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Arıkan MK, Uysal Ö, Gıca Ş, Orhan Ö, İlhan R, Esmeray MT, Bakay H, Metin B, Pogarell O, Turan Ş. REM parameters in drug-free major depressive disorder: A systematic review and meta-analysis. Sleep Med Rev 2024; 73:101876. [PMID: 37995418 DOI: 10.1016/j.smrv.2023.101876] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
Previous studies revealed that rapid eye movement (REM) parameters, such as REM latency (RL) and REM density (RD) could be used as electrophysiological markers of depression. Yet these finding should be re-tested in a comorbid-free and drug-free sample. The present systematic review and meta-analysis was conducted to investigate whether drug-free and comorbid-free patients with unipolar depression differentiate from controls with respect to the RL and RD. The PubMed and Web of Science databases were screened from inception to 23 January 2023 for case-control studies comparing RL and RD of patients with unipolar depression and controls. The primary outcome was the standard mean difference. The data were fitted with a random-effects model. Meta-regressions were conducted to investigate patient characteristics and effect size. Publication bias assessment was checked by Egger's Regression and funnel plot asymmetry. Among 43 articles accepted as eligible, 46 RL and 22 RD measurements were included in the meta-analysis. The results indicated shortened RL and increased RD in the patient group than controls. Neither Egger's regression nor funnel plot asymmetry were significant for publication bias. In conclusion, our results tested within drug-free and comorbid-free samples are in line with the literature.
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Affiliation(s)
| | - Ömer Uysal
- Istanbul University Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey
| | - Şakir Gıca
- Department of Mental Health and Disease, MERAM School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Özden Orhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | - Reyhan İlhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | | | - Hasan Bakay
- Department of Mental Health and Disease, MERAM School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Barış Metin
- Department of Neurology, Medical Faculty, Uskudar University, Istanbul, Turkey
| | - Oliver Pogarell
- Department of Psychiatry, Division of Clinical Neurophysiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Şenol Turan
- Istanbul University Cerrahpasa, Department of Psychiatry, Cerrahpasa Medical School, Istanbul, Turkey
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Dagay A, Oz S, Katzav S, Wasserman D, Tauman R, Thaler A, Giladi N, Mirelman A. Overnight Distribution of REM Sleep Features in People with Parkinson's Disease (PD) and Non-PD Controls. J Parkinsons Dis 2023; 13:1213-1223. [PMID: 37807787 PMCID: PMC10657693 DOI: 10.3233/jpd-230116] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Rapid eye movement (REM) sleep behavior disorder (RBD) is a leading predictor of Parkinson's disease (PD). Diagnosis is performed in the sleep laboratory by detecting pathological REM sleep without atonia (RSWA). The evidence on the overnight distribution of RSWA% is conflicting. OBJECTIVE To investigate the temporal distribution of the number of ocular movements per REM sleep minute (REM density), and RSWA% in people with PD and non-PD controls. METHODS All participants underwent a single overnight evaluation in a sleep laboratory. Clinical evaluation was performed on a separate day. REM density and RSWA% were compared between PD and controls both across four sleep periods and individual REM cycles. RESULTS A total of 51 participants with recorded RSWA in polysomnography laboratory were included, 28 with PD aged 64±9 years with a disease duration of 3.3±2.9 years, and 23 controls aged 55±8 years. People with PD had lower REM density and higher RSWA% compared to controls. As expected, REM density was higher towards the morning. In contrast, RSWA% was equally distributed across the night, for both PD and controls. CONCLUSIONS PD pathology affects REM sleep features, but not the overnight distribution of those features. While REM density increased towards the end of the night, RSWA% was equally distributed across the night for both PD and controls. Our findings have clinical implications for diagnosing RBD, as quantification of RSWA% in any sleep cycle is sufficient for reliably evaluating total RSWA% and reduced REM density may be a marker of PD.
