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Reid KJ, Ingram LT, Jimenez M, Orban ZS, Abbott SM, Grimaldi D, Knutson KL, Zee PC, Koralnik IJ, Maas MB. Impact of sleep disruption on cognitive function in patients with postacute sequelae of SARS-CoV-2 infection: initial findings from a Neuro-COVID-19 clinic. Sleep Adv 2024; 5:zpae002. [PMID: 38370438 PMCID: PMC10873785 DOI: 10.1093/sleepadvances/zpae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/27/2023] [Indexed: 02/20/2024]
Abstract
Introduction Fatigue, brain fog, and sleep disturbance are among the most common symptoms of postacute sequelae of SARS-CoV-2 infection (PASC). We sought to determine the impact of sleep disruption on cognition and quality of life in patients with neurologic manifestations of PASC (Neuro-PASC). Methods Thirty-nine patients were recruited from Neuro-COVID-19 clinic. Mean age was 48.1 years, 71.8% were female, and 82% were never hospitalized for COVID-19. Patients were evaluated via clinical assessment, quality-of-life measures in domains of cognitive function, fatigue, sleep disturbance, anxiety, and depression, NIH Toolbox cognitive tests, and 7 days of wrist actigraphy. Results The median number of neurologic symptoms attributed to PASC was 6, with brain fog being the most common in 89.7%. Regarding non-neurologic symptoms, 94.9% complained of fatigue and 74.4% of insomnia. Patients reported significant impairment in all quality-of-life domains and performed worse in a task of attention compared to a normative US population. Actigraphy showed Neuro-PASC patients had lower sleep efficiency, longer sleep latency (both p < 0.001), and later sleep midpoint (p = 0.039) compared to 71 age-matched healthy controls with no PASC history. Self-reported cognitive symptoms correlated with the severity of fatigue (p < 0.001), anxiety (p = 0.05), and depression (p < 0.01). Objective evidence of sleep disruption measured by wakefulness after sleep onset, sleep efficiency, and latency were associated with decreased performance in attention and processing speed. Conclusion Prospective studies including larger populations of patients are needed to fully determine the interplay of sleep disruption on the cognitive function and quality of life of patients with PASC.
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Affiliation(s)
- Kathryn J Reid
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Louis T Ingram
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Millenia Jimenez
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zachary S Orban
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sabra M Abbott
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniela Grimaldi
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristen L Knutson
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Igor J Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mathew B Maas
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Samynathan A, Fishbein AB, Abbott SM, Booster GD, Zee PC, Sheldon SH, Yosipovitch G, Silverberg JI. Assessment and Management of Sleep Disturbances in Atopic Dermatitis: A Review. Dermatitis 2024; 35:S7-S12. [PMID: 37756222 DOI: 10.1089/derm.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Atopic dermatitis (AD) is a chronic burdensome inflammatory skin disease with well-established cutaneous and systemic comorbidities and disease burden. AD particularly has profound impacts on sleep in individuals of all ages. Sleep disturbances (SDs) affect 6.2% of school-age children and 33-87.1% of adults with AD. This narrative review addresses the burden of SD in AD patients, as well as biological mechanisms of SD in AD, including biological clocks influencing sleep, inflammation, and behavior. Approaches for early detection, diagnosis, objective quantification, patient education, and management are reviewed. It is imperative to break the itch-scratch cycle to reduce SDs and improve quality of life in individuals with AD.
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Affiliation(s)
- Archana Samynathan
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Anna B Fishbein
- Department of Allergy and Immunology, Robert and Anne Lurie Children's Hospital, Chicago, Illinois, USA
| | - Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Genery D Booster
- Department of Pediatrics, National Jewish Hospital, Denver, Colorado, USA
| | - Phyllis C Zee
- Department of Sleep Medicine, Robert and Anne Lurie Children's Hospital, Chicago, Illinois, USA
| | - Stephen H Sheldon
- Sleep Medicine Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Gil Yosipovitch
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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3
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Abbott SM, Phillips AJ, Reid KJ, Cain SW, Zee PC. What's in a name? delayed by any other name is still a circadian disorder: a call for improved nomenclature for delayed sleep-wake phase disorder subtypes. Sleep 2023; 46:zsad222. [PMID: 37651094 DOI: 10.1093/sleep/zsad222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, ILUSA
| | - Andrew J Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Kathryn J Reid
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, ILUSA
| | - Sean W Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, ILUSA
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4
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Tu AY, Crawford MR, Dawson SC, Fogg LF, Turner AD, Wyatt JK, Crisostomo MI, Chhangani BS, Kushida CA, Edinger JD, Abbott SM, Malkani RG, Attarian HP, Zee PC, Ong JC. A randomized controlled trial of cognitive behavioral therapy for insomnia and PAP for obstructive sleep apnea and comorbid insomnia: effects on nocturnal sleep and daytime performance. J Clin Sleep Med 2022; 18:789-800. [PMID: 34648425 PMCID: PMC8883096 DOI: 10.5664/jcsm.9696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study examines the impact of cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) therapy for comorbid insomnia and sleep apnea on nocturnal sleep and daytime functioning. METHODS A partial factorial design was used to examine treatment pathways with CBT-I and PAP and the relative benefits of each treatment. One hundred eighteen individuals with comorbid insomnia and sleep apnea were randomized to receive CBT-I followed by PAP, self-monitoring followed by CBT-I concurrent with PAP, or self-monitoring followed by PAP only. Participants were assessed at baseline, PAP titration, and 30 and 90 days after PAP initiation. Outcome measures included sleep diary- and actigraphy-measured sleep, Flinders Fatigue Scale, Epworth Sleepiness Scale, Functional Outcome of Sleep Questionnaire, and cognitive emotional measures. RESULTS A main effect of time was found on diary-measured sleep parameters (decreased sleep onset latency and wake after sleep onset; increased total sleep time and sleep efficiency) and actigraphy-measured sleep parameters (decreased wake after sleep onset; increased sleep efficiency) and daytime functioning (reduced Epworth Sleepiness Scale, Flinders Fatigue Scale; increased Functional Outcome of Sleep Questionnaire) across all arms (all P < .05). Significant interactions and planned contrast comparisons revealed that CBT-I was superior to PAP and self-monitoring on reducing diary-measured sleep onset latency and wake after sleep onset and increasing sleep efficiency, as well as improving Functional Outcome of Sleep Questionnaire and Flinders Fatigue Scale compared to self-monitoring. CONCLUSIONS Improvements in sleep and daytime functioning were found with PAP alone or concomitant with CBT-I. However, more rapid effects were observed on self-reported sleep and daytime performance when receiving CBT-I regardless of when it was initiated. Therefore, concomitant treatment appears to be a favorable approach to accelerate treatment outcomes. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Multidisciplinary Approach to the Treatment of Insomnia and Comorbid Sleep Apnea (MATRICS); URL: https://clinicaltrials.gov/ct2/show/NCT01785303; Identifier: NCT01785303. CITATION Tu AY, Crawford MR, Dawson SC, et al. A randomized controlled trial of cognitive behavioral therapy for insomnia and PAP for obstructive sleep apnea and comorbid insomnia: effects on nocturnal sleep and daytime performance. J Clin Sleep Med. 2022;18(3):789-800.
