Rapid eye movement fragmentation, not slow-wave sleep, predicts neutral declarative memory consolidation in posttraumatic stress disorder

REM disruption and REM vagal activity predict extinction recall in trauma-exposed individuals

BACKGROUND

Accumulating evidence suggests that rapid eye movement sleep (REM) supports the consolidation of extinction memory. REM is disrupted in posttraumatic stress disorder (PTSD), and REM abnormalities after traumatic events increase the risk of developing PTSD. Therefore, it was hypothesized that abnormal REM in trauma-exposed individuals may pave the way for PTSD by interfering with the processing of extinction memory. In addition, PTSD patients display reduced vagal activity. Vagal activity contributes to the strengthening of memories, including fear extinction memory, and recent studies show that the role of vagus in memory processing extends to memory consolidation during sleep. Therefore, it is plausible that reduced vagal activity during sleep in trauma-exposed individuals may be an additional mechanism that impairs extinction memory consolidation. However, to date, the contribution of sleep vagal activity to the consolidation of extinction memory or any emotional memory has not been investigated.

METHODS

Trauma-exposed individuals (n = 113) underwent a 2-day fear conditioning and extinction protocol. Conditioning and extinction learning phases were followed by extinction recall 24 h later. The association of extinction recall with REM characteristics and REM vagal activity (indexed as heart rate variability) during the intervening consolidation night was examined.

RESULTS

Consistent with our hypotheses, REM disruption was associated with poorer physiological and explicit extinction memory. Furthermore, higher vagal activity during REM was associated with better explicit extinction memory, and physiological extinction memory in males.

CONCLUSIONS

These findings support the notion that abnormal REM, including reduced REM vagal activity, may contribute to PTSD by impairing the consolidation of extinction memory.

Alterations in hippocampal somatostatin interneurons, GABAergic metabolism, and ASL perfusion in an aged male mouse model of POCD aggravated by sleep fragmentation

Sleep fragmentation (SF) is increasingly recognized as a contributing factor to postoperative cognitive dysfunction (POCD). Given the critical roles of somatostatin (SST) interneurons, associated gamma-aminobutyric acid (GABA)ergic neurotransmitters, and hippocampal perfusion in sleep-related cognition, this study examined changes in these mechanisms in preoperative SF affecting POCD induced by anesthesia/surgery in aged male mice. The Morris water maze (MWM), novel object recognition (NOR), and Y maze tests were utilized to evaluate POCD. Arterial spin labeling (ASL) was employed to measure hippocampal regional cerebral blood flow (rCBF). In vitro assays quantified the levels of GABAergic metabolites-such as SST, neuropeptide Y (NPY), glutamic acid decarboxylase 1 (GAD1), vesicular GABA transporter (VGAT), and GABA and the distribution of SST interneurons in the hippocampus through enzyme-linked immunosorbent assay and immunofluorescence. Preoperative 24-h SF exacerbated anesthesia/surgery-induced spatial memory impairments observed in the MWM, NOR, and Y maze tests. Preoperative 24-h SF significantly increased the number of SST interneurons in hippocampal CA1, elevated hippocampal levels of SST, NPY, GAD1, and GABA, and reduced the rCBF. Preoperative SF aggravated POCD in aged male mice, with an increased number of SST interneurons in hippocampal CA1, elevated hippocampal GABAergic metabolites, and a further reduction in rCBF.

REM disruption and REM Vagal Activity Predict Extinction Recall in Trauma-Exposed Individuals

