P120 The Relationship Between Sleep Architecture And Cognition In Late-Life Depression

Introduction Depression in older people is associated with changes in sleep, however associations between sleep architecture and cognition have not yet been delineated. We examined sleep architecture in older people with and without depressive symptoms, and relationships with neuropsychological performance. Methods Adults over 50 years underwent overnight polysomnography and memory and executive function tests. Depression and controls groups were defined by a Geriatric Depression Scale-15 cut off score of 6. Sleep architectural outcomes included amount of slow wave sleep (SWS), rapid eye movement (REM) sleep, REM onset latency (ROL), NREM slow wave activity (SWA, 0.5–4 Hz), N2 sleep spindle density and REM density. Results The sample comprised of 71 participants with depressive symptoms and 101 controls (mean age both groups = 64, mean GDS-15 dep= 9.3, con= 1.8). There were no significant group differences in time spent in SWS, REM, REM density or SWA. Those with depressive symptoms had later ROL (p=.008) and less N2 sleep spindles (p=.03) compared to controls. A differential association was observed with less SWS being associated with poor memory recall in the depression group only (z=.342, p=0.008). No associations between sleep and executive function performance were observed. Discussion The link between less time in SWS and poorer memory in those with depressive symptoms could suggest that SWS is particularly pertinent for cognition in depression or that both sleep and cognition mechanisms are influenced by depressive state. Further studies are needed to determine if changes in sleep are linked with underlying neurobiological changes.

Dreaming and Insomnia: Link between Physiological REM Parameters and Mentation Characteristics

(1) Background: An unresolved phenomenon of insomnia disorder is a discrepancy between objectively measured sleep and subjective complaints. It has been shown that rapid eye movement (REM) sleep might be especially vulnerable to an altered perception. The present work aimed to investigate the link between physiological REM parameters and mentation characteristics in REM sleep. (2) Methods: 22 patients with insomnia and 23 good sleepers indicating at least one REM mentation within an awakening study were included. Multivariate analyses of variance (MANOVAs) were calculated to examine group differences and effects of mentation characteristics on number of arousals, REM density, and spectral power prior to awakenings. (3) Results: Increased perceived wakefulness was related to lower delta, theta, and alpha power in the minute prior to the REM awakenings. Nevertheless, no group differences regarding spectral power were found. With respect to number of arousals and REM density, no significant effects of mentation characteristics and no group differences were found. (4) Conclusions: Our results suggest that spectral power in REM sleep is linked with altered sleep perception. Reduced delta, theta, and alpha power might be a signature of this modified REM sleep associated with a high level of perceived wakefulness. Future awakening studies are necessary to further explore the link between physiological REM parameters and sleep perception.

1081 Associations Among REM Density And Parasympathetic Activity, Nightmares, And Hyperarousal In Trauma-exposed Individuals

Introduction Individuals with posttraumatic stress disorder (PTSD) exhibit autonomic hyperarousal and nightmares. We hypothesized that REM density (REMD) and REM heart rate variability would predict self-reported hyperarousal, nightmares, and PTSD diagnosis in trauma-exposed individuals. Methods Ninety-nine individuals (aged 18-40, 68 females) exposed to a DSM-5 PTSD criterion-A trauma within the past two years (48 meeting PTSD criteria) completed a night of ambulatory polysomnography (PSG) preceded by an acclimation night. REMD in scored sleep recordings were computed using the Matlab program written by Benjamin Yetton. Indices of parasympathetic tone during REM were computed using Kubios software and included Average Root Mean Square of the Successive Differences (RMSSD) and High Frequency power (HFpower). Participants completed two weeks of sleep diaries with nightmare questionnaire and completed the Clinician-Administered PTSD Scale (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5). Hyperarousal-item scores were computed from the PCL-5 without the sleep item (PCLhyp) and from the CAPS-5 (CAPShyp), and these scores (with their sleep items) were combined into a Composite Hyperarousal Index (CHI). Nightmare rate was the proportion of sleep diaries reporting a nightmare. Simple regressions measured associations among REMD, REM parasympathetic indices, hyperarousal measures, and nightmare rate. Results REMD did not significantly predict PTSD diagnosis or hyperarousal scores but did predict decreased parasympathetic activity for both RMSSD (p= 0.002, R= -0.316) and HFpower (p= 0.016 R= -0.250). REMD predicted increased nightmare rate (p= 0.011 R= 0.262). Parasympathetic tone was negatively correlated with CAPShyp, PCLhyp, and CHI for both RMSSD (p= 0.04, 0.011, <0.000, respectively) and HFpower (p= 0.051, 0.021, 0.010, respectively). Lower parasympathetic tone also predicted PTSD diagnosis with both RMSSD (p=0.012, t=2.559) and HFpower (p=0.010, t=2.627), but did not predict nightmare rate. Conclusion REMD predicted decreased parasympathetic tone and higher nightmare rate. Parasympathetic tone, but not REMD, predicted hyperarousal and PTSD diagnosis. Support R01MH109638

