1
|
Mehra R, Tjurmina OA, Ajijola OA, Arora R, Bolser DC, Chapleau MW, Chen PS, Clancy CE, Delisle BP, Gold MR, Goldberger JJ, Goldstein DS, Habecker BA, Handoko ML, Harvey R, Hummel JP, Hund T, Meyer C, Redline S, Ripplinger CM, Simon MA, Somers VK, Stavrakis S, Taylor-Clark T, Undem BJ, Verrier RL, Zucker IH, Sopko G, Shivkumar K. Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation: A Report From the National Heart, Lung, and Blood Institute and the National Institutes of Health Office of the Director Workshop. JACC Basic Transl Sci 2022; 7:265-293. [PMID: 35411324 PMCID: PMC8993767 DOI: 10.1016/j.jacbts.2021.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022]
Abstract
This virtual workshop was convened by the National Heart, Lung, and Blood Institute, in partnership with the Office of Strategic Coordination of the Office of the National Institutes of Health Director, and held September 2 to 3, 2020. The intent was to assemble a multidisciplinary group of experts in basic, translational, and clinical research in neuroscience and cardiopulmonary disorders to identify knowledge gaps, guide future research efforts, and foster multidisciplinary collaborations pertaining to autonomic neural mechanisms of cardiopulmonary regulation. The group critically evaluated the current state of knowledge of the roles that the autonomic nervous system plays in regulation of cardiopulmonary function in health and in pathophysiology of arrhythmias, heart failure, sleep and circadian dysfunction, and breathing disorders. Opportunities to leverage the Common Fund's SPARC (Stimulating Peripheral Activity to Relieve Conditions) program were characterized as related to nonpharmacologic neuromodulation and device-based therapies. Common themes discussed include knowledge gaps, research priorities, and approaches to develop novel predictive markers of autonomic dysfunction. Approaches to precisely target neural pathophysiological mechanisms to herald new therapies for arrhythmias, heart failure, sleep and circadian rhythm physiology, and breathing disorders were also detailed.
Collapse
Key Words
- ACE, angiotensin-converting enzyme
- AD, autonomic dysregulation
- AF, atrial fibrillation
- ANS, autonomic nervous system
- Ach, acetylcholine
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CSA, central sleep apnea
- CVD, cardiovascular disease
- ECG, electrocardiogram
- EV, extracellular vesicle
- GP, ganglionated plexi
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HRV, heart rate variability
- LQT, long QT
- MI, myocardial infarction
- NE, norepinephrine
- NHLBI, National Heart, Lung, and Blood Institute
- NPY, neuropeptide Y
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PAH, pulmonary arterial hypertension
- PV, pulmonary vein
- REM, rapid eye movement
- RV, right ventricular
- SCD, sudden cardiac death
- SDB, sleep disordered breathing
- SNA, sympathetic nerve activity
- SNSA, sympathetic nervous system activity
- TLD, targeted lung denervation
- asthma
- atrial fibrillation
- autonomic nervous system
- cardiopulmonary
- chronic obstructive pulmonary disease
- circadian
- heart failure
- pulmonary arterial hypertension
- sleep apnea
- ventricular arrhythmia
Collapse
Affiliation(s)
- Reena Mehra
- Cleveland Clinic, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Olga A. Tjurmina
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Rishi Arora
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | | | - Mark W. Chapleau
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | | | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - David S. Goldstein
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Beth A. Habecker
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - M. Louis Handoko
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - James P. Hummel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | - Marc A. Simon
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- University of California-San Francisco, San Francisco, California, USA
| | | | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | - Richard L. Verrier
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - George Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | |
Collapse
|
2
|
Williams-Cooke C, Watts E, Bonnett J, Alshehri M, Siengsukon C. Association Between Sleep Duration and Functional Disability in Inpatient Stroke Rehabilitation: A Pilot Observational Study. Arch Rehabil Res Clin Transl 2021; 3:100150. [PMID: 34589700 PMCID: PMC8463457 DOI: 10.1016/j.arrct.2021.100150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To describe the change in sleep duration during inpatient rehabilitation and to determine if sleep quality and sleep duration is associated with functional disability for individuals after stroke. It was hypothesized that participants who experienced optimal sleep during inpatient rehabilitation would have greater functional ability at discharge. Design Longitudinal observation study. Setting Inpatient rehabilitation unit at a large, urban hospital. Participants Thirty-seven individuals with acute stroke (N=37; mean age, 62.5±11.8y, male=20, female=17) were recruited from September 2018 to September 2019. Participants were invited to participate in the study by clinical personnel associated with their usual care as they were admitted to inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures Participants were asked to wear an actigraph for the duration of their rehabilitation program to assess sleep. The first 3 nights of actigraphy data were averaged to obtain total sleep time (TST) and sleep efficiency (SE) at admission, and the last 3 nights were averaged for TST and SE at discharge. Functional disability (primary outcome was FIM) at admission and discharge was gathered from the participants’ medical records. One-way analysis of variance and chi-square analyses assessed for group differences, and regression modeling was used to determine if sleep was associated with functional ability at discharge. Results Sixteen participants (43%) were categorized as “good sleepers” and 21 (57%) were “poor sleepers” based on their TST at admission. Of the poor sleepers, 14 participants (66%) remained short duration sleepers (<7h at admission and discharge). Sleep outcomes did not significantly predict FIM score at discharge. Conclusions Most participants had less than optimal sleep duration during inpatient rehabilitation. Efforts may be warranted to optimize sleep during inpatient rehabilitation.