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Affiliation(s)
- Andrew Dagay
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
| | - Shani Oz
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Katzav
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Danielle Wasserman
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Riva Tauman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Thaler
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yeh WC, Lin PJ, Chuang YC, Hsu CY. Quantitative evaluation of the microstructure of rapid eye movement sleep in refractory epilepsy: a preliminary study using electroencephalography and heart rate variability analysis. Sleep Med 2021; 85:239-245. [PMID: 34364095 DOI: 10.1016/j.sleep.2021.07.022] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with epilepsy have a disturbed sleep architecture. Polysomnographic studies have shown that patients with refractory epilepsy have decreased rapid eye movement (REM) sleep and longer REM latency than those with medically controlled epilepsy. However, little is known about the differences in the REM sleep microstructure between these patient groups. METHODS We conducted a retrospective case-control study of 20 patients with refractory epilepsy (refractory group) and 28 patients with medically controlled epilepsy (medically controlled group). All patients completed sleep questionnaires and underwent overnight in-lab polysomnography. Five-minute electroencephalogram recordings at the C3 and C4 electrodes from each REM sleep were selected for spectral analysis, and 5-min electrocardiogram segments recorded during REM sleep were used for heart rate variability analysis. The groups' scores on the sleep questionnaires, polysomnographic sleep parameters, indices of sleep-related breathing disorders, and REM sleep electroencephalogram spectra were compared. RESULTS The refractory group had decreased REM sleep (p < 0.001) and longer REM latency (p = 0.0357) than those of the medically controlled group. Moreover, electroencephalogram spectral analysis revealed that the refractory group had decreased absolute beta power (p = 0.0039) and relative beta power (p = 0.0035) as well as increased relative delta power (p = 0.0015) compared with the medically controlled group. CONCLUSIONS Differences in the polysomnographic macrostructure and REM sleep microstructure between the study groups suggest REM sleep dysregulation in patients with refractory epilepsy.
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Affiliation(s)
- Wei-Chih Yeh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Pei-Jung Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Neurology, Da-Sin Hospital, Pingtung County, Taiwan.
| | - Yao-Chung Chuang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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Abstract
Increased REM density and alpha intrusion are routinely seen in COVID-19 patient. These findings may correlate with unstable sleep pattern in COVID-19 survivors and therefore, sleep hygiene and proper counselling should be emphasized upon. Clinicians and technicians should be aware of these EEG changes with reference to COVID-19 survivors in interpreting polysomnography.
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Affiliation(s)
- Abhishek Goyal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Avishek Kar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Khushboo Saxena
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, India
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Lechinger J, Koch J, Weinhold SL, Seeck-Hirschner M, Stingele K, Kropp-Näf C, Braun M, Drews HJ, Aldenhoff J, Huchzermeier C, Göder R. REM density is associated with treatment response in major depression: Antidepressant pharmacotherapy vs. psychotherapy. J Psychiatr Res 2021; 133:67-72. [PMID: 33310502 DOI: 10.1016/j.jpsychires.2020.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 01/04/2023]
Abstract
Major depression is one of the most common psychiatric illnesses. Interestingly, a few studies have indicated the existence of depression subgroups, which respond differently to the available treatment options. Previously, sleep abnormalities have been suggested to indicate amenability to different treatment regimens. Thereby, especially REM-sleep parameters seem to play a prominent role, and REM-sleep dysregulation has been repeatedly discussed as a potential endophenotype of depression. With that said, estimating therapy outcome in order to choose the best line of treatment is of utmost importance to patients suffering from depression. The present study looks deeper into these clues by investigating the capability of polysomnographic sleep parameters to predict treatment response in depressed patients to either pharmacotherapy or psychotherapy. Moderately to severely depressed patients (n = 38) were randomly assigned to either psychotherapy (i.e. interpersonal psychotherapy) or pharmacotherapy (i.e., monotherapy with selective serotonin reuptake inhibitors, SSRI, or selective serotonin noradrenalin reuptake inhibitors, SSNRI). Prior to treatment, all patients underwent polysomnography in the sleep laboratory. After treatment, responders and non-responders of both treatment groups were compared regarding their baseline sleep parameters. Higher baseline REM density, i.e. the amount of rapid eye movements during REM sleep, predicted better response to antidepressant pharmacotherapy. In the psychotherapy group, the effect seemed reversed but was not statistically significant. No other sleep parameter predicted treatment response. Our findings support the notion that REM-sleep dysregulation is indeed indicative of a distinct endophenotype of depression and that pharmacotherapy with SSRI/SSNRI might be superior to psychotherapy in these patients.