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Affiliation(s)
- Alice Y. Tu
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan R. Crawford
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Spencer C. Dawson
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Louis F. Fogg
- College of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Arlener D. Turner
- Center for Translational Sleep and Circadian Sciences, Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida
| | - James K. Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | | | - Bantu S. Chhangani
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Clete A. Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Jack D. Edinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Sabra M. Abbott
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Roneil G. Malkani
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Neurology Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| | - Hrayr P. Attarian
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Phyllis C. Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jason C. Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Nox Health, Suwanee, Georgia,Address correspondence to: Jason C. Ong, PhD, Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Room 1004, Chicago, IL 60611;
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5
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Grimaldi D, Reid KJ, Papalambros NA, Braun RI, Malkani RG, Abbott SM, Ong JC, Zee PC. Autonomic dysregulation and sleep homeostasis in insomnia. Sleep 2021; 44:6029088. [PMID: 33295989 DOI: 10.1093/sleep/zsaa274] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/24/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is common in older adults, and is associated with poor health, including cognitive impairment and cardio-metabolic disease. Although the mechanisms linking insomnia with these comorbidities remain unclear, age-related changes in sleep and autonomic nervous system (ANS) regulation might represent a shared mechanistic pathway. In this study, we assessed the relationship between ANS activity with indices of objective and subjective sleep quality in older adults with insomnia. METHODS Forty-three adults with chronic insomnia and 16 age-matched healthy sleeper controls were studied. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), objective sleep quality by electroencephalogram spectral components derived from polysomnography, and ANS activity by measuring 24-h plasma cortisol and norepinephrine (NE). RESULTS Sleep cycle analysis displayed lower slow oscillatory (SO: 0.5-1.25 Hz) activity in the first cycle in insomnia compared to controls. In insomnia, 24-h cortisol levels were higher and 24-h NE levels were lower than controls. In controls, but not in insomnia, there was a significant interaction between NE level during wake and SO activity levels across the sleep cycles, such that in controls but not in insomnia, NE level during wake was positively associated with the amount of SO activity in the first cycle. In insomnia, lower 24-h NE level and SO activity in the first sleep cycle were associated with poorer subjective sleep quality. CONCLUSION Dysregulation of autonomic activity may be an underlying mechanism that links objective and subjective measures of sleep quality in older adults with insomnia, and potentially contribute to adverse health outcomes.
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Affiliation(s)
- Daniela Grimaldi
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kathryn J Reid
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Nelly A Papalambros
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Rosemary I Braun
- Biostatistics Division, Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL, USA.,Department of Physics and Astronomy, Northwestern University, Evanston, IL, USA
| | - Roneil G Malkani
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sabra M Abbott
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jason C Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Abstract
PURPOSE OF REVIEW This article provides an overview of circadian physiology and discusses common presentations and treatment strategies for the circadian rhythm sleep-wake disorders. RECENT FINDINGS Circadian rhythms are present throughout the body, and appreciation for the role that circadian dysregulation plays in overall health is increasing, with mounting associations between circadian disruption and cardiometabolic disease risk. SUMMARY It is important to recognize the ubiquitous role that circadian rhythms play throughout the brain and body. An understanding of circadian neurophysiology will provide insight into the means by which patients with a variety of neuropathologies at the level of the retina, optic nerve, or hypothalamus may also be at risk for circadian dysfunction.
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7
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Maas MB, Lizza BD, Kim M, Abbott SM, Gendy M, Reid KJ, Zee PC. Stress-Induced Behavioral Quiescence and Abnormal Rest-Activity Rhythms During Critical Illness. Crit Care Med 2021; 48:862-871. [PMID: 32317592 DOI: 10.1097/ccm.0000000000004334] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To characterize acute alterations of circadian and ultradian rest-activity rhythms in critically ill patients and their association with brain dysfunction, systemic multiple organ dysfunction, and melatonin rhythms. DESIGN Prospective study observing a cohort for 48 hours beginning within the first day of ICU admission. SETTING ICUs within an academic medical center. PATIENTS Patients presenting from the community with acute onset of either intracerebral hemorrhage or sepsis as representative neurologic and systemic critical illnesses. Healthy control patients were studied in the community, during hospital bedrest, and during sleep deprivation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Circadian and ultradian characteristics of rest-activity patterns were measured by wrist actigraphy, severity of neurologic and systemic illness by Glasgow Coma Scale and Sequential Organ Failure Assessment, and central circadian rhythm by melatonin profile. We studied 112 critically ill patients, including 53 with sepsis and 59 with intracerebral hemorrhage, along with 53 control participants. Total daily activity was markedly reduced and rest-activity rhythmicity was undetectable, neither of which was replicated by hospital bedrest in healthy controls. Circadian rest-activity rhythm fragmentation and attenuation and ultradian disorganization was associated with Glasgow Coma Scale and Sequential Organ Failure Assessment in adjusted models. Rest-activity rhythms showed no detectable phase coherence with melatonin rhythms. CONCLUSIONS Critically ill patients rapidly enter a state of behavioral quiescence proportionate to their illness severity with concomitant disturbance of circadian and ultradian rest-activity rhythms and loss of phase coherence with the melatonin rhythm. Quiescence characteristics in rest-activity rhythms were not different in patients with and without delirium, suggesting them to be distinct phenomena. Animal models of severe physiologic stress have shown that specific neural pathway separate from the sleep-wake regulatory pathway induce behavioral quiescence and rest-activity arrhythmia, and facilitate recovery of cellular homeostasis. Whether quiescence is a conserved protective response pathway in humans is not yet understood.
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Affiliation(s)
- Matthew B Maas
- Department of Neurology, Northwestern University, Chicago, IL.,Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
| | - Bryan D Lizza
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO
| | - Minjee Kim
- Department of Neurology, Northwestern University, Chicago, IL.,Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
| | - Sabra M Abbott
- Department of Neurology, Northwestern University, Chicago, IL.,Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
| | - Maged Gendy
- Department of Neurology, Northwestern University, Chicago, IL.,Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
| | - Kathryn J Reid
- Department of Neurology, Northwestern University, Chicago, IL.,Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Chicago, IL.,Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
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8
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Duffy JF, Abbott SM, Burgess HJ, Crowley SJ, Emens JS, Epstein LJ, Gamble KL, Hasler BP, Kristo DA, Malkani RG, Rahman SA, Thomas SJ, Wyatt JK, Zee PC, Klerman EB. Workshop report. Circadian rhythm sleep-wake disorders: gaps and opportunities. Sleep 2021; 44:zsaa281. [PMID: 33582815 PMCID: PMC8120340 DOI: 10.1093/sleep/zsaa281] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/02/2020] [Indexed: 01/09/2023] Open
Abstract
This White Paper presents the results from a workshop cosponsored by the Sleep Research Society (SRS) and the Society for Research on Biological Rhythms (SRBR) whose goals were to bring together sleep clinicians and sleep and circadian rhythm researchers to identify existing gaps in diagnosis and treatment and areas of high-priority research in circadian rhythm sleep-wake disorders (CRSWD). CRSWD are a distinct class of sleep disorders caused by alterations of the circadian time-keeping system, its entrainment mechanisms, or a misalignment of the endogenous circadian rhythm and the external environment. In these disorders, the timing of the primary sleep episode is either earlier or later than desired, irregular from day-to-day, and/or sleep occurs at the wrong circadian time. While there are incomplete and insufficient prevalence data, CRSWD likely affect at least 800,000 and perhaps as many as 3 million individuals in the United States, and if Shift Work Disorder and Jet Lag are included, then many millions more are impacted. The SRS Advocacy Taskforce has identified CRSWD as a class of sleep disorders for which additional high-quality research could have a significant impact to improve patient care. Participants were selected for their expertise and were assigned to one of three working groups: Phase Disorders, Entrainment Disorders, and Other. Each working group presented a summary of the current state of the science for their specific CRSWD area, followed by discussion from all participants. The outcome of those presentations and discussions are presented here.