Collapse
Affiliation(s)
- Cierra Williams-Cooke
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
| | - Elise Watts
- Rehabilitation Department, St. Luke's Hospital, Kansas City, MO
| | | | - Mohammed Alshehri
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
| | - Catherine Siengsukon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
3
|
Ye H, Kaszuba S. Neuromodulation with electromagnetic stimulation for seizure suppression: From electrode to magnetic coil. IBRO Rep 2019; 7:26-33. [PMID: 31360792 PMCID: PMC6639724 DOI: 10.1016/j.ibror.2019.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022] Open
Abstract
Non-invasive brain tissue stimulation with a magnetic coil provides several irreplaceable advantages over that with an implanted electrode, in altering neural activities under pathological situations. We reviewed clinical cases that utilized time-varying magnetic fields for the treatment of epilepsy, and the safety issues related to this practice. Animal models have been developed to foster understanding of the cellular/molecular mechanisms underlying magnetic control of epileptic activity. These mechanisms include (but are not limited to) (1) direct membrane polarization by the magnetic field, (2) depolarization blockade by the deactivation of ion channels, (3) alteration in synaptic transmission, and (4) interruption of ephaptic interaction and cellular synchronization. Clinical translation of this technology could be improved through the advancement of magnetic design, optimization of stimulation protocols, and evaluation of the long-term safety. Cellular and molecular studies focusing on the mechanisms of magnetic stimulation are of great value in facilitating this translation.
Collapse
Key Words
- 4-AP, 4-aminopyridine
- Animal models
- CD50, convulsant dose
- Cellular mechanisms
- DBS, deep brain stimulation
- EEG, electroencephalography
- ELF-MF, extremely low frequency magnetic fields
- EcoG, electrocorticography
- Epilepsy
- GABA, gamma-aminobutyric acid
- HFS, high frequency stimulation
- KA, kainic acid
- LD50, lethal dose
- LTD, long-term depression
- LTP, long-term potential
- MEG, magnetoencephalography
- MRI, magnetic resonance imaging
- Magnetic stimulation
- NMDAR, N-methyl-d-aspartate receptor
- PTZ, pentylenetetrazol
- REM, rapid eye movement
- SMF, static magnetic field
- TES, transcranial electrical stimulation
- TLE, temporal lobe epilepsy
- TMS, transcranial magnetic stimulation
- rTMS, repetitive transcranial magnetic stimulation
- tDCS, transcranial direct-current stimulation
Collapse
Affiliation(s)
- Hui Ye
- Department of Biology, Loyola University Chicago, Chicago, 1032 W. Sheridan Rd., IL, 60660, United States
| | - Stephanie Kaszuba
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd., North Chicago, IL, 60064, United States
| |
Collapse
|
4
|
Toi N, Inaba M, Kurajoh M, Morioka T, Hayashi N, Hirota T, Miyaoka D, Emoto M, Yamada S. Improvement of glycemic control by treatment for insomnia with suvorexant in type 2 diabetes mellitus. J Clin Transl Endocrinol 2018; 15:37-44. [PMID: 30619717 PMCID: PMC6306692 DOI: 10.1016/j.jcte.2018.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/19/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 12/25/2022]
Abstract
