Evening prolonged relatively low melanopic equivalent daylight illuminance light exposure increases arousal before and during sleep without altering sleep structure.

Light can influence many psychophysiological functions beyond vision, including alertness, circadian rhythm, and sleep, namely the non-image forming (NIF) effects of light. Melanopic equivalent daylight illuminance (mel-EDI) is currently recommended as the predictor of the NIF effects of light. Although light dose is also critical for entraining and regulating circadian cycle, it is still unknown whether relatively low mel-EDI light exposure for prolonged duration in the evening would affect pre-sleep arousal and subsequent sleep. In all, 18 healthy college students (10 females, mean [standard deviation] age 21.67 [2.03] years) underwent 2 experimental nights with a 1 week interval in a simulated bedroom environment. During experimental nights, participants were either exposed to high or low mel-EDI light (73 versus 38 lx mel-EDI, 90 versus 87 photopic lx at eye level, 150 photopic lx at table level) for 3.5 h before regular bedtime, and their sleep was monitored by polysomnography. Subjective sleepiness, mood, and resting-state electroencephalography during light exposure were also investigated. Results showed no significant differences in sleep structure and sleep quality between the two light conditions, whereas 3.5 h of exposure to high versus low mel-EDI light induced marginally higher physiological arousal in terms of a lower delta but higher beta power density before sleep, as well as a lower delta power density during sleep. Moreover, participants felt happier before sleep under exposure to high versus low mel-EDI light. These findings together with the current literature suggest that evening prolonged relatively low mel-EDI light exposure may mildly increase arousal before and during sleep but affected sleep structure less.

The association between sleep-wake ratio and overnight picture recognition is moderated by BDNF genotype.

A wealth of studies supports the role of sleep in memory performance. Experimentally controlled studies indicate that prolonged wake after memory encoding is detrimental for memory outcome whereas sleep protects from wake-time interference and promotes memory consolidation. We examined how the natural distribution of wake and sleep between encoding and retrieval associated with overnight picture recognition accuracy among 161 adolescents following their typical sleep schedule with an in-home polysomnography. The memorized pictures varied in their level of arousal (calm to exciting) and valence (negative to positive). Suspecting genotypic influence on the sensitivity for sleep/wake dynamics, we also assessed if these associations were affected by known gene polymorphisms involved in neural plasticity and sleep homeostasis: brain-derived neurotrophic factor (BDNF) Val66Met and Catechol-O-methyltransferase (COMT) Val158Met. In the whole sample, overnight recognition accuracy was associated with the levels of arousal and valence of the pictures, but not with sleep percentage (i.e. the percentage of time spent asleep between memory encoding and retrieval). While the allelic status of BDNF or COMT did not have any main effect on recognition accuracy, a significant moderation by BDNF Val66Met was found (p = .004): the subgroup homozygous for valine allele showed positive association between sleep percentage and recognition accuracy. This was underlain by detrimental influence of wake, rather than by any memory benefit of sleep. Our results complement the mounting evidence that the relation between sleep and memory performance is moderated by BDNF Val66Met. Further studies are needed to clarify the specific mechanisms.

Development of nap neurophysiology: preliminary insights into sleep regulation in early childhood.

Although all young children nap, the neurophysiological features and associated developmental trajectories of daytime sleep remain largely unknown. Longitudinal studies of napping physiology are fundamental to understanding sleep regulation during early childhood, a sensitive period in brain and behaviour development and a time when children transition from a biphasic to a monophasic sleep-wakefulness pattern. We investigated daytime sleep in eight healthy children with sleep electroencephalography (EEG) assessments at three longitudinal points: 2 years (2.5-3.0 years), 3 years (3.5-4.0 years) and 5 years (5.5-6.0 years). At each age, we measured nap EEG during three randomized conditions: after 4 h (morning nap), 7 h (afternoon nap) and 10 h (evening nap) duration of prior wakefulness. Developmental changes in sleep were most prevalent in the afternoon nap (e.g. decrease in sleep duration by 30 min from 2 to 3 years and by 20 min from 3 to 5 years). In contrast, nap sleep architecture (% of sleep stages) remained unchanged across age. Maturational changes in non-rapid eye movement sleep EEG power were pronounced in the slow wave activity (SWA, 0.75-4.5 Hz), theta (4.75-7.75 Hz) and sigma (10-15 Hz) frequency ranges. These findings indicate that the primary marker of sleep depth, SWA, is less apparent in daytime naps as children mature. Moreover, our fundamental data provide insight into associations between sleep regulation and functional modifications in the central nervous system during early childhood.

