Cognitive dysfunction in rapid eye movement sleep behavior disorder

Cognitive impairment is a frequent feature of rapid eye movement sleep behavior disorder (RBD). The cognitive profile of RBD patients is heterogeneous, with impairments in attention, executive functions, episodic memory, and visuospatial abilities. Moreover, over 50% of RBD patients meet the diagnostic criteria for mild cognitive impairment (MCI). Although a comprehensive neuropsychological assessment remains the most sensitive way to detect MCI, three cognitive screening tests have been validated in RBD. The Montreal Cognitive Assessment was found to be the most appropriate screening test for detecting MCI in RBD. In addition RBD in Parkinson’s disease may be a risk factor for MCI and dementia.

     

Spectrum of rapid eye movement sleep behavior disorder (overlap between rapid eye movement sleep behavior disorder and other parasomnias)

Parasomnia Overlap Disorder (POD) was described and named in 1997 with a series of 33 cases of rapid eye movement (REM) sleep behavior disorder (RBD) combined with a disorder of arousal from non-rapid eye movement (NREM) sleep (sleepwalking, sleep terrors) that emerged idiopathically or symptomatically with neurological and other disorders. POD is a subtype of RBD in the International Classification of Sleep Disorders Diagnostic and Coding Manual, second edition (ICSD-2). An updated classification of POD also includes subclinical RBD-NREM parasomnia, RBD-sleep-related eating disorder, RBD-sexsomnia, RBD-rhythmic movement disorder, and status dissociatus (SD), which is another subtype of RBD in the ICSD-2. Similar to POD, a core feature of SD is sleep motor-behavioral dyscontrol, with release of dream-related behaviors suggestive of RBD, but with nearly continuous ambiguous polygraphic sleep precluding the identification of NREM/REM sleep states. SD exemplifies extreme state dissociation. SD is always a symptomatic disorder, and is causally associated with a broad range of neurologic disorders, often with thalamic, limbic, striatal, and pontine involvement. The parasomnia behaviors associated with POD and SD — typical RBD behaviors — can often be controlled with bedtime clonazepam therapy, including the abnormal dreaming.

     

Brainstem structures involved in rapid eye movement sleep behavior disorder

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by the loss of muscle atonia during paradoxical (REM) sleep (PS). The neuronal dysfunctions responsible for RBD are not known. In the present review, we propose an updated integrated model of the mechanisms responsible for PS and explore different hypotheses explaining RBD. We propose that RBD appears based on a specific degeneration of PS-on glutamatergic neurons localized in the caudal pontine sublaterodorsal tegmental nucleus or the glycinergic/GABAergic premotoneurons localized in the medullary ventral gigantocellular reticular nucleus.

     

Characteristics of rapid eye movement sleep behavior disorder in narcolepsy

The basal forebrain (BF) plays an important role in regulating cortical activity and sleep/wake states. Both cholinergic and non-cholinergic neurons of the BF project to the cerebral cortex and hippocampus, whereas the hypothalamus and brainstem nuclei are mostly innervated by non-cholinergic BF neurons. Neurons in the BF show various discharge profiles in relation to cortical activity and behavioral states and are differentially modulated by neurotransmitters of other sleep/wake regulatory neurons. Recent technical advances have made it possible to correlate discharge profiles of single BF neurons during sleep/wake states with their neurochemical phenotypes, and to make selective lesions of certain cell types. The goal of this review is to summarize the current knowledge of the anatomy and sleep/wake regulatory functions of cholinergic and non-cholinergic BF neurons. We will first review the anatomical heterogeneity of BF neurons, and then discuss recent evidence for the firing patterns of BF cholinergic and non-cholinergic neurons during natural sleep–wake patterns, and finally, discuss their roles in sleep homeostasis. It is proposed that through different neurotransmitters, projections, and state-regulated activity, the cholinergic and non-cholinergic BF neurons collectively and differently regulate cortical activity and sleep-wake states.