Introduction Acute and chronic insomnia can exacerbate type 2 diabetes mellitus (T2DM). We investigated suvorexant (an anti-insomnia drug that targets the orexin system) effects on sleep architecture and glucose metabolism in T2DM patients with insomnia. Materials and methods This 7 day open-label, single-arm, intervention trial included 18 subjects with T2DM and insomnia. After 1 day acclimatization, daily glucose levels, sleep architecture, and autonomic nervous function were evaluated by continuous glucose monitoring (CGM), single-channel electroencephalography, and accelerometry, respectively. Results Suvorexant treatment for 3 days significantly increased total sleep time and sleep efficiency, with partial suppression of sympathetic nerve activity. CGM-measured 24 h mean glucose level decreased significantly from 157.7 ± 22.9 to 152.3 ± 17.8 mg/dL, especially in the early glucose surge after the midnight nadir (from 28.3 ± 15.0 to 18.2 ± 9.9 mg/dL), and until supper with a significant improvement in homeostasis model assessment of insulin resistance from 4.0 ± 2.8 to 2.9 ± 1.6, respectively. Conclusions Suvorexant treatment for insomnia of subjects with T2DM significantly improved CGM-measured daily glycemic control, which was associated with changes in sympathomimetic tone and/or improved insulin sensitivity. The amelioration of insomnia may therefore be a target for improving glycemic control in T2DM patients with insomnia.
Collapse
Key Words
- AHI, Apnea–Hypopnea Index
- AUC, area under the curve
- Autonomic nervous function
- BMI, body mass index
- CGM, continuous glucose monitoring
- CPR, C-peptide immunoreactivity
- CVR-R, coefficient of variation of RR intervals
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- Dawn phenomenon
- EEG, electroencephalography
- Glycemic control
- HOMA-IR, homeostasis model assessment of insulin resistance
- HR, heart rate
- HRV, heart rate variability
- HbA1c, glycated hemoglobin A1c
- IQR, interquartile range
- IRI, immunoreactive insulin
- Insulin resistance
- PSQI, Pittsburgh Sleep Quality Index
- REM, rapid eye movement
- SAS, Sleep Apnea Syndrome
- SD, standard deviation
- SDNN, standard deviation of the NN (i.e., R-R) intervals
- T2DM, type 2 diabetes mellitus
- Therapy for insomnia
- Type 2 diabetes mellitus
- bpm, beats per minute
- eGFR, estimated glomerular filtration ratio
Collapse
Affiliation(s)
- Norikazu Toi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Noriyuki Hayashi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomoe Hirota
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Daichi Miyaoka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| |
Collapse
|
5
|
Hitomi T, Inouchi M, Takeyama H, Kobayashi K, Sultana S, Inoue T, Nakayama Y, Shimotake A, Matsuhashi M, Matsumoto R, Chin K, Takahashi R, Ikeda A. Sleep is associated with reduction of epileptiform discharges in benign adult familial myoclonus epilepsy. Epilepsy Behav Case Rep 2018; 11:18-21. [PMID: 30591883 PMCID: PMC6305661 DOI: 10.1016/j.ebcr.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/07/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 11/18/2022]
Abstract
To clarify the effects of sleep on cortical irritability in benign adult familial myoclonus epilepsy (BAFME), we retrospectively compared epileptiform discharges of electroencephalographies (EEGs) between awake and sleep periods in 5 patients (mean age: 49.6 ± 20.3 years). We also analyzed polysomnography (PSG) of 1 patient. Epileptiform discharges were significantly more frequent during the awake period (1.3 ± 1.2/min) than those during light sleep stages (0.02 ± 0.04/min) (P < 0.05). Regarding PSG analysis, epileptiform discharges were also reduced during all sleep stages compared to those during awake periods. Our study suggests a relative reduction in cortical irritability during sleep in BAFME. We retrospectively analyzed the number of epileptiform discharges in BAFME. Epileptiform discharges were more frequent during awake period in BAFME. Our study indicated a reduction in cortical irritability during sleep in BAFME. BAFME and Unverricht-Lundborg disease may share a similar phenomenological mechanism.