Effect of prolonged wakefulness on electroencephalographic oscillatory activity during sleep.

The human sleep electroencephalogram (EEG) is characterized by the occurrence of distinct oscillatory events such as delta waves, sleep spindles and alpha activity. We applied a previously proposed algorithm for the detection of such events and investigated their incidence and frequency in baseline and recovery sleep after 40 h of sustained wakefulness in 27 healthy young subjects. The changes in oscillatory events induced by sleep deprivation were compared to the corresponding spectral changes. Both approaches revealed, on average, an increase in low frequency activity and a decrease in spindle activity after sleep deprivation. However, the increase of oscillatory events in the delta range and decrease in the sigma range occurred in a more restricted frequency range compared to spectral changes. The mean relative power spectra showed a significant increase in theta and alpha activity after sleep deprivation while, on average, the event analysis showed only a weak effect in the theta band. The reason for this discrepancy is that the spectral analysis does not distinguish between diffuse activity and clearly visible temporally localized oscillations, while the event analysis would detect only the latter. Additionally, only a few individuals clearly showed activity in the theta or alpha frequency bands. Conversely, event analysis revealed that some individuals showed an increased rate of sleep spindles after sleep deprivation, a fact that was not evident in the relative power spectra due to a decrease in background activity. The two methods complement each other and facilitate the interpretation of distinct changes induced by prolonged wakefulness in sleep EEG.

Characteristics of ADHD Symptoms and EEG Theta/Beta Ratio in Children With Sleep Disordered Breathing.

Objectives. This study aimed to explore parent-reported symptoms of attention deficit-hyperactivity disorder (ADHD) and sleep electroencephalogram (EEG) theta/beta ratio (TBR) characteristics in children with sleep disordered breathing (SDB). Methods. The parents of children (aged 6-11 years) with SDB (n = 103) and healthy controls (n = 28) completed the SNAP-IV questionnaire, and children underwent overnight polysomnography. Children with SDB were grouped according to obstructive apnea/hypopnea index: primary snoring, mild, and moderate-severe obstructive sleep apnea (OSA) groups. The TBR in non-rapid eye movement (NREM) periods in three sleep cycles was analyzed. Results. Children with SDB showed worse ADHD symptoms compared with the healthy control. There was no intergroup difference in TBR. The time-related decline in TBR observed in the control, primary snoring and mild OSA groups, which was not observed in the moderate-severe OSA group. Overnight transcutaneous oxygen saturation was negatively associated with the hyperactivity/impulsivity score of ADHD symptom. The global TBR during the NREM period in the first sleep cycle was positively correlated with inattention score. Conclusion. Children with SDB showed more ADHD inattention symptoms than the healthy control. Although we found no difference in TBR among groups, we found significant main effect for NREM period. There existed a relationship between hypoxia, TBR, and scores of ADHD symptoms. Hence, it was speculated that TBR can reflect the nocturnal electrophysiological manifestations in children with SDB, which may be related to daytime ADHD symptoms.

Machine-learning-based classification of obstructive sleep apnea using 19-channel sleep EEG data.