Accumulating evidence suggests that rapid eye movement sleep (REM) supports the consolidation of extinction memory. REM is disrupted in PTSD, and REM abnormalities after traumatic events increase the risk of developing PTSD. Therefore, it was hypothesized that abnormal REM in trauma-exposed individuals may pave the way for PTSD by interfering with the processing of extinction memory. In addition, PTSD patients display reduced vagal activity. Vagal activity contributes to the strengthening of memories, including fear extinction memory, and recent studies show that the role of vagus in memory processing extends to memory consolidation during sleep. Therefore, it is plausible that reduced vagal activity during sleep in trauma-exposed individuals may be an additional mechanism that impairs extinction memory consolidation. However, to date, the contribution of sleep vagal activity to the consolidation of extinction memory or any emotional memory has not been investigated. To test these hypotheses, we examined the association of extinction memory with REM characteristics and REM vagal activity (indexed as heart rate variability) in a large sample of trauma-exposed individuals (n=113). Consistent with our hypotheses, REM disruption was associated with poorer physiological and explicit extinction memory. Furthermore, higher vagal activity during REM was associated with better explicit extinction memory, and physiological extinction memory in males. These findings support the notion that abnormal REM may contribute to PTSD by impairing the consolidation of extinction memory and indicate the potential utility of interventions that target REM sleep characteristics and REM vagal activity in fear-related disorders.

The Relationship Between Slow Wave Sleep and Blood Oxygen Saturation Among Patients With Apnea: Retrospective Study

Background and Objective Prior research suggests that slow wave sleep (SWS) is disrupted in people with obstructive sleep apnea (OSA). However, it was not clear whether the reduction in SWS is related to abnormal breathing or the extent of OSA as determined by the minimum oxygen saturation. Further, there is limited research on the relationship between oxygen saturation and SWS. The present study examined the relationship between SWS and minimum oxygen saturation levels in patients with OSA.Methods The sample consisted of 589 patients with OSA (mean age: 48.54 years) who completed full-night polysomnography.Results Results showed that there was a significant difference in SWS scores across three apnea-hypopnea index (AHI) groups (AHI score 5–15 for mild apnea, 16–30 for moderate apnea, and >30 for severe apnea). Lower SWS scores were observed in the severe apnea group. Additionally, results indicated that as oxygen saturation decreased, the SWS scores decreased.Conclusions Results from this study indicate that oxygen saturation significantly predicts SWS amounts. These findings suggest that interventions for low oxygen saturation could enhance the amounts of SWS. The clinical ramifications of these findings are worthy of consideration.

Rapid Eye Movement Sleep Engages Melanin-Concentrating Hormone Neurons to Reduce Cocaine Seeking

BACKGROUND

Persistent sleep disruptions following withdrawal from abused drugs may hold keys to battle drug relapse. It is posited that there may be sleep signatures that predict relapse propensity, identifying which may open new avenues for treating substance use disorders.

METHODS

We trained male rats (approximately postnatal day 56) to self-administer cocaine. After long-term drug withdrawal (approximately postnatal day 100), we examined the correlations between the intensity of cocaine seeking and key sleep features. To test for causal relationships, we then used behavioral, chemogenetic, or optogenetic methods to selectively increase rapid eye movement sleep (REMS) and measured behavioral and electrophysiological outcomes to probe for cellular and circuit mechanisms underlying REMS-mediated regulation of cocaine seeking.

RESULTS

A selective set of REMS features was preferentially associated with the intensity of cue-induced cocaine seeking after drug withdrawal. Moreover, selectively increasing REMS time and continuity by environmental warming attenuated a withdrawal time-dependent intensification of cocaine seeking, or incubation of cocaine craving, suggesting that REMS may benefit withdrawal. Warming increased the activity of lateral hypothalamic melanin-concentrating hormone (MCH) neurons selectively during prolonged REMS episodes and counteracted cocaine-induced synaptic accumulation of calcium-permeable AMPA receptors in the nucleus accumbens-a critical substrate for incubation. Finally, the warming effects were partly mimicked by chemogenetic or optogenetic stimulations of MCH neurons during sleep, or intra-accumbens infusions of MCH peptide during the rat's inactive phase.

CONCLUSIONS

REMS may encode individual vulnerability to relapse, and MCH neuron activities can be selectively targeted during REMS to reduce drug relapse.

Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits

Post-traumatic stress disorder (PTSD) is a maladaptive and debilitating psychiatric disorder, characterized by re-experiencing, avoidance, negative emotions and thoughts, and hyperarousal in the months and years following exposure to severe trauma. PTSD has a prevalence of approximately 6-8% in the general population, although this can increase to 25% among groups who have experienced severe psychological trauma, such as combat veterans, refugees and victims of assault. The risk of developing PTSD in the aftermath of severe trauma is determined by multiple factors, including genetics - at least 30-40% of the risk of PTSD is heritable - and past history, for example, prior adult and childhood trauma. Many of the primary symptoms of PTSD, including hyperarousal and sleep dysregulation, are increasingly understood through translational neuroscience. In addition, a large amount of evidence suggests that PTSD can be viewed, at least in part, as a disorder that involves dysregulation of normal fear processes. The neural circuitry underlying fear and threat-related behaviour and learning in mammals, including the amygdala-hippocampus-medial prefrontal cortex circuit, is among the most well-understood in behavioural neuroscience. Furthermore, the study of threat-responding and its underlying circuitry has led to rapid progress in understanding learning and memory processes. By combining molecular-genetic approaches with a translational, mechanistic knowledge of fear circuitry, transformational advances in the conceptual framework, diagnosis and treatment of PTSD are possible. In this Review, we describe the clinical features and current treatments for PTSD, examine the neurobiology of symptom domains, highlight genomic advances and discuss translational approaches to understanding mechanisms and identifying new treatments and interventions for this devastating syndrome.

Sleep and PTSD in the Military Forces: A Reciprocal Relationship and a Psychiatric Approach

Sleep disturbances are well-recognised symptoms of Post-Traumatic Stress Disorder (PTSD). This review updates knowledge regarding the relationship between sleep during deployment, combat-related trauma, and PTSD in military personnel, from which the importance of restorative sleep results. The description of the characteristics of sleep in military forces with the considerable roles of the operational and training contexts highlights the important consequences of degraded sleep. Indeed, a lot of data suggest a dynamic link between sleep and the onset and chronicity of PTSD. We propose a reciprocal relationship model with strategies strongly recommended or already adopted by the military to promote restorative sleep before and after combat exposure. Among the alterations in a variety of sleep architecture and sleep patterns described in PTSD, the physiological hypothesis of REM sleep fragmentation in the development of PTSD symptoms may be important because REM sleep is generally associated with emotional memory. Finally, we address clinical and research perspectives that could be used to detect or restore sleep continuity before and during military deployment to possibly alleviate nightmares and insomnia related to combat exposure and PTSD occurrence and improve our understanding of sleep in PTSD.

No evidence for intra-individual correlations between sleep-mediated declarative memory consolidation and slow-wave sleep

STUDY OBJECTIVES

Memory consolidation benefits from a retention period filled with sleep. Several theoretical accounts assume that slow-wave sleep (SWS) contributes functionally to processes underlying the stabilization of declarative memories during sleep. However, reports on correlations between memory retention and the amount of SWS are mixed and typically rely on between-subject correlations and small sample sizes. Here we tested for the first time whether the amount of SWS during sleep predicts the effect of sleep on memory consolidation on an intra-individual level in a large sample.

METHODS

One hundred and fifty-nine healthy participants came to the lab twice and took a 90 min nap in both sessions. Sleep-mediated memory benefits were tested using the paired associates word-learning task in both sessions.

RESULTS

In contrast to the theoretical prediction, intra-individual differences in sleep-mediated memory benefits did not significantly correlate with differences in SWS or SWA between the two naps. Also between subjects, the amount of SWS did not correlate with memory retention across the nap. However, subjective ratings of sleep quality were significantly associated with the amount of SWS.

CONCLUSION

Our results question the notion that the amount of SWS per se is functionally related to processes of memory consolidation during sleep. While our results do not exclude an important role of SWS for memory, they suggest that "more SWS" does not necessarily imply better memory consolidation.

