The assessment of emotion reactivity: The Italian validation of the Perth Emotional Reactivity Scale-Short Form (PERS-S).

Emotion reactivity refers to the activation, intensity and duration of emotional responses to internal or external stimuli. It can be differentiated from emotion regulation since the former is the very first response to an emotional trigger, and the latter can be defined as a tool for maintaining one's arousal in a window of tolerance. Since, to date, there are no Italian self-report measures able to evaluate individuals' emotional reactivity, this study aimed to contribute to the Italian validation of the Perth Emotional Reactivity Scale-Short Form (PERS-S). The PERS-S is an 18-item self-report measure answered on a 5-point Likert scale that generates six subscale scores and two composite scores, with higher scores indicating higher levels of reactivity. Data from 768 individuals showed that the PERS-S had good to excellent goodness of fit. The internal consistency was high, with an overall reliability coefficient (Cronbach's α) of .87 and .86 for the negative and positive general scales, respectively. The PERS-S also demonstrated appropriate convergent validity, showing significant correlations with conceptually related measures, and acceptable divergent validity, showing minimal correlations with unrelated constructs. Finally, we evaluated the Test-Retest Reliability by administering the PERS-S to the same sample twice, with a 2-week interval. The significant correlations between the two PERS-S administrations suggest temporal stability. The Italian version of the PERS-S will enrich the repertoire of self-report measures for investigating the development and risk factors of mental health disorders and may have practical applications in clinical settings.

The role of the sleep K-complex on the conversion from mild cognitive impairment to Alzheimer's disease.

The present literature points to an alteration of the human K-complex during non-rapid eye movement sleep in Alzheimer's disease. Nevertheless, the few findings on the K-complex changes in mild cognitive impairment and their possible predictive role on the Alzheimer's disease conversion show mixed findings, lack of replication, and a main interest for the frontal region. The aim of the present study was to assess K-complex measures in amnesic mild cognitive impairment subsequently converted in Alzheimer's disease over different cortical regions, comparing them with healthy controls and stable amnesic mild cognitive impairment. We assessed baseline K-complex density, amplitude, area under the curve and overnight changes in frontal, central and parietal midline derivations of 12 amnesic mild cognitive impairment subsequently converted in Alzheimer's disease, 12 stable amnesic mild cognitive impairment and 12 healthy controls. We also assessed delta electroencephalogram power, to determine if K-complex alterations in amnesic mild cognitive impairment occur with modification of the electroencephalogram power in the frequency range of the slow-wave activity. We found a reduced parietal K-complex density in amnesic mild cognitive impairment subsequently converted in Alzheimer's disease compared with stable amnesic mild cognitive impairment and healthy controls, without changes in K-complex morphology and overnight modulation. Both amnesic mild cognitive impairment groups showed decreased slow-wave sleep percentage compared with healthy controls. No differences between groups were observed in slow-wave activity power. Our findings suggest that K-complex alterations in mild cognitive impairment may be observed earlier in parietal regions, likely mirroring the topographical progression of Alzheimer's disease-related brain pathology, and express a frontal predominance only in a full-blown phase of Alzheimer's disease. Consistently with previous results, such K-complex modification occurs in the absence of significant electroencephalogram power changes in the slow oscillations range.

Poor sleep quality, insomnia, and short sleep duration before infection predict long-term symptoms after COVID-19.

