States of consciousness and interoceptive hypersensibility: A study in patients with insomnia disorder.

This exploratory study aimed to investigate the relationship between interoceptive sensibility and quality of consciousness in individuals with insomnia disorder, in order to understand how the modulation of internal states may contribute to modifying the experience of consciousness during sleep difficulties. A total of 37 patients with insomnia disorder (mean age = 46.05 ± 18.16) and 41 healthy good sleepers (mean age = 50.2 ± 12.99) underwent a psychometric sleep and interoceptive sensibility assessment, using Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Multidimensional Assessment of Interoceptive Awareness (MAIA). Moreover, patients with insomnia disorder also completed a quality of consciousness evaluation, using the Phenomenology of Consciousness Inventory (PCI). Patients with insomnia disorder exhibited heightened interoceptive sensibility, particularly in noticing body sensations (p < 0.0001) and emotional awareness (p = 0.032), along with diminished abilities in attention regulation (p = 0.040), not-worrying (p = 0.001), and trusting (p = 0.002). Furthermore, correlations between interoceptive sensibility and multiple aspects of the consciousness state during the insomnia night were identified. Specifically, higher emotional awareness was linked to a 2.49-fold increase in the likelihood of subjectively experiencing altered consciousness states during insomnia. The study sheds light on the relationship between interoceptive sensibility and the subjective state of consciousness during insomnia, emphasising the importance of exploring and considering interoception as part of the therapeutic process for insomnia disorder. Given the exploratory nature of the study and the increased risk of type-I error from numerous correlations, the results should be interpreted with caution. Further research is needed to validate and confirm their robustness.

Correlated P300b and phasic pupil-dilation responses to motivationally significant stimuli.

Motivationally significant events like oddball stimuli elicit both a characteristic event-related potential (ERPs) known as P300 and a set of autonomic responses including a phasic pupil dilation. Although co-occurring, P300 and pupil-dilation responses to oddball events have been repeatedly found to be uncorrelated, suggesting separate origins. We re-examined their relationship in the context of a three-stimulus version of the auditory oddball task, independently manipulating the frequency (rare vs. repeated) and motivational significance (relevance for the participant's task) of the stimuli. We used independent component analysis to derive a P300b component from EEG traces and linear modeling to separate a stimulus-related pupil-dilation response from a potentially confounding action-related response. These steps revealed that, once the complexity of ERP and pupil-dilation responses to oddball targets is accounted for, the amplitude of phasic pupil dilations and P300b are tightly and positively correlated (across participants: r = .69 p = .002), supporting their coordinated generation.

Current models of insomnia disorder: a theoretical review on the potential role of the orexinergic pathway with implications for insomnia treatment.

Insomnia disorder is considered as a stress-related disorder associated with hyperarousal, stress and emotion dysregulation and the instability of the 'flip-flop' switch system. The orexinergic system is well known for its key role in sleep and arousal processes but also in the allostatic system regulating stress and emotions and may thus be of major interest for insomnia and its treatment. Accordingly, we discuss the potential role of orexins on sleep processes, brain systems modulating stress and emotions with potential implications for insomnia pathophysiology. We reviewed available data on the effect of dual orexin receptor antagonists (DORAs) on sleep and brain systems modulating stress/emotions with implications for insomnia treatment. We present our findings as a narrative review. Few data in animals and humans have reported that disrupted sleep and insomnia may be related to the overactivation of orexinergic system, while some more consistent data in humans and animals reported the overactivation of orexins in response to acute stress and in stress-related disorders. Taken together these findings may let us hypothesise that an orexins overactivation may be associated with stress-related hyperarousal and the hyperactivation of arousal-promoting systems in insomnia. On the other hand, it is possible that by rebalancing orexins with DORAs we may regulate both sleep and allostatic systems, in turn, contributing to a 'switch off' of hyperarousal in insomnia. Nevertheless, more studies are needed to clarify the role of the orexin system in insomnia and to evaluate the effects of DORAs on sleep, stress and emotions regulating systems.

Digital Phenotyping for Monitoring Mental Disorders: Systematic Review.