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Affiliation(s)
- Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Stephanie J Crowley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Jonathan S Emens
- Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Lawrence J Epstein
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Karen L Gamble
- Department of Psychiatry University of Alabama at Birmingham, Birmingham, AL
| | - Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - David A Kristo
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Roneil G Malkani
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shadab A Rahman
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - S Justin Thomas
- Department of Psychiatry University of Alabama at Birmingham, Birmingham, AL
| | - James K Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Abbott SM, Choi J, Wilson J, Zee PC. Melanopsin-dependent phototransduction is impaired in delayed sleep-wake phase disorder and sighted non-24-hour sleep-wake rhythm disorder. Sleep 2021; 44:5905410. [PMID: 32926153 DOI: 10.1093/sleep/zsaa184] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 08/26/2020] [Indexed: 02/02/2023] Open
Abstract
STUDY OBJECTIVES The circadian system must perform daily adjustments to align sleep-wake and other physiologic rhythms with the environmental light-dark cycle: This is mediated primarily through melanopsin containing intrinsically photosensitive retinal ganglion cells. Individuals with delayed sleep-wake phase disorder (DSWPD) exhibit a delay in sleep-wake timing relative to the average population, while those with sighted non-24-hour sleep-wake rhythm disorder (N24SWD) exhibit progressive delays. An inability to maintain appropriate entrainment is a characteristic of both disorders. In this study, we test the hypothesis that individuals with DSWPD exhibit alteration in melanopsin-dependent retinal photo-transduction as measured with the postillumination pupil response (PIPR). METHODS Twenty-one control and 29 participants with DSWPD were recruited from the community and clinic. Of the 29 DSWPD participants, 17 reported a history of N24SWD. A pupillometer was used to measure the PIPR in response to a bright 30-second blue or red-light stimulus. The PIPR was calculated as the difference in average pupil diameter at baseline and 10-40 seconds after light stimulus offset. RESULTS The PIPR was significantly reduced in the DSWPD group when compared with the control group (1.26 ± 1.11 mm vs 2.05 ± 1.04 mm, p < 0.05, t-test). The PIPR was significantly reduced in the sighted N24SWD subgroup when compared with individuals with the history of only DSWPD (0.88 ± 0.58 mm vs 1.82 ± 1.44 mm, p < 0.05, analysis of variance [ANOVA]) or controls (0.88 ± 0.58 mm vs 2.05 ± 1.04 mm, p < 0.01, ANOVA). CONCLUSIONS These results indicate that reduced melanopsin-dependent retinal photo-transduction may be a novel mechanism involved in the development of DSWPD and sighted N24SWD.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Northwestern University, Chicago, IL.,Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jin Choi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John Wilson
- Department of Neurology, Northwestern University, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Chicago, IL.,Feinberg School of Medicine, Northwestern University, Chicago, IL
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10
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Maas MB, Kim M, Malkani RG, Abbott SM, Zee PC. Obstructive Sleep Apnea and Risk of COVID-19 Infection, Hospitalization and Respiratory Failure. Sleep Breath 2020; 25:1155-1157. [PMID: 32989673 PMCID: PMC7521948 DOI: 10.1007/s11325-020-02203-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
Purpose To study the relationship between OSA and risk of COVID-19 infection and disease severity, identified by the need for hospitalization and progression to respiratory failure. Methods We queried the electronic medical record system for an integrated health system of 10 hospitals in the Chicago metropolitan area to identify cases of COVID-19. Comorbidities and outcomes were ascertained by ICD-10-CM coding and medical record data. We evaluated the risk for COVID-19 diagnosis, hospitalization, and respiratory failure associated with OSA by univariate tests and logistic regression, adjusting for diabetes, hypertension, and BMI to account for potential confounding in the association between OSA, COVID-19 hospitalization, and progression to respiratory failure. Results We identified 9405 COVID-19 infections, among which 3185 (34%) were hospitalized and 1779 (19%) were diagnosed with respiratory failure. OSA was more prevalent among patients requiring hospitalization than those who did not (15.3% versus 3.4%, p < 0.0001; OR 5.20, 95% CI (4.43, 6.12)), and among those who progressed to respiratory failure (19.4% versus 4.5%, p < 0.0001; OR 5.16, 95% CI (4.41, 6.03)). After adjustment for diabetes, hypertension, and BMI, OSA was associated with increased risk for hospitalization (OR 1.65; 95% CI (1.36, 2.02)) and respiratory failure (OR 1.98; 95% CI (1.65, 2.37)). Conclusions Patients with OSA experienced approximately 8-fold greater risk for COVID-19 infection compared to a similar age population receiving care in a large, racially, and socioeconomically diverse healthcare system. Among patients with COVID-19 infection, OSA was associated with increased risk of hospitalization and approximately double the risk of developing respiratory failure.
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Affiliation(s)
- Matthew B Maas
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, 625 N Michigan Ave, Suite 1150, Chicago, IL, 60611, USA. .,Section of Critical Care Medicine, Department of Anesthesiology, Northwestern University, Chicago, IL, USA. .,Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL, USA.
| | - Minjee Kim
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, 625 N Michigan Ave, Suite 1150, Chicago, IL, 60611, USA.,Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL, USA
| | - Roneil G Malkani
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL, USA.,Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Sabra M Abbott
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL, USA.,Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL, USA.,Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, IL, USA
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11
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Ong JC, Crawford MR, Dawson SC, Fogg LF, Turner AD, Wyatt JK, Crisostomo MI, Chhangani BS, Kushida CA, Edinger JD, Abbott SM, Malkani RG, Attarian HP, Zee PC. A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia: main outcomes from the MATRICS study. Sleep 2020; 43:zsaa041. [PMID: 32170307 PMCID: PMC7487869 DOI: 10.1093/sleep/zsaa041] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/30/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To investigate treatment models using cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) for people with obstructive sleep apnea (OSA) and comorbid insomnia. METHODS 121 adults with OSA and comorbid insomnia were randomized to receive CBT-I followed by PAP, CBT-I concurrent with PAP, or PAP only. PAP was delivered following standard clinical procedures for in-lab titration and home setup and CBT-I was delivered in four individual sessions. The primary outcome measure was PAP adherence across the first 90 days, with regular PAP use (≥4 h on ≥70% of nights during a 30-day period) serving as the clinical endpoint. The secondary outcome measures were the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) with good sleeper (PSQI <5), remission (ISI <8), and response (ISI reduction from baseline >7) serving as the clinical endpoints. RESULTS No significant differences were found between the concomitant treatment arms and PAP only on PAP adherence measures, including the percentage of participants who met the clinical endpoint. Compared to PAP alone, the concomitant treatment arms reported a significantly greater reduction from baseline on the ISI (p = .0009) and had a greater percentage of participants who were good sleepers (p = .044) and remitters (p = .008). No significant differences were found between the sequential and concurrent treatment models on any outcome measure. CONCLUSIONS The findings from this study indicate that combining CBT-I with PAP is superior to PAP alone on insomnia outcomes but does not significantly improve adherence to PAP.
