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Hu S, Shi L, Li Z, Ma Y, Li J, Bao Y, Lu L, Sun H. First-night effect in insomnia disorder: a systematic review and meta-analysis of polysomnographic findings. J Sleep Res 2024; 33:e13942. [PMID: 37254247 DOI: 10.1111/jsr.13942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 02/20/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023]
Abstract
Polysomnographic studies have been performed to investigate the first-night effect in insomnia disorder. However, these studies have revealed discrepant findings. This meta-analysis aimed to summarise and quantify the characteristics of the first-night effect in insomnia disorder. We performed a systematic search of the PubMed, Medline, EMBASE, Web of Science and PsycINFO databases to identify studies published through October 2019. A total of 11,862 articles were identified, and seven studies with eight independent populations were included in the meta-analysis. A total of 639 patients with insomnia disorder and 171 healthy controls underwent more than 2 consecutive nights of in-laboratory polysomnography. Pooled results demonstrated that both variables of sleep continuity and sleep architecture, other than slow-wave sleep were significantly altered in the first-night effect in insomnia disorder. Furthermore, the results indicated that patients with insomnia disorder had a disruption of sleep continuity in the first-night effect, including increased sleep onset latency and reduced total sleep time, compared to healthy controls. Overall, the findings show that patients with insomnia disorder experience the first-night effect, rather than reverse first-night effect, and the profiles of the first-night effect in patients with insomnia are different from healthy controls. These indicate that an adaptation night is necessary when sleep continuity and sleep architecture is to be studied in patients with insomnia disorder. More well-designed studies with large samples are needed to confirm the results.
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Affiliation(s)
- Sifan Hu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Zhe Li
- Sleep Medicine Center, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yundong Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jinyu Li
- Peking University Health Science Center, Beijing, China
| | - Yanping Bao
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Jensen S, Abeler K, Friborg O, Rosner A, Olsborg C, Mellgren SI, Müller KI, Rosenberger AD, Vold ML, Arntzen KA. Insomnia and sleep-disordered breathing in FKRP-related limb-girdle muscular dystrophy R9. The Norwegian LGMDR9 cohort study (2020). J Neurol 2024; 271:274-288. [PMID: 37695533 PMCID: PMC10770197 DOI: 10.1007/s00415-023-11978-7] [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: 05/20/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
Limb-girdle muscular dystrophy R9 (LGMDR9) is a progressive and disabling genetic muscle disease. Sleep is relevant in the patient care as it impacts on health, functioning, and well-being. LGMDR9 may potentially affect sleep by physical or emotional symptoms, myalgia, or sleep-disordered breathing (SDB) through cardiorespiratory involvement. The objective was to investigate the occurrence of insomnia and unrecognized or untreated SDB in LGMDR9, associated factors, and relationships with fatigue and health-related quality of life (HRQoL). All 90 adults in a Norwegian LGMDR9 cohort received questionnaires on sleep, fatigue, and HRQoL. Forty-nine of them underwent clinical assessments and 26 without mask-based therapy for respiration disorders additionally underwent polysomnography (PSG) and capnometry. Among 77 questionnaire respondents, 31% received mask-based therapy. The prevalence of insomnia was 32% of both those with and without such therapy but was significantly increased in fatigued respondents (54% vs 21%). Insomnia levels correlated inversely with mental HRQoL. Among 26 PSG candidates, an apnea-hypopnea index (AHI) ≥ 5/h was observed in 16/26 subjects (≥ 15/h in 8/26) with median 6.8 obstructive apneas and 0.2 central apneas per hour of sleep. The AHI was related to advancing age and an ejection fraction < 50%. Sleep-related hypoventilation was detected in one subject. Fatigue severity did not correlate with motor function or nocturnal metrics of respiration or sleep but with Maximal Inspiratory Pressure (r = - 0.46). The results indicate that insomnia and SDB are underrecognized comorbidities in LGMDR9 and associated with HRQoL impairment and heart failure, respectively. We propose an increased attention to insomnia and SDB in the interdisciplinary care of LGMDR9. Insomnia and pulmonary function should be examined in fatigued patients.
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Affiliation(s)
- Synnøve Jensen
- National Neuromuscular Centre Norway and Department of Neurology, University Hospital of North Norway, 9038, Tromsø, Norway.
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø-The Artic University of Norway, Tromsø, Norway.
| | - Karin Abeler
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø-The Artic University of Norway, Tromsø, Norway
- Department of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Department of Psychology, Faculty of Health Sciences, University of Tromsø-The Artic University of Norway, Tromsø, Norway
| | - Assami Rosner
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø-The Artic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Caroline Olsborg
- Department of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø, Norway
| | - Svein Ivar Mellgren
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø-The Artic University of Norway, Tromsø, Norway
| | - Kai Ivar Müller
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Andreas Dybesland Rosenberger
- National Neuromuscular Centre Norway and Department of Neurology, University Hospital of North Norway, 9038, Tromsø, Norway
| | - Monica L Vold
- Department of Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Kjell Arne Arntzen
- National Neuromuscular Centre Norway and Department of Neurology, University Hospital of North Norway, 9038, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø-The Artic University of Norway, Tromsø, Norway
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Ma N, Ning Q, Li M, Hao C. The First-Night Effect on the Instability of Stage N2: Evidence from the Activity of the Central and Autonomic Nervous Systems. Brain Sci 2023; 13:brainsci13040667. [PMID: 37190632 DOI: 10.3390/brainsci13040667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
A series of studies have suggested that stage N2 is vulnerable and strongly affected by the first-night effect (FNE). However, the neurophysiological mechanism underlying the vulnerability of stage N2 of the FNE has not been well examined. A total of 17 healthy adults (11 women and 6 men, mean age: 21.59 ± 2.12) underwent two nights of polysomnogram recordings in the sleep laboratory. We analyzed sleep structure and central and autonomic nervous system activity during stage N2 and applied the electroencephalographic (EEG) activation index (beta/delta power ratio) and heart rate variability to reflect changes in central and autonomic nervous system activity caused by the FNE. Correlation analyses were performed between EEG activation and heart rate variability. The results showed that EEG activation and high-frequency heart rate variability increased on the adaptation night (Night 1). Importantly, EEG activation was significantly associated with the percentage of stage N1, and the correlation between EEG activation and high-frequency heart rate variability decreased due to the FNE. These findings indicate that the FNE affects the instability of stage N2 by increasing central nervous system activity and uncoupling the activity between the central and autonomic nervous systems.
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Affiliation(s)
- Ning Ma
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou 510631, China
- Center for Sleep Research, Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health & Cognitive Science, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Qian Ning
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou 510631, China
- Center for Sleep Research, Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health & Cognitive Science, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Mingzhu Li
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou 510631, China
- Center for Sleep Research, Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health & Cognitive Science, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Chao Hao
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou 510631, China
- Center for Sleep Research, Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health & Cognitive Science, School of Psychology, South China Normal University, Guangzhou 510631, China
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Elder GJ, Lazar AS, Alfonso‐Miller P, Taylor J. Sleep disturbances in Lewy body dementia: A systematic review. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5814. [PMID: 36168299 PMCID: PMC9827922 DOI: 10.1002/gps.5814] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lewy body dementia (LBD) refers to both dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD). Sleep disturbances are common in LBD, and can include poor sleep quality, excessive daytime sleepiness (EDS), and rapid eye movement behaviour disorder (RBD). Despite the high clinical prevalence of sleep disturbances in LBD, they are under-studied relative to other dementias. The aim of the present systematic review was to examine the nature of sleep disturbances in LBD, summarise the effect of treatment studies upon sleep, and highlight specific and necessary directions for future research. METHODS Published studies in English were located by searching PubMED and PSYCArticles databases (until 10 June 2022). The search protocol was pre-registered in PROSPERO (CRD42021293490) and performed in accordance with PRISMA guidelines. RESULTS Following full-text review, a final total of 70 articles were included. These included 20 studies focussing on subjective sleep, 14 on RBD, 8 on EDS, 7 on objective sleep, and 1 on circadian rhythms. The majority of the 18 treatment studies used pharmacological interventions (n = 12), had an open-label design (n = 8), and were of low-to-moderate quality. Most studies (n = 55) included only patients with DLB. Due to the heterogeneity of the studies, we reported a narrative synthesis without meta-analysis. CONCLUSIONS At least one form of sleep disturbance may be present in as many as 90% of people with LBD. Subjectively poor sleep quality, excessive daytime sleepiness, and RBD are more common and severe in LBD relative to other dementias.
