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Kjaerby C, Andersen M, Hauglund N, Untiet V, Dall C, Ding F, Hirase H, Nedergaard M. Reply to: 'Do all norepinephrine surges disrupt sleep?'. Nat Neurosci 2023:10.1038/s41593-023-01314-7. [PMID: 37081298 DOI: 10.1038/s41593-023-01314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/20/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Celia Kjaerby
- Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, University of Copenhagen, Copenhagen, Denmark.
| | - Mie Andersen
- Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, University of Copenhagen, Copenhagen, Denmark
| | - Natalie Hauglund
- Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, University of Copenhagen, Copenhagen, Denmark
| | - Verena Untiet
- Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Dall
- Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, University of Copenhagen, Copenhagen, Denmark
| | - Fengfei Ding
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Hajime Hirase
- Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Maiken Nedergaard
- Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
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Zhang Z, Qi M, Hügli G, Khatami R. Predictors of changes in cerebral perfusion and oxygenation during obstructive sleep apnea. Sci Rep 2021; 11:23510. [PMID: 34873232 PMCID: PMC8648752 DOI: 10.1038/s41598-021-02829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder. Severe OSAS defined as apnea-hypopnea index (AHI) ≥ 30/h is a risk factor for developing cerebro-cardiovascular diseases. The mechanisms of how repetitive sleep apneas/hypopneas damage cerebral hemodynamics are still not well understood. In this study, changes in blood volume (BV) and oxygen saturation (StO2) in the left forehead of 29 newly diagnosed severe OSAS patients were measured by frequency-domain near-infrared spectroscopy during an incremental continuous positive airway pressure (CPAP) titration protocol together with polysomnography. The coefficients of variation of BV (CV-BV) and the decreases of StO2 (de-StO2) of more than 2000 respiratory events were predicted using linear mixed-effect models, respectively. We found that longer events and apneas rather than hypopneas induce larger changes in CV-BV and stronger cerebral desaturation. Respiratory events occurring during higher baseline StO2 before their onsets, during rapid-eye-movement sleep and those associated with higher heart rate induce smaller changes in CV-BV and de-StO2. The stepwise increased CPAP pressures can attenuate these changes. These results suggest that in severe OSAS the length and the type of respiratory event rather than widely used AHI may be better parameters to indicate the severity of cerebral hemodynamic changes.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017, Barmelweid, Switzerland. .,Barmelweid Academy, Clinic Barmelweid AG, Barmelweid, Switzerland.
| | - Ming Qi
- grid.452327.50000 0004 0519 8976Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland
| | - Gordana Hügli
- grid.452327.50000 0004 0519 8976Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland
| | - Ramin Khatami
- grid.452327.50000 0004 0519 8976Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland ,grid.452327.50000 0004 0519 8976Barmelweid Academy, Clinic Barmelweid AG, Barmelweid, Switzerland ,grid.411656.10000 0004 0479 0855Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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Mekky J, El-Kholy O, Hamdy E, Fawzy A. Rapid eye movement (REM) sleep microarchitecture is altered in patients with wake-up ischemic stroke: A polysomnographic study. Neurobiol Sleep Circadian Rhythms 2021; 11:100069. [PMID: 34258472 PMCID: PMC8255241 DOI: 10.1016/j.nbscr.2021.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 12/05/2022] Open
Abstract
It is well established that certain alteration of sleep disorders occur in patients with wake-up stroke (WUS) such as sleep disordered breathing, periodic limb movements and sleep duration. However, the data are lacking about the microarchitecture of different sleep stages among those patients. Aim of work To compare the polysomnographic microarchitecture of rapid eye movement (REM) sleep between WUS and daytime stroke (DTS). Methods A cross-sectional polysomnographic study was conducted on 20 patients with WUS and 20 patients with DTS, with analysis of REM sleep microarchitecture in specific. Results Patients with WUS had significantly shorter REM stage (11.76 ± 5.48% in WUS versus 16.59 ± 5.33% in DTS, P = 0.008), longer early morning REM was (25.70 ± 13.13 min in WUS versus 4.15 ± 4.69 min in DTS, P=<0.001), higher apnea-hypopnea index (AHI) during REM (6.29 ± 10.18 in WUS versus 1.10 ± 4.57 in DTS, P = 0.009), and lower mean Oxygen saturation during REM (92.70 ± 3.63 WUS versus 95.45 ± 1.35 DTS, P = 0.012). The OR of early morning REM duration was 1.8 (CI 1.099–3.130, p = 0.021) for WUS. Conclusion The microarchitecture of REM sleep is disrupted in patients with wake-up stroke. The polysomnographic parameters are significantly different between patients with daytime stroke (DTS) and wake-up stroke (WUS). Patients with WUS have longer stage 2 and shorter REM stage. The REM microarchitecture is disrupted among patients with WUS e.g. early morning REM duration in comparison to patients with daytime stroke (DTS). The distruption was in the form of shorter REM percentage to total sleep time, higher sleep apnea hypopnea index (AHI) during REM sleep, lower oxygen saturation during REM sleep and longer early morning REM duration. Periodic limb movement (PLM) index, and PLM-related arousals are higher among DTS.
