 female healthy controls using simultaneous functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) while they were resting and while they were trying to fall asleep. In examining the dynamic regional activity within intrinsic brain networks, we found that, compared with controls, insomniacs had greater involvement of the anterior insula with salience networks, as well as insula BOLD correlation with EEG gamma frequency power during rest in insomniacs. This increased involvement of the anterior insula was associated with negative affect in insomniacs. Aberrant activation of the insula, which integrates temporal and bodily states, in arousal networks may underlie the misperception of sleep quality and subjective distress in insomnia.
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Affiliation(s)
- Michael C Chen
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, United States; Department of Psychology, Stanford University, Stanford, CA 94305, United States.
| | - Catie Chang
- Advanced MRI Section, Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Department of Electrical Engineering, Stanford University, Stanford, CA 94305, United States; Department of Radiology, Stanford University, Stanford, CA 94305, United States
| | - Gary H Glover
- Department of Electrical Engineering, Stanford University, Stanford, CA 94305, United States; Department of Radiology, Stanford University, Stanford, CA 94305, United States
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA 94305, United States
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St-Jean G, Turcotte I, Pérusse AD, Bastien CH. REM and NREM power spectral analysis on two consecutive nights in psychophysiological and paradoxical insomnia sufferers. Int J Psychophysiol 2013; 89:181-94. [DOI: 10.1016/j.ijpsycho.2013.06.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 11/15/2022]
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Putilov AA. The EEG indicators of the dynamic properties of sleep–wake regulating processes: comparison of the changes occurring across wake–sleep transition with the effects of prolonged wakefulness. BIOL RHYTHM RES 2013. [DOI: 10.1080/09291016.2012.721689] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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31
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Increased EEG sigma and beta power during NREM sleep in primary insomnia. Biol Psychol 2012; 91:329-33. [DOI: 10.1016/j.biopsycho.2012.08.009] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 05/16/2012] [Accepted: 08/16/2012] [Indexed: 11/19/2022]
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Corsi-Cabrera M, Figueredo-Rodríguez P, del Río-Portilla Y, Sánchez-Romero J, Galán L, Bosch-Bayard J. Enhanced frontoparietal synchronized activation during the wake-sleep transition in patients with primary insomnia. Sleep 2012; 35:501-11. [PMID: 22467988 PMCID: PMC3296792 DOI: 10.5665/sleep.1734] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Cognitive and brain hyperactivation have been associated with trouble falling asleep and sleep misperception in patients with primary insomnia (PI). Activation and synchronization/temporal coupling in frontal and frontoparietal regions involved in executive control and endogenous attention might be implicated in these symptoms. METHODS Standard polysomnography (PSG) and electroencephalogram (EEG) were recorded in 10 unmedicated young patients (age 19-34 yr) with PI with no other sleep/medical condition, and in 10 matched control subjects. Absolute power, temporal coupling, and topographic source distribution (variable resolution electromagnetic tomography or VARETA) were obtained for all time spent in waking, Stage 1 and Stage 2 of the wake-sleep transition period (WSTP), and the first 3 consecutive min of N3. Subjective sleep quality and continuity were evaluated. RESULTS In comparison with control subjects, patients with PI exhibited significantly higher frontal beta power and current density, and beta and gamma frontoparietal temporal coupling during waking and Stage 1. CONCLUSION These findings suggest that frontal deactivation and disengagement of brain regions involved in executive control, attention, and self-awareness are impaired in patients with PI. The persistence of this activated and coherent network during the wake-sleep transition period (WSTP) may contribute to a better understanding of underlying mechanisms involved in difficulty in falling asleep, in sleep misperception, and in the lighter, poorer, and nonrefreshing sleep experienced by some patients with PI.
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Affiliation(s)
- María Corsi-Cabrera
- Laboratory for Sleep Research, Faculty of Psychology, Universidad Nacional Autónoma de México, México.