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Affiliation(s)
- Greg J. Elder
- Northumbria Sleep ResearchDepartment of PsychologyFaculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK
| | - Alpar S. Lazar
- Sleep and Brain Research UnitFaculty of Medicine and Health SciencesUniversity of East AngliaNorwichUK
| | - Pam Alfonso‐Miller
- Northumbria Sleep ResearchDepartment of PsychologyFaculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityCampus for Ageing and VitalityNewcastle Upon TyneUK
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Gulf War veterans exhibit broadband sleep EEG power reductions in regions overlying the frontal lobe. Life Sci 2021; 280:119702. [PMID: 34111462 DOI: 10.1016/j.lfs.2021.119702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022]
Abstract
AIMS Nearly a third of U.S. veterans who deployed in support of the 1990-1991 Persian Gulf War are affected by Gulf War illness (GWI). Here we aimed to characterize whether subjective sleep complaints in GWI veterans are associated with objective sleep EEG disturbances relative to healthy veterans and controls; and whether Gulf War veterans show alterations in neural activity during sleep that differentiate them from healthy subjects. MAIN METHODS We used high-density EEG (HDEEG) to assess regional patterns of rapid eye movement (REM) sleep and non-REM (NREM) sleep between three groups: Gulf War male veterans with fatigue and GWI, Gulf War male veterans without fatigue or GWI, and control males. The groups were matched relative to age, sex and obstructive sleep apnea. Topographic comparisons of nocturnal NREM and REM sleep were made between groups for all frequency bands. KEY FINDINGS Topographic analysis revealed a broadband reduction in EEG power in a circumscribed region overlying the frontal lobe in both groups of Gulf War veterans, regardless of GWI and fatigue. This frontal reduction in neural activity was present, to some extent, across all frequency bands in NREM and REM sleep. SIGNIFICANCE Given that our findings were observed in all Gulf War veterans, it appears unlikely that frontal sleep HDEEG power reductions prove wholly responsible for fatigue symptoms. These results provide avenues for research which may someday contribute to improved clinical care of formerly deployed veterans of the Persian Gulf War.
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Shirota A, Kamimura M, Kishi A, Adachi H, Taniike M, Kato T. Discrepancies in the Time Course of Sleep Stage Dynamics, Electroencephalographic Activity and Heart Rate Variability Over Sleep Cycles in the Adaptation Night in Healthy Young Adults. Front Physiol 2021; 12:623401. [PMID: 33867997 PMCID: PMC8044772 DOI: 10.3389/fphys.2021.623401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/12/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of the present study was to characterize the cyclic sleep processes of sleep-stage dynamics, cortical activity, and heart rate variability during sleep in the adaptation night in healthy young adults. METHODS Seventy-four healthy adults participated in polysomnographic recordings on two consecutive nights. Conventional sleep variables were assessed according to standard criteria. Sleep-stage continuity and dynamics were evaluated by sleep runs and transitions, respectively. These variables were compared between the two nights. Electroencephalographic and cardiac activities were subjected to frequency domain analyses. Cycle-by-cycle analysis was performed for the above variables in 34 subjects with four sleep cycles and compared between the two nights. RESULTS Conventional sleep variables reflected lower sleep quality in the adaptation night than in the experimental night. Bouts of stage N1 and stage N2 were shorter, and bouts of stage Wake were longer in the adaptation night than in the experimental night, but there was no difference in stage N3 or stage REM. The normalized transition probability from stage N2 to stage N1 was higher and that from stage N2 to N3 was lower in the adaptation night, whereas that from stage N3 to other stages did not differ between the nights. Cycle-by-cycle analysis revealed that sleep-stage distribution and cortical beta EEG power differed between the two nights in the first sleep cycle. However, the HF amplitude of the heart rate variability was lower over the four sleep cycles in the adaptation night than in the experimental night. CONCLUSION The results suggest the distinct vulnerability of the autonomic adaptation processes within the central nervous system in young healthy subjects while sleeping in a sleep laboratory for the first time.
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Affiliation(s)
- Ai Shirota
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Mayo Kamimura
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Akifumi Kishi
- Graduate School of Education, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroyoshi Adachi
- Osaka University Hospital, Sleep Medicine Center, Suita, Japan
- Osaka University Health and Counseling Center, Toyonaka, Japan
| | - Masako Taniike
- Osaka University Hospital, Sleep Medicine Center, Suita, Japan
- Department of Child Development, Osaka University United Graduate School of Child Development, Suita, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
- Osaka University Hospital, Sleep Medicine Center, Suita, Japan
- Department of Child Development, Osaka University United Graduate School of Child Development, Suita, Japan
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7
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Sawangjit A, Oyanedel CN, Niethard N, Born J, Inostroza M. Deepened sleep makes hippocampal spatial memory more persistent. Neurobiol Learn Mem 2020; 173:107245. [DOI: 10.1016/j.nlm.2020.107245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/28/2020] [Accepted: 05/02/2020] [Indexed: 12/28/2022]
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8
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Leach S, Chung KY, Tüshaus L, Huber R, Karlen W. A Protocol for Comparing Dry and Wet EEG Electrodes During Sleep. Front Neurosci 2020; 14:586. [PMID: 32625053 PMCID: PMC7313551 DOI: 10.3389/fnins.2020.00586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/12/2020] [Indexed: 01/17/2023] Open
Abstract
Background Sleep is commonly assessed by recording the electroencephalogram (EEG) of the sleeping brain. As sleep assessments in a lab environment are cumbersome for both the participant and researcher, it would be highly desirable to record sleep EEG with a user-friendly and mobile device. Dry electrodes that are reusable, low-cost, and easy to apply would be an essential component of such a device. In this study, we developed a testing protocol to investigate the performance of novel flat-type dry electrodes for sleep EEG recordings in free-living conditions. Methods Overnight sleep EEG, electrooculogram and electromyogram of four young and healthy participants were recorded at home. Two identical ambulatory recording devices, one using novel flat-type dry electrodes, the other using self-adhesive pre-gelled electrodes, simultaneously recorded sleep EEG. Between both electrode types, we then compared the signal quality, the incidence of artifacts, the sensitivity, specificity and inter-scoring reliability (Cohen’s kappa) of sleep staging, as well as the agreement of important characteristics of sleep-specific EEG microstructure features, such as slow waves (0.5–4 Hz) and sleep spindles (10–16 Hz). Results Our testing protocol comprehensively compared the two electrode types on a macro- and microstructure level of sleep. The dry and pre-gelled electrodes both had comparable signal quality and sleep staging was feasible with both electrodes. Also, slow-wave and spindle characteristics were similar. However, sweat artifacts were more prevalent in the flat-type dry electrodes. Conclusion With a reliable testing protocol, the performance of dry electrodes can be compared to reference technologies and objectively assessed also in free-living conditions.
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Affiliation(s)
- Sven Leach
- Child Development Center and Pediatric Sleep Disorders Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ku-Young Chung
- Mobile Health Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | - Laura Tüshaus
- Mobile Health Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | - Reto Huber
- Child Development Center and Pediatric Sleep Disorders Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Walter Karlen
- Mobile Health Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
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Reward does not facilitate visual perceptual learning until sleep occurs. Proc Natl Acad Sci U S A 2019; 117:959-968. [PMID: 31892542 DOI: 10.1073/pnas.1913079117] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A growing body of evidence indicates that visual perceptual learning (VPL) is enhanced by reward provided during training. Another line of studies has shown that sleep following training also plays a role in facilitating VPL, an effect known as the offline performance gain of VPL. However, whether the effects of reward and sleep interact on VPL remains unclear. Here, we show that reward interacts with sleep to facilitate offline performance gains of VPL. First, we demonstrated a significantly larger offline performance gain over a 12-h interval including sleep in a reward group than that in a no-reward group. However, the offline performance gains over the 12-h interval without sleep were not significantly different with or without reward during training, indicating a crucial interaction between reward and sleep in VPL. Next, we tested whether neural activations during posttraining sleep were modulated after reward was provided during training. Reward provided during training enhanced rapid eye movement (REM) sleep time, increased oscillatory activities for reward processing in the prefrontal region during REM sleep, and inhibited neural activation in the untrained region in early visual areas in non-rapid eye movement (NREM) and REM sleep. The offline performance gains were significantly correlated with oscillatory activities of visual processing during NREM sleep and reward processing during REM sleep in the reward group but not in the no-reward group. These results suggest that reward provided during training becomes effective during sleep, with excited reward processing sending inhibitory signals to suppress noise in visual processing, resulting in larger offline performance gains over sleep.