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Affiliation(s)
- Julia Lechinger
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany.
| | - Jakob Koch
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Sara Lena Weinhold
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Mareen Seeck-Hirschner
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Karoline Stingele
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Cornelia Kropp-Näf
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Milena Braun
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Henning Johannes Drews
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Josef Aldenhoff
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Christian Huchzermeier
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Robert Göder
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany.
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Zhu J, Lu L, Zhong M, Jiang X, Wu Z, Dong J, Pan Y, Zhang L. Increased rapid eye movement density in Chinese patients with Parkinson's disease and RBD. Neurol Sci 2020; 42:961-968. [PMID: 32676757 DOI: 10.1007/s10072-020-04597-x] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Impaired rapid eye movement sleep is common among patients with Parkinson's disease (PD). However, information on rapid eye movement density (REM) among PD patients is currently lacking. The current study sought to characterize REM density in PD patients and to examine the associations between REM density sleep parameters and clinical manifestations. PARTICIPANTS AND METHODS We retrospectively recruited 172 PD patients. All participants were assessed with a two-night polysomnography, and REM density was calculated. Clinical assessments were completed in PD patients before polysomnography. RESULTS Rapid eye movement sleep behavior disorder (RBD) was observed in 93 patients (54.1%). The disease duration, UPDRS part III score, Hoehn and Yahr (H-Y) stage, and HAMA, HAMD, PDQ-39 scores, and REM density in the Parkinson's disease patients with rapid eye movement sleep behavior disorder (RBD) were significantly higher than in the patients without RBD (P < 0.05). However, NREM sleep stage 3 time (N3 time) and percentage of N3 time of total sleep time (N3%) were significantly lower in the RBD patients than in the patients without RBD (P < 0.05). The forward binary logistic regression model showed that REM density, UPDRS-III score, and N3 sleep time were associated with RBD in the PD patients. CONCLUSIONS Our results confirm the high prevalence of RBD in patients with PD. Increased REM density was the main risk factor of RBD.
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Affiliation(s)
- Jun Zhu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Liyu Lu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Min Zhong
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Xu Jiang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Zhuang Wu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Jingde Dong
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yang Pan
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Li Zhang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China.
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van Wyk M, Solms M, Lipinska G. Increased Awakenings From Non-rapid Eye Movement Sleep Explain Differences in Dream Recall Frequency in Healthy Individuals. Front Hum Neurosci 2019; 13:370. [PMID: 31680920 PMCID: PMC6803546 DOI: 10.3389/fnhum.2019.00370] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 07/24/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022] Open
Abstract
Background Dreaming is a universal experience, yet there is considerable inter-individual variability in dream recall frequency (DRF). One dominant model, the “arousal-retrieval” model, posits that intra-sleep wakefulness is required for dream traces to be encoded into long-term storage, essentially proposing that a better memory for dreams underlie increased DRF. A recent study utilizing polysomnography combined with an event-related potentials paradigm, provides direct support for this model by demonstrating increased intra-sleep wakefulness in a healthy population by comparing high frequency recallers (HFRs) and low frequency recallers (LFRs). Another study by the same group demonstrated increased regional cerebral blood flow in regions associated with dream production, supporting the premise that HFRs also may produce more dreams. Hypotheses This study investigated the profile of nocturnal awakenings and dream production in healthy HFRs and LFRs. Hypothesis (1a): HFRs will spend significantly more time awake after sleep onset; (1b): HFRs will experience significantly more awakenings across the night, and from rapid eye movement (REM) sleep in particular; (2) HFRs will have significantly higher rates of dream production across the night as measured by REM density. Methods We studied two groups of healthy adults: HFRs (n = 19) and LFRs (n = 17) who underwent polysomnographic recordings on two non-consecutive nights. Results Hypothesis (1a) was confirmed: HFRs spent significantly more time awake after sleep onset. Hypothesis (1b) was partially confirmed: HFRs experienced significantly more awakenings across the night; however, awakenings from REM sleep were comparable. Interestingly, HFRs had significantly more awakenings, as well as a higher number of longer awakenings, from non-rapid eye movement (NREM) stage 2 sleep. Hypothesis (2) was not confirmed: There was no significant difference in rates of REM density between groups. Conclusion This is the first study to provide evidence that awakenings from NREM 2 sleep might underlie increased DRF in HFRs. This finding coupled with null findings in relation to REM sleep variables, support the premise that inter-individual variability in DRF cannot be ascribed to differences in REM sleep parameters in healthy individuals. Instead, the data indicates that awakenings from NREM sleep is of particular importance in relation to DRF in a healthy population.