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Affiliation(s)
- Jason C Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Megan R Crawford
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Spencer C Dawson
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Louis F Fogg
- College of Nursing, Rush University Medical Center, Chicago, IL
| | - Arlener D Turner
- Center for Sleep and Brain Health, Department of Psychiatry, New York University, New York, NY
| | - James K Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | | | | | - Clete A Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Jack D Edinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - Sabra M Abbott
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roneil G Malkani
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hrayr P Attarian
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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12
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Maas MB, Lizza BD, Abbott SM, Liotta EM, Gendy M, Eed J, Naidech AM, Reid KJ, Zee PC. Factors Disrupting Melatonin Secretion Rhythms During Critical Illness. Crit Care Med 2020; 48:854-861. [PMID: 32317599 DOI: 10.1097/ccm.0000000000004333.factors] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The circadian system modulates many important physiologic processes, synchronizing tissue-specific functions throughout the body. We sought to characterize acute alterations of circadian rhythms in critically ill patients and to evaluate associations between brain dysfunction, systemic multiple organ dysfunction, environmental stimuli that entrain the circadian rhythm (zeitgebers), rest-activity rhythms, and the central circadian rhythm-controlled melatonin secretion profile. DESIGN Prospective study observing a cohort for 24-48 hours beginning within the first day of ICU admission. SETTING Multiple specialized ICUs within an academic medical center. PATIENTS Patients presenting from the community with acute onset of either intracerebral hemorrhage as a representative neurologic critical illness or sepsis as a representative systemic critical illness. Healthy control patients were studied in using modified constant routine in a clinical research unit. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Light, feeding, activity, medications, and other treatment exposures were evaluated along with validated measures of encephalopathy (Glasgow Coma Scale), multiple organ system function (Sequential Organ Failure Assessment score), and circadian rhythms (profiles of serum melatonin and its urinary metabolite 6-sulphatoxymelatonin). We studied 112 critically ill patients, including 53 with sepsis and 59 with intracerebral hemorrhage. Environmental exposures were abnormal, including light (dim), nutritional intake (reduced or absent and mistimed), and arousal stimuli (increased and mistimed). Melatonin amplitude and acrophase timing were generally preserved in awake patients but dampened and delayed with increasing encephalopathy severity. Melatonin hypersecretion was observed in patients exposed to catecholamine vasopressor infusions, but unaffected by sedatives. Change in vasopressor exposure was the only factor associated with changes in melatonin rhythms between days 1 and 2. CONCLUSIONS Encephalopathy severity and adrenergic agonist medication exposure were the primary factors contributing to abnormal melatonin rhythms. Improvements in encephalopathy and medical stabilization did not rapidly normalize rhythms. Urinary 6-sulphatoxymelatonin is not a reliable measure of the central circadian rhythm in critically ill patients.
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Affiliation(s)
- Matthew B Maas
- Department of Neurology, Northwestern University, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
| | - Bryan D Lizza
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO
| | - Sabra M Abbott
- Department of Neurology, Northwestern University, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
| | - Eric M Liotta
- Department of Neurology, Northwestern University, Chicago, IL
| | - Maged Gendy
- Department of Neurology, Northwestern University, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
| | - John Eed
- William Beaumont School of Medicine, Oakland University, Rochester, MI
| | | | - Kathryn J Reid
- Department of Neurology, Northwestern University, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL
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13
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Tu AY, Crawford MR, Dawson SC, Fogg LF, Turner AD, Wyatt JK, Crisostomo MI, Chhangani BS, Kushida CA, Edinger JD, Abbott SM, Malkani RG, Attarian HP, Zee PC, Ong JC. 0655 CBT-I and CPAP in Comorbid Insomnia and Sleep Apnea: Effects on Daytime Functioning. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
This study examines the effects of treatment sequences using cognitive-behavioral therapy for insomnia (CBT-I) and continuous positive airway pressure (CPAP) therapy on daytime functioning in people with comorbid insomnia and sleep apnea (COMISA).
Methods
118 participants with COMISA (Age=49.99±13.12; 53.4% female) were randomized to one of the three study arms: Arm A- CBT-I followed by CPAP, Arm B- CBT-I concurrent with CPAP, and Arm C- CPAP only. Participants were assessed at four time points [baseline/ start of phase 1 (A1), CPAP titration/ start of phase 2 (A2), 30 days (A3) and 90 days (A4) after CPAP initiation]. This study examined secondary outcome measures of daytime functioning, including the Functional Outcomes of Sleep Questionnaire (FOSQ), Epworth Sleepiness Scale, and Flinders Fatigue Scale (FFS).
Results
Linear mixed model analyses showed a main effect of time on improving functional outcomes in all measurements, with all p< 0.001. There were also arm by time interactions on FOSQ [F(6, 105.36)=4.21, p=0.001] and FFS scores [F(6, 106.95)=3.10, p=0.008]. Pairwise comparisons with Bonferroni adjustment showed improved FOSQ scores in Arm A from A1 to A2 (p=0.011) and A2 to A3 (p=0.005), Arm B from A2 to A3 (p< 0.001), and Arm C from A2 to A3 (p=0.006). For FFS scores, improvements were shown in Arm A from A1 to A2 (p=0.003), and Arm B from A2 to A3 (p < 0.001).
Conclusion
The results show daytime functioning improvements in patients with COMISA following CPAP and CBT-I. In addition, CBT-I appears to facilitate improvement in sleepiness-related functional status and daytime fatigue. The findings suggest that the combination of CBT-I and CPAP may have a beneficial effect on daytime functioning in patients with COMISA.
Support
This study was supported by the National Institutes of Health (R01HL114529).