BACKGROUND: Millions of COVID-19 survivors experience a wide range of long-term symptoms after acute infection, giving rise to serious public health concerns. To date, few risk factors for post-COVID-19 conditions have been determined. This study evaluated the role of pre-infection sleep quality/duration and insomnia severity in the incidence of long-term symptoms after COVID-19. MATERIAL AND METHODS: This prospective study involved two assessments (April 2020 and 2022). At the baseline (April 2020), sleep quality/duration and insomnia symptoms in participants without current/prior SARS-CoV-2 infection were measured using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). At the follow-up (April 2022), we asked a group of COVID-19 survivors to retrospectively evaluate the presence of twenty-one symptoms (psychiatric, neurological, cognitive, bodily, and respiratory) that have been experienced one month (n = 713, infection in April 2020-February 2022) and three months after COVID-19 (n = 333, infection in April 2020-December 2021). In April 2022, participants also reported how many weeks passed to fully recover from COVID-19. Zero-inflated negative binomial models were used to estimate the effect of previous sleep on the number of long-term symptoms. Binomial logistic regressions were performed to evaluate the association between sleep variables, the incidence of each post-COVID-19 symptom, and the odds of recovery four/twelve weeks after infection. RESULTS: Analyses highlighted a significant effect of pre-infection sleep on the number of symptoms one/three months after COVID-19. Previous higher PSQI and ISI scores, and shorter sleep duration significantly increased the risk of almost every long-term symptom at one/three months from COVID-19. Baseline sleep problems were also associated with longer recovery times to return to the pre-infection daily functioning level after COVID-19. CONCLUSIONS: This study suggested a prospective dose-dependent association of pre-infection sleep quality/quantity and insomnia severity with the manifestation of post-COVID-19 symptoms. Further research is warranted to determine whether preventively promoting sleep health may mitigate the COVID-19 sequelae, with substantial public health and societal implications.

Two years after lockdown: Longitudinal trajectories of sleep disturbances and mental health over the COVID-19 pandemic, and the effects of age, gender and chronotype.

Since the first lockdown of Spring 2020, the COVID-19 contagion waves pervasively disrupted the sleep and mental health of the worldwide population. Notwithstanding the largest vaccination campaign in human history, the pandemic has continued to impact the everyday life of the general population for 2 years now. The present study provides the first evidence of the longitudinal trajectories of sleep disturbances and mental health throughout the pandemic in Italy, also describing the differential time course of age groups, genders and chronotypes. A total of 1062 Italians participated in a three-time-point longitudinal study covering two critical stages of the emergency (the first lockdown in April 2020 and the second partial lockdown in December 2020) and providing a long-term overview 2 years after the pandemic outbreak (April 2022). We administered validated questionnaires to evaluate sleep quality/habits, insomnia, depression, stress and anxiety symptoms. Analyses showed a gradual improvement in sleep disturbances, depression and anxiety. Conversely, sleep duration progressively decreased, particularly in evening-type and younger people. Participants reported substantial earlier bedtime and get-up time. Stress levels increased during December 2020 and then stabilised. This effect was stronger in the population groups apparently more resilient during the first lockdown (older people, men and morning-types). Our results describe a promising scenario 2 years after the pandemic onset. However, the improvements were relatively small, the perceived stress increased, and the re-establishment of pre-existing social/working dynamics led to general sleep curtailment. Further long-term monitoring is required to claim the end of the COVID-19 emergency on Italians' sleep and mental health.

The effects of bifrontal anodal transcranial direct current stimulation (tDCS) on sleepiness and vigilance in partially sleep-deprived subjects: A multidimensional study.

In recent years, transcranial electrical stimulation techniques have demonstrated their ability to modulate our levels of sleepiness and vigilance. However, the outcomes differ among the specific aspects considered (physiological, behavioural or subjective). This study aimed to observe the effects of bifrontal anodal transcranial direct current stimulation. Specifically, we tested the ability of this stimulation protocol to reduce sleepiness and increase vigilance in partially sleep-deprived healthy participants. Twenty-three subjects underwent a within-subject sham-controlled stimulation protocol. We compared sleepiness and vigilance levels before and after the two stimulation conditions (active versus sham) by using behavioural (reaction-time task), subjective (self-report scales) and physiological (sleep-onset latency and electroencephalogram power [n = 20] during the Maintenance of Wakefulness Test) measures. We showed the efficacy of the active stimulation in reducing physiological sleepiness and preventing vigilance drop compared with the sham stimulation. Consistently, we observed a reduction of perceived sleepiness following the active stimulation for both self-report scales. However, the stimulation effect on subjective measures was not statistically significant probably due to the underpowered sample size for these measures, and to the possible influence of motivational and environmental factors. Our findings confirm the ability of this technique to influence vigilance and sleepiness, pointing out the potential for new treatment developments based on transcranial electrical stimulation.