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Tamaki M, Sasaki Y. Surveillance During REM Sleep for the First-Night Effect. Front Neurosci 2019; 13:1161. [PMID: 31736695 PMCID: PMC6828645 DOI: 10.3389/fnins.2019.01161] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/14/2019] [Indexed: 11/28/2022] Open
Abstract
We experience disturbed sleep in a new place, and this effect is known as the first-night effect (FNE) in sleep research. We previously demonstrated that the FNE is associated with a surveillance system in one brain hemisphere during NREM sleep, which manifests as interhemispheric asymmetry in sleep depth in the default-mode network (DMN) and increased vigilance toward monitoring external stimuli. This surveillance system may be useful for protecting vulnerable sleepers from abnormal events in unfamiliar environments. The present study investigated whether a similar surveillance system is exhibited during rapid eye movement (REM) sleep. The impacts of the FNE could be different between the phasic period, in which eyes move rapidly, and the tonic period, in which eye movement ceases, of REM sleep; without the FNE, vigilance to external stimuli is generally reduced during the phasic period but not the tonic period. Thus, REM sleep was split into phasic and tonic periods. First, we replicated previous findings showing interhemispheric asymmetry in delta activity in the DMN associated with the FNE during NREM sleep. However, during REM sleep, interhemispheric asymmetry in delta activity or theta activities, two oscillatory activities during REM sleep, was not found during the phasic or tonic periods. Next, we tested whether vigilance, as measured by evoked brain responses (P2) to deviant tones, associated with the FNE was increased in one hemisphere during REM sleep. The P2 amplitudes during the phasic period were augmented by the FNE on day 1 and were significantly larger than those on day 2 when the FNE was not present. In contrast, the P2 amplitudes during the tonic period were not different across days. The P2 amplitudes showed no interhemispheric asymmetry during the phasic or tonic periods. These results suggest that while the surveillance system exhibits interhemispheric asymmetry in sleep depth and vigilance during NREM sleep, this system shows no interhemispheric asymmetry in oscillatory activities and exhibits increased vigilance in both hemispheres only during the phasic period of REM sleep. Therefore, the surveillance system associated with the FNE may involve different mechanisms during NREM and REM sleep.
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Affiliation(s)
- Masako Tamaki
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, United States
| | - Yuka Sasaki
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, United States
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Bianchi MT, Goparaju B. Potential Underestimation of Sleep Apnea Severity by At-Home Kits: Rescoring In-Laboratory Polysomnography Without Sleep Staging. J Clin Sleep Med 2017; 13:551-555. [PMID: 28095966 DOI: 10.5664/jcsm.6540] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/09/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Home sleep apnea testing (HSAT) is increasingly available for diagnosing obstructive sleep apnea (OSA). One key limitation of most HSAT involves the lack of sleep staging, such that the respiratory event index is calculated using the total recording time (TRT) rather than total sleep time (TST). METHODS We performed a retrospective analysis of n = 838 diagnostic polysomnography (PSG) nights from our center; n = 444 with OSA (4% rule, apneahypopnea index (AHI) ≥ 5), and n = 394 with AHI < 5. We recalculated the AHI using time in bed (TIB) instead of TST, to assess the predicted underestimation risk of OSA severity. RESULTS Of all the patients with OSA, 26.4% would be reclassified as having less severe or no OSA after recalculating the AHI using TIB rather than TST. Of the n = 275 with mild OSA, 18.5% would be reclassified as not having OSA. The risk of underestimation was higher in those with moderate or severe OSA. Of the n = 119 moderate OSA cases, 40.3% would be reclassified as mild, and of the n = 50 severe OSA cases, 36.0% would be reclassified as moderate. Age strongly correlated with the degree of underestimation of the AHI, because age was significantly correlated with time awake during PSG. CONCLUSIONS The risk of sleep apnea underestimation is predicted to be substantial in a tertiary sleep center population. Phenotyping errors included risk of falsely negative results (from mild to normal), as well as category errors: moderate or severe moving to mild or moderate severity, respectively. Clinicians should recognize this underestimation limitation, which directly affects diagnostic phenotyping and thus therapeutic decisions. COMMENTARY A commentary on this article appears in this issue on page 531.
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Affiliation(s)
- Matt T Bianchi
- Neurology Department, Massachusetts General Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Balaji Goparaju
- Neurology Department, Massachusetts General Hospital, Boston, MA
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12
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Sunnetcioglu A, Sertogullarından B, Ozbay B, Gunbatar H, Ekin S. Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features. J Bras Pneumol 2016; 42:48-54. [PMID: 26982041 PMCID: PMC4805387 DOI: 10.1590/s1806-37562016000000012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 08/08/2015] [Indexed: 12/16/2022] Open
Abstract
Objective : To determine whether there are significant differences between rapid-eye-movement (REM)-related obstructive sleep apnea (OSA) and non-REM (NREM)-related OSA, in terms of the demographic, anthropometric, and polysomnographic characteristics of the subjects. Methods : This was a retrospective study of 110 patients (75 males) with either REM-related OSA (n = 58) or NREM-related OSA (n = 52). To define REM-related and NREM-related OSA, we used a previously established criterion, based on the apnea-hypopnea index (AHI): AHI-REM/AHI-NREM ratio > 2 and ≤ 2, respectively. Results : The mean age of the patients with REM-related OSA was 49.5 ± 11.9 years, whereas that of the patients with NREM-related OSA was 49.2 ± 12.6 years. The overall mean AHI (all sleep stages combined) was significantly higher in the NREM-related OSA group than in the REM-related OSA group (38.6 ± 28.2 vs. 14.8 ± 9.2; p < 0.05). The mean AHI in the supine position (s-AHI) was also significantly higher in the NREM-related OSA group than in the REM-related OSA group (49.0 ± 34.3 vs. 18.8 ± 14.9; p < 0.0001). In the NREM-related OSA group, the s-AHI was higher among the men. In both groups, oxygen desaturation was more severe among the women. We found that REM-related OSA was more common among the patients with mild-to-moderate OSA, whereas NREM-related OSA was more common among those with severe OSA. Conclusions : We found that the severity of NREM-related OSA was associated mainly with s-AHI. Our findings suggest that the s-AHI has a more significant effect on the severity of OSA than does the AHI-REM. When interpreting OSA severity and choosing among treatment modalities, physicians should take into consideration the sleep stage and the sleep posture.
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Affiliation(s)
- Aysel Sunnetcioglu
- Pulmonology Department, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | | | - Bulent Ozbay
- Pulmonology Department, School of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Hulya Gunbatar
- Pulmonology Department, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Selami Ekin
- Pulmonology Department, School of Medicine, Yuzuncu Yil University, Van, Turkey
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Li Y, Liu H, Weed JG, Ren R, Sun Y, Tan L, Tang X. Deficits in attention performance are associated with insufficiency of slow-wave sleep in insomnia. Sleep Med 2016; 24:124-130. [PMID: 27810178 DOI: 10.1016/j.sleep.2016.07.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/06/2016] [Accepted: 07/20/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cognitive impairment is associated with insomnia. However, there is a lack of evidence suggesting a link between insomnia and cognitive dysfunction in objective testing. The objectives of our current study were to assess the differences in components of attentional performance between primary insomnia patients and normal-sleeping controls and to examine potential predictors of attention impairment in patients with insomnia. METHODS We studied 36 patients (age 40.39 ± 12.36 years; 57.1% male) with insomnia and 25 normal-sleeping controls (age 39.88 ± 12.50 years; 52.9% male) who underwent one-night polysomnography followed by Multiple Sleep Latency Test (MSLT) and Attention Network Task (ANT). ANT reflected three attentional networks termed the alerting, orienting, and executive control networks. RESULTS After controlling for age, gender, body mass index, depression, anxiety, and education levels, patients with insomnia scored higher on the executive control variable of the ANT compared with normal-sleeping controls (96.75 ± 7.60 vs. 57.00 ± 10.49, p = 0.01). This higher score was independently associated with insufficiency of slow-wave sleep during nighttime sleep (β = -0.38, p = 0.04). CONCLUSION Our findings suggest that insomnia is associated with deficits in executive control of attention and that the underlying mechanism may be insufficiency of slow-wave sleep in chronic insomnia.
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Affiliation(s)
- Yun Li
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Liu
- Geriatric Department, The First People's Hospital of Yibin, China
| | - Jason G Weed
- Yale University School of Medicine, New Haven, CT, USA
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanfeng Sun
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Tan
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China.
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Butt M, Quan SF, Pentland AS, Khayal I. Gender Differences in Real-Home Sleep of Young and Older Couples. SOUTHWEST JOURNAL OF PULMONARY AND CRITICAL CARE 2015; 10:289-299. [PMID: 26110099 DOI: 10.13175/swjpcc068-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY OBJECTIVES To understand gender differences in sleep quality, architecture and duration of young healthy couples in comparison to older couples in their natural sleep environment. DESIGN Sleep was monitored in a naturalistic setting using a headband sleep monitoring device over a period of two weeks for young couples and home polysomnography for the older couples. PARTICIPANTS Ten heterosexual young couples (male mean age: 28.2±1.0[SD] years/female mean age: 26.8±0.9 years) and 14 older couples (male mean age: 59.3±9.6 years/female mean age: 58.8±9.1 years). MEASUREMENTS AND RESULTS In the young couples, total sleep time (395±66 vs. 367±54 min., p<0.05), sleep efficiency (97.0±3.0 vs. 91.1±7.9, p<0.001), and % REM (31.1±4.8 vs. 23.6±5.5, p<0.001) in males was higher than in females. In contrast, % light sleep (51.7±7.1 vs. 59.7±6.7, p<0.001) and number of arousals (2.9±1.9 vs. 5.3±1.9, p<0.001) were lower. These differences persisted after controlling for evening mood and various evening pre-sleep activities. In the older couples, there were no differences between genders. In addition, children in the household adversely impacted sleep. CONCLUSIONS In couples recorded in the home, young males slept longer and had better sleep quality than young females. This difference appears to dissipate with age. In-home assessment of couples can aid in understanding of gender differences in sleep and how they are affected by age and social environment.