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de Zambotti M, Covassin N, De Min Tona G, Sarlo M, Stegagno L. Sleep onset and cardiovascular activity in primary insomnia. J Sleep Res 2011; 20:318-25. [PMID: 20673289 DOI: 10.1111/j.1365-2869.2010.00871.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The transition from wakefulness to sleep is characterized typically by a shift from sympathetic to parasympathetic regulation. Physiological functions, depending on the neurovegetative system, decrease overall. Previous studies have shown cardiovascular and electroencephalographic hyperactivity during wakefulness and sleep in insomniacs compared with normal sleepers, but there is very little evidence of this in the process of sleep onset. The purpose of this study was to compare cardiovascular and autonomic responses before and after falling asleep in eight insomniacs (who met DSM-IV criteria for primary insomnia) and eight normal sleepers. Non-invasive measures of heart rate (HR), stroke volume (SV), cardiac output (CO) and pre-ejection period (PEP) were collected by impedance cardiography during a night of polysomnographic recording. Frequency domain measures [low-frequency (LF), high-frequency (HF)] of heart rate variability (HRV) were also estimated. Decrements in HR and CO and increases in SV and HF normalized units (n.u.) were found in both groups after sleep onset compared with wakefulness. Conversely, PEP (related inversely to sympathetic β-adrenergic activity) showed increases after sleep onset in controls, but remained unchanged in insomniacs. PEP was also significantly lower in insomniacs than in normal sleepers in both conditions. These data suggest that, whereas normal sleepers follow the expected progressive autonomic drop, constant sympathetic hyperactivation is detected in insomniacs. These results support the aetiological hypothesis of physiological hyperarousal underlying primary insomnia.
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Altena E, Ramautar JR, Van Der Werf YD, Van Someren EJW. Do sleep complaints contribute to age-related cognitive decline? PROGRESS IN BRAIN RESEARCH 2011; 185:181-205. [PMID: 21075240 DOI: 10.1016/b978-0-444-53702-7.00011-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The cognitive changes that occur with ageing are usually referred to as 'age-related cognitive decline'. The most pronounced changes may be found in the executive functions that require integrity of the prefrontal cortical circuitry. With age, sleep also changes profoundly, with more sleep fragmentation, earlier awakenings and less slow wave sleep as its main features. Interestingly, experimental sleep deprivation studies in healthy young adults showed a particularly consistent effect on executive functions, suggesting that sleep problems might contribute to the cognitive changes accompanying older age. We here investigate this possibility by reviewing reports on age-related and insomnia-related changes in cognition and brain function and structure, as found in studies investigating subjective complaints, objective functioning in everyday life, neuropsychological assessment, psychometry, structural and functional magnetic resonance imaging, electroencephalography, positron emission tomography and transcranial magnetic stimulation. The chapter focuses on the 'normal' age-related sleep changes that are experienced as insomnia - that is, fragmentation of sleep, more superficial sleep, more wake after sleep onset and earlier awakenings - rather than on specific sleep disturbances as sleep-disordered breathing, restless legs or periodic limb movements during sleep, for all of which the risk increases with age. It turned out that relatively few studies directly addressed the question whether elderly with different degrees of sleep complaints are differentially affected by 'age-related cognitive decline'. Still, several similarities between age-related and insomnia-related cognitive and brain changes are apparent, notably with respect to performance requiring integrity of the prefrontal cortical system. We suggest that at least part of what we regard as age-related changes may, in fact, be due to poor sleep, which is in some cases a treatable condition. Further research directly comparing aged good sleepers versus aged insomniacs will need to elucidate how sleep disturbances are involved in the cognitive, structural and functional changes observed with increasing age. The findings suggest that discrimination of subtypes of poor sleep at high age will aid in understanding the mechanisms by which it affects cognition and brain function.
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Affiliation(s)
- Ellemarije Altena
- Department Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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Staner L. Comorbidity of insomnia and depression. Sleep Med Rev 2009; 14:35-46. [PMID: 19939713 DOI: 10.1016/j.smrv.2009.09.003] [Citation(s) in RCA: 301] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 09/08/2009] [Accepted: 09/09/2009] [Indexed: 12/18/2022]
Abstract
During the last decade, several studies have shown that insomnia, rather than a symptom of depression, could be a medical condition on its own, showing high comorbidity with depression. Epidemiological research indicates that insomnia could lead to depression and/or that common causalities underlie the two disorders. Neurobiological and sleep EEG studies suggest that a heightened level of arousal may play a common role in both conditions and that signs of REM sleep disinhibition may appear in individuals prone to depression. The effects of antidepressant drugs on non-REM and REM sleep are discussed in relation to their use in insomnia comorbid with depression. Empirical treatment approaches are behavioral management of sleep combined with prescription of a sedative antidepressant alone, co-prescription of two antidepressants, or of an antidepressant with a hypnotic drug.