Collapse
Key Words
- ADCME, autosomal dominant cortical tremor, myoclonus, and epilepsy
- BAFME, benign adult familial myoclonus epilepsy
- Benign adult familial myoclonus epilepsy (BAFME)
- EEG, electroencephalography
- EMG, electromyography
- Effects of sleep modification on cortical irritability
- Epileptiform discharges
- FCMTE, familial cortical myoclonic tremor with epilepsy
- PSG, polysomnography
- REM, rapid eye movement
- ULD, Unverricht-Lundborg disease
- nCPAP, nasal continuous positive airway pressure
Collapse
Affiliation(s)
- Takefumi Hitomi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Laboratory, Kyoto University Hospital, Kyoto, Japan
| | - Morito Inouchi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirofumi Takeyama
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shamima Sultana
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Inoue
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuko Nakayama
- Department of Clinical Laboratory, Kyoto University Hospital, Kyoto, Japan
| | - Akihiro Shimotake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Matsuhashi
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
6
|
Blanco-Centurion C, Bendell E, Zou B, Sun Y, Shiromani PJ, Liu M. VGAT and VGLUT2 expression in MCH and orexin neurons in double transgenic reporter mice. IBRO Rep 2018; 4:44-49. [PMID: 30155524 PMCID: PMC6111069 DOI: 10.1016/j.ibror.2018.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/23/2018] [Accepted: 05/09/2018] [Indexed: 11/11/2022] Open
Abstract
MCH neurons contain neither VGAT nor VGLUT2. Majority of orexin neurons contain VGLUT2. MCH neurons do not contain orexin.
The neuropeptides orexin and melanin-concentrating hormone (MCH), as well as the neurotransmitters GABA (γ-Aminobutyric acid) and glutamate are chief modulators of the sleep-wake states in the posterior hypothalamus. To investigate co-expression of vesicular GABA transporter (VGAT, a marker of GABA neurons) and the vesicular glutamate transporter-2 (VGLUT2, a marker of glutamate neurons) in orexin and MCH neurons, we generated two transgenic mouse lines. One line selectively expressed the reporter gene EYFP in VGAT+ neurons, whereas the other line expressed reporter gene tdTomato in VGLUT2+ neurons. Co-localization between these genetic reporters and orexin or MCH immunofluorescent tags was determined using 3D computer reconstructions of Z stacks that were acquired using a multiphoton laser confocal microscope. Our results demonstrated that MCH neurons expressed neither VGAT nor VGLUT2, suggesting MCH neurons are a separate cluster of cells from VGAT+ GABAergic neurons and VGLUT2+ glutamatergic neurons. Moreover, most orexin neurons expressed VGLUT2, indicating these neurons are glutamatergic. Our data suggested that in the posterior hypothalamus there are four major distinct groups of neurons: VGAT+, orexin+/VGLUT2+, orexin-/VGLUT2+, and MCH neurons. This study facilitated our understanding of the role of these neurotransmitters and neuropeptides in relation to sleep/wake regulation.
Collapse
Key Words
- Arousal
- CeA, central nucleus of amygdala
- GABA
- GABA-γ, Aminobutyric acid
- GAD65, glutamic acid decarboxylase-65
- GAD67, glutamic acid decarboxylase-67
- Gad1, Glutamate decarboxylase 1
- Glutamate
- MCH, melanin concentrating hormone
- NREM, non-rapid eye movement
- REM, rapid eye movement
- RTN, reticular thalamic nucleus
- SSC, somatosensory cortex
- Sleep
- VGAT, vesicular GABA transporter
- VGLUT2, vesicular glutamate transporter-2
Collapse
Affiliation(s)
- Carlos Blanco-Centurion
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Emmaline Bendell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Bingyu Zou
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Ying Sun
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Priyattam J Shiromani
- Ralph H. Johnson VA Medical Center, Charleston, SC, 29425, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Meng Liu
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| |
Collapse
|
7
|
Meira E Cruz M, Soca R. Sexsomnia and REM- predominant obstructive sleep apnea effectively treated with a mandibular advancement device. ACTA ACUST UNITED AC 2016; 9:140-1. [PMID: 28123649 DOI: 10.1016/j.slsci.2016.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 10/30/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022]