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Affiliation(s)
- Maryam Butt
- Masdar Institute of Science and Technology, Abu Dhabi, UAE
| | - Stuart F Quan
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA ; Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ, USA ; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Inas Khayal
- Masdar Institute of Science and Technology, Abu Dhabi, UAE ; Massachusetts Institute of Technology, Cambridge, MA, USA
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Tamaki M, Bang JW, Watanabe T, Sasaki Y. The first-night effect suppresses the strength of slow-wave activity originating in the visual areas during sleep. Vision Res 2014; 99:154-61. [PMID: 24211789 PMCID: PMC4013254 DOI: 10.1016/j.visres.2013.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 01/12/2023]
Abstract
Our visual system is plastic and adaptive in response to the stimuli and environments we experience. Although visual adaptation and plasticity have been extensively studied while participants are awake, little is known about what happens while they are asleep. It has been documented that sleep structure as measured by sleep stages using polysomnography is altered specifically in the first sleep session due to exposure to a new sleep environment, known as the first-night effect (FNE). However, the impact of the FNE on spontaneous oscillations in the visual system is poorly understood. How does the FNE affect the visual system during sleep? To address this question, the present study examined whether the FNE modifies the strength of slow-wave activity (SWA, 1-4Hz)-the dominant spontaneous brain oscillation in slow-wave sleep-in the visual areas. We measured the strength of SWA originating in the visual areas during the first and the second sleep sessions. Magnetoencephalography, polysomnography, and magnetic resonance imaging were used to localize the source of SWA to the visual areas. The visual areas were objectively defined using retinotopic mapping and an automated anatomical parcellation technique. The results showed that the strength of SWA was reduced in the first sleep session in comparison to the second sleep session, especially during slow-wave sleep, in the ventral part of the visual areas. These results suggest that environmental novelty may affect the visual system through suppression of SWA. The impact of the FNE may not be negligible in vision research.
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Affiliation(s)
- Masako Tamaki
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Box 1821, 190 Thayer Street, Providence, RI 02912, USA.
| | - Ji Won Bang
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Box 1821, 190 Thayer Street, Providence, RI 02912, USA.
| | - Takeo Watanabe
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Box 1821, 190 Thayer Street, Providence, RI 02912, USA.
| | - Yuka Sasaki
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Box 1821, 190 Thayer Street, Providence, RI 02912, USA.
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Technologically sensed social exposure related to slow-wave sleep in healthy adults. Sleep Breath 2014; 19:255-61. [PMID: 24862352 DOI: 10.1007/s11325-014-1005-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study is to understand the relationship between automatically captured social exposure and detailed sleep parameters of healthy young adults. METHODS This study was conducted in a real-world setting in a graduate-student housing community at a US university. Social exposure was measured using Bluetooth proximity sensing technology in mobile devices. Sleep was monitored in a naturalistic setting using a headband sleep monitoring device over a period of 2 weeks. The analysis included a total of 11 subjects (6 males and 5 females) aged 24-35 (149 subject nights). RESULTS Slow-wave sleep showed a significant positive correlation (Spearman's rho = 0.51, p < 0.0001) with social exposure, whereas light non-REM (N1 + N2) sleep and wake time were found to be negatively correlated (rho = -0.25, p < 0.01; rho = -0.21, p < 0.01, respectively). The correlation of median slow-wave sleep with median social exposure per subject showed a strong positive significance (rho = 0.88, p < 0.001). On average, within subjects, following day's social exposure was higher when (slow-wave NREM + REM) percentage was high (Wilcoxon sign-ranked test, p < 0.05). CONCLUSIONS Subjects with higher social exposure spent more time in slow-wave sleep. Following day's social exposure was found to be positively affected by previous night's (slow-wave NREM + REM) percentage. This suggests that sleep affects following day's social exposure and not vice versa. Capturing an individual's dynamic social behavior and sleep from their natural environment can provide novel insights into these relationships.
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Jobert M, Wilson FJ, Roth T, Ruigt GSF, Anderer P, Drinkenburg WHIM, Bes FW, Brunovsky M, Danker-Hopfe H, Freeman J, van Gerven JMA, Gruber G, Kemp B, Klösch G, Ma J, Penzel T, Peterson BT, Schulz H, Staner L, Saletu B, Svetnik V. Guidelines for the recording and evaluation of pharmaco-sleep studies in man: the International Pharmaco-EEG Society (IPEG). Neuropsychobiology 2014; 67:127-67. [PMID: 23548759 DOI: 10.1159/000343449] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/26/2012] [Indexed: 01/19/2023]
Abstract
The International Pharmaco-EEG Society (IPEG) presents guidelines summarising the requirements for the recording and computerised evaluation of pharmaco-sleep data in man. Over the past years, technical and data-processing methods have advanced steadily, thus enhancing data quality and expanding the palette of sleep assessment tools that can be used to investigate the activity of drugs on the central nervous system (CNS), determine the time course of effects and pharmacodynamic properties of novel therapeutics, hence enabling the study of the pharmacokinetic/pharmacodynamic relationship, and evaluate the CNS penetration or toxicity of compounds. However, despite the presence of robust guidelines on the scoring of polysomnography -recordings, a review of the literature reveals inconsistent -aspects in the operating procedures from one study to another. While this fact does not invalidate results, the lack of standardisation constitutes a regrettable shortcoming, especially in the context of drug development programmes. The present guidelines are intended to assist investigators, who are using pharmaco-sleep measures in clinical research, in an effort to provide clear and concise recommendations and thereby to standardise methodology and facilitate comparability of data across laboratories.
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Affiliation(s)
- Marc Jobert
- International Pharmaco-EEG Society, Berlin, Germany.
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18
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Heart Rate Variability Biofeedback Improves Cardiorespiratory Resting Function During Sleep. Appl Psychophysiol Biofeedback 2013; 38:265-71. [DOI: 10.1007/s10484-013-9232-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Goerke M, Cohrs S, Rodenbeck A, Grittner U, Sommer W, Kunz D. Declarative memory consolidation during the first night in a sleep lab: the role of REM sleep and cortisol. Psychoneuroendocrinology 2013; 38:1102-11. [PMID: 23246326 DOI: 10.1016/j.psyneuen.2012.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 10/22/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Abstract
While the consolidation of declarative memory is supported by slow wave sleep (SWS) in healthy subjects, it has been shown to be associated with rapid eye movement (REM) sleep in patients with insomnia. Sleep during a subject's first night in an unfamiliar environment is often disturbed, and this so-called first-night effect (FNE) has often been used as a model of transient insomnia. Additionally, sleeping for the first time in an unfamiliar environment can lead to increased cortisol secretion, and declarative memory consolidation likely depends on low cortisol levels, especially during the early part of the night. Accounting for intersubject variability in the FNE, we examined the relationship between sleep stages, cortisol secretion and declarative memory performance in 27 healthy young men. Declarative memory performance improved significantly after sleep. Whereas memory performance during the learning session and retrieval testing was strongly associated with cortisol secretion, the overnight gain was not. Post hoc analyses indicated that the overnight gain appears to be modulated by the extent of the FNE: a significant overnight improvement in memory performance was found only in subjects with a weak FNE (n=12). In these subjects, no association was found between any sleep stage and the improvement observed in their memory performance. In subjects with a strong FNE (n=12), however, the overnight change in memory performance was associated with the proportion of REM sleep and the total number of REMs. Disturbed sleep in an unfamiliar environment therefore appears to affect the memory consolidation process.
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Affiliation(s)
- Monique Goerke
- Sleep Research & Clinical Chronobiology, Department of Physiology (CBF), Charité-Universitätsmedizin Berlin, 14195 Berlin, Germany.