BACKGROUND: The COVID-19 pandemic has increased the impact and spread of mental illness and made health services difficult to access; therefore, there is a need for remote, pervasive forms of mental health monitoring. Digital phenotyping is a new approach that uses measures extracted from spontaneous interactions with smartphones (eg, screen touches or movements) or other digital devices as markers of mental status. OBJECTIVE: This review aimed to evaluate the feasibility of using digital phenotyping for predicting relapse or exacerbation of symptoms in patients with mental disorders through a systematic review of the scientific literature. METHODS: Our research was carried out using 2 bibliographic databases (PubMed and Scopus) by searching articles published up to January 2023. By following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines, we started from an initial pool of 1150 scientific papers and screened and extracted a final sample of 29 papers, including studies concerning clinical populations in the field of mental health, which were aimed at predicting relapse or exacerbation of symptoms. The systematic review has been registered on the web registry Open Science Framework. RESULTS: We divided the results into 4 groups according to mental disorder: schizophrenia (9/29, 31%), mood disorders (15/29, 52%), anxiety disorders (4/29, 14%), and substance use disorder (1/29, 3%). The results for the first 3 groups showed that several features (ie, mobility, location, phone use, call log, heart rate, sleep, head movements, facial and vocal characteristics, sociability, social rhythms, conversations, number of steps, screen on or screen off status, SMS text message logs, peripheral skin temperature, electrodermal activity, light exposure, and physical activity), extracted from data collected via the smartphone and wearable wristbands, can be used to create digital phenotypes that could support gold-standard assessment and could be used to predict relapse or symptom exacerbations. CONCLUSIONS: Thus, as the data were consistent for almost all the mental disorders considered (mood disorders, anxiety disorders, and schizophrenia), the feasibility of this approach was confirmed. In the future, a new model of health care management using digital devices should be integrated with the digital phenotyping approach and tailored mobile interventions (managing crises during relapse or exacerbation).

Prolonged and short epileptiform discharges have an opposite relationship with the sleep-wake cycle in patients with JME: Implications for EEG recording protocols.

In a recent study, we found that during 20.55 ±â€¯1.60 h of artifact-free ambulatory EEG recordings, epileptiform discharges (EDs) longer than 2.68 s occurred exclusively in patients with Juvenile Myoclonic Epilepsy (JME) who experienced seizure recurrence within a year after the EEG. Here we expanded this analysis, exploring whether long EDs (>2.68 s), and short ones, were uniformly distributed during the day. Lastly, we evaluated the temporal distribution of seizure relapses. By Friedman test, we demonstrated that hourly frequencies of both short and long EDs were dependent on the hours of day and sleep-wake cycle factors, with an opposite trend. Short EDs were found mostly during the night (with two peaks at 1 AM and 6 AM), and sleep, dropping at the wake onset (p < 0.001). Conversely, long EDs surged at the wake onset (0.001), remaining frequent during the whole wake period, when compared to sleep (p = 0.002). Of note, this latter pattern mirrored that of seizures, which occurred exclusively during the wake period, and in 9 out of 13 cases at the wake onset. We therefore suggested that short and long EDs could reflect distinct pathophysiological phenomena. Extended wake EEG recordings, possibly including the awakening, could be extremely useful in clinical practice, as well as in further studies, with the ambitious goal of predicting seizure recurrences.

Sleep slow oscillations favour local cortical plasticity underlying the consolidation of reinforced procedural learning in human sleep.

We investigated changes of slow-wave activity and sleep slow oscillations in the night following procedural learning boosted by reinforcement learning, and how these changes correlate with behavioural output. In the Task session, participants had to reach a visual target adapting cursor's movements to compensate an angular deviation introduced experimentally, while in the Control session no deviation was applied. The task was repeated at 13:00 hours, 17:00 hours and 23:00 hours before sleep, and at 08:00 hours after sleep. The deviation angle was set at 15° (13:00 hours and 17:00 hours) and increased to 45° (reinforcement) at 23:00 hours and 08:00 hours. Both for Task and Control nights, high-density electroencephalogram sleep recordings were carried out (23:30-19:30 hours). The Task night as compared with the Control night showed increases of: (a) slow-wave activity (absolute power) over the whole scalp; (b) slow-wave activity (relative power) in left centro-parietal areas; (c) sleep slow oscillations rate in sensorimotor and premotor areas; (d) amplitude of pre-down and up states in premotor regions, left sensorimotor and right parietal regions; (e) sigma crowning the up state in right parietal regions. After Task night, we found an improvement of task performance showing correlations with sleep slow oscillations rate in right premotor, sensorimotor and parietal regions. These findings suggest a key role of sleep slow oscillations in procedural memories consolidation. The diverse components of sleep slow oscillations selectively reflect the network activations related to the reinforced learning of a procedural visuomotor task. Indeed, areas specifically involved in the task stand out as those with a significant association between sleep slow oscillations rate and overnight improvement in task performance.