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Affiliation(s)
- Luc Staner
- Sleep Laboratory, Forenap, Centre Hospitalier de Rouffach, 27 rue du 4ème R.S.M. F-68250 Rouffach, France.
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The efficacy of pregabalin and benzodiazepines in generalized anxiety disorder presenting with high levels of insomnia. Int Clin Psychopharmacol 2009; 24:214-22. [PMID: 19542983 DOI: 10.1097/yic.0b013e32832dceb9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to assess the impact of high levels of insomnia on response to pregabalin (PGB) in patients with generalized anxiety disorder (GAD). Pooled data were analyzed from six double-blind, placebo-controlled, 4- to 6-week trials of outpatients who met the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) criteria for GAD with a minimum Hamilton Rating Scale for Anxiety (HAM-A) score = 18. Response was evaluated for three fixed-dose PGB groups (150, 300-450, 600 mg/day), and for a benzodiazepine group (alprazolam or lorazepam). A 'high-insomnia' subgroup was defined by a baseline HAM for Depression (HAM-D) insomnia factor score greater than 3 (maximum = 6). At baseline, 1002 (54%) patients met the criteria for the high-insomnia subgroup, and 852 (46%) for the low-insomnia subgroup. Mean baseline HAM-A scores were 1-2 points higher in high-insomnia versus low-insomnia patients. In high-insomnia patients, PGB produced significantly greater improvement in HAM-A total scores at last observation carried forward endpoint on 300-450 mg (-13.1+/-0.6) and 600 mg (-11.2+/-0.5) dose groups compared with placebo (-8.3+/-0.5; P<0.0001 for both comparisons); the improvement on PGB 150 mg was not significant (-9.9+/-0.7; P = 0.051). Improvement was significant in the benzodiazepine group (-11.0+/-0.6; P<0.0001). In the high-insomnia subgroup, treatment with PGB significantly (P<0.001) improved the HAM-D insomnia factor scores on both the 300-450 mg (-2.73) and 600 mg (-2.35) doses, and on benzodiazepines (-2.52) compared with placebo (-1.51); improvement on PGB 150 mg (-1.69) was not significant. Rates of treatment-emergent insomnia were lower on PGB compared with placebo in both the high- and low-insomnia subgroups. In conclusion, PGB was well tolerated, and improved overall anxiety symptoms, while specifically improving insomnia in patients with GAD presenting with high levels of concurrent insomnia.
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Buysse DJ, Germain A, Hall ML, Moul DE, Nofzinger EA, Begley A, Ehlers CL, Thompson W, Kupfer DJ. EEG spectral analysis in primary insomnia: NREM period effects and sex differences. Sleep 2009; 31:1673-82. [PMID: 19090323 DOI: 10.1093/sleep/31.12.1673] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES To compare NREM EEG power in primary insomnia (PI) and good sleeper controls (GSC), examining both sex and NREM period effects; to examine relationships between EEG power, clinical characteristics, and self-reports of sleep. DESIGN Overnight polysomnographic study. SETTING Sleep laboratory. PARTICIPANTS PI (n=48; 29 women) and GSC (n=25; 15 women). INTERVENTIONS None. MEASUREMENTS EEG power from 1-50 Hz was computed for artifact-free sleep epochs across four NREM periods. Repeated measures mixed effect models contrasted differences between groups, EEG frequency bands, and NREM periods. EEG power-frequency curves were modeled using regressions with fixed knot splines. RESULTS Mixed models showed no significant group (PI vs. GSC) differences; marginal sex differences (delta and theta bands); significant differences across NREM periods; and group*sex and group*NREM period interactions, particularly in beta and gamma bands. Modeled power-frequency curves showed no group difference in whole-night NREM, but PI had higher power than GSC from 18-40 Hz in the first NREM period. Among women, PI had higher 16 to 44-Hz power than GSC in the first 3 NREM periods, and higher 3 to 5-Hz power across all NREM periods. PI and GSC men showed no consistent differences in EEG power. High-frequency EEG power was not related to clinical or subjective sleep ratings in PI. CONCLUSIONS Women with PI, but not men, showed increased high-frequency and low-frequency EEG activity during NREM sleep compared to GSC, particularly in early NREM periods. Sex and NREM period may moderate quantitative EEG differences between PI and GSC.