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Affiliation(s)
- Jaidaa Mekky
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Osama El-Kholy
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman Hamdy
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Akram Fawzy
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Ren H, Jiang X, Xu K, Chen C, Yuan Y, Dai C, Chen W. A Review of Cerebral Hemodynamics During Sleep Using Near-Infrared Spectroscopy. Front Neurol 2020; 11:524009. [PMID: 33329295 PMCID: PMC7710901 DOI: 10.3389/fneur.2020.524009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Investigating cerebral hemodynamic changes during regular sleep cycles and sleep disorders is fundamental to understanding the nature of physiological and pathological mechanisms in the regulation of cerebral oxygenation during sleep. Although sleep neuroimaging methods have been studied and have been well-reviewed, they have limitations in terms of technique and experimental design. Neurologists are convinced that Near-infrared spectroscopy (NIRS) provides essential information and can be used to assist the assessment of cerebral hemodynamics, and numerous studies regarding sleep have been carried out based on NIRS. Thus, a brief historical overview of the sleep studies using NIRS will be helpful for the biomedical students, academicians, and engineers to better understand NIRS from various perspectives. In this study, the existing literature on sleep studies is reviewed, and an overview of the NIRS applications is synthesized and provided. The paper first reviews the application scenarios, as well as the patterns of fluctuation of NIRS, which includes the investigation in regular sleep and sleep-disordered breathing. Various factors such as different sleep stages, populations, and degrees of severity were considered. Furthermore, the experimental design and signal processing, as well as the regulation mechanisms involved in regular and pathological sleep, are investigated and discussed. The strengths and weaknesses of the existing NIRS applications are addressed and presented, which can direct further NIRS analysis and utilization.
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Affiliation(s)
- Haoran Ren
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Xinyu Jiang
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Ke Xu
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chen Chen
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yafei Yuan
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chenyun Dai
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Wei Chen
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Shanghai, China
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The Sustained Attention to Response Task Shows Lower Cingulo-Opercular and Frontoparietal Activity in People with Narcolepsy Type 1: An fMRI Study on the Neural Regulation of Attention. Brain Sci 2020; 10:brainsci10070419. [PMID: 32630358 PMCID: PMC7408461 DOI: 10.3390/brainsci10070419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 01/21/2023] Open
Abstract
Vigilance complaints often occur in people with narcolepsy type 1 and severely impair effective daytime functioning. We tested the feasibility of a three-level sustained attention to response task (SART) paradigm within a magnetic resonance imaging (MRI) environment to understand brain architecture underlying vigilance regulation in individuals with narcolepsy type 1. Twelve medication-free people with narcolepsy type 1 and 11 matched controls were included. The SART included four repetitions of a baseline block and two difficulty levels requiring moderate and high vigilance. Outcome measures were between and within-group performance indices on error rates and reaction times, and functional MRI (fMRI) parameters: mean activity during the task and between-group activity differences across the three conditions and related to changes in activation over time (time-on-task) and error-related activity. Patients—but not controls—made significantly more mistakes with increasing difficulty. The modified SART is a feasible MRI vigilance task showing similar task-positive brain activity in both groups within the cingulo-opercular, frontoparietal, arousal, motor, and visual networks. During blocks of higher vigilance demand, patients had significantly lower activation in these regions than controls. Patients had lower error-related activity in the left pre- and postcentral gyrus. The time-on-task activity differences between groups suggest that those with narcolepsy are insufficiently capable of activating attention- and arousal-related regions when transitioning from attention initiation to stable attention, specifically when vigilance demand is high. They also show lower inhibitory motor activity in relation to errors, suggesting impaired executive functioning.