     

Dream imagery,rapid eye movement sleep behavior disorder,and hallucinations

Rapid eye movement (REM) sleep behavior disorder (RBD) and hypnagogic hallucinations are salient symptoms of abnormal and dissociated REM sleep that are frequently associated in serious neurological diseases. RBD is a strong, independent risk factor for hallucinations in narcolepsy (odds ratio: 4.3) and in Parkinson’s disease (odds ratio: 2.7). In Parkinson’s disease, RBD also predicts incident hallucinations and psychosis in prospective cohorts. Status dissociatus (a mixture of hallucinations, RBD, and dissociated sleep-wake states) is observed in patients with Guillain-Barré when hallucinating, but also in Lewy bodies dementia, delirium tremens, fatal familial insomnia, and Morvan’s chorea. This co-occurrence of RBD and visual hallucinations suggests a common, extensive lesion within REM sleep executive systems.

     

Differences in rapid eye movement sleep behavior disorder manifestation between synucleinopathies and tauopathies

Rapid eye movement sleep behavior disorder (RBD) frequently occurs in synucleinopathies including multiple system atrophy, Parkinson’s disease, and dementia with Lewy bodies despite the clinical course of RBD being different between these disorders. Comparatively, the existence of RBD symptoms is relatively rare in patients with progressive supranuclear palsy, a tauopathy showing atypical parkinsonism compared with Parkinson’s disease. Moreover, in patients with Alzheimer’s disease, which is another tauopathy, RBD symptoms are less frequent than dementia with Lewy bodies, although both disorders share commonalities in terms of the existence of cortical dementia. Thus, RBD is thought to be relatively specific to synucleinopathies.

     

Magnetic resonance imaging in rapid eye movement sleep behavior disorder: Diffusion tensor imaging and voxel-based morphometry

Economo observed in 1930 that many cases of lethargy begin with a severe insomnia and fever followed by a long-lasting hypersomnia. We confirmed this evidence in animal cases where chemical lesions of the preoptic region resulted in severe insomnia accompanied with fever. Moreover, a subsequent pharmacological inhibition of neuronal activity of the posterior ventrolateral hypothalamus caused transient hypersomnia in these insomniac animals. However, vigilance states of the experimental animals returned to normal after several weeks, suggesting that the irreversible Economo’s lethargy may be due to the damage of passing fibers in the ventral hypothalamus. Similarly, chemical lesions of neurons of the midbrain reticular formation did not induce coma nor hypersomnia, which is inconsistent with lesion studies reported by Lindsley et al. using electrolytic coagulation. This fact further supports the importance of passing fibers in the midbrain. In addition, Mauthner in 1890 observed hypersomnia and abnormal eye movements in lethargic patients infected by “nona”, suggesting the implication of the periaqueductal gray in the vicinity of the 3rd nerve. We confirmed this hypothesis: hypersomnia was accompanied by a significant increase in REM sleep after chemical inactivation of a small part of the ventrolateral periaqueductal gray and dorsal portion of the subjacent reticular formation. On the other hand, removal of the tele- and di-encephalon caused an irreversible coma and abolished the daily rhythm of REM. This state of sleep is also regulated by forebrain structures and internal clocks in the suprachiasmatic nucleus.

     

Predicting neurodegenerative disease in idiopathic rapid eye movement (REM) sleep behavior disorder: Conference proceedings,REM Sleep Behavior Symposium 2011

