Strong association of the rest-activity rhythm with well-being in demented elderly women.

OBJECTIVE: The objective of this study is to investigate the association between actigraphic estimates of the sleep-wake rhythm and a range of functional domains that contribute to well-being in demented elderly patients. METHOD: Eighty-seven women aged 85.5 +/- 5.9 years (mean +/- standard deviation) wore an actigraph for two weeks. Activity profiles were analyzed using nonparametric variables, including dichotomy indices, interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA). The associations between these variables and cognitive, functional, behavioral, and emotional states (obtained from standardized neuropsychologic assessments and questionnaires administered to caregivers) were investigated by partial correlations and stepwise regressions. RESULTS: Cognitive, functional, behavioral, and emotional states showed medium to strong correlations with multiple rhythm variables. Partial correlations indicated that this could not be attributed to a uniform worsening with advancing cognitive decline. Stepwise regressions indicated three most distinctive rhythm variables: 1) the interdaily stability of the 24-hour rhythm was most strongly, negatively, related to cognitive decline and depression; 2) the median level of daytime activity was most strongly, negatively, related to impairments of function, of activities of daily living, and of social interaction; and 3) nocturnal restlessness was secondarily, positively, related to impairments of function and social interaction. CONCLUSION: Especially the interdaily stability and median daytime activity level, and secondarily nocturnal restlessness, showed a strong relationship with the functional status and well-being of demented elderly. This raises the possibility that treatments that enhance daytime activity and the stability of the rest-activity rhythm may improve well-being.     

Circadian and age-related modulation of thermoreception and temperature regulation: mechanisms and functional implications

At older ages, the circadian rhythm of body temperature shows a decreased amplitude, an advanced phase, and decreased stability. The present review evaluates to what extent these changes may result from age-related deficiencies at several levels of the thermoregulatory system, including thermoreception, thermogenesis and conservation, heat loss, and central regulation. Whereas some changes are related to the aging process per se, others appear to be secondary to other factors, for which the risk increases with aging, notably a decreased level of fitness and physical activity. Moreover, functional implications of the body temperature rhythm are discussed. For example, the relation between circadian rhythm and thermoregulation has hardly been investigated, while evidence showed that sleep quality is dependent on both aspects. It is proposed that the circadian rhythm in temperature in homeotherms should not be regarded as a leftover of ectothermy in early evolution, but appears to be of functional significance for physiology from the level of molecules to cognition. A new view on the functional significance of the circadian rhythm in peripheral vasodilation and the consequent out-of-phase rhythms in skin and core temperature is presented. It is unlikely that the strong, daily occurring, peripheral vasodilation primarily represents heat loss in response to a lowering of set point, since behavioral measures are simultaneously taken in order to prevent heat loss. Several indications rather point towards a supportive role in immunological host defense mechanisms. Given the functional significance of the temperature rhythm, research should focus on the feasibility and effectiveness of methods that can in principle be applied in order to enhance the weakened circadian temperature rhythm in the elderly.     

Chronic stress undermines the compensatory sleep efficiency increase in response to sleep restriction in adolescents

To investigate the effects of real‐life stress on the sleep of adolescents, we performed a repeated‐measures study on actigraphic sleep estimates and subjective measures during one regular school week, two stressful examination weeks and a week's holiday. Twenty‐four adolescents aged 17.63 ± 0.10 years (mean ± standard error of the mean) wore actigraphs and completed diaries on subjective stress, fatigue, sleep quality, number of examinations and consumption of caffeine and alcohol for 4 weeks during their final year of secondary school. The resulting almost 500 assessments were analysed using mixed‐effect models to estimate the effects of mere school attendance and additional examination stress on sleep estimates and subjective ratings. Total sleep time decreased from 7:38 h ± 12 min during holidays to 6:40 h ± 12 min during a regular school week. This 13% decrease elicited a partial compensation, as indicated by a 3% increase in sleep efficiency and a 6% decrease in the duration of nocturnal awakenings. During examination weeks total sleep time decreased to 6:23 h ± 8 min, but it was now accompanied by a decrease in sleep efficiency and subjective sleep quality and an increase in wake bout duration. In conclusion, school examination stress affects the sleep of adolescents. The compensatory mechanism of more consolidated sleep, as elicited by the sleep restriction associated with mere school attendance, collapsed during 2 weeks of sustained examination stress.     

Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease

OBJECTIVES: To test whether the addition of melatonin to bright-light therapy enhances the efficacy in treating rest–activity (circadian) disruption in institutionalized patients with Alzheimer's disease (AD).
DESIGN: Randomized, controlled trial.
SETTING: Two nursing homes in San Francisco, California.
PARTICIPANTS: Fifty subjects (mean age 86) with AD.
INTERVENTION: Experimental subjects received 1 hour of morning light exposure (≥2,500 lux in gaze direction) Monday to Friday for 10 weeks and 5 mg melatonin (LM, n=16) or placebo (LP, n=17) in the evening. Control subjects (n=17) received usual indoor light (150–200 lux).
MEASUREMENTS: Nighttime sleep variables, day sleep time, day activity, day:night sleep ratio, and rest–activity parameters were determined using actigraphy.
RESULTS: Linear mixed models were employed to test the primary study hypotheses. No significant differences in nighttime sleep variables were found between groups. At the end of the intervention, the LM group showed significant improvement in daytime somnolence as indicated by a reduction in the duration of daytime sleep, an increase in daytime activity, and an improvement in day:night sleep ratio. The LM group also evidenced a significant increase in rest–activity rhythm amplitude and goodness of fit to the cosinor model.
CONCLUSION: Light treatment alone did not improve nighttime sleep, daytime wake, or rest–activity rhythm. Light treatment plus melatonin increased daytime wake time and activity levels and strengthened the rest–activity rhythm. Future studies should resolve the question of whether these improvements can be attributed to melatonin or whether the two zeitgebers interact to amplify efficacy.     

Arginine Vasopressin Immunoreactivity is Decreased in the Hypothalamic Suprachiasmatic Nucleus of Subjects with Suprasellar Tumors

Suprasellar tumors with compression of the optic chiasm are associated with an impaired sleep–wake rhythm. We hypothesized that this reflects a disorder of the biological clock of the human brain, the suprachiasmatic nucleus (SCN), which is located just above the optic chiasm. In order to test this hypothesis, we investigated the expression of two key neuropeptides of the SCN, that is, arginine vasopressin (AVP) and vasoactive intestinal peptide (VIP), as assessed by quantitative immunocytochemistry in post‐mortem hypothalamic tissue of patients with a suprasellar tumor inducing permanent visual field defects. Post‐mortem hypothalamic tissue of 5 patients with a suprasellar tumor inducing permanent visual field defects (acromegaly n = 2, nonfunctioning macro‐adenoma n = 1, macroprolactinoma n = 1, infundibular metastasis of a colorectal adenocarcinoma n = 1) and 15 age‐ and gender‐matched controls was obtained from the Netherlands Brain Bank. Total AVP immunoreactivity in the SCN was lower in patients with a suprasellar tumor than in controls (P = 0.03). By contrast, total VIP immunoreactivity was not different between patients and controls (P = 0.44). Suprasellar tumors leading to permanent visual field defects are associated with reduced AVP, but not VIP immunoreactivity, in the SCN. These findings raise the possibility that selective impairment of the SCN contributes to sleep–wake disturbances in these patients.     

Does sleep restore the topology of functional brain networks?

Previous studies have shown that healthy anatomical as well as functional brain networks have small‐world properties and become less optimal with brain disease. During sleep, the functional brain network becomes more small‐world‐like. Here we test the hypothesis that the functional brain network during wakefulness becomes less optimal after sleep deprivation (SD). Electroencephalography (EEG) was recorded five times a day after a night of SD and after a night of normal sleep in eight young healthy subjects, both during eyes‐closed and eyes‐open resting state. Overall synchronization was determined with the synchronization likelihood (SL) and the phase lag index (PLI). From these coupling strength matrices the normalized clustering coefficient C (a measurement of local clustering) and path length L (a measurement of global integration) were computed. Both measures were normalized by dividing them by their corresponding C‐s and L‐s values of random control networks. SD reduced alpha band C/C‐s and L/L‐s and theta band C/C‐s during eyes‐closed resting state. In contrast, SD increased gamma‐band C/C‐s and L/L‐s during eyes‐open resting state. Functional relevance of these changes in network properties was suggested by their association with sleep deprivation‐induced performance deficits on a sustained attention simple reaction time task. The findings indicate that SD results in a more random network of alpha‐coupling and a more ordered network of gamma‐coupling. The present study shows that SD induces frequency‐specific changes in the functional network topology of the brain, supporting the idea that sleep plays a role in the maintenance of an optimal functional network. Hum Brain Mapp, 2013. © 2011 Wiley Periodicals, Inc.     