OBJECTIVE: This study aimed to investigate the neurophysiological effects of obstructive sleep apnea (OSA) using multi-channel sleep electroencephalography (EEG) through machine learning methods encompassing various analysis methodologies including power spectral analysis, network analysis, and microstate analysis. METHODS: Twenty participants with apnea-hypopnea index (AHI) ≥ 15 and 18 participants with AHI <15 were recruited. Overnight polysomnography was conducted concurrently with 19-channel EEG. Preprocessed EEG data underwent computation of relative spectral power. A weighted network based on graph theory was generated; and indices of strength, path length, eigenvector centrality, and clustering coefficient were calculated. Microstate analysis was conducted to derive four topographic maps. Machine learning techniques were employed to assess EEG features capable of differentiating two groups. RESULTS: Among 71 features that showed significant differences between the two groups, seven exhibited good classification performance, achieving 88.3 % accuracy, 92 % sensitivity, and 84 % specificity. These features were power at C4 theta, P3 theta, P4 theta, and F8 gamma during NREM1 sleep and at Pz gamma during REM sleep from power spectral analysis; eigenvector centrality at F7 gamma during REM sleep from network analysis; and duration of microstate 4 during NREM2 sleep from microstate analysis. These seven EEG features were significantly correlated with polysomnographic parameters reflecting the severity of OSA. CONCLUSIONS: The application of machine learning techniques and various EEG analytical methods resulted in a model that showed good performance in classifying moderate to severe OSA and highlights the potential of EEG to serve as a biomarker of functional changes in OSA.

Transdiagnostic association between subjective insomnia and depressive symptoms in major psychiatric disorders.

In psychiatric disorders, comorbid depressive symptoms are associated with clinically important issues such as reduced quality of life, a poor prognosis, and increased suicide risk. Previous studies have found a close relationship between insomnia and depressive symptoms in major depressive disorder (MDD), and that actively improving insomnia heightens the improvement of depressive symptoms. This study aimed to investigate whether the association between insomnia and depressive symptoms is also found in other psychiatric disorders besides MDD. The subjects were 144 patients with MDD (n = 71), schizophrenia (n = 25), bipolar disorder (n = 22), or anxiety disorders (n = 26). Sleep status was assessed subjectively and objectively using the Athens Insomnia Scale (AIS) and sleep electroencephalography (EEG), respectively. Sleep EEG was performed using a portable EEG device. Depressive symptoms were assessed using the Beck Depression Inventory. Subjective insomnia, as defined by the AIS, was associated with depressive symptoms in all disorders. Moreover, in schizophrenia, a relation between depressive symptoms and insomnia was also found by objective sleep assessment methods using sleep EEG. Our findings suggest that the association between subjective insomnia and depressive symptoms is a transdiagnostic feature in major psychiatric disorders. Further studies are needed to clarify whether therapeutic interventions for comorbid insomnia can improve depressive symptoms in major psychiatric disorders, similar to MDD.

Electroencephalography Theta/Beta Ratio Decreases in Patients with Severe Obstructive Sleep Apnea.

Purpose: Accumulating evidence suggests that theta/beta ratio (TBR), an electroencephalographic (EEG) frequency band parameter, might serve as an objective marker of executive cognitive control in healthy adults. Obstructive sleep apnea (OSA) has a detrimental impact on patients' behavior and cognitive performance while whether TBR is different in OSA population has not been reported. This study aimed to explore the difference in relative EEG spectral power and TBR during sleep between patients with severe OSA and non-OSA groups. Patients and Methods: 142 participants with in-laboratory nocturnal PSG recording were included, among which 100 participants suffered severe OSA (apnea hypopnea index, AHI > 30 events/hour; OSA group) and 42 participants had no OSA (AHI ≤ 5 events/h; control group). The fast Fourier transformation was used to compute the EEG power spectrum for total sleep duration within contiguous 30-second epochs of sleep. The demographic and polysomnographic characteristics, relative EEG spectral power and TBR of the two groups were compared. Results: It was found that the beta band power during NREM sleep and total sleep was significantly higher in the OSA group than controls (p < 0.001, p = 0.012, respectively), and the theta band power during NREM sleep and total sleep was significantly lower in the OSA group than controls (p = 0.019, p = 0.014, respectively). TBR during NREM sleep, REM sleep and total sleep was significantly lower in the OSA group compared to the control group (p < 0.001 for NREM sleep and total sleep, p = 0.015 for REM sleep). TBR was negatively correlated with AHI during NREM sleep (r=-0.324, p < 0.001) and total sleep (r=-0. 312, p < 0.001). Conclusion: TBR was significantly decreased in severe OSA patients compared to the controls, which was attributed to both increased beta power and decreased theta power. TBR may be a stable EEG-biomarker of OSA patients, which may accurately and reliably identify phenotype of patients.