Abstract
Parasomnias with sexual behavior or sexsomnias are considered a subtype of NREM parasomnias. Obstructive sleep apnea/hypopnea (OSAH) has been described as a known triggering factor for parasomnias including sexsomnia. Nasal continuous positive airway pressure (nCPAP) has been the standard of treatment for OSAH but mandibular advancement devices (MAD) are becoming an important treatment alternative. We present the case of a patient with mild OSAH and sexsomnia who had resolution of both conditions with a MAD. This patient had the added uniqueness of having REM-predominant OSAH
Collapse
|
8
|
González-Cuevas M, Romero O, Toledo M, Quintana M, Cambrodí R, Santamarina E, Jurado MJ, Ferrer A, Salas-Puig X. Effect of adjunctive perampanel on the quality of sleep and daytime somnolence in patients with epilepsy. Epilepsy Behav Case Rep 2016; 7:13-15. [PMID: 28066710 PMCID: PMC5200874 DOI: 10.1016/j.ebcr.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/05/2016] [Accepted: 10/13/2016] [Indexed: 11/29/2022]
Abstract
This prospective uncontrolled study evaluated the effect of low-dose adjunctive perampanel therapy (4 mg/day for 3 months) on the sleep-wake cycle and daytime somnolence in adult patients (n = 10) with focal seizures. A > 50% reduction in the number of seizures was reported in 80% of the study patients; treatment had no significant effect on any sleep parameters as evident by the Maintenance of Wakefulness Test, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale scores. Two patients reported dizziness with treatment. In conclusion, low-dose perampanel may improve seizure control without affecting the sleep characteristics or daytime somnolence in patients with epilepsy.
Collapse
Affiliation(s)
| | - Odile Romero
- Sleep Unit, Neurophysiology Department, Hospital Vall Hebron, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Hospital Vall Hebron, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Hospital Vall Hebron, Barcelona, Spain
| | - Roser Cambrodí
- Sleep Unit, Neurophysiology Department, Hospital Vall Hebron, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Hospital Vall Hebron, Barcelona, Spain
| | - Maria José Jurado
- Sleep Unit, Neurophysiology Department, Hospital Vall Hebron, Barcelona, Spain
| | - Alex Ferrer
- Sleep Unit, Neurophysiology Department, Hospital Vall Hebron, Barcelona, Spain
| | - Xavier Salas-Puig
- Epilepsy Unit, Neurology Department, Hospital Vall Hebron, Barcelona, Spain
| |
Collapse
|
9
|
Yue JK, Robinson CK, Winkler EA, Upadhyayula PS, Burke JF, Pirracchio R, Suen CG, Deng H, Ngwenya LB, Dhall SS, Manley GT, Tarapore PE. Circadian variability of the initial Glasgow Coma Scale score in traumatic brain injury patients. Neurobiol Sleep Circadian Rhythms 2016; 2:85-93. [PMID: 31236497 PMCID: PMC6575566 DOI: 10.1016/j.nbscr.2016.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/13/2016] [Accepted: 09/29/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction The Glasgow Coma Scale (GCS) score is the primary method of assessing consciousness after traumatic brain injury (TBI), and the clinical standard for classifying TBI severity. There is scant literature discerning the influence of circadian rhythms or emergency department (ED) arrival hour on this important clinical tool. Methods Retrospective cohort analysis of adult patients suffering blunt TBI using the National Sample Program of the National Trauma Data Bank, years 2003–2006. ED arrival GCS score was characterized by midday (10 a.m.–4 p.m.) and midnight (12 a.m.–6 a.m.) cohorts (N=24548). Proportions and standard errors are reported for descriptive data. Multivariable regressions using odds ratios (OR), mean differences (B), and their associated 95% confidence intervals [CI] were performed to assess associations between ED arrival hour and GCS score. Statistical significance was assessed at p<0.05. Results Patients were 42.48±0.13-years-old and 69.5% male. GCS score was 12.68±0.13 (77.2% mild, 5.2% moderate, 17.6% severe-TBI). Overall, patients were injured primarily via motor vehicle accidents (52.2%) and falls (24.2%), and 85.7% were admitted to hospital (33.5% ICU). Injury severity score did not differ between day and nighttime admissions. Nighttime admissions associated with decreased systemic comorbidities (p<0.001) and increased likelihood of alcohol abuse and drug intoxication (p<0.001). GCS score demonstrated circadian rhythmicity with peak at 12 p.m. (13.03±0.08) and nadir at 4am (12.12±0.12). Midnight patients demonstrated lower GCS (12 a.m.