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Griessenberger H, Heib DPJ, Kunz AB, Hoedlmoser K, Schabus M. Assessment of a wireless headband for automatic sleep scoring. Sleep Breath 2013; 17:747-52. [PMID: 22996794 PMCID: PMC3655221 DOI: 10.1007/s11325-012-0757-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 06/20/2012] [Accepted: 07/17/2012] [Indexed: 12/04/2022]
Abstract
PURPOSE Classically, professional assessment of sleep is done in the sleep laboratory using whole-night polysomnography (PSG). However, given a misbalance between accredited sleep laboratories and the large amount of patients suffering from sleep disorders, only few receive appropriate diagnostic assessment. Recently, some low-cost home sleep scoring systems have been proposed, yet such systems are rarely tested scientifically. The aim of the present study was to evaluate the staging accuracy of the home sleep scoring system Zeo (Newton, MA, USA). METHODS A final sample of 21 nights from ten subjects (aged 23-45) was digitally recorded with PSG as well as with the Zeo system. We compared scorings of Zeo (on an epoch-be-epoch basis) with the Somnolyzer 24 × 7 (an automatic staging algorithm), expert scorers as well as the freeware SleepExplorer. RESULTS It was revealed that Zeo shows moderate overall agreement as compared to our study standard Somnolyzer 24 × 7 (κ = 0.56). The most obvious performance difference between Zeo and both other scoring approaches was stage wake (sleep onset latency + wake after sleep onset). While Zeo detected only 40.8 % of the study standard wake epochs, 70.1 % were detected by the expert scorers and 83.4 % by the SleepExplorer, respectively. CONCLUSIONS Data suggest that the Zeo system produces acceptable sleep scoring for stage REM, light and deep sleep, with a specific weakness in correctly detecting waking periods.
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Affiliation(s)
- H. Griessenberger
- Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
| | - D. P. J. Heib
- Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
| | - A. B. Kunz
- Christian Doppler Clinic, Department of Neurology, Paracelsus Private Medical University, Ignaz-Harrerstraße 79, 5020 Salzburg, Austria
| | - K. Hoedlmoser
- Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
| | - M. Schabus
- Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
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Israel B, Buysse DJ, Krafty RT, Begley A, Miewald J, Hall M. Short-term stability of sleep and heart rate variability in good sleepers and patients with insomnia: for some measures, one night is enough. Sleep 2012; 35:1285-91. [PMID: 22942507 DOI: 10.5665/sleep.2088] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Quantify the short-term stability of multiple indices of sleep and nocturnal physiology in good sleeper controls and primary insomnia patients. DESIGN Intra-class correlation coefficients (ICC) were used to quantify the short-term stability of study outcomes. SETTING Sleep laboratory. PARTICIPANTS Fifty-four adults with primary insomnia (PI) and 22 good sleeper controls (GSC). MEASUREMENTS Visually scored sleep outcomes included indices of sleep duration, continuity, and architecture. Quantitative EEG outcomes included power in the delta, theta, alpha, sigma, and beta bands during NREM sleep. Power spectral analysis was used to estimate high-frequency heart rate variability (HRV) and the ratio of low- to high-frequency HRV power during NREM and REM sleep. RESULTS With the exception of percent stage 3+4 sleep; visually scored sleep outcomes did not exhibit short-term stability across study nights. Most QEEG outcomes demonstrated short-term stability in both groups. Although power in the beta band was stable in the PI group (ICC = 0.75), it tended to be less stable in GSCs (ICC = 0.55). Both measures of cardiac autonomic tone exhibited short-term stability in GSCs and PIs during NREM and REM sleep. CONCLUSIONS Most QEEG bandwidths and HRV during sleep show high short-term stability in good sleepers and patients with insomnia alike. One night of data is, thus, sufficient to derive reliable estimates of these outcomes in studies focused on group differences or correlates of QEEG and/or HRV. In contrast, one night of data is unlikely to generate reliable estimates of PSG-assessed sleep duration, continuity or architecture, with the exception of slow wave sleep.
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Affiliation(s)
- Benjamin Israel
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Voderholzer U, Piosczyk H, Holz J, Landmann N, Feige B, Loessl B, Kopasz M, Doerr JP, Riemann D, Nissen C. Sleep restriction over several days does not affect long-term recall of declarative and procedural memories in adolescents. Sleep Med 2011; 12:170-8. [PMID: 21256802 DOI: 10.1016/j.sleep.2010.07.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 07/21/2010] [Accepted: 07/27/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES There is broad evidence that sleep as opposed to waking facilitates the consolidation of both declarative and procedural memory. The current study addressed the question whether different extents of sleep restriction after learning would impair long-term memory consolidation in adolescents. METHODS Eighty-eight healthy adolescents were randomized to five different sleep protocols with 9, 8, 7, 6 or 5 h of time in bed for four consecutive nights under controlled conditions that excluded daytime sleep. Declarative (word-pair task) and procedural memory (mirror tracing task) encoding was assessed prior to the sleep restriction protocol. Recall was assessed after two recovery nights following the sleep protocol and 4 weeks later. RESULTS Sleep diaries and actigraphy data demonstrated that the participants closely followed the sleep protocols. There were no differences in demographic parameters or memory encoding at baseline. In contrast to the initial prediction, restriction of nocturnal sleep over four consecutive nights had no significant impact on declarative or procedural memory consolidation. Polysomnographic monitoring after sleep restriction demonstrated a high preservation of the amount of slow wave sleep in the restricted conditions. CONCLUSIONS The results suggest that adolescents show a high resilience of memory consolidation to substantial sleep curtailment across four nights that might be promoted by increased sleep intensity under conditions of sleep restriction.
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Affiliation(s)
- Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany.
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Cyclic alternating pattern and sleep quality in healthy subjects—Is there a first-night effect on different approaches of sleep quality? Biol Psychol 2010; 83:20-6. [DOI: 10.1016/j.biopsycho.2009.09.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 08/31/2009] [Accepted: 09/17/2009] [Indexed: 11/20/2022]
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Moderating Laboratory Adaptation with the Use of a Heart-rate Variability Biofeedback Device (StressEraser®). Appl Psychophysiol Biofeedback 2009; 34:245-9. [DOI: 10.1007/s10484-009-9086-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 04/22/2009] [Indexed: 10/20/2022]
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25
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Selwa LM, Marzec ML, Chervin RD, Weatherwax KJ, Vaughn BV, Foldvary-Schaefer N, Wang L, Song Y, Malow BA. Sleep staging and respiratory events in refractory epilepsy patients: Is there a first night effect? Epilepsia 2008; 49:2063-8. [PMID: 18513353 PMCID: PMC3748715 DOI: 10.1111/j.1528-1167.2008.01681.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We performed this analysis of possible first night effects (FNEs) on sleep and respiratory parameters in order to evaluate the need for two serial night polysomnograms (PSGs) to diagnose obstructive sleep apnea (OSA) in epilepsy patients. METHODS As part of a pilot multicenter clinical trial investigating the effects of treating sleep apnea in epilepsy, two nights of PSG recording were performed for 40 patients with refractory epilepsy and OSA symptoms. Sleep architecture was examined in detail, along with respiratory parameters including apnea/hypopnea index (AHI) and minimum oxygen saturation. Analysis included two-tailed t-tests, Wilcox sign rank analysis, and Bland Altman measures of agreement. RESULTS Total sleep time differed between the two nights (night 1,363.8 min + 59.4 vs. 386.3 min + 68.6, p = 0.05). Rapid eye movement (REM) sleep and percentage of REM sleep were increased during night two (night 1: 12.3% + 5.9 vs. night 2: 15.5% + 6.2, p = 0.007), and the total minutes of slow-wave sleep (SWS) were increased (night 1: 35.6 + 60.7 vs. night 2: 46.4 + 68.1, p = 0.01). No other sleep or respiratory variables differed between the two nights. Given an AHI inclusion criterion of five apneas per hour, the first PSG identified all but one patient with OSA. DISCUSSION Respiratory parameters showed little variability between the first and second nights. Sleep architecture was mildly different between the first and second PSG night. Performing two consecutive baseline PSGs to diagnose OSA may not be routinely necessary in this population.
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Affiliation(s)
- Linda M Selwa
- Department of Neurology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0117, USA.
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Abstract
Sleep architecture is often disturbed after a stressful event; nevertheless, little is known about the brain circuitry responsible for the sleep perturbations induced by stress. We exposed rats to a psychological stressor (cage exchange) that initially causes an acute stress response, but several hours later generates a pattern of sleep disturbances similar to that observed in stress-induced insomnia in humans: increased sleep latency, decreased non-REM (nREM) and REM sleep, increased fragmentation, and high-frequency EEG activity during nREM sleep. We examined the pattern of Fos expression to identify the brain circuitry activated, and found increased Fos in the cerebral cortex, limbic system, and parts of the arousal and autonomic systems. Surprisingly, there was simultaneous activation of the sleep-promoting areas, most likely driven by ongoing circadian and homeostatic pressure. The activity in the cerebral cortex and arousal system while sleeping generates a novel intermediate state characterized by EEG high-frequency activity, distinctive of waking, during nREM sleep. Inactivation of discrete limbic and arousal regions allowed the recovery of specific sleep components and altered the Fos pattern, suggesting a hierarchical organization of limbic areas that in turn activate the arousal system and subsequently the cerebral cortex, generating the high-frequency activity. This high-frequency activity during nREM was eliminated in the stressed rats after inactivating parts of the arousal system. These results suggest that shutting down the residual activity of the limbic-arousal system might be a better approach to treat stress-induced insomnia, rather than potentiation of the sleep system, which remains fully active.