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Affiliation(s)
- Daniel J Buysse
- Neuroscience Clinical and Translational Research Center and Sleep Medicine Institute, University ofPittsburgh School ofMedicine, Pittsburgh, PA, USA.
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Abstract
Desynchronisation of normal circadian rhythms, including the sleep-wake rhythm, is common in major depressive disorder (MDD). The association between sleep disturbances and depression has long been recognised. Disturbed sleep is a diagnostic criterion for MDD, and insomnia commonly precedes the onset of symptomatic mood disorders. Disruptions of the sleep-wake cycle (sleep architecture and timing) are residual symptoms that may prevent the attainment of high-quality remission and delay recovery from MDD. Therefore, early recognition and treatment of sleep disturbances may be important for the treatment and prevention of recurrent depression. Evidence suggests that melatonergic (MT(1) and MT(2)) and the 5-HT(2C) serotonergic receptor subtypes are important modulators of circadian rhythmicity. Agomelatine is the first melatonergic antidepressant; an agonist of melatonin MT(1) and MT(2) receptors, with additional antagonist properties at the 5-HT(2C) receptors. Agomelatine combines antidepressant efficacy including quality and efficiency of sleep, with a more favourable side-effect profile than current antidepressant treatments, including neutral effects on sexual function, bodyweight and the absence of discontinuation symptoms. These positive features provide a novel approach to the treatment of depression and the attainment of high-quality remission in MDD.
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Affiliation(s)
- R W Lam
- Division of Clinical Neuroscience, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Abstract
SynopsisIn insomnia, which is a very common sleep disorder, objective sleep measures, EEG activity, physiologic findings, HPA axis activity and inflammation markers suggest that it is not a state of sleep loss, but a disorder of hyperarousal present both during the night and the daytime. Several psychological and physiological factors contribute to the onset and perpetuation of insomnia, such as anxious-ruminative personality traits, stressful events, age-related sleep homeostasis weakening mechanisms, menopause and biologic - genetic diathesis of CNS hyperarousal. The therapeutic approach in insomnia should be multidimensional reducing the overall emotional and physiologic hyperarousal and its underlying factors present throughout the 24-h sleep/wake period.
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Hubain P, Le Bon O, Vandenhende F, Van Wijnendaele R, Linkowski P. Major depression in males: effects of age, severity and adaptation on sleep variables. Psychiatry Res 2006; 145:169-77. [PMID: 17074401 DOI: 10.1016/j.psychres.2005.08.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2004] [Revised: 04/07/2005] [Accepted: 08/08/2005] [Indexed: 10/24/2022]
Abstract
Sleep abnormalities have been repeatedly demonstrated in major depression. However, the respective influences of age, severity, adaptation and gender have never been clearly disentangled. In a retrospective study, full polysomnograms of 67 male depressive patients and 67 carefully age-matched male healthy control subjects were analyzed. The usual differences associated with the sleep of depressed patients were observed. However, in contrast to most reports, REMS was also found to be reduced; although no comparisons between sexes can be made in this all-male study, one interpretation of this finding is that reduction of REMS is a marker of male depression. Age was found to influence most sleep variables, but not the order of their association with depression. Depression severity was found to be associated with Wake After Sleep Onset (WASO), REMS, and Non-REMS (NREMS). No residual adaptation effect was observed. One of the main markers of depression was in fact the absence of sleep, whether observed as long delays prior to entering sleep, or excessive intermittent awakenings. This sleep reduction affected both REMS and NREMS, in comparable percentages. This supports the hypothesis of a hyperarousal possibly linked to stress.