–6 a.m.: 12.23±0.04; 10 a.m.–4 p.m.: 12.95±0.03, p<0.001). Multivariable regression adjusted for demographic and injury factors confirmed that midnight-hours independently associated with decreased GCS (B=−0.29 [−0.40, −0.19]). In patients who did not die in ED or go directly to surgery (N=21862), midnight-hours (multivariable OR 1.73 [1.30–2.31]) associated with increased likelihood of ICU admission; increasing GCS score (per-unit OR 0.82 [0.80–0.83]) associated with decreased odds. Notably, the interaction factor ED GCS score*ED arrival hour independently demonstrated OR 0.96 [0.94–0.98], suggesting that the influence of GCS score on ICU admission odds is less important at night than during the day. Conclusions Nighttime TBI patients present with decreased GCS scores and are admitted to ICU at higher rates, yet have fewer prior comorbidities and similar systemic injuries. The interaction between nighttime hours and decreased GCS score on ICU admissions has important implications for clinical assessment/triage. Glasgow Coma Scale (GCS) score demonstrates circadian rhythmicity following TBI. Midnight-hours (12 a.m.–6 a.m.) independently associate with decreased GCS score. Midnight-hours independently associate with increased likelihood of ICU admission. Influence of GCS score on ICU admission is less important at night than in daytime. Nighttime TBIs present with less systemic comorbidities&increased substance use.
Collapse
Key Words
- CAD, coronary artery disease
- CCI, Charlson Comorbidity Index
- CI, confidence interval
- COPD, chronic obstructive pulmonary disease
- CRSD, circadian rhythm sleep disorder
- Circadian
- ED, emergency department
- Emergency department
- GABA, gamma-aminobutyric acid
- GCS, Glasgow Coma Scale
- Glasgow Coma Scale
- Hospital admission
- ICD-9, International Classification of Diseases, 9th Revision
- ICU, intensive care unit
- IQR, interquartile range
- ISS, injury severity score
- MVA, motor vehicle accident
- NSP, National Sample Program
- NTDB, National Trauma Data Bank
- Neurologic deficit
- OR, odds ratio
- REM, rapid eye movement
- RHT, reticulohypothalamic tract
- SCN, suprachiasmatic nucleus
- SD, standard deviation
- SE, standard error
- TBI, traumatic brain injury
- Traumatic brain injury
Collapse
Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| | - Caitlin K Robinson
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States.,Department of Neurological Surgery, University of California, La Jolla, San Diego, CA, United States
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, United States.,Division of Biostatistics, University of California, Berkeley, CA, United States
| | - Catherine G Suen
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| | - Laura B Ngwenya
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco, CA, United States.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States
| |
Collapse
|
10
|
Garcia-Rill E, Luster B, D’Onofrio S, Mahaffey S, Bisagno V, Urbano FJ. Pedunculopontine arousal system physiology - Deep brain stimulation (DBS). Sleep Sci 2015; 8:153-61. [PMID: 26779322 PMCID: PMC4688589 DOI: 10.1016/j.slsci.2015.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 12/19/2022] Open
Abstract
This review describes the wake/sleep symptoms present in Parkinson׳s disease, and the role of the pedunculopontine nucleus in these symptoms. The physiology of PPN cells is important not only because it is a major element of the reticular activating system, but also because it is a novel target for deep brain stimulation in the treatment of gait and postural deficits in Parkinson׳s disease. A greater understanding of the physiology of the target nuclei within the brainstem and basal ganglia, amassed over the past decades, has enabled increasingly better patient outcomes from deep brain stimulation for movement disorders.