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Affiliation(s)
- Jeanetta C. Rains
- Center for Sleep Evaluation
Elliot Hospital
One Elliot Way
Manchester, NH 03103
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Suetsugi M, Mizuki Y, Yamamoto K, Uchida S, Watanabe Y. The effect of placebo administration on the first-night effect in healthy young volunteers. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:839-47. [PMID: 17328999 DOI: 10.1016/j.pnpbp.2007.01.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 01/23/2007] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
The first-night effect is a well-known phenomenon that is considered to result from a subject's lack of adaptation to the unfamiliar environment of a sleep laboratory and to the technical equipment used for polysomnography. The effect has been explored as a laboratory model for transient insomnia. The main characteristics of this effect are short total sleep time (TST) and rapid eye movement (REM) sleep, a lower sleep efficiency index, and longer REM sleep latency. Previous studies have reported that personality traits (such as trait anxiety) are a potential cause of the first-night effect and that the placebo effect is closely related to the anxiety levels of the subjects. To the best of our knowledge, there are no reports regarding the effects of a placebo on first-night sleep. This omission can be explained by the fact that the polysomnographic recordings obtained during the first night of a study are generally excluded from the analysis in order to avoid the inclusion of the first-night effect. In the present study, 8 male university students were subjected to polysomnographic examinations during drug-free, placebo-administration, and benzodiazepine-administration conditions in order to clarify the placebo effect on sleep during consecutive nights, particularly on the first night. The recordings for each condition were conducted for 4 consecutive nights. A placebo or 5 mg nitrazepam was administered at 2230 h using a double-blind crossover design, while no drug was administered during the drug-free condition. There was a 10-day interval between the examination of each condition. Polysomnographic recording was started at 2300 h and continued until the natural awakening of the subjects on the next morning. Subsequently, the subjects were requested to fill in a rating scale that is used to evaluate the subjective perception of sleep. An increase in stage-2 sleep associated with the first-night effect was observed on the first night during the drug-free and placebo-administration conditions. However, REM sleep reduction associated with the first-night effect was detected on the first night during the drug-free condition; this decrease in REM sleep was counteracted by the placebo during the placebo-administration condition. The nitrazepam, but not the placebo, decreased both slow-wave sleep (SWS) and REM sleep. The values for the tendency to fall asleep, feeling refreshed upon awakening in the morning, and the tension upon awakening in the morning were improved to a greater extent by the placebo and nitrazepam administrations than when no drug was administered. These results demonstrate the possibility that placebo administration may have a hypnotic/anxiolytic effect and may improve transient insomnia without causing SWS and REM sleep reductions.
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Affiliation(s)
- Masatomo Suetsugi
- Department of Neuropsychiatry, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
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Abstract
This systematic review examines the effect of diverse psychosocial stressors on polysomnographic measures of sleep. Sixty-three articles were located and categorized in terms of the types of stressors imposed. Experimental stress resulted in fairly consistent changes: decreases in slow wave sleep, REM sleep, and sleep efficiency (SE), as well as increases in awakenings. Data were limited in terms of response to non-experimental stressors, except for the case of post-traumatic stress disorder (PTSD) on sleep, where a number of reports suggest that PTSD patients have increased awakenings and decreased SE. Future research needs to define stress more precisely in terms of duration and severity and to measure its impacts on sleep in populations that differ in terms of age, comorbid illness, gender, and so forth. Without such fine-grained analyses, it is difficult to draw definitive conclusions about this important area.
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Affiliation(s)
- Eui-Joong Kim
- Department of Psychiatry Eulji University School of Medicine, Daejeon, Korea
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TAMAKI M, NITTONO H, HAYASHI M, HORI T. Spectral analysis of the first-night effect on the sleep-onset period. Sleep Biol Rhythms 2005. [DOI: 10.1111/j.1479-8425.2005.00173.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hornyak M, Feige B, Voderholzer U, Riemann D. Spectral analysis of sleep EEG in patients with restless legs syndrome. Clin Neurophysiol 2005; 116:1265-72. [PMID: 15978488 DOI: 10.1016/j.clinph.2005.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Revised: 01/21/2005] [Accepted: 02/09/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Conventional analyses of sleep EEG recordings according to standard criteria indicate severe sleep disturbances in patients with restless legs syndrome (RLS). Spectral analysis of sleep EEG may be a sensitive tool to detect functional alterations of sleep mechanisms beyond the visual scoring of polysomnographic records. We analysed sleep EEG spectral power differences between RLS patients and healthy subjects. Furthermore, we studied the relationship of sleep EEG spectral power to the occurrence of periodic leg movements in sleep (PLMS) and arousal events. METHODS Sleep EEGs from 20 patients with idiopathic RLS and of 20 age and sex matched healthy subjects were investigated. The spectral analysis was carried out on the same 30s epochs for which sleep stages had been determined. As a first step, whole-night spectral power excluding epochs with an arousal or with a PLMS was compared separately for REM and NREM sleep between RLS and healthy subjects. In a second step, we evaluated the spectral effects of PLMS, PLMS with associated arousals and isolated arousals relative to epochs of sleep without such events in both groups. In this part of the analysis, we only included the epochs of sleep stage 2 (the main and most stable non-REM sleep stage) and of REM sleep. RESULTS Spectral power of all sleep epochs (excluding arousals and PLMS) did not differ between patients with RLS and healthy subjects. As expected, arousals and PLMS-associated arousals resulted in a significant increase in higher-frequency activity (alpha, beta1, beta2 and gamma bands) in both groups. Spectral power in epochs with PLMS alone did not significantly differ from spectral power in epochs without PLMS and without arousal in any of the groups. CONCLUSIONS We found no evidence for an altered cortical activity in sleep stage 2 and REM sleep epochs in RLS patients compared to that in healthy controls if epochs with arousals were not considered. Furthermore, while PLMS associated with an arousal have a high impact on EEG spectra, the effect of a PLMS without arousal seems to be minor and transient. SIGNIFICANCE Our data suggest that RLS related symptoms may intermittently disrupt sleep but do not appear to involve a persistent disturbance of the basic sleep generating patterns.
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Affiliation(s)
- Magdolna Hornyak
- Department of Psychiatry and Psychotherapy, University Hospital, Hauptstrasse 5, D-79104 Freiburg, Germany.
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Li AM, Wing YK, Cheung A, Chan D, Ho C, Hui S, Fok TF. Is a 2-night polysomnographic study necessary in childhood sleep-related disordered breathing? Chest 2005; 126:1467-72. [PMID: 15539714 DOI: 10.1378/chest.126.5.1467] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are limited data on the night-to-night variability of childhood sleep-related disordered breathing (SDB). We aim to assess for the presence of first-night effect (FNE) and to examine whether a single-night sleep study is adequate in the assessment of childhood SDB. DESIGN In a case-control study investigating whether obesity is a risk factor for childhood SDB, the night-to-night variability of sleep and respiratory variables were studied. PARTICIPANTS AND SETTING Forty-six obese children from a pediatric obesity clinic and 44 age- and sex-matched normal weight control subjects from local schools. INTERVENTIONS All subjects underwent two consecutive overnight polysomnographic studies. An obstructive apnea index (OAI) >/= 1/h was considered diagnostic of SDB. RESULTS The mean age of the children was 11.21 years (SD 2.21). Forty-four obese children and 43 control subjects completed the 2-night study. Based on the criterion of the worst OAI over the 2 nights, 13 subjects were found to have SDB, 12 subjects were primary snorers, and 62 were normal subjects. In all subjects, the sleep efficiency improved and sleep-onset latency was reduced on the second night. While there was a rebound of rapid eye movement sleep with the associated worsening of respiratory indexes (mainly accounted for by an increase in central apneas and hypopneas) evident in normal subjects, there was a significant improvement of respiratory disturbances in the SDB group on the second night. The first-night polysomnography would have correctly identified 84.6% of cases as defined by the criteria of the worst OAI over the 2 nights. All cases missed by the first-night study had only borderline OAI. CONCLUSIONS The phenomenon of FNE in children was well demonstrated in our study. We proposed that a single-night sleep study is adequate and more cost-effective in assessing for childhood SDB.