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Affiliation(s)
- Philippe Hubain
- Department of Psychiatry, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Cortoos A, Verstraeten E, Cluydts R. Neurophysiological aspects of primary insomnia: Implications for its treatment. Sleep Med Rev 2006; 10:255-66. [PMID: 16807007 DOI: 10.1016/j.smrv.2006.01.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Insomnia has usually been studied from a behavioral perspective. Somatic and/or cognitive conditioned arousal was shown to play a central role in sleep complaints becoming chronic, and was used as a starting point for the development of treatment modalities. The introduction of the neurocognitive perspective, with its focus on cortical or CNS arousal, has given rise to a renewed interest in the neurophysiological characteristics of insomnia. Recent research, using quantitative EEG, neuroimaging techniques and the study of the microstructure of sleep, suggests a state of hyperarousal with a biological basis. Furthermore, insomnia might not be restricted to sleep complaints alone because it appears to be a 24-h disorder, affecting several aspects of daytime functioning as well. These new findings have implications for the treatments used and indicate that a focus on cortical or CNS arousal should be pursued. As such, the use of EEG neurofeedback, a self-regulation method based on the paradigm of operant conditioning, might be a promising treatment modality. Preliminary results for insomnia and successful applications for other disorders suggest that this treatment can have the necessary stabilizing effects on the EEG activity, possibly resulting in a normalizing effect on daytime as well as nighttime functioning.
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Affiliation(s)
- Aisha Cortoos
- Department of Cognitive and Biological Psychology, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium.
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Edéll-Gustafsson U, Carstensen J, Regestein Q, Swahn E, Svanborg E. Hyperarousal, depression and quality of life - validity and reliability of the Swedish version of the Hyperarousal Scale. Scand J Caring Sci 2006; 20:58-67. [PMID: 16489961 DOI: 10.1111/j.1471-6712.2006.00381.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Research focusing on hyperarousability in association with general sensitivity to stress has increased. This study aimed to: (i) describe values for self-reported hyperarousal behaviour traits, depression, sleeplessness behaviour and health-related quality of life [The Short Form 36 Health Survey Questionnaire (SF-36)] in a gender-stratified random sample from the Swedish population; and (ii) test the validity and reliability of the Swedish version of the Hyperarousal Behavioural Trait Scale (H-scale). METHODS In this study, 402 women and 391 men from Sweden were included. A test-retest study was performed on 297 subjects. RESULTS The total mean score on the H-scale was 29.5 (SD 10.0, 95% CI 28.8-30.2). Compared to men, women scored higher on the H-scale (total score, sub-scales and many items), whereas no evidence of an age trend was seen. The H-scale has proven to be a valid and reliable scale. Pearson's correlation coefficient showed similar magnitude and direction between the H-scale and the Zung's Self-rating Depression Scale, as between the H-scale and the Vicious Cycle of Sleeplessness Behaviour Scale, Vitality, Mental Health and the Mental Component Summary index on the SF-36 respectively. The Cronbach's alpha for the H-scale was 0.84 and estimated stability test-retest point of time varies between 0.73 and 0.80. CONCLUSIONS This study indicates gender differences in response style in association with altered health-related quality of life. The H-scale is a valid and reliable self-reported scale for measuring hyperarousal behavioural trait research outcome in clinical practice.
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Affiliation(s)
- Ulla Edéll-Gustafsson
- Department of Medicine and Care, Nursing Science, Faculty of Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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Stepanski EJ, Rybarczyk B. Emerging research on the treatment and etiology of secondary or comorbid insomnia. Sleep Med Rev 2006; 10:7-18. [PMID: 16376125 DOI: 10.1016/j.smrv.2005.08.002] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Secondary insomnia is defined as difficulty initiating or maintaining sleep that occurs as a consequence of another primary medical or psychiatric disorder. This distinction from primary insomnia has been thought to be important from a diagnostic standpoint so that treatment for secondary insomnia can appropriately target the primary disorder. By convention, treating insomnia directly has only been recommended with primary insomnia. However, a number of recent studies of cognitive-behavioral treatment for a wide range of secondary insomnias have demonstrated that this approach is an effective treatment in this population. These results are not predicted by the traditional conceptualization of secondary insomnia. Results of epidemiological research also argue against viewing insomnia that is comorbid with another disorder as being caused by that disorder. A revised model is needed to understand insomnia that is comorbid with medical and/or psychiatric illness, in addition to re-evaluating standard treatment protocols for comorbid insomnia.