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Affiliation(s)
- Mariza van Wyk
- UCT Sleep Sciences, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Mark Solms
- UCT Sleep Sciences, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Gosia Lipinska
- UCT Sleep Sciences, Department of Psychology, University of Cape Town, Cape Town, South Africa
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Zanatta A, Camargo CHF, Germiniani FMB, Raskin S, de Souza Crippa AC, Teive HAG. Abnormal Findings in Polysomnographic Recordings of Patients with Spinocerebellar Ataxia Type 2 (SCA2). Cerebellum 2019; 18:196-202. [PMID: 30264264 DOI: 10.1007/s12311-018-0982-x] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Spinocerebellar ataxia type 2 (SCA2) is characterized by a progressive cerebellar syndrome, and additionally saccadic slowing, cognitive dysfunction, and sleep disorders. The aim of this study was to assess the frequency of abnormal findings in sleep recordings of patients with SCA2. Seventeen patients with genetically confirmed SCA2 from the Movement Disorders Outpatient group of the Hospital de Clínicas da UFPR were evaluated with a structured medical interview and the Scale for the Assessment and Rating of Ataxia (SARA). Polysomnographic recordings were performed and sleep stages were scored according to standard criteria. There were 10 male subjects and 7 females, aged 24-66 years (mean 47.44). A sex- and age-matched control group of healthy subjects was used for comparison. There was a reduction of rapid eye movement (REM) sleep in 12 (70.58%), increased REM latency in 9 (52.94%), increased obstructive sleep apnea-index in 14 (82.35%), absent REM density (REM density was calculated as the total number of 3-s miniepochs of REM sleep with at least 1 REM per minute) in 13 (76.47%), and markedly reduced REM density in 4 (23.52%). There was an indirect correlation according to the SARA scale and the REM density decrease (r = - 0.6; P = < 0.001); and with a disease progression correlating with a reduction in the REM density (r = - 0.52, P = 0.03). In SCA2, changes occur mainly REM sleep. The absence/decrease of REM sleep density, even in oligosymptomatic patients, and the correlation of this finding with disease time and with the SARA scale were the main findings of the study.
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Affiliation(s)
- Alessandra Zanatta
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil.
| | | | - Francisco Manoel Branco Germiniani
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
| | - Salmo Raskin
- Advanced Molecular Research Center, Center for Biological and Health Sciences, Catholic University of Parana, Curitiba, Brazil
| | | | - Hélio Afonso Ghizoni Teive
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
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Åkerstedt T, Schwarz J, Gruber G, Theorell-Haglöw J, Lindberg E. Short sleep-poor sleep? A polysomnographic study in a large population-based sample of women. J Sleep Res 2019; 28:e12812. [PMID: 30609172 PMCID: PMC6849745 DOI: 10.1111/jsr.12812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/29/2022]
Abstract
There is a lack of studies on the association between total sleep time (TST) and other polysomnographical parameters. A key question is whether a short sleep is an expression of habitual short sleep, or whether it reflects temporary impairment. The purpose of the present study was to investigate the association between TST and amount of sleep stages and sleep continuity measures, in a large population-based sample of women (n = 385), sleeping at home in a normal daily life setting. The results show that sleep efficiency, N1 (min), N2 (min), REM (min), REM% and proportion of long sleep segments, increased with increasing TST, whereas the number of awakenings/hr, the number of arousals/hr, N1% and REM intensity decreased. In addition, longer sleep was more associated with TST being perceived as of "usual" duration and with better subjective sleep quality. TST was not associated with habitual reported sleep duration. It was concluded that short TST of a recorded sleep in a real-life context may be an indicator of poor objective sleep quality for that particular sleep episode. Because individuals clearly perceived this reduction, it appears that self-reports of poor sleep quality often may be seen as indicators of poor sleep quality. It is also concluded that PSG-recorded sleep duration does not reflect habitual reported sleep duration in the present real-life context.