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Affiliation(s)
- Albert M Li
- Department of Psychiatry, Shatin Hospital, Shatin, The Chinese University of Hong Kong, Hong Kong
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Curcio G, Ferrara M, Piergianni A, Fratello F, De Gennaro L. Paradoxes of the first-night effect: a quantitative analysis of antero-posterior EEG topography. Clin Neurophysiol 2004; 115:1178-88. [PMID: 15066543 DOI: 10.1016/j.clinph.2003.12.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2003] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The first-night effect (FNE) is a common issue in sleep research. Being considered fragmented and poorly efficient, the adaptation night is discarded for data analysis. The present study aims to provide a quantitative and topographical EEG analysis of this phenomenon. METHODS Eight healthy subjects slept for two consecutive nights (adaptation (AD) and baseline (BSL)), and their polysomnography was visually scored and then submitted to spectral power analysis. RESULTS The results showed a decreased quality and quantity of first-night sleep as indicated by more stage 1 and intrasleep wake, paralleled by a reduced sleep efficiency and a longer sleep onset latency. On the other hand, EEG quantitative data showed a more complex and apparently paradoxical picture. An increase in delta power was observed, particularly over the central areas during the first night, paralleled by an increased power in beta bin frequencies solely at posterior scalp locations. CONCLUSIONS These results have been interpreted as caused by, respectively, a reduced total sleep time during the adaptation night and a cortical hyperactivity, typical of psychophysiological insomnia. The present results confirm the need to exclude the laboratory sleep adaptation night from data analysis since it is not a reliable index of sleep on subsequent nights as regards both visual scoring and quantitative EEG analysis. Finally, regional differences between REM and NREM sleep have been confirmed. SIGNIFICANCE This is the first attempt to evaluate the FNE with a quantitative approach to the antero-posterior EEG topography, providing both a Hz-by-Hz and a classical EEG band-based analysis.
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Affiliation(s)
- Giuseppe Curcio
- Laboratorio di Psicofisiologia del Sonno, Department of Psychology, University of Rome La Sapienza, Via dei Marsi 78, 00185 Rome, Italy.
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Scholle S, Scholle HC, Kemper A, Glaser S, Rieger B, Kemper G, Zwacka G. First night effect in children and adolescents undergoing polysomnography for sleep-disordered breathing. Clin Neurophysiol 2004; 114:2138-45. [PMID: 14580612 DOI: 10.1016/s1388-2457(03)00209-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To establish whether there is a first night effect (FNE) in children and adolescents with suspected obstructive sleep apnoea undergoing polysomnography (PSG) and whether this affects sleep and breathing, furthermore, to determine the extent to which age may influence the sleep and cardiorespiratory parameters. METHODS One hundred and thirty-one children and adolescents (age classes-A: 2-6 years n=37; B: 7-12 years n=60; C: 13-17 years n=34) underwent PSG on 2 consecutive nights (I and II) under identical conditions for suspected sleep-related respiratory disorders. One hundred and five patients including 3 patients with obstructive sleep apnoea syndrome (OSAS) treated by adenotonsillectomy and 18 OSAS patients receiving nCPAP-therapy had no PSG-abnormalities (Group 1-A: n=28; B: n=53; C: n=24). A further 26 patients (Group 2) had clinically and polysomnographically confirmed untreated OSAS (A: n=9; B: n=12; C: n=5). RESULTS There were no statistically significant differences between children with no PSG-abnormalities (Group 1) and those with OSAS (Group 2) in terms of sleep parameters (arousal indices excluded), oxygen saturation (SaO(2)) and heart rate (HR), and these parameters have, therefore, been pooled for the entire group (n=131) in the 3 age classes A, B and C. In the second and third age classes, sleep efficiency on the first night was reduced. In all age classes, there was significantly more wakefulness during the first night. In the second and third age ranges, the proportion of NREM 1 in the first night was significantly higher, with a correspondingly reduced proportion of NREM 4 in the third age group. In all age classes, REM sleep was significantly less during the first night, but REM latency was comparable on both nights. On the first night, the mean HR was higher. There were significant differences in apnoea/hypopnoea-index (AHI), electroencephalogram (EEG)-arousal-index (AI) and motoric arousal index (jerk index, JI) between Groups 1 and 2. In neither group, were there any significant differences in AHI, mean SaO(2) or number of EEG-arousals between nights 1 and 2. Only in the age class A, in Group 2 (n=9) was the number of motoric arousals significantly higher on the first night. Comparison of the age classes A, B, and C revealed that most polysomnographic parameters were age-dependent. Increasing age was found to correlate with a higher proportion of NREM 1, especially on the first night. Also, there was an age-dependent increase in NREM 2 on both nights, a decrease in NREM 3 on the first night, and a decrease in NREM 4 on both nights. In older children, we also found a lower proportion of REM sleep on the first night and a lower HR on both nights. In Group 1, we found a lowered AHI, AI and JI (for JI significant only on the first night) in older patients. No such age dependence of AHI, AI and JI was seen in OSAS patients (Group 2). CONCLUSIONS In children and adolescents, there is an FNE comparable with that described in adults. In OSAS children and also in children with no PSG-abnormalities, there is night-to-night-variability in sleep parameters, but not in respiratory parameters. An adaptation night is, therefore, necessary when sleep architecture is to be studied, but not when only the nocturnal respiratory pattern is investigated. Sleep parameters, HR and arousal indices are all age-dependent.
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Affiliation(s)
- S Scholle
- Centre of Sleep Medicine and Children's Hospital, Robert-Koch-Hospital Apolda, Jenaer Strasse 66, D-99510 Apolda, Germany.
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Klein KM, Knake S, Hamer HM, Ziegler A, Oertel WH, Rosenow F. Sleep but not hyperventilation increases the sensitivity of the EEG in patients with temporal lobe epilepsy. Epilepsy Res 2003; 56:43-9. [PMID: 14529952 DOI: 10.1016/j.eplepsyres.2003.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the relative impact of 3 and 5 min of hyperventilation (HV) and different sleep stages on the sensitivity of the interictal EEG in focal epilepsy. METHODS We examined 20 patients with temporal lobe epilepsy (TLE, 85%) or extratemporal epilepsy during EEG-monitoring. We compared 6 min EEG (12 epochs of 30s) during/after each: (a) waking; (b) 5 or 3 min of HV; (c) sleep stages 1, 2, 3/4 and REM regarding the frequency of epileptiform discharges (ED). The Wilcoxon matched pairs signed rank test was used. The main endpoint was the comparison of 5 min of HV with sleep stage 2. RESULTS During sleep stage 2, ED were more frequent than during/after 5 min of HV (P=0.002). Compared to the waking EEG, all NREM-sleep stages activated ED. Sleep stage 2 was associated with the strongest activation. There was no difference between the waking state and REM-sleep. Compared to the waking EEG, neither 3 nor 5 min of HV showed an activation of ED. CONCLUSION In patients with TLE, sleep stage 2 shows a significantly higher sensitivity for ED than 5 min of HV. Compared to the waking EEG, HV showed no activating effect on ED. These results suggest that in patients with the clinical diagnosis of TLE (and possibly other focal epilepsies) measures to record sleep stage 2 (such as sleep deprivation) should be increased whereas HV appears to be dispensable in this setting.
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Affiliation(s)
- Karl Martin Klein
- Interdisciplinary Epilepsy-Center, Department of Neurology, Neurologische Klinik, Philipps-University Marburg, Rudolf-Bultmann-Str. 8, 35033 Marburg, Germany
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Barreiro B, Badosa G, Quintana S, Esteban L, Heredia JL. Comparación entre el análisis automático y manual de la polisomnografía convencional en el diagnóstico del síndrome de apnea-hipopnea obstructiva del sueño. Arch Bronconeumol 2003; 39:544-8. [PMID: 14636490 DOI: 10.1016/s0300-2896(03)75452-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare automatic and manual analysis of neurological and respiratory variables obtained with the SomnoStar alpha 4100, a 16-channel polysomnographic system. PATIENTS AND METHOD Twenty-eight patients suspected of obstructive sleep apnea-hypopnea syndrome were enrolled and given conventional polysomnographic tests. The order of automatic and manual reading of respiratory episodes, sleep stages, and arousals was randomized. We assessed agreement with the intraclass correlation coefficient and plotted standardized differences against standardized means, using the Bland-Altman method. RESULTS Poor agreement was observed between the 2 types of analysis of sleep stages, especially for REM and deep sleep stages. Agreement was good for apneic episodes among the respiratory variables; however, automatic analysis underestimated hypopneas. If manual analysis is considered the gold standard at the apnea-hypopnea index cut point greater than 10, automatic analysis obtained a sensitivity of 55%, a specificity and positive predictive value of 100%, a negative predictive value of 47%, and an overall diagnostic yield of 67.8%. CONCLUSIONS The automatic analysis of the SomnoStar 4100 system provides an unsatisfactory reading of sleep stages and respiratory episodes, especially hypopneas.