0788 Increased Rapid Eye Movement Density in Chinese Patients with Parkinson’s Disease and RBD

Introduction Impaired rapid eye movement sleep is common among patients with Parkinson’s disease (PD). However, information on rapid eye movement density (REM density) 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. 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) were observed in 93 patients (54.1%). The disease duration, UPDRS part III score, Hoehn and Yahr (H-Y) stage, and HAMA, HAMD, and PDQ-39 scores 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). The REM density was also significantly higher in the RBD patients than in the patients without RBD (P<0.05). NREM sleep stage 3 time (N3 time) and percentage of N3 time of total sleep time (N3%) were higher in patients without RBD. 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. Conclusion Our results confirm the high prevalence of RBD in patients with PD. Increased REM density was the main risk factor of RBD. Support Special Funds of the Jiangsu Provincial Key Research and Development Projects (grant No. BE2018610)

Depression and Sleep

Impaired sleep is both a risk factor and a symptom of depression. Objective sleep is assessed using the sleep electroencephalogram (EEG). Characteristic sleep-EEG changes in patients with depression include disinhibition of rapid eye movement (REM) sleep, changes of sleep continuity, and impaired non-REM sleep. Most antidepressants suppress REM sleep both in healthy volunteers and depressed patients. Various sleep-EEG variables may be suitable as biomarkers for diagnosis, prognosis, and prediction of therapy response in depression. In family studies of depression, enhanced REM density, a measure for frequency of rapid eye movements, is characteristic for an endophenotype. Cordance is an EEG measure distinctly correlated with regional brain perfusion. Prefrontal theta cordance, derived from REM sleep, appears to be a biomarker of antidepressant treatment response. Some predictive sleep-EEG markers of depression appear to be related to hypothalamo-pituitary-adrenocortical system activity.

Effects of Supraphysiological Doses of Levothyroxine on Sleep in Healthy Subjects: A Prospective Polysomnography Study

Disrupted sleep is prevalent in both mood and thyroid disorders. Given the emerging use of thyroid hormones in the treatment of mood disorders, we investigated the effects of supraphysiological doses of levothyroxine (L-T4) on sleep. In an open-label design, 13 healthy subjects received up to 500 μg/day for an eight-week period. A baseline night was polysomnographically recorded (PSG) followed by PSG under the maximum tolerated dose of L-T4. All subjects developed hyperthyroxinemia. The heart rate and respiration rate increased significantly with treatment; a significant increase in body temperature was observed in men but not in women. Surprisingly, treatment with supraphysiological doses of L-T4 did not cause significant effects on sleep architecture. However, the increase in body movements and REM density was close to reaching statistical significance. Here, we report on the sleep data, thyroid hormone levels, and physiological parameters during sleep. We conclude that experimentally induced hyperthyroidism does not profoundly change the sleep structure in healthy individuals underlining the good tolerability of treatment with supraphysiological doses of L-T4 in patients with mood disorders.

Changes in Sleep Architecture following Motor Learning Depend on Initial Skill Level

Previous research has linked both rapid eyemovement (REM) sleep and Stage 2 sleep to procedural memory consolidation. The present study sought to clarify the relationship between sleep stages and procedural memory consolidation by examining the effect of initial skill level in this relationship in young adults. In-home sleep recordings were performed on participants before and after learning the pursuit rotor task. We divided the participants into low- and high-skill groups based on their initial performance of the pursuit rotor task. In high-skill participants, there was a significant increase in Stage 2 spindle density after learning, and there was a significant correlation between the spindle density that occurred after learning and pursuit rotor performance at retest 1 week later. In contrast, there was a significant correlation between changes in REM density and performance on the pursuit rotor task during retest 1 week later in low-skill participants, although the actual increase in REM density failed to reach significance in this group. The results of the present study suggest the presence of a double dissociation in the sleep-related processes that are involved in procedural memory consolidation in low- and high-skill individuals. These results indicate that the changes in sleep microarchitecture that take place after learning depend on the initial skill level of the individual and therefore provide validation for the model proposed by Smith et al. [Smith, C. T., Aubrey, J. B., & Peters, K. R. Different roles for REM and Stage 2 sleep in motor learning. Psychologica Belgica, 44, 79–102, 2004]. Accordingly, skill level is an important variable that needs to be considered in future research on sleep and memory consolidation.