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment behavior during rapid eye movement sleep, which is generally related to damage of pontomedullary structures. Idiopathic RBD is a well-established risk factor for neurodegenerative disease; at least 40-65% of patients with idiopathic RBD will develop a defined neurodegenerative phenotype over 10 years. This is almost always a “synucleinopathy” (Parkinson’s disease, dementia with Lewy bodies, or multiple system atrophy). Often, patients develop a syndrome with overlapping parkinsonism and cognitive impairment. The ability of RBD to predict disease has major implications for development of neuroprotective therapy, by providing a high-risk prodromal group for neuro-protective trials. In addition, it allows testing of other predictive markers of neurodegeneration. Recent prospective studies found that idiopathic RBD patients with abnormal olfaction at baseline had a 65% 5-year risk of developing neurodegenerative disease, compared with a 14% risk in those with normal olfaction. Those with abnormal color vision had a 74% risk of neurodegenerative disease compared with 26% in those with normal vision. Additionally, neuroimaging markers of the sub-stantia nigra including dopaminergic functional imaging and transcranial ultrasound have been able to predict imminent development of defined neurodegenerative disease in RBD, although sensitivity and lead time have not been established. Future studies will continue to expand the list of predictive markers of neurodegeneration and will better define specificity, sensitivity, and lead time of prodromal markers.

     

Phencyclidine produces aggressive behavior in rapid eye movement sleep-deprived rats

This study examined effects of acute doses of phencyclidine (PCP; 0.025, 0.05, 0.10, and 0.20 mg/kg intraperitoneally) on intra-specific aggressive behavior and muricide in normal rats and rats deprived of rapid eye movement (REM) sleep. Dose-related changes in intra-specific aggression and muricide occurred in REM sleep-deprived rats only. Dose-response curves are inverted-U shaped with the .05 mg/kg dose producing increases in aggression. Intra-specific and muricide may serve as models of PCP-induced aggression in humans.     

Pontogeniculooccipital waves: spontaneous visual system activity during rapid eye movement sleep

1. Pontogeniculooccipital (PGO) waves are recorded during rapid eye movement (REM) sleep from the pontine reticular formation, lateral geniculate bodies, and occipital cortex of many species. 2. PGO waves are associated with increased visual system excitability but arise spontaneously and not via stimulation of the primary visual afferents. Both auditory and somatosensory stimuli influence PGO wave activity. 3. Studies using a variety of techniques suggest that the pontine brain stem is the site of PGO wave generation. Immediately prior to the appearance of PGO waves, neurons located in the region of the brachium conjunctivum exhibit bursts of increased firing, while neurons in the dorsal raphe nuclei show a cessation of firing. 4. The administration of pharmacological agents antagonizing noradrenergic or serotonergic neurotransmission increases the occurrence of PGO waves independent of REM sleep. Cholinomimetic administration increases the occurrence of both PGO waves and other components of REM sleep. 5. Regarding function, the PGO wave-generating network has been postulated to inform the visual system about eye movements, to promote brain development, and to facilitate the response to novel environmental stimuli.     

Auditory event-related potentials from a single-stimulus paradigm during rapid eye movement sleep

Sleep and Biological Rhythms - Auditory evoked potentials to a 2000-Hz pure tone were recorded in wakefulness and in rapid eye movement (REM) sleep. A late positive wave with a maximal amplitude...     

快速眼动睡眠剥夺对大鼠恐惧消退再现的影响

目的：研究两种实验范式AAA和ABA（A、B表示不同场景）中快速眼动睡眠剥夺（RSD）对大鼠恐惧消退再现的影响。方法：1d大鼠适应环境;2d进行恐惧条件化;3d恐惧消退训练并进行RSD;4d进行恐惧消退再现检测。结果：AAA实验范式中,在恐惧消退再现检测阶段,0～6hRSD组大鼠的僵直水平显著高于对照组（P〈0．05）,其他阶段处理组与对照组大鼠的僵直水平都无显著性;ABA实验范式中,各阶段处理组与对照组大鼠的僵直水平都无显著性。结论：不同实验范式中RSD对恐惧消退影响不同,并且这种影响依赖于睡眠剥夺的时段。     

Effect of rapid eye movement sleep deprivation on sexual behaviour of male rats

Rapid eye movement sleep deprivation for 3 to 4 days by the platform pedestal procedure produced an increase in sexual behaviour of male rats. The possible factors contributing towards the increase in sexual behaviour are discussed.     