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Affiliation(s)
- Edward J Stepanski
- Department of Behavioral Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Abstract
Brain neurotransmitter dysfunctions involved in the pathophysiological processes of psychiatric disorders are likely to be reflected by concomitant alterations in sleep continuity and architecture. Since the corrective effects of psychotropic drugs on dysfunctional neurotransmission systems can be evidenced through polysomnographic recordings, one may consider sleep as a kind of “window” on the neurobiology of psychiatric disorders. During the last 10 years, major breakthroughs in our understanding of sleep-wake mechanisms have provided some indications on how psychotropic drugs could influence the sleep-wake cycle. In this review, recent inroads into the understanding of sleep regulatory neural mechanisms are introduced and discussed in terms of the effects of psychotropic drugs. The relationship between the patho-physiological process of a disease, its consequence on sleep, and the corrective effect of a psychotropic drug are exemplified by two psychopathological states: substance withdrawal and major depression. One may conclude that polysomnographic recordings are a unique noninvasive tool to analyze brain functioning, and are particularly well suited to evaluating the objective effects of new psychotropic drugs.
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Affiliation(s)
- Luc Staner
- Sleep Laboratory, Forenap, Centre Hospitalier de Rouffach, Rouffach, France.
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Abstract
This paper focuses on several aspects of the relationship between sleep and depression, with particular attention to objective factors and subjective perceptions. It does not address the effect that antidepressants have on sleep, nor does it explore the wider implications of the types and course of depression, age, or other psychiatric conditions. "Normal sleep" is explored, examining typical sleep architecture in individuals without sleep disorders, psychiatric conditions or physical illness. Sleep disorders are reviewed and examined to present the nature of the disturbance and the role that they may play in depression, with particular attention paid to insomnia. Studies have identified a sub-group of insomnia patients (highly distressed poor sleepers), who appear to be less satisfied with their sleep quality than "low distressed poor sleepers", even though they did not differ on sleep timing perceptions. Recent work has shown that depressed individuals to be less satisfied with sleep quality than healthy controls, even though they did not differ on sleep timing perceptions. The evidence presented here supports the view that subjective sleep perceptions play an important role in depression. Poor subjective perceptions of sleep in depression may be associated with faulty cognitions. This has been found extensively in insomnia, but is under-researched in depression.
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Staner L, Ertlé S, Boeijinga P, Rinaudo G, Arnal MA, Muzet A, Luthringer R. Next-day residual effects of hypnotics in DSM-IV primary insomnia: a driving simulator study with simultaneous electroencephalogram monitoring. Psychopharmacology (Berl) 2005; 181:790-8. [PMID: 16025317 DOI: 10.1007/s00213-005-0082-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 05/21/2005] [Indexed: 11/24/2022]
Abstract
RATIONALE Most studies that investigated the next-day residual effects of hypnotic drugs on daytime driving performances were performed on healthy subjects and after a single drug administration. OBJECTIVES In the present study, we further examine whether the results of these studies could be generalised to insomniac patients and after repeated drug administration. METHOD Single and repeated (7 day) doses of zolpidem (10 mg), zopiclone (7.5 mg), lormetazepam (1 mg) or placebo were administered at bedtime in a crossover design to 23 patients (9 men and 14 women aged 38.8+/-2.0 years) with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) primary insomnia. Driving tests were performed 9-11 h post-dose. RESULTS Results showed that treatment effects were evidenced for subjective sleep, for driving abilities, and for electroencephalogram (EEG) recorded before (resting EEG) and during the driving simulation test (driving EEG). Compared to placebo, zopiclone increased the number of collisions and lormetazepam increased deviation from speed limit and deviation from absolute speed, whereas zolpidem did not differentiate from placebo on these analyses. EEG recordings showed that in contrast to zolpidem, lormetazepam and zopiclone induced typical benzodiazepine-like alterations, suggesting that next-day poor driving performance could relate to a prolonged central nervous system effect of these two hypnotics. CONCLUSION The present results corroborate studies on healthy volunteers showing that residual effects of hypnotics increase with their half-lives. The results further suggest that drugs preserving physiological EEG rhythms before and during the driving simulation test 9-11 h post-dose, such as zolpidem, do not influence next-day driving abilities.
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Affiliation(s)
- Luc Staner
- FORENAP-Institute for Research in Neurosciences, Neuropharmacology and Psychiatry, Centre Hospitalier, Rouffach, France.
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Macher JP. Spectral EEG sleep profiles as a tool for prediction of clinical response to antidepressant treatment. DIALOGUES IN CLINICAL NEUROSCIENCE 2004. [PMID: 22033557 PMCID: PMC3181791 DOI: 10.31887/dcns.2004.6.1/jpmacher] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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