Association of a Novel EEG Metric of Sleep Depth/Intensity with Attention-Deficit/Hyperactivity, Learning and Internalizing Disorders and their Pharmacotherapy in Adolescence

SLEEP ◽  
2021 ◽  
Author(s):  
Anna Ricci ◽  
Susan L Calhoun ◽  
Fan He ◽  
Jidong Fang ◽  
Alexandros N Vgontzas ◽  
...  
Keyword(s):  
Rem Sleep ◽  
Attention Deficit ◽  
Odds Ratio ◽  
Sleep Disturbances ◽  
Primary Outcome ◽  
Nrem Sleep ◽  
Learning Disorders ◽  
Typically Developing ◽  
Sleep Depth ◽  
Youth With Adhd

Abstract Study Objectives Psychiatric/learning disorders are associated with sleep disturbances, including those arising from abnormal cortical activity. The odds ratio product (ORP) is a standardized electroencephalogram metric of sleep depth/intensity validated in adults, while ORP data in youth are lacking. We tested ORP as a measure of sleep depth/intensity in adolescents with and without psychiatric/learning disorders. Methods 418 adolescents (median 16y) underwent a 9-hour, in-lab polysomnography. Of them, 263 were typically developing (TD), 89 were unmedicated and 66 were medicated for disorders including attention-deficit/hyperactivity (ADHD), learning (LD) and internalizing (ID). Central ORP during non-rapid eye movement (NREM) sleep was the primary outcome. Secondary/exploratory outcomes included central and frontal ORP during NREM stages, in the 9-seconds following arousals (ORP-9), in first and second halves of the night, during REM sleep and wakefulness. Results Unmedicated youth with ADHD/LD had greater central ORP than TD during stage 3 and in central and frontal regions during stage 2 and the second half of the sleep period, while ORP in youth with ADHD/LD on stimulants did not significantly differ from TD. Unmedicated youth with ID did not significantly differ from TD in ORP, while youth with ID on antidepressants had greater central and frontal ORP than TD during NREM and REM sleep, and higher ORP-9. Conclusion The greater ORP in unmedicated youth with ADHD/LD, and normalized levels in those on stimulants, suggests ORP is a useful metric of decreased NREM sleep depth/intensity in ADHD/LD. Antidepressants are associated with greater ORP/ORP-9, suggesting these medications induce cortical arousability.

scholarly journals The determinants of the subjective perception of sleep: insights from a high-density EEG study with serial awakenings

2021 ◽  
Author(s):  
Aurelie M Stephan ◽  
Sandro Lecci ◽  
Jacinthe Cataldi ◽  
Francesca Siclari
Keyword(s):  
Eye Movement ◽  
Rem Sleep ◽  
High Frequency ◽  
Nrem Sleep ◽  
High Density ◽  
Subjective Perception ◽  
Rapid Eye Movement ◽  
Eeg Activity ◽  
Subjective Sleep ◽  
Sleep Depth

What determines the feeling of being asleep? Standard sleep recordings only incompletely reflect subjective aspects of sleep and some individuals with so-called sleep misperception frequently feel awake although sleep recordings indicate clear-cut sleep. Here we performed 787 awakenings in 20 good sleepers and 10 individuals with severe sleep misperception to interview them about their subjective sleep depth while they underwent high-density EEG sleep recordings (256-channels). Surprisingly, in good sleepers, sleep was subjectively lightest in the first two hours of Non-rapid eye movement (NREM) sleep, generally considered the ′deepest′ sleep, and deepest in rapid eye movement (REM) sleep. Compared to good sleepers, sleep misperceptors felt more frequently awake during sleep, reported overall lighter REM sleep and had more thought-like conscious experiences. In both groups, subjective sleep depth positively correlated with dream-like features of conscious experiences. At the EEG level, spatially widespread high-frequency power was inversely related to subjective sleep depth in NREM sleep in both groups and in REM sleep in misperceptors. Taken together, these findings challenge the widely held notion that ′deep′ (slow wave) sleep best accounts for feeling soundly asleep. Instead, they suggest that subjective sleep depth is inversely related to a neurophysiological process that predominates in NREM sleep early in the night, becomes quiescent in REM sleep and is reflected in high-frequency EEG-activity. In sleep misperceptors, this neurophysiological process is more active and spatially widespread, and abnormally persists into REM sleep. Thus, it is not the presence of ′sleep rhythms′ but rather the absence of ′wake-like′ EEG activity that predicts the feeling of being deeply asleep. These findings will help identify the neuromodulatory systems involved in subjective sleep depth and are therefore relevant for future studies aiming to improve subjective sleep quality.