Relationship between the Spectral Power Density of Sleep Electroencephalography and Psychiatric Symptoms in Patients with Breathing-related Sleep Disorder.

OBJECTIVE: Patients with breathing-related sleep disorder (BRSD) often complain of psychiatric symptoms such as depression in addition to snoring, excessive sleepiness, and disturbed sleep. However, the relationship between psychiatric symptoms and severity of sleep apnea in BRSD is controversial. We conducted this study to investigate the relationship between psychiatric symptoms and sleep electroencephalography (EEG) findings in BRSD patients using spectral analysis. METHODS: All participants underwent polysomnography and evaluation using Symptom Checklist-90-Revised (SCL-90-R) scale. We analyzed the absolute spectral power density values of standard EEG frequency bands in the participants (n = 169) with BRSD during the non-rapid eye movement (NREM) sleep period. We performed correlation analysis between the domain scores of SCL-90-R scale and the absolute values of the EEG frequency bands. RESULTS: Significant positive correlation was observed between the absolute spectral power density values in the slow oscillation band and the degree of paranoid ideation (r = 0.226, p = 0.028) and depression (r = 0.216, p = 0.044) in SCL-90-R. The multiple linear regression model showed that higher paranoid ideation domain score (B = 0.007, p = 0.020), younger age (B = -0.011, p < 0.001), and female sex (B = 0.213, p = 0.004) were associated with higher slow oscillation power during NREM sleep. CONCLUSION: The results of the present study suggested a relationship between sleep EEG and psychiatric symptoms in patients with BRSD. This relationship needs to be validated with further studies.

Alterations in sleep electroencephalography synchrony in combat-exposed veterans with post-traumatic stress disorder.

STUDY OBJECTIVES: We assessed whether the synchrony between brain regions, analyzed using electroencephalography (EEG) signals recorded during sleep, is altered in subjects with post-traumatic stress disorder (PTSD) and whether the results are reproducible across consecutive nights and subpopulations of the study. METHODS: A total of 78 combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive laboratory nights of high-density EEG recordings. We computed a measure of synchrony for each EEG channel-pair across three sleep stages (rapid eye movement [REM] and non-REM stages 2 and 3) and six frequency bands. We examined the median synchrony in 9 region-of-interest (ROI) pairs consisting of 6 bilateral brain regions (left and right frontal, central, and parietal regions) for 10 frequency-band and sleep-stage combinations. To assess reproducibility, we used the first 47 consecutive subjects (18 with PTSD) for initial discovery and the remaining 31 subjects (13 with PTSD) for replication. RESULTS: In the discovery analysis, five alpha-band synchrony pairs during non-REM sleep were consistently larger in PTSD subjects compared with controls (effect sizes ranging from 0.52 to 1.44) across consecutive nights: two between the left-frontal and left-parietal ROIs, one between the left-central and left-parietal ROIs, and two across central and parietal bilateral ROIs. These trends were preserved in the replication set. CONCLUSION: PTSD subjects showed increased alpha-band synchrony during non-REM sleep in the left frontoparietal, left centro-parietal, and inter-parietal brain regions. Importantly, these trends were reproducible across consecutive nights and subpopulations. Thus, these alterations in alpha synchrony may be discriminatory of PTSD.

Age-related cortical signatures of human sleep electroencephalography.