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Affiliation(s)
- Torbjörn Åkerstedt
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Johanna Schwarz
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | | | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Pawlowski MA, Gazea M, Wollweber B, Dresler M, Holsboer F, Keck ME, Steiger A, Adamczyk M, Mikoteit T. Heart rate variability and cordance in rapid eye movement sleep as biomarkers of depression and treatment response. J Psychiatr Res 2017; 92:64-73. [PMID: 28411417 DOI: 10.1016/j.jpsychires.2017.03.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/28/2017] [Accepted: 03/31/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The relevance of rapid eye movement (REM) sleep in affective disorders originates from its well-known abnormalities in depressed patients, who display disinhibition of REM sleep reflected by increased frequency of rapid eye movements (REM density). In this study we examined whether heart rate variability (HRV) and prefrontal theta cordance, both derived from REM sleep, could represent biomarkers of antidepressant treatment response. METHODS In an open-label, case-control design, thirty-three in-patients (21 females) with a depressive episode were treated with various antidepressants for four weeks. Response to treatment was defined as a ≥50% reduction of HAM-D score at the end of the fourth week. Sleep EEG was recorded after the first and the fourth week of medication. HRV was derived from 3-min artifact-free electrocardiogram segments during REM sleep. Cordance was computed for prefrontal EEG channels in the theta frequency band during tonic REM sleep. RESULTS HRV during REM sleep was decreased in depressed patients at week four as compared to controls (high effect size; Cohen's d > 1), and showed a negative correlation with REM density in both, healthy subjects and patients at week four. Further, the fourteen responders had significantly higher prefrontal theta cordance as compared to the nineteen non-responders after the first week of antidepressant medication; in contrast, HRV at week one did not discriminate between responders and non-responders. CONCLUSIONS Our data suggest that HRV in REM sleep categorizes healthy subjects and depressed patients, whereas REM sleep-derived prefrontal cordance may predict the response to antidepressant treatment in depressed patients.
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Affiliation(s)
| | - Mary Gazea
- Max Planck Institute of Psychiatry, Munich, Germany; University of Bern, Inselspital University Hospital, Department of Neurology, Bern, Switzerland
| | | | - Martin Dresler
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | | | | | - Axel Steiger
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Marek Adamczyk
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Thorsten Mikoteit
- Max Planck Institute of Psychiatry, Munich, Germany; Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland.
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Schroeder LA, Rufra O, Sauvageot N, Fays F, Pieri V, Diederich NJ. Reduced Rapid Eye Movement Density in Parkinson Disease: A Polysomnography-Based Case-Control Study. Sleep 2016; 39:2133-2139. [PMID: 27748239 DOI: 10.5665/sleep.6312] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 05/09/2016] [Accepted: 08/05/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To explore rapid eye movement density (RD) in patients with idiopathic Parkinson disease (IPD) and to investigate its usefulness as surrogate marker of excessive daytime sleepiness, a frequent complaint in IPD patients. METHODS Retrospective polysomnography study on 81 subjects without dementia: 29 patients with early stage IPD (disease duration ≤ 3 y), 21 patients with middle- stage IPD (disease duration > 3 and < 8 y) and 31 healthy controls (HC). Rapid eye movement (REM) sleep was defined as any REM episode with > 3 min of continuous REM sleep. RD was defined as number of ocular movements per minute of REM sleep. Patients with early stage IPD and HC fulfilled the PD-specific sleepiness questionnaires Parkinson's Disease Sleep Scale (PDSS) and the Nonmotor Symptoms Questionnaire for Parkinson's disease (NMSQuest). RESULTS RD was lower in patients with IPD than in HC. The difference was most significant between patients with middle stage IPD and HC (P = 0.001), and most prominent for the third REM episode, again when comparing patients with middle stage IPD and HC (P = 0.03). RD was independent from sex, age, and other sleep parameters. In early stage IPD, RD correlated with the PDSS score (r = -0.63, P = 0.001) and the sleep-related questions of the NMSQuest score (r = 0.48, P = 0.017). CONCLUSIONS REM density is reduced in patients with IPD and correlates with subjective scores on sleep impairment. As an indicator of persistent high sleep pressure, reduced RD in IPD is eligible as a biomarker of excessive daytime sleepiness in IPD. It possibly reflects direct involvement of the brainstem REM generation sites by the disease process. RD is a promising new tool for sleep research in IPD.