Sleeping under the waves: A longitudinal study across the contagion peaks of the COVID-19 pandemic in Italy.

After the March-April 2020 coronavirus disease 2019 (COVID-19) outbreak, a second contagion wave afflicted Europe in the autumn. The present study aimed to evaluate sleep health/patterns of Italians during this further challenging situation. A total of 2,013 Italians longitudinally participated in a web-based survey during the two contagion peaks of the COVID-19 outbreak. We investigated the risk factors for sleep disturbances during the second wave, and we compared sleep quality and psychological well-being between the two assessments (March-April and November-December 2020). Female gender, low education, evening chronotype, being a high-risk person for COVID-19 infection, reporting negative social or economic impact, and evening smartphone overuse predicted a higher risk of poor sleep and insomnia symptoms during the second wave. Advanced age, living with a high-risk person for COVID-19 infection, and having a relative/friend infected with COVID-19 before the prior 2 weeks were risk categories for poor sleep quality. Living with children, having contracted COVID-19 before the prior 2 weeks, being pessimistic about the vaccine and working in healthcare, were risk factors for insomnia symptoms. The follow-up assessment highlighted reduced insomnia symptoms and anxiety. Nevertheless, we found reduced sleep duration, higher daytime dysfunction, advanced bedtime and wake-up time, and a shift to morningness, confirming the alarming prevalence of poor sleepers (~60%) and severe depression (~20%) in a context of increased perceived stress. The present study showed a persistent impact of the COVID-19 pandemic on sleep and mental health. Large-scale interventions to counteract the chronicity and exacerbation of sleep and psychological disturbances are necessary, especially for the at-risk categories.

The effect of 5 nights of sleep restriction on empathic propensity.

Literature supports the existence of a significant relationship between sleep quality/quantity and empathy. However, empathic ability and empathic propensity are distinct constructs. Expression of empathic propensity depends on the subjective cognitive costs attributed to the empathic experience. Studies on the effects of the experimental reduction in sleep duration on empathic behaviour are still lacking. Therefore, we investigated the consequences of 5 consecutive nights of sleep restriction on empathic propensity. A total of 42 university students (mean [SEM] age 24.09 [0.65] years; 22 females) underwent a cross-over design consisting of 5 consecutive nights of regular sleep and 5 consecutive nights of sleep restriction with a maximum of 5 hr sleep/night. After each condition, all participants were evaluated using the Empathy Selection Task, a new test assessing the motivated avoidance of empathy for its associated cognitive costs. The results showed different effects of sleep restriction depending on the habitual way of responding in the empathic context. Participants with baseline high levels of empathic propensity reduced their empathic propensity after prolonged sleep restriction. Differently, participants who tended to avoid empathising already in the habitual sleep condition maintained their empathic behaviour unchanged after sleep curtailment. In conclusion, inter-individual variability should be taken into account when evaluating the effects of sleep restriction on empathic propensity. People with habitual higher tendency to empathise could choose to avoid empathic experience following several consecutive nights of inadequate sleep.

Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials.