scholarly journals Executive Functions in Neurodevelopmental Disorders: Comorbidity Overlaps Between Attention Deficit and Hyperactivity Disorder and Specific Learning Disorders

2021 ◽  
Vol 15 ◽  
Author(s):  
Giulia Crisci ◽  
Sara Caviola ◽  
Ramona Cardillo ◽  
Irene C. Mammarella
Keyword(s):  
Attention Deficit ◽  
Clinical Sample ◽  
Learning Disorders ◽  
Specific Pattern ◽  
Clinical Samples ◽  
Typically Developing ◽  
Children With Adhd ◽  
Hyperactivity Disorder ◽  
Significant Impairment ◽  
Specific Learning

The present study examines the comorbidity between specific learning disorders (SLD) and attention deficit and hyperactivity disorder (ADHD) by comparing the neuropsychological profiles of children with and without this comorbidity. Ninety-seven schoolchildren from 8 to 14 years old were tested: a clinical sample of 49 children with ADHD (n = 18), SLD (n = 18) or SLD in comorbidity with ADHD (n = 13), and 48 typically-developing (TD) children matched for age and intelligence. Participants were administered tasks and questionnaires to confirm their initial diagnosis, and a battery of executive function (EF) tasks testing inhibition, shifting, and verbal and visuospatial updating. Using one-way ANOVAs, our results showed that all children in the clinical samples exhibited impairments on EF measures (inhibition and shifting tasks) when compared with TD children. A more specific pattern only emerged for the updating tasks. Only children with SLD had significant impairment in verbal updating, whereas children with ADHD, and those with SLD in comorbidity with ADHD, had the worst performance in visuospatial updating. The clinical and educational implications of these findings are discussed.

scholarly journals Forethought in Youth with Attention Deficit/Hyperactivity Disorder: An fMRI Study of Sex-Specific Differences

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
H. Poissant ◽  
L. Rapin ◽  
S. Chenail ◽  
A. Mendrek
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Neural Correlates ◽  
Typically Developing ◽  
Hyperactivity Disorder ◽  
Performance Accuracy ◽  
Fmri Study ◽  
The Right ◽  
Girls With Adhd ◽  
Youth With Adhd

Objective. The majority of studies investigating neurocognitive processing in attention deficit/hyperactivity disorder (ADHD) have been conducted on male participants. Few studies evaluated females or examined sex differences. Among various cognitive anomalies in ADHD, deficit in forethought seems particularly important as children with ADHD often fail to adequately use previous information in order to prepare for responses. The main goal of this study was to assess sex-specific differences in behavioral and neural correlates of forethought in youth with ADHD.Methods. 21 typically developing (TD) youth and 23 youth with ADHD were asked to judge whether two pictures told a congruent or incongruent story. Reaction time, performance accuracy, and cerebral activations were recorded during functional magnetic resonance imaging (fMRI).Results. Significant sex-specific differences in cerebral activations appeared, despite equivalent performance. Relative to the boys TD participants, boys with ADHD had extensive bilateral frontal and parietal hypoactivations, while girls with ADHD demonstrated more scattered hypoactivations in the right cerebral regions.Conclusion. Present results revealed that youth with ADHD exhibit reduced cerebral activations during forethought. Nevertheless, the pattern of deficits differed between boys and girls, suggesting the use of a different neurocognitive strategy. This emphasizes the importance of including both genders in the investigations of ADHD.

scholarly journals 0049 Odds Ratio Product as a Measure of Sleep Depth During REM Sleep: Effects on REM Duration and REM Sleep Fragmentation