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Kokkinos V, Vulliémoz S, Koupparis AM, Koutroumanidis M, Kostopoulos GK, Lemieux L, Garganis K. A hemodynamic network involving the insula, the cingulate, and the basal forebrain correlates with EEG synchronization phases of sleep instability. Sleep 2018; 42:5253667. [DOI: 10.1093/sleep/zsy259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/27/2018] [Indexed: 01/25/2023] Open
Affiliation(s)
- Vasileios Kokkinos
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, PA
- Epilepsy Center of Thessaloniki, St. Luke’s Hospital, Thessaloniki, Greece
- Neurophysiology Unit, Department of Physiology, Medical School, University of Patras, Greece
| | - Serge Vulliémoz
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St. Peter, UK
- EEG and Epilepsy Unit, Neurology, University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Andreas M Koupparis
- Neurophysiology Unit, Department of Physiology, Medical School, University of Patras, Greece
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Michalis Koutroumanidis
- Department of Clinical Neurophysiology and Epilepsies, Guy’s, St. Thomas’ and Evelina Hospital for Children, NHS Foundation Trust, London, UK
- Department of Neuroscience, Institute of Psychiatry, Kings College London, UK
| | - George K Kostopoulos
- Neurophysiology Unit, Department of Physiology, Medical School, University of Patras, Greece
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St. Peter, UK
| | - Kyriakos Garganis
- Epilepsy Center of Thessaloniki, St. Luke’s Hospital, Thessaloniki, Greece
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Busch DR, Lynch JM, Winters ME, McCarthy AL, Newland JJ, Ko T, Cornaglia MA, Radcliffe J, McDonough JM, Samuel J, Matthews E, Xiao R, Yodh AG, Marcus CL, Licht DJ, Tapia IE. Cerebral Blood Flow Response to Hypercapnia in Children with Obstructive Sleep Apnea Syndrome. Sleep 2016; 39:209-16. [PMID: 26414896 DOI: 10.5665/sleep.5350] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/07/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Children with obstructive sleep apnea syndrome (OSAS) often experience periods of hypercapnia during sleep, a potent stimulator of cerebral blood flow (CBF). Considering this hypercapnia exposure during sleep, it is possible that children with OSAS have abnormal CBF responses to hypercapnia even during wakefulness. Therefore, we hypothesized that children with OSAS have blunted CBF response to hypercapnia during wakefulness, compared to snorers and controls. METHODS CBF changes during hypercapnic ventilatory response (HCVR) were tested in children with OSAS, snorers, and healthy controls using diffuse correlation spectroscopy (DCS). Peak CBF changes with respect to pre-hypercapnic baseline were measured for each group. The study was conducted at an academic pediatric sleep center. RESULTS Twelve children with OSAS (aged 10.1 ± 2.5 [mean ± standard deviation] y, obstructive apnea hypopnea index [AHI] = 9.4 [5.1-15.4] [median, interquartile range] events/hour), eight snorers (11 ± 3 y, 0.5 [0-1.3] events/hour), and 10 controls (11.4 ± 2.6 y, 0.3 [0.2-0.4] events/hour) were studied. The fractional CBF change during hypercapnia, normalized to the change in end-tidal carbon dioxide, was significantly higher in controls (9 ± 1.8 %/mmHg) compared to OSAS (7.1 ± 1.5, P = 0.023) and snorers (6.7 ± 1.9, P = 0.025). CONCLUSIONS Children with OSAS and snorers have blunted CBF response to hypercapnia during wakefulness compared to controls. Noninvasive DCS blood flow measurements of hypercapnic reactivity offer insights into physiopathology of OSAS in children, which could lead to further understanding about the central nervous system complications of OSAS.
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Affiliation(s)
- David R Busch
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Jennifer M Lynch
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Madeline E Winters
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - John J Newland
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Tiffany Ko
- Department of Biomedical Engineering, University of Pennsylvania, Philadelphia, PA
| | - Mary Anne Cornaglia
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jerilynn Radcliffe
- Clinical and Translational Research Center, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Joseph M McDonough
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John Samuel
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Edward Matthews
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Carole L Marcus
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Daniel J Licht
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ignacio E Tapia
- The Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Zhang Q, Ivkovic V, Hu G, Strangman GE. Twenty-four-hour ambulatory recording of cerebral hemodynamics, systemic hemodynamics, electrocardiography, and actigraphy during people's daily activities. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:47003. [PMID: 24781591 DOI: 10.1117/1.jbo.19.4.047003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/05/2014] [Indexed: 06/03/2023]
Abstract
The feasibility and utility of wearable 24-h multimodality neuromonitoring during daily activities are demonstrated. We have developed a fourth-generation ambulatory near infrared spectroscopy device, namely NINscan 4. NINscan 4 enables recording of brain function (via cerebral hemodynamics), systemic hemodynamics, electrocardiography, and actigraphy simultaneously and continuously for up to 24 h at 250-Hz sampling rate, during (and with minor restriction to) daily activities. We present initial 24-h human subject test results, with example analysis including (1) comparison of cerebral perfusion and oxygenation changes during wakefulness and sleep over a 24-h period and (2) capturing of hemodynamic changes prior, during and after sudden waken up in the night during sleep. These results demonstrate the first ambulatory 24-h cerebral and systemic hemodynamics monitoring, and its unique advantages including long-term data collection and analysis capability, ability to catch unpredictable transient events during activities of daily living, as well as coregistered multimodality analysis capabilities. These results also demonstrate that NINscan 4's motion artifact at 1-g head movement is smaller than physiological hemodynamic fluctuations during motionless sleep. The broader potential of this technology is also discussed.
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Affiliation(s)
- Quan Zhang
- Massachusetts General Hospital, Harvard Medical School Neural Systems Group, 13th Street, Building 149, Room 2651, Charlestown, Massachusetts 02129bCenter for Space Medicine, Baylor College of Medicine, Houston, Texas
| | - Vladimir Ivkovic
- Massachusetts General Hospital, Harvard Medical School Neural Systems Group, 13th Street, Building 149, Room 2651, Charlestown, Massachusetts 02129
| | - Gang Hu
- Massachusetts General Hospital, Harvard Medical School Neural Systems Group, 13th Street, Building 149, Room 2651, Charlestown, Massachusetts 02129
| | - Gary E Strangman
- Massachusetts General Hospital, Harvard Medical School Neural Systems Group, 13th Street, Building 149, Room 2651, Charlestown, Massachusetts 02129bCenter for Space Medicine, Baylor College of Medicine, Houston, Texas
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