Moving Auto-Correlation Window Approach for Heart Rate Estimation in Ballistocardiography Extracted by Mattress-Integrated Accelerometers.

Continuous heart monitoring is essential for early detection and diagnosis of cardiovascular diseases, which are key factors for the evaluation of health status in the general population. Therefore, in the future, it will be increasingly important to develop unobtrusive and transparent cardiac monitoring technologies for the population. The possible approaches are the development of wearable technologies or the integration of sensors in daily-life objects. We developed a smart bed for monitoring cardiorespiratory functions during the night or in the case of continuous monitoring of bedridden patients. The mattress includes three accelerometers for the estimation of the ballistocardiogram (BCG). BCG signal is generated due to the vibrational activity of the body in response to the cardiac ejection of blood. BCG is a promising technique but is usually replaced by electrocardiogram due to the difficulty involved in detecting and processing the BCG signals. In this work, we describe a new algorithm for heart parameter extraction from the BCG signal, based on a moving auto-correlation sliding-window. We tested our method on a group of volunteers with the simultaneous co-registration of electrocardiogram (ECG) using a single-lead configuration. Comparisons with ECG reference signals indicated that the algorithm performed satisfactorily. The results presented demonstrate that valuable cardiac information can be obtained from the BCG signal extracted by low cost sensors integrated in the mattress. Thus, a continuous unobtrusive heart-monitoring through a smart bed is now feasible.

Linking Sleep to Externalizing Behavioral Difficulties: A Longitudinal Psychometric Survey in a Cohort of Italian School-Age Children.

We examined the longitudinal relationship between sleep problems and behavioral problems at primary school in Italian children. We recruited a school-based sample of 227 children (age range 6-10 years) in schools located in Pisa (Italy). Parents completed the Sleep Disturbance Scale for Children (SDSC), and teachers completed the Strengths and Difficulties Questionnaire (SDQ) to evaluate children's behavioral difficulties. We used a two-step robust regression approach to identify which aspects of sleep problems might affect children's behavior at school. After removing socio-demographic effects, results indicated an association between an increase in sleep problems and the worsening of inattentive and hyperactive behavioral problems at school 1 year later. This association was particularly robust in children whose sleep problems had gotten worse over the year. We found no associations between child sleep problems and conduct problems in school settings. Schools may be a suitable arena in which to identify and prevent the development of severe externalizing behaviors through screening procedures and intervention for children's sleep problems.

Linking Sleep Slow Oscillations with consciousness theories: new vistas on Slow Wave Sleep unconsciousness.

We review current models of consciousness in the context of wakefulness and sleep. We show that recent results on Slow Wave Sleep, including our own works, naturally fit within consciousness models. In particular, Sleep Slow Oscillations, namely low-frequency (<1Hz) oscillations, contain electrophysiological properties (up and down states) able to elicit and quench neural integration during Slow Wave Sleep. The physiological unconsciousness related to the Sleep Slow Oscillation derives from the interplay between spontaneous or evoked wake-like activities (up states) and half-a-second's electrical silences (down states). Sleep Slow Oscillation induces unconsciousness via the formation of parallel and segregated neural activities.

RELICA: a method for estimating the reliability of independent components.

Independent Component Analysis (ICA) is a widely applied data-driven method for parsing brain and non-brain EEG source signals, mixed by volume conduction to the scalp electrodes, into a set of maximally temporally and often functionally independent components (ICs). Many ICs may be identified with a precise physiological or non-physiological origin. However, this process is hindered by partial instability in ICA results that can arise from noise in the data. Here we propose RELICA (RELiable ICA), a novel method to characterize IC reliability within subjects. RELICA first computes IC "dipolarity" a measure of physiological plausibility, plus a measure of IC consistency across multiple decompositions of bootstrap versions of the input data. RELICA then uses these two measures to visualize and cluster the separated ICs, providing a within-subject measure of IC reliability that does not involve checking for its occurrence across subjects. We demonstrate the use of RELICA on EEG data recorded from 14 subjects performing a working memory experiment and show that many brain and ocular artifact ICs are correctly classified as "stable" (highly repeatable across decompositions of bootstrapped versions of the input data). Many stable ICs appear to originate in the brain, while other stable ICs account for identifiable non-brain processes such as line noise. RELICA might be used with any linear blind source separation algorithm to reduce the risk of basing conclusions on unstable or physiologically un-interpretable component processes.