BACKGROUND: Transcranial direct current stimulation (tDCS) could counteract the pathophysiological triggers of migraine attacks by modulating cortical excitability. Several pilot randomized controlled trials (RCTs) assessed the efficacy of tDCS for migraine prevention. We reviewed and summarized the state of the art of tDCS protocols for migraine prevention, discussing study results according to the stimulations parameters and patients' populations. MAIN BODY: We combined the keywords 'migraine', 'headache', 'transcranial direct current stimulation', and 'tDCS' and searched Pubmed, Scopus, and Web of Science, from the beginning of indexing to June 22, 2021. We only included RCTs comparing the efficacy of active tDCS with sham tDCS to decrease migraine frequency, intensity, and/or acute drug utilization. The risk of bias of each RCT was assessed by using the RoB-2 tool (Cochrane Collaboration). Thirteen RCTs (from 2011 to 2021) were included in the review. The included patients ranged from 13 to 135. RCTs included patients with any migraine (n=3), chronic migraine (n=6), episodic migraine (n=3) or menstrual migraine (n=1). Six RCTs used cathodal and five anodal tDCS, while two RCTs compared the efficacy of both cathodal and anodal tDCS with that of sham. In most of the cathodal stimulation trials, the target areas were the occipital regions, with reference on central or supraorbital areas. In anodal RCTs, the anode was usually placed above the motor cortical areas and the cathode on supraorbital areas. All RCTs adopted repeated sessions (from 5 to 28) at variable intervals, while the follow-up length spanned from 1 day up to 12 months. Efficacy results were variable but overall positive. According to the RoB-2 tool, only four of the 13 RCTs had a low risk of bias, while the others presented some concerns. CONCLUSIONS: Both anodal and cathodal tDCS are promising for migraine prevention. However, there is a need for larger and rigorous RCTs and standardized procedures. Additionally, the potential benefits and targeted neurostimulation protocols should be assessed for specific subgroups of patients.

Predicting Dream Recall: EEG Activation During NREM Sleep or Shared Mechanisms with Wakefulness?

The common knowledge of a uniqueness of REM sleep as a privileged scenario of dreaming still persists, although consolidated empirical evidence shows that the assumption that dreaming is just an epiphenomenon of REM sleep is no longer tenable. However, the brain mechanisms underlying dream generation and its encoding in memory during NREM sleep are still mostly unknown. In fact, only few studies have investigated on the mechanisms of dream phenomenology related to NREM sleep. For this reason, our study is specifically aimed to elucidate the electrophysiological (EEG) correlates of dream recall (DR) upon NREM sleep awakenings. Under the assumption that EEG activity predicts the presence/absence of DR also during NREM sleep, we have investigated whether DR from stage 2 NREM sleep shares similar brain mechanisms to those involved in the encoding of episodic memory during wakefulness, or it depends on the specific electrophysiological milieu of the sleep period along the desynchronized/synchronized EEG continuum. We collected DR from a multiple nap protocol in a within-subjects design. We found that DR is predicted by an extensive reduction of delta activity during the last segment of sleep, encompassing left frontal and temporo-parietal areas. The results could represent an update on the mechanisms underlying the sleep mentation during NREM sleep. In particular, they support the hypothesis that an increased cortical EEG activation is a prerequisite for DR, and they are not necessarily in conflict with the hypothesis of common wake-sleep mechanisms. We also confirmed that EEG correlates of DR depend on a state-like relationship.

Mapping changes in cortical activity during sleep in the first 4 years of life.

A coherent body of evidence supports the notion that sleep is a local and use-dependent process. Significant changes in brain morphology and function occur in the first years of life, revealing a postero-anterior trajectory of cortical maturation. On this basis, a recent study demonstrated that regional cortical maturation between early childhood and late adolescence is reflected in regional changes of sleep slow wave activity (SWA) during non-rapid eye movement (NREM) sleep. Our hypothesis is that changes of electroencephalogram (EEG) rhythms during sleep from birth to childhood are also mirrored by parallel regional changes in the EEG rhythms of sleep according to the assumption of a postero-anterior gradient in cortical maturation. We studied all-night EEG of 39 healthy, full-term, infants and children aged between 0 and 48 months, evaluating regional differences in NREM sleep. We confirmed the strictly local nature of sleep with frequency-specific regional differences. Specifically, we found a general shift of maxima of the upper alpha activity from occipital to prefrontal regions, expressed mainly by the ~11 Hz frequency. This shift corresponds to a postero-anterior trajectory of the so-called 'slow spindles'. The theta and alpha EEG activity of the frontal cortex exhibits a clear, positive, correlation with age. We conclude that specific local differences during NREM sleep, parallel cortical maturation also in the first 4 years of life.

Parietal Fast Sleep Spindle Density Decrease in Alzheimer's Disease and Amnesic Mild Cognitive Impairment.