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Affiliation(s)
- A Y Tu
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - M R Crawford
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UNITED KINGDOM
| | - S C Dawson
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - L F Fogg
- College of Nursing, Rush University Medical Center, Chicago, IL
| | - A D Turner
- Center for Sleep and Brain Health, Department of Psychiatry, New York University, New York, NY
| | - J K Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | | | - B S Chhangani
- Department of Medicine, Rush University Medical Center, Chicago, IL
| | - C A Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - J D Edinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - S M Abbott
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - R G Malkani
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - H P Attarian
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - P C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J C Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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14
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Carley DW, Prasad B, Reid KJ, Malkani R, Attarian H, Abbott SM, Vern B, Xie H, Yuan C, Zee PC. Pharmacotherapy of Apnea by Cannabimimetic Enhancement, the PACE Clinical Trial: Effects of Dronabinol in Obstructive Sleep Apnea. Sleep 2019; 41:4600041. [PMID: 29121334 DOI: 10.1093/sleep/zsx184] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study Objectives There remains an important and unmet need for fully effective and acceptable treatments in obstructive sleep apnea (OSA). At present, there are no approved drug treatments. Dronabinol has shown promise for OSA pharmacotherapy in a small dose-escalation pilot study. Here, we present initial findings of the Phase II PACE (Pharmacotherapy of Apnea by Cannabimimetic Enhancement) trial, a fully blinded parallel groups, placebo-controlled randomized trial of dronabinol in people with moderate or severe OSA. Methods By random assignment, 73 adults with moderate or severe OSA received either placebo (N = 25), 2.5 mg dronabinol (N = 21), or 10 mg dronabinol (N = 27) daily, 1 hour before bedtime for up to 6 weeks. Results At baseline, overall apnea-hypopnea index (AHI) was 25.9 ± 11.3, Epworth Sleepiness Scale (ESS) score was 11.45 ± 3.8, maintenance of wakefulness test (MWT) mean latency was 19.2 ± 11.8 minutes, body mass index was 33.4 ± 5.4 kg/m2, and age was 53.6 ± 9.0 years. The number and severity of adverse events, and treatment adherence (0.3 ± 0.6 missed doses/week) were equivalent among all treatment groups. Participants receiving 10 mg/day of dronabinol expressed the highest overall satisfaction with treatment (p = .04). In comparison to placebo, dronabinol dose-dependently reduced AHI by 10.7 ± 4.4 (p = .02) and 12.9 ± 4.3 (p = .003) events/hour at doses of 2.5 and 10 mg/day, respectively. Dronabinol at 10 mg/day reduced ESS score by -3.8 ± 0.8 points from baseline (p < .0001) and by -2.3 ± 1.2 points in comparison to placebo (p = .05). MWT sleep latencies, gross sleep architecture, and overnight oxygenation parameters were unchanged from baseline in any treatment group. Conclusions These findings support the therapeutic potential of cannabinoids in people with OSA. In comparison to placebo, dronabinol was associated with lower AHI, improved self-reported sleepiness, and greater overall treatment satisfaction. Larger scale clinical trials will be necessary to clarify the best potential approach(es) to cannabinoid therapy in OSA.
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Affiliation(s)
- David W Carley
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL.,Department of Medicine, University of Illinois at Chicago, Chicago, IL.,Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL
| | - Bharati Prasad
- Department of Medicine, University of Illinois at Chicago, Chicago, IL.,Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL.,Jesse Brown VA Medical Center, Chicago, IL
| | - Kathryn J Reid
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
| | - Roneil Malkani
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
| | - Hryar Attarian
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
| | - Sabra M Abbott
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
| | - Boris Vern
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL.,Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL
| | - Hui Xie
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
| | - Chengbo Yuan
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
| | - Phyllis C Zee
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
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15
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Grimaldi D, Papalambros NA, Reid KJ, Abbott SM, Malkani RG, Gendy M, Iwanaszko M, Braun RI, Sanchez DJ, Paller KA, Zee PC. Strengthening sleep-autonomic interaction via acoustic enhancement of slow oscillations. Sleep 2019; 42:zsz036. [PMID: 30753650 PMCID: PMC7729207 DOI: 10.1093/sleep/zsz036] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/25/2019] [Indexed: 11/14/2022] Open
Abstract
Slow-wave sleep (SWS) is important for overall health since it affects many physiological processes including cardio-metabolic function. Sleep and autonomic nervous system (ANS) activity are closely coupled at anatomical and physiological levels. Sleep-related changes in autonomic function are likely the main pathway through which SWS affects many systems within the body. There are characteristic changes in ANS activity across sleep stages. Notably, in non-rapid eye-movement sleep, the progression into SWS is characterized by increased parasympathetic activity, an important measure of cardiovascular health. Experimental manipulations that enhance slow-wave activity (SWA, 0.5-4 Hz) can improve sleep-mediated memory and immune function. However, effects of SWA enhancement on autonomic regulation have not been investigated. Here, we employed an adaptive algorithm to deliver 50 ms sounds phase-locked to slow-waves, with regular pauses in stimulation (~5 s ON/~5 s OFF), in healthy young adults. We sought to determine whether acoustic enhancement of SWA altered parasympathetic activity during SWS assessed with heart rate variability (HRV), and evening-to-morning changes in HRV, plasma cortisol, and blood pressure. Stimulation, compared with a sham condition, increased SWA during ON versus OFF intervals. This ON/OFF SWA enhancement was associated with a reduction in evening-to-morning change of cortisol levels and indices of sympathetic activity. Furthermore, the enhancement of SWA in ON intervals during sleep cycles 2-3 was accompanied by an increase in parasympathetic activity (high-frequency, HRV). Together these findings suggest that acoustic enhancement of SWA has a positive effect on autonomic function in sleep. Approaches to strengthen brain-heart interaction during sleep could have important implications for cardiovascular health.
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Affiliation(s)
- Daniela Grimaldi
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nelly A Papalambros
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kathryn J Reid
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sabra M Abbott
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Roneil G Malkani
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Maged Gendy
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Marta Iwanaszko
- Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rosemary I Braun
- Biostatistics Division, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL
| | | | - Ken A Paller
- Department of Psychology, Northwestern University, Evanston, IL
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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16
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Abstract
Non-24-hour sleep-wake rhythm disorder is a circadian rhythm sleep-wake disorder characterized by an inability to entrain to the 24-hour environment. Patients present with complaints of insomnia or hypersomnia, with progressive daily shifts of sleep-wake activity on actigraphy or sleep logs. Although first recognized in blind individuals without light perception, it also can be seen in individuals with intact vision. Treatment focuses on timed melatonin in blind individuals, whereas it is more complex in sighted individuals, using multiple time cues, such as light, melatonin, social interactions, feeding, and activity.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Abbott Hall 524, Chicago, IL 60610, USA.
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17
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Ong JC, Crawford MR, Wyatt JK, Fogg LF, Turner AD, Dawson SC, Edinger JD, Kushida CA, Abbott SM, Malkani RG, Attarian HP, Zee PC. 0379 A Randomized Controlled Trial Of CBT-I and CPAP For Comorbid Insomnia and OSA: Initial Findings from the MATRICS Study. Sleep 2019. [DOI: 10.1093/sleep/zsz067.378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jason C Ong
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Louis F Fogg
- Rush University Medical Center, Chicago, IL, USA
| | | | - Spencer C Dawson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Sabra M Abbott
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roneil G Malkani
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hrayr P Attarian
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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18
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Grimaldi D, Papalambros N, Malkani RG, Reid KJ, Abbott SM, Zee PC. 0353 Altered Modulation Of Spindle Density Across The Night In Older Adults With Chronic Insomnia. Sleep 2019. [DOI: 10.1093/sleep/zsz067.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Choi JH, Abbott SM, Wilson J, Zee PC. 0008 Impaired Post Illumination Pupil Response in Individuals with Delayed Sleep Wake Phase Disorder. Sleep 2019. [DOI: 10.1093/sleep/zsz067.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jin Hyeuk Choi
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sabra M Abbott
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Wilson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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20
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Abbott SM, Malkani RG, Zee PC. Circadian disruption and human health: A bidirectional relationship. Eur J Neurosci 2019; 51:567-583. [PMID: 30549337 DOI: 10.1111/ejn.14298] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
Circadian rhythm disorders have been classically associated with disorders of abnormal timing of the sleep-wake cycle, however circadian dysfunction can play a role in a wide range of pathology, ranging from the increased risk for cardiometabolic disease and malignancy in shift workers, prompting the need for a new field focused on the larger concept of circadian medicine. The relationship between circadian disruption and human health is bidirectional, with changes in circadian amplitude often preceding the classical symptoms of neurodegenerative disorders. As our understanding of the importance of circadian dysfunction in disease grows, we need to develop better clinical techniques for identifying circadian rhythms and also develop circadian based strategies for disease management. Overall this review highlights the need to bring the concept of time to all aspects of medicine, emphasizing circadian medicine as a prime example of both personalized and precision medicine.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Roneil G Malkani
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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21
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Abstract
Circadian rhythms are the endogenous near-24-h oscillations in physiologic processes. In mammals the suprachiasmatic nucleus serves as the primary circadian pacemaker, and it maintains rhythmicity at a genetic level through a complex transcription-translation feedback loop of core circadian clock genes. The circadian clock is entrained to the environment through daily exposure to light and melatonin. Disruption of these endogenous rhythms or the ability to entrain to the surrounding environment results in the circadian rhythm sleep-wake disorders (CRSWDs). Patients with CRSWDs can present with either late sleep/wake times (delayed sleep-wake phase disorder), early sleep/wake times (advanced sleep-wake phase disorder), inconsistent sleep/wake times (irregular sleep-wake rhythm disorder) or sleep-wake times that move progressively later each day (non-24-h sleep-wake rhythm disorder). Diagnosis of these disorders relies on the use of sleep logs and/or actigraphy to demonstrate the daily patterns of rest and activity. Treatment of the CRSWDs focuses on sleep hygiene and strategically timed light and melatonin.