Eight-Section Brocade Exercises Improve the Sleep Quality and Memory Consolidation and Cardiopulmonary Function of Older Adults With Atrial Fibrillation-Associated Stroke

Purpose: Poor sleep quality is harmful for everyone and potentially even more harmful for older adults with atrial fibrillation-associated stroke (AFAS). This study aims to explore the effects of eight-section brocade (ESB) on sleep quality, memory, and cardiopulmonary function in the older adults with AFAS. Methods: Older adults with AFAS and sleep disorders were recruited and divided into the ESB (EG, n = 85) and control groups (CG, general exercise, n = 85). EG patients received 60 min ESB exercises 5 times a week for 12 weeks; CG patients received normal exercise. Pittsburgh sleep quality index (PSQI) scores (poor sleepers ≥8 and normal sleepers < 8), memory for word pairs (poor memory ≤ 7 and normal memory > 7), left ventricular posterior wall (LVPW) thickness, and maximum ventilation (MV, to evaluate cardiopulmonary function) values were measured. The correlation between sleep and memory quality was analyzed using PSQI scores and word pairs via the Pearson correlation coefficients test. Adjusted Cox models were used to explore an interaction between PSQI and ESB exercise. Results: After 12-week exercise intervention, ESB improved sleep quality, latency, duration, disturbance and daytime dysfunction when compared to conventional exercise. In similar cases, the MV values in the EG were also higher than that in the CG (p = 0.009). ESB intervention could not affect the cardiac structure and left ventricular ejection fraction. Compared with the CG, the ESB intervention reduced PSQI scores and increased memorized word pairs (p < 0.001 for poor and normal sleepers in both unadjusted and adjusted analysis, p = 0.012 and 0.003 for poor and normal memory). The test of Pearson correlation coefficients showed that PSQI scores were strongly associated with the number of word pairs in both unadjusted and adjusted analyses (p < 0.0001). Conclusion: Eight-section brocade exercise improved sleep quality and memory consolidation and cardiopulmonary function by reducing PSQI scores, increasing word pairs and MV values in the older adults with AFAS.

The Interaction of REM Fragmentation and Night-Time Arousal Modulates Sleep-Dependent Emotional Memory Consolidation

The sleep-to-forget, sleep-to-remember (SFSR) hypothesis states that the neurobiological environment provided by rapid-eye movement (REM)-rich sleep decouples the content of an emotional memory from its attendant emotional arousal. This decoupling allows divergent attenuation and enhancement effects (i.e., erosion of the memory’s emotional tone and simultaneous strengthening of its content). However, support for this proposal is mixed. An alternative account suggests there might be convergent attenuation and enhancement (i.e., elevated emotional arousal is positively coupled with enhanced emotional memory). We tested predictions emerging from the SFSR hypothesis using (a) individuals diagnosed with post-traumatic stress disorder (PTSD; n = 21), (b) trauma-exposed non-PTSD individuals (n = 19), and (c) healthy controls (n = 20). We included PTSD-diagnosed individuals because they typically experience altered REM sleep, impaired emotional memory, and heightened emotional arousal in response to threatening stimuli. Participants were assessed before and after both an 8-h period of polysomnographically monitored sleep and an 8-h period of waking activity. The assessment included exposure to negatively valenced, positively valenced, and neutral pictures before the 8-h delay, and a recognition task afterward. We measured emotional arousal by recording psychophysiological responses to the pictures, both pre- and post-delay. Results indicated no significant between-group differences in emotional memory accuracy or arousal. However, after a sleep-filled delay, pictures of all categories were recognized with equal accuracy, whereas after a wake-filled delay, negative pictures were recognized preferentially. Furthermore, the findings demonstrated that a sleep-filled delay was associated with attenuated emotional arousal to pictures of all categories, whereas a wake-filled delay was associated with a rise in emotional arousal across the day. Intriguingly, poorer recognition accuracy for valenced (but not neutral) pictures was predicted by an interaction of increased REM fragmentation and increased emotional arousal. In summary, we found some support for the SFSR hypothesis in the way it describes the REM- and arousal-based mechanisms that process emotional material. We also, however, found disconfirming evidence regarding the outcome of that process (i.e., sleep did not favor consolidation of emotional over neutral memory), and we demonstrated a convergence between attenuation of emotional arousal and weakening of emotional content relative to neutral content.