Learning by observation requires an early sleep window

Numerous studies have shown that sleep enhances memory for motor skills learned through practice. Motor skills can, however, also be learned through observation, a process possibly involving the mirror neuron system. We investigated whether motor skill enhancement through prior observation requires sleep to follow the observation, either immediately or after a delay, to consolidate the procedural memory. Sequence-specific fingertapping performance was tested in 64 healthy subjects in a balanced design. Electromyography verified absence of overt or subliminal hand muscle activations during observation. The results show that immediate sleep is necessary for the enhancement of a motor skill through prior observation. Immediate sleep improved the speed of subsequent performance by 22 ± 11% (mean ± SEM) (P = 0.04) and reduced the error rate by 42 ± 19% (P = 0.02). In contrast, no performance gains occurred if sleep was initiated more than 12 h after observation. A second study on 64 subjects ruled out explicit familiarity with the sequence or the spatiotemporal rhythm of the sequence to underlie performance improvements. The sleep-dependent observational motor learning enhancement is at least similar to that previously reported for implicit and declarative memory. The apparent prerequisite of observing real movements indicates that subjects transfer experience obtained through observation of movements to subsequent self-initiated movements, in the absence of practice. Moreover, the consolidation of this transfer requires an early sleep window. These findings could improve learning new motor skills in athletes and children, but also in patients having to remaster skills following stroke or injury.     

No influence of melatonin on cerebral blood flow in humans

Melatonin has been attributed a role in a number of physiological processes. Changes in distal skin temperature and blood pressure after intake of melatonin suggest that melatonin induces peripheral vasodilation. The effect on the cerebral blood flow is still unknown. We examined the effect of a single pulse of melatonin on cerebral and peripheral blood flow, using the latter as a positive control. Ten male healthy volunteers (mean age, 22 +/- 3.2 yr) participated in a double-blind, randomized, placebo-controlled, cross-over study. On one occasion 10 microg melatonin were infused i.v., and on the other occasion saline was infused as the matching placebo. Cerebral blood flow was measured using phase contrast magnetic resonance imaging. Peripheral blood flow was determined from changes in the distal to proximal skin temperature gradient and finger pulse volume. Serum melatonin concentration increased from 12 +/- 5 pg/ml at baseline to 487 +/- 377 pg/ml at 5 min and 156 +/- 68 pg/ml at 10 min after melatonin administration. There was no significantly different time course for cerebral blood flow and cerebrovascular resistance. Compared with placebo, melatonin significantly increased peripheral blood flow, as measured by distal to proximal skin temperature gradient and finger pulse volume. These data demonstrate that melatonin does not have an acute regulatory effect on cerebral blood flow in humans.     

Effect of antenatal gymnastics on childbirth: a study on 50 sedentary women in the Republic of Benin during the second and third quarters of pregnancy

Antenatal gymnastics is a form of non-pharmacological childbirth preparation methods. It helps maintain rachidian statics and to relieve painful syndromes (joints, lumbar pains) during pregnancy. It also helps correct gravidic problems (leg cramps, back ache, weight increase, etc.). It is both a physical and psychological training method in accordance with the natural mechanisms of childbirth, implying personal involvement on the part of the parturient. Fifty (50) pregnant women of Benin (apart from pathological pregnancies) divided into two groups of 25 subjects (experimental group) and 25 subjects (control group) voluntarily took part in the study after having given their written assent. Each involved subject is paired with a counterpart of control following the same criteria: age of the gestante, parity, characteristic of the pelvis. Subjects aged from 17 to 42 trained twice a week with a minimum of 24 hours rest between two sessions; the training period intensity of exercise is limited to 60% of the maximum heart frequency and each training session lasts 45 min. The results show a lower number of caesareans and a significant lower number of untorn perineas in the experimental group. Apgar scores are also statistically higher in the children of trained women. This study confirms that sedentary pregnant women without any medical counter-indications (repetitive miscarriages, premature births, placenta praevia, cervical gaping, cardiac diseases, hypertension, narrow pelvis) can participate in antenatal gymnastics at a moderated rhythm, for their own benefit and that of their babies. Muscular force improvement (quality of the abdominal pushing), psychological control (absence of stress and panic), and good body form, can be noticed in trained mothers. However, abnormal presentation of baby, fetal suffering and the inherent characteristics of the pelvis (narrow) are factors requiring a caesarean. On the whole, antenatal gymnastics is an effective non-pharmacological means to avoid complications in childbirth. This method might be one of the solutions which could benefit pregnant women in Africa, considering its low cost compared to the exorbitant cost of medicines and hospitalisation.