Disentangling different functional roles of evoked K-complex components: Mapping the sleeping brain while quenching sensory processing.

During non-REM sleep the largest EEG response evoked by sensory stimulation is the K-complex (eKC), composed of an initial positive bump (P200) followed by a bistable cortical response: a giant negative deflection (N550) and a large positive one (P900), respectively reflecting down states and up states of < 1 Hz oscillations.Sensory-modality-independent topology of N550 and P900, with maximal detection rate on fronto-central areas, has been consistently reported, suggesting that sensory inputs arise to the cortex avoiding specific primary sensory areas. However, these studies neglected latencies of all KC components as a function of electrode sites.Our aim is to identify, component by component, which topological/dynamical properties of eKCs depend on stimulus modality and which are mainly related to local cortical properties. We measured temporal and morphological features of acoustic, tactile and visual eKCs to disentangle specific sensory excitatory activities from aspecific responses due to local proneness to bistability, measured by means of the N550 descending steepness (synchronization in falling into down state).While confirming the sensory-modality independence of N550 and P900 topology with maximal detection rate in fronto-central areas, four main original results emerge from this study: (i) the topology of P200 latency depends on the sensory modality with earliest waves in the stimulation-related primary sensory areas; (ii) P200 rapidly travels as a cortical excitation; (iii) P200-like excitations when KCs are not evoked are detected over the scalp with significantly smaller amplitudes in fronto-central areas, compared to eKC P200s; and (iv) N550 latency mirrors its mean local steepness which is a function of topological proneness to bistability.From these results we can describe the emergence N550/P900 complex as the interplay between a waxing P200 cortical travel and higher fronto-central proneness to bistability.In conclusion, eKCs exhibit a physiological dichotomy: P200 acts as a traveling cortical excitation whose function is to induce the bistable cortical response (N550/P900), which in turn is crucial for maintaining sleep and unconsciousness.

Brain responses to emotional stimuli during breath holding and hypoxia: an approach based on the independent component analysis.

Voluntary breath holding represents a physiological model of hypoxia. It consists of two phases of oxygen saturation dynamics: an initial slow decrease (normoxic phase) followed by a rapid drop (hypoxic phase) during which transitory neurological symptoms as well as slight impairment of integrated cerebral functions, such as emotional processing, can occur. This study investigated how breath holding affects emotional processing. To this aim we characterized the modulation of event-related potentials (ERPs) evoked by emotional-laden pictures as a function of breath holding time course. We recorded ERPs during free breathing and breath holding performed in air by elite apnea divers. We modeled brain responses during free breathing with four independent components distributed over different brain areas derived by an approach based on the independent component analysis (ICASSO). We described ERP changes during breath holding by estimating amplitude scaling and time shifting of the same components (component adaptation analysis). Component 1 included the main EEG features of emotional processing, had a posterior localization and did not change during breath holding; component 2, localized over temporo-frontal regions, was present only in unpleasant stimuli responses and decreased during breath holding, with no differences between breath holding phases; component 3, localized on the fronto-central midline regions, showed phase-independent breath holding decreases; component 4, quite widespread but with frontal prevalence, decreased in parallel with the hypoxic trend. The spatial localization of these components was compatible with a set of processing modules that affects the automatic and intentional controls of attention. The reduction of unpleasant-related ERP components suggests that the evaluation of aversive and/or possibly dangerous situations might be altered during breath holding.

The Role of Consciousness in Coupling Emotions, Motivations, and Behaviors.

A potential function of consciousness is to integrate emotions, motivations, and subsequent behaviors into a coherent narrative [...].

Awareness of everyday effects of climate change: The climate change perceptual awareness scale (CCPAS).