Several studies have identified two types of sleep spindles: fast (13-15 Hz) centroparietal and slow (11-13 Hz) frontal spindles. Alterations in spindle activity have been observed in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). Only few studies have separately assessed fast and slow spindles in these patients showing a reduction of fast spindle count, but the possible local specificity of this phenomenon and its relation to cognitive decline severity are not clear. Moreover, fast and slow spindle density have never been assessed in AD/MCI. We have assessed fast and slow spindles in 15 AD patients, 15 amnesic MCI patients, and 15 healthy elderly controls (HC). Participants underwent baseline polysomnographic recording (19 cortical derivations). Spindles during nonrapid eye movements sleep were automatically detected, and spindle densities of the three groups were compared in the derivations where fast and slow spindles exhibited their maximum expression (parietal and frontal, resp.). AD and MCI patients showed a significant parietal fast spindle density decrease, positively correlated with Minimental State Examination scores. Our results suggest that AD-related changes in spindle density are specific for frequency and location, are related to cognitive decline severity, and may have an early onset in the pathology development.

The assessment of somatosensory cortex plasticity during sleep deprivation by paired associative stimulation.

Many animal studies suggest that during sleep deprivation (SD) synaptic strength should progressively increase, leading to the saturation of the ability to induce long-term potentiation (LTP). Nevertheless, direct evidences about the effects of sustained wakefulness on cortical plasticity in humans are still lacking. The aim of the present study was to assess changes in the ability to induce LTP-like mechanism in humans during a period of SD by means of a paired associative stimulation (PAS) protocol, which combines median nerve stimulation with transcranial magnetic stimulation (TMS) applied over the contralateral somatosensory cortex. During a 41-h SD protocol, 16 healthy subjects, defined as responders to the PAS protocol after a pre-selection session, were involved in 4 experimental sessions (11.00 a.m. and 11.00 p.m. of first and second day) with: a) pre-PAS somatosensory evoked potentials (SEPs) recordings; b) PAS protocol; c) post-PAS SEPs recordings. The effect of PAS on SEPs early components (N20-P25 complex) was assessed. During the first experimental session (without SD) no significant PAS effects on SEPs components amplitude have been found, and large intra- and inter-individual variability have been observed. A lack of significant changes has been observed also in the subsequent sessions. Our results index a low intra- and inter-individual reliability of the PAS protocol, suggesting particular caution when longitudinally evaluating the effect of this technique on cortical plasticity.

Frequency-dependent effects of oscillatory-tDCS on EEG oscillations: a study with Better OSCillation detection method (BOSC).

Oscillating transcranial direct current stimulation (osc-tDCS) modulates the spontaneous brain activity in a frequency-specific manner. Most studies evaluated cortical effects of osc-tDCS through spectral measures, without differentiating components associated with rhythmic and non-rhythmic activity. Since osc-tDCS mainly affects brain oscillatory activity, our aim was to investigate on the specific changes of EEG oscillations following a frontal osc-tDCS at 0.8 and at 5 Hz. 20 healthy subjects (26.8 ± 2.5 years) participated in one of two experiments (Exp.1= 0.8-Hz tDCS, n= 10; Exp.2= 5-Hz tDCS, n= 10), consisting of 3 within-subject sessions: two active conditions with different stimulation polarity (anodal osctDCS, cathodal osc-tDCS), and a control condition (sham). EEG oscillatory components (28 cortical derivations) at the stimulation frequency were measured by the Better OSCillation detection method (BOSC). Variations between before and after the osc-tDCS were compared between conditions as a function of polarity (anodal vs. cathodal vs. sham) and frequency (0.8 vs. 5 Hz) of stimulation. The main finding is a significant local increase of 0.81-Hz slow oscillations (F(1,18)=19.97; p=0.0004) and 5.3-Hz theta oscillations (F(1,18)=26.93; p= 0.0001) after 5 Hz compared to 0.8-Hz tDCS. Our study shows larger frequency-specific and cross-frequency effects of 5-Hz compared to 0.8-Hz stimulation, not revealed by conventional FFT analyses. This finding is consistent with a more effective induction of EEG synchronization during wakefulness by means of a stimulation in the theta range, and it suggests to combine measurement of EEG power and EEG oscillations in future studies involving transcranial stimulations.