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A20-A20
Author(s):  
D R Mazzotti ◽  
M Younes
Keyword(s):  
Rem Sleep ◽  
Odds Ratio ◽  
Linear Models ◽  
Sleep Stage ◽  
Traffic Noise ◽  
Sleep Fragmentation ◽  
Health Study ◽  
Sleep Stages ◽  
Arousal Index ◽  
Sleep Depth

Abstract Introduction The odds ratio product (ORP) is a new highly-validated electroencephalogram biomarker of sleep depth. ORP has been validated as such by several studies investigating the effect of sleep disorders, responses to sleep deprivation and traffic noise. ORP during REM sleep varies considerably among individuals. Whether ORP reflects sleep depth also in REM sleep is unknown. We hypothesized that subjects with high REM ORP are more prone to REM sleep fragmentation. Methods Using data from the baseline (SHHS1; N=5,537) and follow-up (SHHS2; N=2,595) visits of the Sleep Heart Health Study, we calculated and summarized ORP in 30-second intervals corresponding to manually scored sleep stage epochs. We developed a heuristic to identify REM periods, defined as sequences of REM sleep epochs separated by no more than 10 minutes of other sleep stages or wake epochs. Using general linear models adjusted by age, sex, body mass index, race and ethnicity, we evaluated the relationship between REM ORP and total REM duration, number of awakening episodes per REM period and arousal index during REM sleep. Results Higher REM ORP was correlated with shorter total REM duration (ρ SHHS1=-0.12; p &lt 0.001, ρ SHHS2=-0.07; p &lt 0.001), more awakening episodes (ρ SHHS1=0.26; p<0.001, ρ SHHS2=0.30; p &lt 0.001) and higher arousal index (ρ SHHS1=0.18; p &lt 0.001, ρ SHHS2=0.16; p &lt < 0.001) during identified REM periods. In adjusted analyses, one-unit increase in REM ORP was associated, on average, with a 7 minute decrease in total REM duration (β=-7.10; p &lt 0.001), 1 more awakening episode per REM period (β=1.29; p &lt 0.001) and an increase of 6 arousals/hour (β=6.16; p &lt 0.001) during REM sleep periods. Conclusion We found that higher REM ORP was associated with shorter REM periods, higher proportion of awake during REM periods and higher REM arousal index. Although small, these differences suggest that ORP is consistent with the concept of sleep depth also during REM sleep. Support None

129 Greater NREM Sleep Rebound in Response to Experimental Sleep Disturbance Associated with Higher Inflammatory Resolution in Humans

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A52-A53
Author(s):  
Larissa Engert ◽  
Marc Dubourdeau ◽  
Rammy Dang ◽  
Janet Mullington ◽  
Monika Haack
Keyword(s):  
Sleep Disturbance ◽  
Slow Wave ◽  
Rem Sleep ◽  
Sleep Disturbances ◽  
Slow Wave Sleep ◽  
Sleep Onset ◽  
Nrem Sleep ◽  
Low Grade ◽  
German Research Foundation ◽  
Recovery Sleep