Climate change is intrinsically complex and demands a certain degree of abstraction. However, different individuals report a wide range and degree of tangible and sensory experiences of climate change. As perceptual and sensory awareness of climate change has important consequences for the promotion of sustainable behaviors, pro-climate policies, and clinical interventions for climate-related disorders such as climate anxiety, new specific tools are required: herein we detail the development of a psychometric measure of perceptual awareness of climate change, as well as provide evidence for its discriminant, convergent, and predictive validity for sustainable behaviors. The administration of this scale on a representative sample of the UK population (Study 1) yielded a 4-factor structure, with items measuring perception of temperature changes and those measuring perception of humidity changes loading on separate factors, and two additional factors identifying the awareness of own feelings and perception of media attention on climate change. A second administration (Study 2) to an independent sample gathered from the Italian population supports the reliability of this factorial structure. As the rising field of climate neuroscience starts to investigate the determinants of perceptions of climate change, this novel scale will allow assessing the perceptual features affecting awareness of climate change.

Impaired Well-Being and Insomnia as Residuals of Resolved Medical Conditions: Survey in the Italian Population.

BACKGROUND: Well-being encompasses physical, mental, social, and cultural aspects. Sleep quality and pathologies are among the objective conditions jeopardising it. Chronic insomnia, inflammatory-based diseases, and mood disorders often occur in a single cluster, and inflammation can negatively impact sleep, potentially harming well-being. Some evidence from specific clinical populations suggests that also some resolved past diseases could still have an impact on present sleep quality and well-being. The aim of the present study is to investigate, in the general population, whether and to what degree well-being and insomnia are associated with resolved pathologies. METHODS: A cross-sectional survey (IPSAD®) was carried out using anonymous postal questionnaires that investigated past and present general health, well-being, and insomnia. A total of 10,467 subjects answered the questionnaire. RESULTS: Several classes of both current and resolved pathologies resulted in increased odds ratios for current insomnia (odds ratios = 1.90; 1.43, respectively) and impaired well-being (odds ratios = 1.75; 1.33, respectively), proportional to the number of the displayed pathologies. Notably, both current and resolved past psychiatric disorders were strongly associated with both current impaired well-being (odds ratios = 5.38; 1.70, respectively) and insomnia (odds ratios = 4.99; 2.15, respectively). CONCLUSIONS: To explain these associations, we suggest that systemic inflammation conveyed by several medical conditions disrupts homeostatic processes, with final effects on sleep quality and behaviour.

Do Individual Differences in Perception Affect Awareness of Climate Change?

One significant obstacle to gaining a widespread awareness of the ongoing climate change is the nature of its manifestations in relation to our perception: climate change effects are gradual, distributed, and sometimes seemingly contradictory. These features result in a lag in collective climate action and sometimes foster climate skepticism and climate denial. While the literature on climate change perception and belief has thoroughly explored its sociocultural and sociopolitical aspects, research on the potential contribution of psychophysiological factors remains scarce. In this perspective paper, we outline evidence and arguments for the involvement of psychophysiological systems such as thermoception, hygroreception, and interoception in modulating climate change awareness. We discuss psychophysiological mechanisms of climate change awareness in animals and humans, as well as possible sources of individual variance in climate change perception. We conclude by suggesting novel research questions which would be worthwhile to pursue in future studies.

The fear of spiders: perceptual features assessed in augmented reality.

Background: Persons with specific phobias typically generalize the dangerousness of the phobic animal to all members of its species, possibly as a result of malfunctioning brain circuitry normally providing quick and dirty identification of evolutionary-relevant stimuli. An objective assessment of which perceptual features make an animal more or less scary to phobic and non-phobic people would help overcome the limitations of the few studies available so far, based on self-reports. Objective: To achieve this aim, we built an augmented reality setting where volunteers with different levels of fear of spiders were asked to make holographic spiders that look either dangerous or harmless. To reach this goal, a computerized interface allowed participants to modify the spider's perceptual features (hairiness, body/leg size, and locomotion) in real time. Results: On average, the dangerous spiders were made hairy, thick, and moving according to spider-like locomotion; coherently, the harmless spiders were made hairless, slim, and moving according to a butterfly-like locomotion. However, these averaged preferences could not fully describe the complex relationship between perceptual preferences with each other and with arachnophobia symptoms. An example of a key finding revealed by cluster analysis is the similarity in perceptual preferences among participants with little or no fear of spiders, whereas participants with more arachnophobia symptoms expressed more varying preferences. Conclusion: Perceptual preferences toward the spider's features were behaviorally assessed through an observational study, objectively confirming a generalization effect characterizing spider-fearful participants. These results advance our knowledge of phobic preferences and could be used to improve the acceptability of exposure therapies.