Spatiotemporal EEG dynamics of the sleep onset process in preadolescence.

BACKGROUND: During preadolescence the sleep electroencephalography undergoes massive qualitative and quantitative modifications. Despite these relevant age-related peculiarities, the specific EEG pattern of the wake-sleep transition in preadolescence has not been exhaustively described. METHODS: The aim of the present study is to characterize regional and temporal electrophysiological features of the sleep onset (SO) process in a group of 23 preadolescents (9-14 years) and to compare the topographical pattern of slow wave activity and delta/beta ratio of preadolescents with the EEG pattern of young adults. RESULTS: Results showed in preadolescence the same dynamics known for adults, but with peculiarities in the delta and beta activity, likely associated with developmental cerebral modifications: the delta power showed a widespread increase during the SO with central maxima, and the lower bins of the beta activity showed a power increase after SO. Compared to adults, preadolescents during the SO exhibited higher delta power only in the slowest bins of the band: before SO slow delta activity was higher in prefrontal, frontal and occipital areas in preadolescents, and, after SO the younger group had higher slow delta activity in occipital areas. In preadolescents delta/beta ratio was higher in more posterior areas both before and after the wake-sleep transition and, after SO, preadolescents showed also a lower delta/beta ratio in frontal areas, compared to adults. CONCLUSION: Results point to a general higher homeostatic drive for the developing areas, consistently with plastic-related maturational modifications, that physiologically occur during preadolescence.

Is sleep essential for neural plasticity in humans, and how does it affect motor and cognitive recovery?

There is a general consensus that sleep is strictly linked to memory, learning, and, in general, to the mechanisms of neural plasticity, and that this link may directly affect recovery processes. In fact, a coherent pattern of empirical findings points to beneficial effect of sleep on learning and plastic processes, and changes in synaptic plasticity during wakefulness induce coherent modifications in EEG slow wave cortical topography during subsequent sleep. However, the specific nature of the relation between sleep and synaptic plasticity is not clear yet. We reported findings in line with two models conflicting with respect to the underlying mechanisms, that is, the "synaptic homeostasis hypothesis" and the "consolidation" hypothesis, and some recent results that may reconcile them. Independently from the specific mechanisms involved, sleep loss is associated with detrimental effects on plastic processes at a molecular and electrophysiological level. Finally, we reviewed growing evidence supporting the notion that plasticity-dependent recovery could be improved managing sleep quality, while monitoring EEG during sleep may help to explain how specific rehabilitative paradigms work. We conclude that a better understanding of the sleep-plasticity link could be crucial from a rehabilitative point of view.

Assessing Resilience to Sleep Loss Among the Italian Population: A 13-Item Model of the Iowa Resistance to Sleeplessness Test (iREST).

Purpose: The present study aimed to validate the Italian version of the Iowa Resistance to Sleeplessness Test (iREST), a 16-item self-report assessing resilience to sleep debt in the affective, cognitive, and somatic domains. Participants and Methods: We examined its factor structure, assessed internal consistency and criterion validity, and established test-retest reliability on 768 Italian native speakers (65.8% of women) with a mean age of 25.98 years old. Results: Confirmatory factor analysis (CFA) revealed a new 13-item structure for the Italian iREST (iREST-13), demonstrating more satisfactory goodness-of-fit values, and exhibiting good internal consistency (Cronbach's α ranging from 0.73 to 0.89), relative to the 16-item original version. Results supported the iREST convergent validity, showing significant independence from established measures of sleep; low correlations with conceptually unrelated measures supported divergent validity, indicating that the iREST effectively measures resistance to sleeplessness without confounding with other constructs. Lastly, test-retest reliability was evaluated by administering the iREST to the same sample with a 2-week interval: the significant correlations supported its temporal stability. Conclusion: Further studies are needed to evaluate the applicability of the iREST in diverse populations and explore its relationship with objective sleep measures. Nevertheless, the Italian iREST provides a valuable tool for assessing resistance to sleep loss, offering insights into individual differences in resilience. Additionally, the iREST can assist in identifying individuals who require interventions to enhance resilience to sleep debt, as well as help clinicians evaluate the impact of chronic sleep disruption and deliver targeted interventions.