Accumulating evidence demonstrates a direct relationship between impaired neural integrity and disrupted sleep physiology in normal and pathological aging. However, previous work has focus almost exclusively on nonrapid eye movement sleep electroencephalography as a proxy of cortical integrity with aging. Whether this relationship holds true for rapid eye movement sleep electroencephalography is unknown. Our results show that age-related reduction in low-frequency delta activity during both rapid eye movement and nonrapid eye movement sleep was statistically mediated by the thinning of the medial frontal and anterior cingulate cortices. These findings (1) support the potential role of the medial frontal and cingulate cortices, major hubs of the human brain, in synchronizing neuronal assemblies during sleep, and (2) suggest that, with age, a reduction in cortical integrity within this frontal network mediates the loss of delta power during sleep. Further work will determine whether cortical thinning and delta loss may interact and contribute to cognitive decline with aging.

Correspondence of maternal and paternal perception of school-aged children's sleep with in-home sleep-electroencephalography and diary-reports of children's sleep.

OBJECTIVE: Parents are often the first to report children's sleep difficulties. The aim of the present study was to evaluate the accuracy of parent reports by examining the correspondence of maternal and paternal reports of children's sleep with in-home electroencephalography (EEG) sleep assessment and sleep diary reports. METHODS: A total of 143 children (57 formerly very preterm born children) aged 7-12 years underwent one night of in-home sleep-EEG; mothers and fathers reported children's sleep-related behavior by using the German version of the Children's Sleep Habits Questionnaire, and children and parents together completed a sleep diary of children's sleep. RESULTS: Less EEG-derived total sleep time (TST) was associated with increased mother questionnaire reports of sleep duration problems, while less sleep efficiency (SE) and longer sleep onset latency (SOL) were associated with increased mother questionnaire reports of sleep onset delay. For fathers, only longer SOL was related to increased father questionnaire reports of sleep onset delay. The abovementioned associations did not change with children's increasing age and did not differ for boys and girls. More parent questionnaire reports of sleep duration problems, sleep onset delay, and night wakings were related to shorter diary reports of sleep duration, increased sleep latency, and more nocturnal awakenings, respectively. CONCLUSIONS: Mother questionnaire reports of children's sleep corresponded moderately with objective measures of TST, SE, and SOL assessed with in-home sleep-EEG. Both mother and father questionnaire reports of children's sleep duration problems, sleep onset delay, and night wakings were related to diary reports of children's sleep.

The association of mothers' and fathers' insomnia symptoms with school-aged children's sleep assessed by parent report and in-home sleep-electroencephalography.

OBJECTIVE: Sleep plays an essential role for children's well-being. Because children's sleep is associated with parental sleep patterns, it must be considered in the family context. As a first aim of the present study, we test whether parental insomnia symptoms are related to children's in-home sleep-electroencephalography (EEG). Second, we examine the association between parental insomnia symptoms and maternal and paternal perception of children's sleep using actor-partner interdependence models. METHODS: A total of 191 healthy children enrolled in public school and aged 7-12 years took part in the study. Ninety-six were formerly very preterm born children. Children underwent in-home sleep-EEG, and parents reported children's sleep-related behavior by using the German version of the Children's Sleep Habits Questionnaire. Further, parents completed the Insomnia Severity Index to report their own insomnia symptoms. RESULTS: Maternal but not paternal insomnia symptoms were related to less children's EEG-derived total sleep time, more stage 2 sleep, less slow wave sleep, later sleep onset time, and later awakening time. Mothers' and fathers' own insomnia symptoms were related to their reports of children's bedtime resistance, sleep duration, sleep anxiety, night wakings, and/or daytime sleepiness. Moreover, maternal insomnia symptoms were associated with paternal reports of children's bedtime resistance, sleep anxiety, and sleep-disordered breathing. The associations between parental insomnia symptoms and parents' perception of children's sleep could not be explained by children's objectively measured sleep. CONCLUSIONS: Mothers' insomnia symptoms and children's objective sleep patterns are associated. Moreover, the parents' own insomnia symptoms might bias their perception of children's sleep-related behavior problems.

Salivary and hair glucocorticoids and sleep in very preterm children during school age.