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Affiliation(s)
- Yumna Saeed
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Phyllis C Zee
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - Sabra M Abbott
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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22
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Wilson J, Reid KJ, Braun RI, Abbott SM, Zee PC. Habitual light exposure relative to circadian timing in delayed sleep-wake phase disorder. Sleep 2018; 41:5078613. [PMID: 30423177 PMCID: PMC6231529 DOI: 10.1093/sleep/zsy166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/16/2018] [Indexed: 12/16/2022] Open
Abstract
Study Objectives To compare melatonin timing, a well-validated marker for endogenous circadian phase, and habitual light-exposure patterns in adults with delayed sleep-wake phase disorder (DSWPD) and intermediate chronotype controls. Methods Twelve individuals with DSWPD (five females, mean age: 31.1) and 12 age-matched controls (six females, mean age: 33.6) underwent a minimum of 7 days of light and activity monitoring followed by an inpatient hospital stay, where blood was taken to assess melatonin timing (calculated as dim light melatonin onset-DLMO). Habitual light-exposure patterns were then compared with a human phase-response curve (PRC) to light. Results Relative to clock time, individuals with DSWPD had a later light-exposure pattern compared with controls, but their light-exposure pattern was earlier relative to DLMO. According to the human PRC to light, individuals with DSWPD had less daily advancing light exposure compared with controls. The primary difference was seen in the late portion of the advancing window, in which individuals with DSWPD were exposed to fewer pulses of light of equivalent duration and intensity compared with controls. Conclusions Diminished advancing light exposure may play a role in the development and perpetuation of delayed sleep-wake timing in individuals with DSWPD. Enhancing light exposure during the later portion of the advancing window represents an innovative and complementary strategy that has the potential to improve the effectiveness of bright light therapy in DSWPD.
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Affiliation(s)
- John Wilson
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Kathryn J Reid
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Rosemary I Braun
- Biostatistics Division (Preventive Medicine), Northwestern University, Feinberg School of Medicine, Chicago, IL
- Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL
| | - Sabra M Abbott
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
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23
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Abbott SM, Weng J, Reid KJ, Daviglus ML, Gallo LC, Loredo JS, Nyenhuis SM, Ramos AR, Shah NA, Sotres-Alvarez D, Patel SR, Zee PC. Sleep Timing, Stability, and BP in the Sueño Ancillary Study of the Hispanic Community Health Study/Study of Latinos. Chest 2018; 155:60-68. [PMID: 30300651 DOI: 10.1016/j.chest.2018.09.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/23/2018] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Timing and stability of the sleep-wake cycle are potential modifiable risk factors for cardiometabolic disease. The aim of this study was to evaluate the relationship between objective measures of sleep-wake timing and stability with cardiometabolic disease risk. METHODS In this multicenter, cross-sectional, population-based study, actigraphy data were obtained from the 2,156 adults, aged 18 to 64 years, recruited from the Sueño ancillary study of the Hispanic Community Health Study/Study of Latinos (2010-2013). These data were correlated with measures of cardiometabolic disease risk, including systolic and diastolic BPs, homeostatic assessment of insulin resistance, glycosylated hemoglobin, BMI, and hypertension and diabetes status. RESULTS Each 10% decrease in interdaily stability was associated with a 3.0% absolute increase in the prevalence of hypertension (95% CI, 0.6-5.3; P < .05), an increase in systolic BP by 0.78 mm Hg (95% CI, 0.12-1.45; P < .05) and an increase in diastolic BP by 0.80 mm Hg (95% CI, 0.28-1.32; P < .05). In addition, delaying the midpoint of sleep by 1 h was associated with an increase in systolic BP by 0.73 mm Hg (95% CI, 0.30-1.16; P < .01) and diastolic BP by 0.53 mm Hg (95% CI, 0.17-0.90; P < .01). These associations were not significant after adjusting for shift work status. No association was found between interdaily stability or sleep timing and diabetes, BMI, or insulin resistance. CONCLUSIONS These results suggest that beyond sleep duration, the timing and regularity of sleep-wake schedules are related to hypertension prevalence and BP.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Northwestern University, Chicago, IL.
| | - Jia Weng
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Kathryn J Reid
- Department of Neurology, Northwestern University, Chicago, IL
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| | - Jose S Loredo
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA
| | | | | | - Neomi A Shah
- Division of Pulmonary, Critical Care and Sleep, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sanjay R Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Chicago, IL
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Braun R, Kath WL, Iwanaszko M, Kula-Eversole E, Abbott SM, Reid KJ, Zee PC, Allada R. Universal method for robust detection of circadian state from gene expression. Proc Natl Acad Sci U S A 2018; 115:E9247-E9256. [PMID: 30201705 PMCID: PMC6166804 DOI: 10.1073/pnas.1800314115] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Circadian clocks play a key role in regulating a vast array of biological processes, with significant implications for human health. Accurate assessment of physiological time using transcriptional biomarkers found in human blood can significantly improve diagnosis of circadian disorders and optimize the delivery time of therapeutic treatments. To be useful, such a test must be accurate, minimally burdensome to the patient, and readily generalizable to new data. A major obstacle in development of gene expression biomarker tests is the diversity of measurement platforms and the inherent variability of the data, often resulting in predictors that perform well in the original datasets but cannot be universally applied to new samples collected in other settings. Here, we introduce TimeSignature, an algorithm that robustly infers circadian time from gene expression. We demonstrate its application in data from three independent studies using distinct microarrays and further validate it against a new set of samples profiled by RNA-sequencing. Our results show that TimeSignature is more accurate and efficient than competing methods, estimating circadian time to within 2 h for the majority of samples. Importantly, we demonstrate that once trained on data from a single study, the resulting predictor can be universally applied to yield highly accurate results in new data from other studies independent of differences in study population, patient protocol, or assay platform without renormalizing the data or retraining. This feature is unique among expression-based predictors and addresses a major challenge in the development of generalizable, clinically useful tests.