Effectiveness of Transcranial Direct Current Stimulation and Monoclonal Antibodies Acting on the CGRP as a Combined Treatment for Migraine (TACTIC): Protocol for a Randomized, Double-Blind, Sham-Controlled Trial.

Background: Migraine is a recurrent headache disorder that has a still unclear pathophysiology, involving several circuits of both the central and peripheral nervous system. Monoclonal antibodies acting on the calcitonin gene-related (CGRP) pathway (CGRP-MAbs) are the first drugs specifically designed for migraine; those drugs act peripherally on the trigeminal ganglion without entering the blood-brain barrier. Conversely, neuromodulation techniques such as transcranial direct current stimulation (tDCS) act centrally by increasing or decreasing the neuronal firing rate of brain cortical areas. The aim of the study will be to evaluate whether tDCS, in addition to CGRP-MAbs, is an effective add-on treatment in reducing headache frequency, intensity and acute medication use in patients with migraine. To demonstrate the biological effects of tDCS, the electroencephalographic (EEG) power changes after tDCS will be assessed. Methods: We will include patients with migraine on treatment with CGRP-MAbs and reporting ≥8 monthly migraine days. During a prospective 28-day baseline period, patients will fill in a headache diary and questionnaires to evaluate migraine-related disability, anxiety and depressive symptoms, sleep quality, and health-related quality of life. Subjects will be randomly assigned in a 1:1 ratio to active or sham tDCS. The stimulation protocol will consist in five daily sessions, the cathodes will be applied bilaterally above the occipital areas, with the reference anode electrodes positioned above the primary motor areas. Before the first, and immediately after the last stimulation session, patients will perform a 10-min resting EEG recording. During a 28-day follow-up period following tDCS, patients will have to fill in a headache diary and questionnaires identical to those of the baseline period. Discussion: This trial will evaluate the efficacy of an add-on treatment acting on the brain in patients with migraine, who are already treated with peripherally acting drugs, showing how tDCS acts in restoring the dysfunctional brain networks typical of the migraine patient. Clinical Trial Registration: NCT05161871.

Sleep talking versus sleep moaning: electrophysiological patterns preceding linguistic vocalizations during sleep.

STUDY OBJECTIVES: Sleep talking (ST) has been rarely studied as an isolated phenomenon. Late investigations over the psycholinguistic features of vocal production in ST pointed to coherence with wake language formal features. Therefore, we investigated the EEG correlates of Verbal ST as the overt manifestation of sleep-related language processing, with the hypothesis of shared electrophysiological correlates with wake language production. METHODS: From a sample of 155 Highly frequent STs, we recorded 13 participants (age range 19-30 years, mean age 24.6 ± 3.3; 7F) via vPSG for at least two consecutive nights, and a total of 28 nights. We first investigated the sleep macrostructure of STs compared to 13 age and gender-matched subjects. We then compared the EEG signal before 21 Verbal STs versus 21 Nonverbal STs (moaning, laughing, crying, etc.) in six STs reporting both vocalization types in Stage 2 NREM sleep. RESULTS: The 2 × 2 mixed analysis of variance Group × Night interaction showed no statistically significant effect for macrostructural variables, but significant main effects for Group with lower REM (%), total sleep time, total bedtime, sleep efficiency index, and greater NREM (%) for STs compared to controls. EEG statistical comparisons (paired-samples Student's t-test) showed a decrement in power spectra for Verbal STs versus Nonverbal STs within the theta and alpha EEG bands, strongly lateralized to the left hemisphere and localized on centro-parietal-occipitals channels. A single left parietal channel (P7) held significance after Bonferroni correction. CONCLUSIONS: Our results suggest shared neural mechanisms between Verbal ST and language processing during wakefulness and a possible functional overlapping with linguistic planning in wakefulness.