Abstract Introduction Sleep disturbances deteriorate immune function by not only affecting pro-inflammatory pathways, but also inflammatory resolution pathways, which actively terminate inflammation. It is assumed that slow wave sleep (SWS) amount and slow wave activity (SWA) convey the immune-supportive functions of sleep. We investigated whether changes in SWS induced by experimental sleep disturbance followed by recovery sleep predict changes in inflammatory resolution mediators. Methods The randomized controlled within-subjects trial (N=24, 20-42 years, 12 women) consisted of two 19-day in-hospital protocols (experimental sleep disturbance/control). After three nights of baseline sleep (8h/night), participants in the experimental sleep disturbance condition were exposed to three cycles of three nights of disturbed sleep (delayed sleep-onset, hourly sleep disruption, advanced sleep-offset) followed by one night of 8h-recovery sleep. The protocol ended with three nights of recovery sleep. In the control condition, participants had uninterrupted sleep (8h/night). Sleep (PSG) and resolvin lipid mediators in plasma (1100h, LC-MS/MS) were assessed at baseline, during the last cycle of sleep disturbance, and during/after the first and third night of final recovery sleep. Data were analyzed using generalized linear mixed models and Pearson/Spearman correlations. Results As expected, SWS amount decreased during experimental sleep disturbance and increased during the first recovery sleep night (p<.001). Similarly, resolvin (Rv) D2 and RvD3 decreased during sleep disturbance and RvD2 increased with subsequent recovery sleep (p<.001). The SWS response did not correlate with the resolvin response to sleep disturbance or to recovery sleep. However, the NREM sleep response correlated with the resolvin response during the third recovery sleep night, i.e., a greater NREM response was associated with a greater RvD2 and RvD3 response (r=.68, p=.002; r=.58, p=.012). In contrast, a greater REM sleep response was associated with a lower resolvin response (r=−.63, p=.005; r=−.66, p=.003). Conclusion These data suggest that during recovery from sleep disturbance, NREM rather than REM sleep promotes inflammatory resolution, thereby acting as the sleep state that protects against low-grade systemic inflammation, which has been frequently observed as a consequence of sleep disturbances. Analysis whether SWA is related to inflammatory resolution is in progress. Support (if any) NIH/NINDS R01-NS091177; NIH/NCRR UL1-RR02758, M01-RR01032; German Research Foundation (DFG) EN1291/1-1.

scholarly journals Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: A pragmatic randomized trial

2020 ◽  
Author(s):  
Elaine C Khoong ◽  
Valy Fontil ◽  
Natalie A Rivadeneira ◽  
Mekhala Hoskote ◽  
Shantanu Nundy ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Randomized Trial ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Mixed Effects ◽  
Regression Analyses ◽  
Diagnostic Confidence ◽  
Diagnostic Uncertainty ◽  
Intervention Impact ◽  
High Uncertainty

Abstract Objective The study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. Materials and Methods This randomized trial of a peer input intervention occurred among 28 clinicians with case-level randomization. Encounters with diagnostic uncertainty were entered onto a digital platform to collect input from ≥5 clinicians. The primary outcome was diagnostic confidence. We used mixed-effects logistic regression analyses to assess for intervention impact on diagnostic confidence. Results Among the 509 cases (255 control; 254 intervention), the intervention did not impact confidence (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.999-2.12), but after adjusting for clinician and case traits, the intervention was associated with higher confidence (OR, 1.53; 95% CI, 1.01-2.32). The intervention impact was greater in cases with high uncertainty (OR, 3.23; 95% CI, 1.09- 9.52). Conclusions Peer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.

scholarly journals Toward asleep DBS: cortico-basal ganglia spectral and coherence activity during interleaved propofol/ketamine sedation mimics NREM/REM sleep activity

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jing Guang ◽  
Halen Baker ◽  
Orilia Ben-Yishay Nizri ◽  
Shimon Firman ◽  
Uri Werner-Reiss ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Rem Sleep ◽  
Standard Procedure ◽  
Low Frequency ◽  
Nrem Sleep ◽  
Sleep Cycle ◽  
Advanced Parkinson’S Disease ◽  
Low Frequency Power ◽  
The Brain ◽  
Frequency Power

AbstractDeep brain stimulation (DBS) is currently a standard procedure for advanced Parkinson’s disease. Many centers employ awake physiological navigation and stimulation assessment to optimize DBS localization and outcome. To enable DBS under sedation, asleep DBS, we characterized the cortico-basal ganglia neuronal network of two nonhuman primates under propofol, ketamine, and interleaved propofol-ketamine (IPK) sedation. Further, we compared these sedation states in the healthy and Parkinsonian condition to those of healthy sleep. Ketamine increases high-frequency power and synchronization while propofol increases low-frequency power and synchronization in polysomnography and neuronal activity recordings. Thus, ketamine does not mask the low-frequency oscillations used for physiological navigation toward the basal ganglia DBS targets. The brain spectral state under ketamine and propofol mimicked rapid eye movement (REM) and Non-REM (NREM) sleep activity, respectively, and the IPK protocol resembles the NREM-REM sleep cycle. These promising results are a meaningful step toward asleep DBS with nondistorted physiological navigation.

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