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Affiliation(s)
- Rosemary Braun
- Biostatistics Division, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611;
- Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL 60208
- NSF-Simons Center for Quantitative Biology, Northwestern University, Evanston, IL 60208
| | - William L Kath
- Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL 60208
- NSF-Simons Center for Quantitative Biology, Northwestern University, Evanston, IL 60208
- Department of Neurobiology, Northwestern University, Evanston, IL 60208
| | - Marta Iwanaszko
- Biostatistics Division, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611
- NSF-Simons Center for Quantitative Biology, Northwestern University, Evanston, IL 60208
| | | | - Sabra M Abbott
- Department of Neurology, Northwestern University, Chicago, IL 60611
- the Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL 60611
| | - Kathryn J Reid
- Department of Neurology, Northwestern University, Chicago, IL 60611
- the Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL 60611
| | - Phyllis C Zee
- Department of Neurobiology, Northwestern University, Evanston, IL 60208
- Department of Neurology, Northwestern University, Chicago, IL 60611
| | - Ravi Allada
- NSF-Simons Center for Quantitative Biology, Northwestern University, Evanston, IL 60208
- Department of Neurobiology, Northwestern University, Evanston, IL 60208
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Malkani RG, Abbott SM, Zee PC. Adopting the Unentrained Orphan. J Clin Sleep Med 2018; 14:1447. [PMID: 30092911 DOI: 10.5664/jcsm.7306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Roneil G Malkani
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sabra M Abbott
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Papalambros NA, Grimaldi D, Reid KJ, Abbott SM, Malkani RG, Santostasi G, Gendy M, Ritger A, Braun R, Sanchez D, Paller KA, Zee PC. 0083 Acoustically Induced Changes In Sleep Spindle And Autonomic Activity Predict Memory Consolidation. Sleep 2018. [DOI: 10.1093/sleep/zsy061.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - K J Reid
- Northwestern University, Chicago, IL
| | | | | | | | - M Gendy
- Northwestern University, Chicago, IL
| | - A Ritger
- Northwestern University, Chicago, IL
| | - R Braun
- Northwestern University, Chicago, IL
| | - D Sanchez
- Northwestern University, Evanston, IL
| | | | - P C Zee
- Northwestern University, Chicago, IL
- SRI International, Menlo Park, CA
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Grimaldi D, Papalambros NA, Reid KJ, Abbott SM, Malkani RG, Santostasi G, Sanchez DJ, Paller KA, Zee PC. 0116 Autonomic And Sleep Interaction During Acoustic Enhancement Of Sleep. Sleep 2018. [DOI: 10.1093/sleep/zsy061.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - K J Reid
- Northwestern University, Chicago, IL
| | | | | | | | | | | | - P C Zee
- Northwestern University, Chicago, IL
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Malkani RG, Abbott SM, Reid KJ, Zee PC. Diagnostic and Treatment Challenges of Sighted Non-24-Hour Sleep-Wake Disorder. J Clin Sleep Med 2018; 14:603-613. [PMID: 29609703 DOI: 10.5664/jcsm.7054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/05/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To report the diagnostic and treatment challenges of sighted non-24-hour sleep-wake disorder (N24SWD). METHODS We report a series of seven sighted patients with N24SWD clinically evaluated by history and sleep diaries, and when available wrist actigraphy and salivary melatonin levels, and treated with timed melatonin and bright light therapy. RESULTS Most patients had a history of a delayed sleep-wake pattern prior to developing N24SWD. The typical sleep-wake pattern of N24SWD was seen in the sleep diaries (and in actigraphy when available) in all patients with a daily delay in midpoint of sleep ranging 0.8 to 1.8 hours. Salivary dim light melatonin onset (DLMO) was evaluated in four patients but was missed in one. The estimated phase angle from DLMO to sleep onset ranged from 5.25 to 9 hours. All six patients who attempted timed melatonin and bright light therapy were able to entrain their sleep-wake schedules. Entrainment occurred at a late circadian phase, possibly related to the late timing of melatonin administration, though the patients often preferred late sleep times. Most did not continue treatment and continued to have a non-24-hour sleep-wake pattern. CONCLUSIONS N24SWD is a chronic debilitating disorder that is often overlooked in sighted people and can be challenging to diagnose and treat. Tools to assess circadian pattern and timing can be effectively applied to aid the diagnosis. The progressive delay of the circadian rhythm poses a challenge for determining the most effective timing for melatonin and bright light therapies. Furthermore, once the circadian sleep-wake rhythm is entrained, long-term effectiveness is limited because of the behavioral and environmental structure that is required to maintain stable entrainment.
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Affiliation(s)
- Roneil G Malkani
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sabra M Abbott
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kathryn J Reid
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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29
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Abbott SM, Knutson KL, Zee PC. Health implications of sleep and circadian rhythm research in 2017. Lancet Neurol 2017; 17:17-18. [PMID: 29262995 DOI: 10.1016/s1474-4422(17)30410-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Sabra M Abbott
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Kristen L Knutson
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Phyllis C Zee
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Abstract
Alzheimer's disease (AD) is increasing in prevalence and has a significant impact on caregivers and the healthcare system. One of the many physiologic process affected by AD is the circadian system, with disruption reflected in abnormalities of the sleep-wake cycle. This interaction is bidirectional, with circadian and sleep disruption influencing disease progression. Understanding the bidirectional relationship between AD and circadian disruption may allow for earlier recognition of the potential to develop dementia as well as improved targeted approaches for therapy. Therapies including melatonin and bright light therapy may be advantageous in improving sleep and circadian rhythms and preventing the progression of disease. However, unfortunately, these modalities are not curative, and additional research is needed to improve treatment options for these individuals.
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Affiliation(s)
- Yumna Saeed
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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31
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Mullington JM, Abbott SM, Carroll JE, Davis CJ, Dijk DJ, Dinges DF, Gehrman PR, Ginsburg GS, Gozal D, Haack M, Lim DC, Macrea M, Pack AI, Plante DT, Teske JA, Zee PC. Developing Biomarker Arrays Predicting Sleep and Circadian-Coupled Risks to Health. Sleep 2016; 39:727-36. [PMID: 26951388 DOI: 10.5665/sleep.5616] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
| | | | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience & Human Behavior, UCLA, Los Angeles, CA
| | - Christopher J Davis
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, UK
| | - David F Dinges
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Philip R Gehrman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Geoffrey S Ginsburg
- Duke Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
| | | | - Monika Haack
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
| | - Diane C Lim
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Madalina Macrea
- Salem VAMC, Salem, VA.,University of Virginia, Charlottesville, VA
| | - Allan I Pack
- Department of Medicine, Center for Sleep and Circadian Neurobiology Translational Research Laboratories, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Abstract
Sleep-wake disruption is frequently observed and often one of the earliest reported symptoms of many neurodegenerative disorders. This provides insight into the underlying pathophysiology of these disorders, as sleep-wake abnormalities are often accompanied by neurodegenerative or neurotransmitter changes. However, in addition to being a symptom of the underlying neurodegenerative condition, there is also emerging evidence that sleep disturbance itself may contribute to the development and facilitate the progression of several of these disorders. Due to its impact both as an early symptom and as a potential factor contributing to ongoing neurodegeneration, the sleep-wake cycle is an ideal target for further study for potential interventions not only to lessen the burden of these diseases but also to slow their progression. In this review, we will highlight the sleep phenotypes associated with some of the major neurodegenerative disorders, focusing on the circadian disruption associated with Alzheimer's disease, the rapid eye movement behavior disorder and sleep fragmentation associated with Parkinson's disease, and the insomnia and circadian dysregulation associated with Huntington's disease.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
The circadian system regulates the timing and expression of nearly all biological processes, most notably, the sleep-wake cycle, and disruption of this system can result in adverse effects on both physical and mental health. The circadian rhythm sleep-wake disorders (CRSWDs) consist of 5 disorders that are due primarily to pathology of the circadian clock or to a misalignment of the timing of the endogenous circadian rhythm with the environment. This article outlines the nature of these disorders, the association of many of these disorders with psychiatric illness, and available treatment options.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Suite 500, Chicago, IL 60611, USA
| | - Kathryn J Reid
- Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Suite 500, Chicago, IL 60611, USA
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Suite 500, Chicago, IL 60611, USA.