The fall of vulnerability to sleep disturbances in evening chronotypes when working from home and its implications for depression.

Eveningness is distinctively associated with sleep disturbances and depression symptoms due to the misalignment between biological and social clocks. The widespread imposition of remote working due to the COVID-19 pandemic allowed a more flexible sleep schedule. This scenario could promote sleep and mental health in evening-type subjects. We investigated the effect of working from home on sleep quality/quantity and insomnia symptoms within the morningness-eveningness continuum, and its indirect repercussions on depressive symptomatology. A total of 610 Italian office workers (mean age ± standard deviation, 35.47 ± 10.17 years) and 265 remote workers (40.31 ± 10.69 years) participated in a web-based survey during the second contagion wave of COVID-19 (28 November-11 December 2020). We evaluated chronotype, sleep quality/duration, insomnia, and depression symptoms through validated questionnaires. Three moderated mediation models were performed on cross-sectional data, testing the mediation effect of sleep variables on the association between morningness-eveningness continuum and depression symptoms, with working modality (office vs. remote working) as moderator of the relationship between chronotype and sleep variables. Remote working was associated with delayed bedtime and get-up time. Working modality moderated the chronotype effect on sleep variables, as eveningness was related to worse sleep disturbances and shorter sleep duration among the office workers only. Working modality also moderated the mediation of sleep variables between chronotype and depression. The above mediation vanished among remote workers. The present study suggests that evening-type people did not show their characteristic vulnerability to sleep problems when working from home. This result could imply a reduction of the proposed sleep-driven predisposition to depression of late chronotypes. A working environment complying with individual circadian preferences might ensure an adequate sleep quantity/quality for the evening-type population, promoting their mental health.

The Oneiric Activity during and after the COVID-19 Total Lockdown in Italy: A Longitudinal Study.

A growing body of evidence highlights that the COVID-19 pandemic affected oneiric activity. However, only a few studies have assessed the longitudinal changes in dream phenomenology during different phases of the pandemic, often focused on a limited number of dream variables. The aim of the present study was to provide an exhaustive assessment of dream features during total lockdown (TL) and a post-lockdown (PL) period characterized by eased restrictive measures in Italy. We performed a longitudinal study using a web-based survey to collect demographic, COVID-19 related, clinical, sleep, and dream data at TL and PL. Our final sample included 108 participants. The high frequency of poor sleep quality, anxiety, and depressive symptoms observed during TL remained stable at PL, while sleep latency (t = −4.09; p < 0.001) and PTSD-related disruptive nocturnal behaviors (t = −5.68; p < 0.001) exhibited a reduction at PL. A PL decrease in time spent with digital media was observed (t = −2.77; p = 0.007). We found a strong PL reduction in dream frequency (t = −5.49; p < 0.001), emotional load (t = −2.71; p = 0.008), vividness (t = −4.90; p < 0.001), bizarreness (t = −4.05; p < 0.001), length (t = −4.67; p < 0.001), and lucid dream frequency (t = −2.40; p = 0.018). Fear was the most frequently reported emotion in dreams at TL (26.9%) and PL (22.2%). Only the frequency of specific lockdown-related dream contents exhibited a reduction at PL. These findings highlight that the end of the home confinement had a strong impact on the oneiric activity, in the direction of reduced dream frequency, intensity, and lockdown-related contents. The co-occurrence of such changes with a decline in nocturnal PTSD-related symptoms, sleep latency, and time with digital media suggests an influence of post-traumatic stress levels, lifestyle modifications, and sleep pattern on dream changes during different phases of the pandemic. The stable prevalence of fear in dreams and the large frequency of poor sleep quality, depressive symptoms, and anxiety are probably related to the persistence of many negative consequences of the pandemic. Overall, these results are consistent with the continuity hypothesis of dreams.