The effects of right temporoparietal junction stimulation on embodiment, presence, and performance in teleoperation.

Embodiment (the sensation that arises when the properties of an external instrument are processed as if they are the attributes of one's own biological body) and (tele)presence (the sensation of being fully engaged and immersed in a location other than the physical space occupied by one's body) sustain the perception of the physical self and potentially improve performance in teleoperations (a system that enables human intelligence to control robots and requires implementing an effective human-machine interface). Embodiment and presence may be interdependent and influenced by right temporo-parietal junction (rTPJ) activity. We investigated the interplay between embodiment, (tele)presence, and performance in teleoperation, focusing on the role of the rTPJ. Participants underwent a virtual reality task with transcranial direct current stimulation (tDCS) twice, receiving either active or sham stimulation. Behavioral measures (driving inaccuracy, elapsed time in the lap, time spent in attentional lapses, short-term self-similarity, and long-term self-similarity), perceived workload (mental demand, physical demand, temporal demand, own performance, effort, and frustration), embodiment's components (ownership, agency, tactile sensations, location, and external appearance), and presence's components (realism, possibility to act, quality of interface, possibility to examine, self-evaluation of performance, haptic, and sounds) were assessed. The results showed that rTPJ stimulation decreased perceived ownership but enhanced presence with changes in the complexity of visuomotor adjustments (long and short-term self-similarity indices). Structural equation modeling revealed that embodiment increased visuomotor inaccuracy (a composite variable of overall performance, including deviations from the optimal trajectory and the time taken to complete the task), presence reduced workload, and workload increased inaccuracy. These results suggested a dissociation between embodiment and presence, with embodiment hindering performance. Prioritizing virtual integration may lower human performance, while reduced workload from presence could aid engagement. These findings emphasize the intricate interplay between rTPJ, subjective experiences, and performance in teleoperation.

Sense of Agency and Skills Learning in Virtual-Mediated Environment: A Systematic Review.

Agency is central to remote actions, and it may enhance skills learning due to a partial overlap between brain structures and networks, the promotion of confidence towards a telemanipulator, and the feeling of congruence of the motor choice to the motor plan. We systematically reviewed studies aiming to verify the role of agency in improving learning. Fifteen studies were selected from MEDLINE and Scopus®. When a mismatch is introduced between observed and performed actions, the decrease in agency and learning is proportional to the intensity of the mismatch, which is due to greater interference with the motor programming. Thanks to multisensory integration, agency and learning benefit both from sensory and performance feedback and from the timing of feedback based on control at the goal level or the perceptual-motor level. This work constitutes a bedrock for professional teleoperation settings (e.g., robotic surgery), with particular reference to the role of agency in performing complex tasks with remote control.

Unconscious multisensory integration: behavioral and neural evidence from subliminal stimuli.

Introduction: The prevailing theories of consciousness consider the integration of different sensory stimuli as a key component for this phenomenon to rise on the brain level. Despite many theories and models have been proposed for multisensory integration between supraliminal stimuli (e.g., the optimal integration model), we do not know if multisensory integration occurs also for subliminal stimuli and what psychophysical mechanisms it follows. Methods: To investigate this, subjects were exposed to visual (Virtual Reality) and/or haptic stimuli (Electro-Cutaneous Stimulation) above or below their perceptual threshold. They had to discriminate, in a two-Alternative Forced Choice Task, the intensity of unimodal and/or bimodal stimuli. They were then asked to discriminate the sensory modality while recording their EEG responses. Results: We found evidence of multisensory integration for supraliminal condition, following the classical optimal model. Importantly, even for subliminal trials participant's performances in the bimodal condition were significantly more accurate when discriminating the intensity of the stimulation. Moreover, significant differences emerged between unimodal and bimodal activity templates in parieto-temporal areas known for their integrative role. Discussion: These converging evidences - even if preliminary and needing confirmation from the collection of further data - suggest that subliminal multimodal stimuli can be integrated, thus filling a meaningful gap in the debate about the relationship between consciousness and multisensory integration.