Very preterm birth involves increased stress for the child, which may lead to programming of the hypothalamic-pituitary-adrenal (HPA) axis activity and poor sleep in later life. Moreover, there is evidence for a relationship between HPA axis activity and sleep. However, research with objective sleep measures in very preterm children during school-age is rare. Eighty-five healthy children born very preterm (<32nd gestational week) and 91 full-term children aged 7-12 years were recruited for the present study. To assess HPA axis activity, salivary cortisol was measured at awakening, 10, 20, and 30min later. In addition, hair cortisol and cortisone concentrations were quantified using liquid chromatography tandem mass spectrometry to assess cumulative endocrine activity over the preceding months. One night of in-home polysomnographic sleep assessment was conducted to assess sleep duration, sleep continuity, and sleep architecture. Children born very preterm showed significantly lower levels of cortisol at awakening and lower overall post-awakening cortisol secretion, lower cortisone in hair, and earlier sleep onset than full-term children. Across the whole sample, overall post-awakening cortisol secretion was positively related to sleep onset time and negatively to sleep duration. The association between prematurity status and post-awakening cortisol secretion was partially mediated by earlier sleep onset time. In conclusion, this study provides evidence for a possible down-regulation of the HPA axis activity and slightly earlier sleep phase in very preterm children during school age.

Morning cortisol secretion in school-age children is related to the sleep pattern of the preceding night.

Sleep disturbance in childhood is common and a risk factor for poor mental health. Evidence indicates that disturbed sleep is associated with altered hypothalamic-pituitary-adrenal axis (HPAA) activity. Knowledge regarding the association between HPAA-activity and objective sleep measures particularly regarding sleep architecture in school-age children is missing. Sleep-electroencephalography was administered to 113 children aged 6-10 years (including 58 children born very preterm and 55 born at term) during one night at the children's homes and sleep duration, sleep continuity, and sleep architecture were assessed. To assess the cortisol awakening response at the following morning, cortisol secretion was measured at awakening, 10, 20, and 30min later. Regression analyses controlling child age, gender, prematurity status, and the awakening time revealed that morning cortisol secretion was negatively associated with sleep duration and slow wave sleep and positively associated with the relative amount of Stage 2 sleep during the preceding night. In addition, morning cortisol secretion linearly increased with age. In conclusion, associations of sleep disturbance with poor mental health may be confounded with altered HPAA-activity.

Polysomnographic features of early-onset depression: a meta-analysis.

BACKGROUND: Undiagnosed major depressive disorder (MDD) is associated with increased morbidity in children and adolescents. This study evaluated features of sleep macro- and microarchitecture assessed by polysomnography (PSG) as diagnostic markers for MDD in children and adolescents. METHODS: MEDLINE, PSYCINFO, EMBASE and PUBMED were searched from their availability dates to March 1st, 2013. The literature search identified 932 abstracts of which 51 studies were retrieved and 28 were included in the analysis. Study design, features of sleep macro- and microarchitecture, demographic and clinical characteristics of study groups were extracted for each study. RESULTS: There were modest differences on sleep macroarchitecture between children and adolescents with MDD and healthy controls. The most robust difference was found in sleep latency, 31% of adolescents with MDD had increased sleep latency. Age, suicidal ideation, suicidal behavior, and psychiatric comorbidities were significant predictors of sleep macroarchitecture. Modest differences were found for sleep microarchitecture, intrahemispheric and interhemispheric temporal coherence was decreased in a third of patients with MDD. Age was a significant predictor of sleep microarchitecture. LIMITATIONS: This meta-analysis is limited by the small number of studies on sleep macroarchitecture in children with MDD and studies on sleep microarchitecture overall and by the heterogeneity in methodology between studies. CONCLUSIONS: This synthetic review of the existing literature is among the largest to quantitatively assess impaired sleep as a diagnostic marker for MDD in children and adolescents. Knowledge of sleep macro- and microarchitecture in early-onset MDD may aid the clinician in developing a treatment strategy for MDD-related sleep symptoms in a subset of patients.