Case report of hypoglossal nerve stimulation therapy failure due to significant underlying central sleep apnea.

Hypoglossal nerve stimulation is indicated for obstructive sleep apnea but is ineffective in treating central sleep apnea. We describe 2 patients implanted with hypoglossal nerve stimulation after being diagnosed with obstructive sleep apnea at outside sleep laboratories and failing a trial of continuous positive airway pressure therapy. Despite successful hypoglossal nerve stimulation implantation, the patients continued to have persistent symptoms with residual apnea-hypopnea indices above 25 events/h. Although obstructive sleep apnea was the presenting diagnosis, we discovered a significant central sleep apnea component in the original diagnostic sleep data upon careful review. One patient was confirmed to have a central sleep apnea-predominant sleep disorder and improved with adaptive servo-ventilation therapy. The other was diagnosed with central sleep apnea and severe periodic limb movement disorder, and improved with medication. Based on these sleep apnea cases, we propose guidelines emphasizing the importance of reviewing basic clinical information upon treatment failure and initiating multidisciplinary collaboration early in the treatment course. CITATION: Banerjee D, Lee C-H, Im K. Case report of hypoglossal nerve stimulation therapy failure due to significant underlying central sleep apnea. J Clin Sleep Med. 2024;20(6):1003-1007.

Pattern Completion and Rate Remapping in Retrosplenial Cortex.

Principles governing the encoding, storage, and updating of memories in cortical networks are poorly understood. In retrosplenial cortex (RSC), cells respond to the animal's position as it navigates a real or virtual (VR) linear track. Position correlated cells (PCCs) in RSC require an intact hippocampus to form. To examine whether PCCs undergo pattern completion and remapping like hippocampal cells, neuronal activity in RSC or CA1 was recorded using two-photon calcium imaging in mice running on VR tracks. RSC and CA1 PCC activity underwent global and rate remapping depending on the degree of change to familiar environments. The formation of position correlated fields in both regions required stability across laps; however, once formed, PCCs became robust to object destabilization, indicating pattern completion of the previously formed memory. Thus, memory and remapping properties were conserved between RSC and CA1, suggesting that these functional properties are transmitted to cortex to support memory functions.

Host interneurons mediate plasticity reactivated by embryonic inhibitory cell transplantation in mouse visual cortex.

The adult brain lacks sensitivity to changes in the sensory environment found in the juvenile brain. The transplantation of embryonic interneurons has been shown to restore juvenile plasticity to the adult host visual cortex. It is unclear whether transplanted interneurons directly mediate the renewed cortical plasticity or whether these cells act indirectly by modifying the host interneuron circuitry. Here we find that the transplant-induced reorganization of mouse host circuits is specifically mediated by Neuregulin (NRG1)/ErbB4 signaling in host parvalbumin (PV) interneurons. Brief visual deprivation reduces the visual activity of host PV interneurons but has negligible effects on the responses of transplanted PV interneurons. Exogenous NRG1 both prevents the deprivation-induced reduction in the visual responses of host PV interneurons and blocks the transplant-induced reorganization of the host circuit. While deletion of ErbB4 receptors from host PV interneurons blocks cortical plasticity in the transplant recipients, deletion of the receptors from the donor PV interneurons does not. Altogether, our results indicate that transplanted embryonic interneurons reactivate cortical plasticity by rejuvenating the function of host PV interneurons.

Activation of serotonin neurons promotes active persistence in a probabilistic foraging task.

The neuromodulator serotonin (5-HT) has been implicated in a variety of functions that involve patience or impulse control. Many of these effects are consistent with a long-standing theory that 5-HT promotes behavioral inhibition, a motivational bias favoring passive over active behaviors. To further test this idea, we studied the impact of 5-HT in a probabilistic foraging task, in which mice must learn the statistics of the environment and infer when to leave a depleted foraging site for the next. Critically, mice were required to actively nose-poke in order to exploit a given site. We show that optogenetic activation of 5-HT neurons in the dorsal raphe nucleus increases the willingness of mice to actively attempt to exploit a reward site before giving up. These results indicate that behavioral inhibition is not an adequate description of 5-HT function and suggest that a unified account must be based on a higher-order function.

Transient inhibition and long-term facilitation of locomotion by phasic optogenetic activation of serotonin neurons.

Serotonin (5-HT) is associated with mood and motivation but the function of endogenous 5-HT remains controversial. Here, we studied the impact of phasic optogenetic activation of 5-HT neurons in mice over time scales from seconds to weeks. We found that activating dorsal raphe nucleus (DRN) 5-HT neurons induced a strong suppression of spontaneous locomotor behavior in the open field with rapid kinetics (onset ≤1 s). Inhibition of locomotion was independent of measures of anxiety or motor impairment and could be overcome by strong motivational drive. Repetitive place-contingent pairing of activation caused neither place preference nor aversion. However, repeated 15 min daily stimulation caused a persistent increase in spontaneous locomotion to emerge over three weeks. These results show that 5-HT transients have strong and opposing short and long-term effects on motor behavior that appear to arise from effects on the underlying factors that motivate actions.

Quantum Kramers equation for energy diffusion and barrier crossing dynamics in the low-friction regime.

Based on a true phase space probability distribution function and an ensemble averaging procedure we have recently developed [Phys. Rev. E 65, 021109 (2002)] a non-Markovian quantum Kramers equation to derive the quantum rate coefficient for barrier crossing due to thermal activation and tunneling in the intermediate to strong friction regime. We complement and extend this approach to weak friction regime to derive quantum Kramers equation in energy space and the rate of decay from a metastable well. The theory is valid for arbitrary temperature and noise correlation. We show that depending on the nature of the potential there may be a net reduction of the total quantum rate below its corresponding classical value, which is in conformity with earlier observation. The method is independent of path integral approaches and takes care of quantum effects to all orders.

Approach to quantum Kramers' equation and barrier crossing dynamics.

We have presented a simple approach to quantum theory of Brownian motion and barrier crossing dynamics. Based on an initial coherent state representation of bath oscillators and an equilibrium canonical distribution of quantum-mechanical mean values of their co-ordinates and momenta we have derived a c number generalized quantum Langevin equation. The approach allows us to implement the method of classical non-Markovian Brownian motion to realize an exact generalized non-Markovian quantum Kramers' equation. The equation is valid for arbitrary temperature and friction. We have solved this equation in the spatial diffusion-limited regime to derive quantum Kramers' rate of barrier crossing and analyze its variation as a function of the temperature and friction. While almost all the earlier theories rest on quasiprobability distribution functions (e.g., Wigner function) and path integral methods, the present work is based on true probability distribution functions and is independent of path integral techniques. The theory is a natural extension of the classical theory to quantum domain and provides a unified description of thermally activated processes and tunneling.

Solution of quantum Langevin equation: approximations, theoretical and numerical aspects.

Based on a coherent state representation of noise operator and an ensemble averaging procedure using Wigner canonical thermal distribution for harmonic oscillators, a generalized quantum Langevin equation has been recently developed [Phys. Rev. E 65, 021109 (2002); 66, 051106 (2002)] to derive the equations of motion for probability distribution functions in c-number phase-space. We extend the treatment to explore several systematic approximation schemes for the solutions of the Langevin equation for nonlinear potentials for a wide range of noise correlation, strength and temperature down to the vacuum limit. The method is exemplified by an analytic application to harmonic oscillator for arbitrary memory kernel and with the help of a numerical calculation of barrier crossing, in a cubic potential to demonstrate the quantum Kramers' turnover and the quantum Arrhenius plot.