Collapse
Key Words
- Basal forebrain
- Calcium channels
- DBS, deep brain stimulation
- EEG, electroencephalogram
- Gamma band activity
- LC, locus coeruleus
- Lateral hypothalamus
- Orexin
- PD, Parkinson׳s disease
- PGO, ponto-geniculo-occipital
- PPN, pedunculopontine nucleus
- RAS, reticular activating system
- REM, rapid eye movement
- SN, substantia nigra
- STN, subthalamic nucleus
- SubCD, subcoeruleus nucleus dorsalis
- Tuberomammillary
Collapse
Affiliation(s)
- Edgar Garcia-Rill
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brennon Luster
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stasia D’Onofrio
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Mahaffey
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Veronica Bisagno
- IFIBYNE-CONICET and ININFA-CONICET, University of Buenos Aires, Argentina
| | | |
Collapse
|
11
|
Garcia-Rill E, D’Onofrio S, Mahaffey S, Bisagno V, Urbano FJ. Pedunculopontine arousal system physiology-Implications for schizophrenia. Sleep Sci 2015; 8:82-91. [PMID: 26483949 PMCID: PMC4608902 DOI: 10.1016/j.slsci.2015.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/23/2015] [Accepted: 04/30/2015] [Indexed: 01/24/2023] Open
Abstract
Schizophrenia is characterized by major sleep/wake disturbances including increased vigilance and arousal, decreased slow wave sleep, and increased REM sleep drive. Other arousal-related symptoms include sensory gating deficits as exemplified by decreased habituation of the blink reflex. There is also dysregulation of gamma band activity, suggestive of disturbances in a host of arousal-related mechanisms. This review examines the role of the reticular activating system, especially the pedunculopontine nucleus, in the symptoms of the disease. Recent discoveries on the physiology of the pedunculopontine nucleus help explain many of these disorders of arousal in, and point to novel therapeutic avenues for, schizophrenia.
Collapse
Key Words
- CaMKII, calcium/calmodulin-dependent protein kinase
- Calcium channels
- EEG, electroencephalogram
- EPSC, excitatory postsynaptic potential
- GABA, γ aminobutyric acid
- Gamma band activity
- InsP, inositol 1,4,5-triphosphate receptor protein
- KA, kainic acid
- NCS-1, neuronal calcium sensor protein 1
- NMDA, n methyl d aspartic acid
- Neuronal calcium sensor protein
- P50 potential
- PGO, ponto-geniculo-occipital
- PPN, pedunculopontine nucleus
- Pf, parafascicular nucleus
- RAS, reticular activating system
- REM, rapid eye movement
- SWS, slow wave sleep
- SubCD, subcoeruleus dorsalis
- cAMP, cyclic adenosine monophosphate
- ω-Aga, ω-agatoxin-IVA
- ω-CgTx, ω-conotoxin-GVIA
Collapse
Affiliation(s)
- Edgar Garcia-Rill
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Stasia D’Onofrio
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Susan Mahaffey
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Veronica Bisagno
- IFIBYNE-CONICET and ININFA-CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | - Francisco J. Urbano
- IFIBYNE-CONICET and ININFA-CONICET, University of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
12
|
Garcia-Rill E, Luster B, Mahaffey S, Bisagno V, Urbano FJ. Pedunculopontine arousal system physiology - Implications for insomnia. Sleep Sci 2015; 8:92-9. [PMID: 26483950 PMCID: PMC4608886 DOI: 10.1016/j.slsci.2015.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 01/09/2023] Open
Abstract
We consider insomnia a disorder of waking rather than a disorder of sleep. This review examines the role of the reticular activating system, especially the pedunculopontine nucleus, in the symptoms of insomnia, mainly representing an overactive waking drive. We determined that high frequency activity during waking and REM sleep is controlled by two different intracellular pathways and channel types in PPN cells. We found three different PPN cell types that have one or both channels and may be active during waking only, REM sleep only, or both. These discoveries point to a specific mechanism and novel therapeutic avenues for insomnia.
Collapse
Key Words
- CaMKII, calcium/calmodulin-dependent protein kinase
- Calcium channels
- EEG, electroencephalogram
- Gamma band activity
- KA, kainic acid
- N-type calcium channel
- NCS-1, neuronal calcium sensor protein 1
- NMDA, n methyl d aspartic acid
- Neuronal calcium sensor protein
- P/Q-type calcium channel
- PGO, ponto-geniculo-occipital
- PPN, pedunculopontine nucleus
- RAS, reticular activating system
- REM, rapid eye movement
- SWS, slow wave sleep
- cAMP, cyclic adenosine monophosphate
- ω-Aga, ω-agatoxin-IVA
- ω-CgTx, ω-conotoxin-GVIA
Collapse
Affiliation(s)
- Edgar Garcia-Rill
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brennon Luster
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Mahaffey
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Veronica Bisagno
- IFIBYNE-CONICET and ININFA-CONICET, University of Buenos Aires, Argentina
| | | |
Collapse
|