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Affiliation(s)
- Lynn A Schroeder
- Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg
| | - Olivier Rufra
- Interdisciplinary Sleep Laboratory, Centre Hospitalier de Luxembourg
| | - Nicolas Sauvageot
- Competence Center of Methodology and Statistics, Luxembourg Institute of Health, Luxembourg-City, Luxembourg
| | - François Fays
- Competence Center of Methodology and Statistics, Luxembourg Institute of Health, Luxembourg-City, Luxembourg
| | - Vannina Pieri
- Department of Neurosciences, Centre Hospitalier de Luxembourg
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Yetton BD, Niknazar M, Duggan KA, McDevitt EA, Whitehurst LN, Sattari N, Mednick SC. Automatic detection of rapid eye movements (REMs): A machine learning approach. J Neurosci Methods 2016; 259:72-82. [PMID: 26642967 PMCID: PMC5310222 DOI: 10.1016/j.jneumeth.2015.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 10/09/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rapid eye movements (REMs) are a defining feature of REM sleep. The number of discrete REMs over time, or REM density, has been investigated as a marker of clinical psychopathology and memory consolidation. However, human detection of REMs is a time-consuming and subjective process. Therefore, reliable, automated REM detection software is a valuable research tool. NEW METHOD We developed an automatic REM detection algorithm combining a novel set of extracted features and the 'AdaBoost' classification algorithm to detect the presence of REMs in Electrooculogram data collected from the right and left outer canthi (ROC/LOC). Algorithm performance measures of Recall (percentage of REMs detected) and Precision (percentage of REMs detected that are true REMs) were calculated and compared to the gold standard of human detection by three expert sleep scorers. REM detection by four non-experts were also investigated and compared to expert raters and the algorithm. RESULTS The algorithm performance (78.1% Recall, 82.6% Precision) surpassed that of the average (expert & non-expert) single human detection performance (76% Recall, 83% Precision). Agreement between non-experts (Cronbach Alpha=0.65) is markedly lower than experts (Cronbach Alpha=0.80). COMPARISON WITH EXISTING METHOD(S) By following reported methods, we implemented all previously published LOC and ROC based detection algorithms on our dataset. Our algorithm performance exceeded all others. CONCLUSIONS The automatic detection algorithm presented is a viable and efficient method of REM detection as it reliably matches the performance of human scorers and outperforms all other known LOC- and ROC-based detection algorithms.
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Affiliation(s)
- Benjamin D Yetton
- University of California, 900 University Ave, Riverside, CA 92521, United States
| | - Mohammad Niknazar
- University of California, 900 University Ave, Riverside, CA 92521, United States
| | - Katherine A Duggan
- University of California, 900 University Ave, Riverside, CA 92521, United States
| | - Elizabeth A McDevitt
- University of California, 900 University Ave, Riverside, CA 92521, United States
| | - Lauren N Whitehurst
- University of California, 900 University Ave, Riverside, CA 92521, United States
| | - Negin Sattari
- University of California, 900 University Ave, Riverside, CA 92521, United States
| | - Sara C Mednick
- University of California, 900 University Ave, Riverside, CA 92521, United States.
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