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Abstract
Irregular sleep-wake rhythm disorder is a circadian rhythm disorder characterized by multiple bouts of sleep within a 24-hour period. Patients present with symptoms of insomnia, including difficulty either falling or staying asleep, and daytime excessive sleepiness. The disorder is seen in a variety of individuals, ranging from children with neurodevelopmental disorders, to patients with psychiatric disorders, and most commonly in older adults with neurodegenerative disorders. Treatment of irregular sleep-wake rhythm disorder requires a multimodal approach aimed at strengthening circadian synchronizing agents, such as daytime exposure to bright light, and structured social and physical activities. In addition, melatonin may be useful in some patients.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Northwestern Feinberg School of Medicine, 710 North Lake Shore Drive, Chicago, IL 60611, USA.
| | - Phyllis C Zee
- Department of Neurology, Northwestern Feinberg School of Medicine, 710 North Lake Shore Drive, Chicago, IL 60611, USA
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35
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Abstract
Sleep disorders are commonly seen in atypical parkinsonism, with particular disorders occurring more frequently in specific parkinsonian disorders. Multiple systems atrophy (MSA) is a synucleinopathy often associated with nocturnal stridor which is a serious, but treatable condition highly specific to MSA. In addition, this disorder is strongly associated with rapid eye movement (REM) sleep behavior disorder (RBD), which is also seen in dementia with Lewy bodies (DLB). RBD is far less prevalent in progressive supranuclear palsy (PSP), which is a tauopathy. Insomnia and impaired sleep architecture are the most common sleep abnormalities seen in PSP. Corticobasilar degeneration (CBD) is also a tauopathy, but has far fewer sleep complaints associated with it than PSP. In this manuscript we review the spectrum of sleep dysfunction across the atypical parkinsonian disorders, emphasize the importance of evaluating for sleep disorders in patients with parkinsonian symptoms, and point to sleep characteristics that can provide diagnostic clues to the underlying parkinsonian disorder.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Abbott SM, Attarian H, Zee PC. Sleep disorders in perinatal women. Best Pract Res Clin Obstet Gynaecol 2014; 28:159-68. [DOI: 10.1016/j.bpobgyn.2013.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 07/23/2013] [Accepted: 09/09/2013] [Indexed: 01/20/2023]
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Abbott SM, Arnold JM, Chang Q, Miao H, Ota N, Cecala C, Gold PE, Sweedler JV, Gillette MU. Signals from the brainstem sleep/wake centers regulate behavioral timing via the circadian clock. PLoS One 2013; 8:e70481. [PMID: 23950941 PMCID: PMC3741311 DOI: 10.1371/journal.pone.0070481] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/19/2013] [Indexed: 11/22/2022] Open
Abstract
Sleep-wake cycling is controlled by the complex interplay between two brain systems, one which controls vigilance state, regulating the transition between sleep and wake, and the other circadian, which communicates time-of-day. Together, they align sleep appropriately with energetic need and the day-night cycle. Neural circuits connect brain stem sites that regulate vigilance state with the suprachiasmatic nucleus (SCN), the master circadian clock, but the function of these connections has been unknown. Coupling discrete stimulation of pontine nuclei controlling vigilance state with analytical chemical measurements of intra-SCN microdialysates in mouse, we found significant neurotransmitter release at the SCN and, concomitantly, resetting of behavioral circadian rhythms. Depending upon stimulus conditions and time-of-day, SCN acetylcholine and/or glutamate levels were augmented and generated shifts of behavioral rhythms. These results establish modes of neurochemical communication from brain regions controlling vigilance state to the central circadian clock, with behavioral consequences. They suggest a basis for dynamic integration across brain systems that regulate vigilance states, and a potential vulnerability to altered communication in sleep disorders.
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Affiliation(s)
- Sabra M. Abbott
- Department of Molecular & Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- College of Medicine University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Jennifer M. Arnold
- Department of Molecular & Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- College of Medicine University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Qing Chang
- Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Hai Miao
- Chemistry, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Nobutoshi Ota
- Chemistry, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Christine Cecala
- Chemistry, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Paul E. Gold
- Department of Molecular & Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- College of Medicine University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Jonathan V. Sweedler
- Department of Molecular & Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Chemistry, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Martha U. Gillette
- Department of Molecular & Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Cell & Developmental Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- College of Medicine University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- * E-mail:
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39
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Affiliation(s)
- Martha U Gillette
- Alumni Professor of Cell & Developmental Biology and the Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL
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Tischkau SA, Weber ET, Abbott SM, Mitchell JW, Gillette MU. Circadian clock-controlled regulation of cGMP-protein kinase G in the nocturnal domain. J Neurosci 2003; 23:7543-50. [PMID: 12930792 PMCID: PMC6740760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
The suprachiasmatic nucleus (SCN) circadian clock exhibits a recurrent series of dynamic cellular states, characterized by the ability of exogenous signals to activate defined kinases that alter clock time. To explore potential relationships between kinase activation by exogenous signals and endogenous control mechanisms, we examined clock-controlled protein kinase G (PKG) regulation in the mammalian SCN. Signaling via the cGMP-PKG pathway is required for light- or glutamate (GLU)-induced phase advance in late night. Spontaneous cGMP-PKG activation occurred at the end of subjective night in free-running SCN in vitro. Phasing of the SCN rhythm in vitro was delayed by approximately 3 hr after treatment with guanylyl cyclase (GC) inhibitors, PKG inhibition, or antisense oligodeoxynucleotide (alphaODN) specific for PKG, but not PKA inhibitor or mismatched ODN. This sensitivity to GC-PKG inhibition was limited to the same 2 hr time window demarcated by clock-controlled activation of cGMP-PKG. Inhibition of the cGMP-PKG pathway at this time caused delays in the phasing of four endogenous rhythms: wheel-running activity, neuronal activity, cGMP, and Per1. Timing of the cGMP-PKG-necessary window in both rat and mouse depended on clock phase, established by the antecedent light/dark cycle rather than solar time. Because behavioral, neurophysiological, biochemical, and molecular rhythms showed the same temporal sensitivities and qualitative responses, we predict that clock-regulated GC-cGMP-PKG activation may provide a necessary cue as to clock state at the end of the nocturnal domain. Because sensitivity to phase advance by light-GLU-activated GC-cGMP-PKG occurs in juxtaposition, these signals may induce a premature shift to this PKG-necessary clock state.
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Affiliation(s)
- Shelley A Tischkau
- Department of Cell and Structural Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois 60801, USA
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