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Affiliation(s)
- B Barreiro
- Servicio de Neumología. Hospital Mútua de Terrassa. Terrassa. Barcelona. Spain
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De Gennaro L, Ferrara M, Curcio G, Cristiani R, Lombardo C, Bertini M. Are polysomnographic measures of sleep correlated to alexithymia? A study on laboratory-adapted sleepers. J Psychosom Res 2002; 53:1091-5. [PMID: 12479991 DOI: 10.1016/s0022-3999(02)00342-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Since recent findings have pointed to a correlation between alexithymia and measures of poor sleep quality during the first night of adaptation to a sleep laboratory, the aim of the current study was to assess the same relation in healthy laboratory-adapted sleepers. As a further measure of rapid eye movement (REM) sleep characteristics, REM density was also measured. METHODS Twenty-seven male subjects, without sleep or psychiatric disorders, filled out the 20-item Toronto Alexithymia Scale (TAS-20) and slept for two consecutive undisturbed nights. Polysomnography and REM density were measured in the postadaptation night. RESULTS Alexithymia scores did not correlate significantly with any polysomnographic variable or with REM density. Only the Externally Oriented Thinking (EOT) subscale showed a negative association with REM latency. Multiple regression on selected sleep measures as predictors confirmed these results. CONCLUSION Results do not extend to normal sleep the association previously found between alexithymia and a poor quality of sleep during the adaptation night in the sleep laboratory. The only polysomnographic measure showing an association, albeit little, with one facet of alexithymia was REM latency.
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Affiliation(s)
- Luigi De Gennaro
- Sezione di Neuroscienze, Department of Psychology, University of Rome La Sapienza, Italy.
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Gottselig JM, Bassetti CL, Achermann P. Power and coherence of sleep spindle frequency activity following hemispheric stroke. Brain 2002; 125:373-83. [PMID: 11844737 DOI: 10.1093/brain/awf021] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Brainstem and thalamic structures are known to play a critical role in modulating sleep-wake cycles, but the extent to which the cerebral hemispheres are involved remains unclear. To study the role of the cerebral hemispheres in generating sleep EEG patterns, all-night polysomnographic recordings were collected in subjects with brain damage (n = 30) caused by hemispheric stroke and in hospitalized controls (n = 12). Recordings were made in the acute (< or =10 days post-stroke), subchronic (11-35 days post-stroke) and chronic (>60 days post-stroke) phases of stroke. Bipolar and referential EEG derivations were recorded. Standard sleep stage scoring was conducted using the referential derivation placed opposite the lesion. Sleep stage 2 power and coherence spectra were calculated based on recordings from bipolar derivations. In the mean spectra, the highest spindle frequency peak was identified and its size was calculated relative to the background spectrum. Analysis of visually scored EEG data indicated that, compared with controls, acute phase brain-damaged subjects had lower sleep efficiency and increased waking after sleep onset. The durations of rapid eye movement and non-rapid eye movement sleep stages did not differ significantly between brain-damaged subjects and hospitalized controls. Spectral analyses revealed that, compared with hospitalized controls, brain-damaged subjects had significantly reduced spindle peak sizes in the power and coherence spectra from derivations ipsilateral to the lesion. Within-subject comparisons across time demonstrated that the power and coherence of sleep spindle frequency activity increased significantly from the acute to the chronic phases of stroke, suggesting that plastic mechanisms allowed the possibility of recovery. Our findings provide novel evidence that the cerebral hemispheres are important in generating coherent sleep spindles in humans, and they are consonant with prior empirical and theoretical evidence that corticothalamic projections modulate the generation of synchronous spindle oscillations. Because spindle oscillations are thought to be involved in blocking sensory input to the cortex during sleep, the decrease in synchronous spindle frequency activity following hemispheric stroke may contribute to the observed reduction in sleep continuity.
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Affiliation(s)
- J M Gottselig
- Institute of Pharmacology and Toxicology, Section of Psychopharmacology and Sleep Research, University of Zürich and Department of Neurology, University Hospital-Inselspital, Bern, Switzerland.
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Tan X, Campbell IG, Feinberg I. Internight reliability and benchmark values for computer analyses of non-rapid eye movement (NREM) and REM EEG in normal young adult and elderly subjects. Clin Neurophysiol 2001; 112:1540-52. [PMID: 11459695 DOI: 10.1016/s1388-2457(01)00570-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the reliability of computer measured non-rapid eye movement (NREM) and REM frequency bands in the 0.3-45 Hz range and to provide benchmark data for these measures in young normal (YN) and elderly normal (EN) subjects (Ss). METHODS Sleep EEG was recorded in 19 YN and 19 EN Ss on 4 non-consecutive baseline nights and simultaneously quantified as fast Fourier transform (FFT) power and 3 zero-cross period-amplitude (PA) measures: integrated amplitude, time in band and average wave amplitude. RESULTS The shapes of both the FFT and PA spectra differed among Ss but were highly consistent within individuals. Inter-night reliability of the separate frequency bands was correspondingly high. Despite substantial age effects, the reliability of computer-measured sleep EEG in the elderly equaled that of the YN Ss. Within both the YN and EN groups, the shapes of the NREM and REM spectral curves differed significantly. The NREM and REM also differed significantly in the two age groups. CONCLUSIONS Computer-measured sleep EEG is highly reliable across non-consecutive nights in both young and elderly normal Ss. The trait-like stability of these measures suggests they are genetically determined. This possibility is supported by twin study data that show strong heritability for FFT-measured waking EEG. The different shapes of NREM and REM spectra add further evidence that these are fundamentally different states of brain organization. The age differences in spectral shape, along with PA data for wave incidence, demonstrate that age effects on sleep EEG are not caused by changes in skull impedance or other non-cerebral factors.
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Affiliation(s)
- X Tan
- Veterans Administration, University of California, Davis Sleep Laboratory, TB-148, University of California, Davis, CA 95616, USA
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Borgersen AK, Skatvedt O, Akre H. Does the oral device Noiselezz prevent sleep apnoea? ACTA OTO-LARYNGOLOGICA. SUPPLEMENTUM 2001; 543:179-82. [PMID: 10909014 DOI: 10.1080/000164800454332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Both snoring and apnoea are caused by the collapse of soft tissue in the upper airways during sleep. Increasing the cross-sectional area of the airways in these segments by moving the mandible and/or the tongue forward stabilizes the upper airways in obstructive sleep apnoea syndrome (OSAS) patients. The aim of this study was to determine the effect of Noiselezz, which is an oral appliance of the mandibular advancing type, designed for easy use. Twenty-one patients, all men (aged 50.6 +/- 10.4, body mass index 26.5 +/- 3.3) were included in the study. Polysomnography (PSG) was performed before the patients started using Noiselezz. After a period of 2 weeks accustomizing to the oral device, the patients had another PSG performed with Noiselezz inserted. We found no significant differences in total sleep time, percentage of time spent snoring, duration of rapid eye movement (REM) sleep, slow-wave sleep, inter-sleep wake and sleep efficiency, apnoea/hypopnoea index (AHI) or lowest measured oxygen saturation after apnoea (minSaO2). No significant differences were found in the localization of obstructions or intrathoracal inspiratory pressure with and without the use of the Noiselezz oral device. Three patients (14%) reported satisfaction with treatment by the oral device. All three continued to use Noiselezz as treatment. The rest of the patients (86%) either did not tolerate the device at all or tried it for a period and then requested alternative treatment (n = 12). Most patients found the oral device "Noiselezz" inconvenient to use, and our results show that the device has little or no effect on snoring and sleep apnoea.
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Affiliation(s)
- A K Borgersen
- Department of Otorhinolaryngology, Ullevaal University Hospital, Oslo, Norway.
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Toussaint M, Luthringer R, Staner L, Muzet A, Macher J. Changes in EEG power density during sleep laboratory adaptation in depressed inpatients. Biol Psychiatry 2000; 47:626-33. [PMID: 10745055 DOI: 10.1016/s0006-3223(99)00161-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the first-night effect in depressed inpatients, using standard sleep measures as well as all-night spectral analysis of the sleep electroencephalogram (EEG). METHODS Eighteen drug-free, depressed inpatients were studied for 3 consecutive nights in the hospital sleep laboratory. RESULTS Visual sleep scoring results showed a slight but measurable first-night effect, characterized by a reduction of rapid eye movement (REM) sleep amount and increased wakefulness. Sleep EEG spectral analysis showed significantly reduced delta (p <.01) and theta (p <.05) power density in non-REM (NREM) sleep of the first night compared with that of the second and third nights. These differences were limited to the early part of the sleep period, a time during the night that is particularly vulnerable to the effects of depressive disorder. In contrast to the NREM sleep findings, spectral REM variables studied did not significantly vary across the three nights. CONCLUSIONS The results obtained suggest that first-night data should not be simply discarded but could be used in subsequent analyses and could be considered useful in the evaluation of the sleep of depressed patients.
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Affiliation(s)
- M Toussaint
- Foundation for Applied Neuroscience Research in Psychiatry (FORENAP) Centre Hospitalier, Rouffach, France
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