Temporally structured replay of awake hippocampal ensemble activity during rapid eye movement sleep

Human dreaming occurs during rapid eye movement (REM) sleep. To investigate the structure of neural activity during REM sleep, we simultaneously recorded the activity of multiple neurons in the rat hippocampus during both sleep and awake behavior. We show that temporally sequenced ensemble firing rate patterns reflecting tens of seconds to minutes of behavioral experience are reproduced during REM episodes at an equivalent timescale. Furthermore, within such REM episodes behavior-dependent modulation of the subcortically driven theta rhythm is also reproduced. These results demonstrate that long temporal sequences of patterned multineuronal activity suggestive of episodic memory traces are reactivated during REM sleep. Such reactivation may be important for memory processing and provides a basis for the electrophysiological examination of the content of dream states.     

Influence of fear conditioning on elicited ponto-geniculo-occipital waves and rapid eye movement sleep

The amygdala plays a central role in fear conditioning, a model of anticipatory anxiety. It has massive projections to brainstem regions involved in rapid eye movement sleep (REM) and ponto-geniculo-occipital (PGO) wave generation. PGO waves occur spontaneously in REM or in response to stimuli. Electrical stimulation of the central nucleus of the amygdala enhances spontaneous PGO wave activity during REM and the amplitude of both the acoustic startle response and the elicited PGO wave (PGOE), a neural marker of alerting. This study examined the effects of fear conditioning on REM and on PGOE. On conditioning days, the number of REM episodes, the average REM duration and the REM percentage were decreased while REM latency was increased. The presentation of auditory stimuli in the presence of a light conditioned stimulus produced PGOE of greater amplitudes. The results suggest that fear, most likely involving the amygdala, can influence REM and brainstem alerting mechanisms.     

Paradoxical inward rib cage motion during rapid eye movement sleep in infants and young children

In neonates, rib cage motion on inspiration during rapid eye movement sleep is almost exclusively paradoxical. We wondered whether or not duration of paradoxical inward rib cage motion on inspiration during rapid eye movement sleep decreases in infancy and early childhood. Thirteen healthy infants from 7 to 31 months of age were tested during natural afternoon naps. Electroencephalogram, electrooculogram and electromyogram were all recorded. Airflow was measured by nasal and buccal thermistors, abdominal and rib cage anteroposterior diameters by magnetometers. Transcutaneous partial pressure of O2 was monitored. Diaphragmatic electromyographic activity was recorded using surface electrodes. The average total sleep time was 138 min ranging from 107 to 186 and rapid eye movement sleep time amounted to 15% of total sleep time ranging from 6 to 25. During rapid eye movement sleep, the total duration of paradoxical inward rib cage motion was measured and expressed as a percentage of rapid eye movement sleep time. We found that duration of paradoxical inward rib cage motion during rapid eye movement sleep decreased significantly with age (r = -0.66, P less than 0.02) which may be explained by the changes in chest wall compliance and geometry of the rib cage occurring with growth. We observed no decrease in transcutaneous partial pressure in O2 during paradoxical inward rib cage motion during rapid eye movement sleep in infants in contrast to that reported in neonates.     

Immune alterations after selective rapid eye movement or total sleep deprivation in healthy male volunteers

We investigated the impact of two nights of total sleep deprivation (SD) or four nights of rapid eye movement (REM) SD on immunological parameters in healthy men. Thirty-two volunteers were randomly assigned to three protocols (control, total SD or REM SD). Both SD protocols were followed by three nights of sleep recovery. The control and REM SD groups had regular nights of sleep monitored by polysomnography. Circulating white blood cells (WBCs), T- (CD4/CD8) and B-lymphocytes, Ig classes, complement and cytokine levels were assessed daily. Two nights of total SD increased the numbers of leukocytes and neutrophils compared with baseline levels, and these levels returned to baseline after 24 h of sleep recovery. The CD4(+) T-cells increased during the total SD period (one and two nights) and IgA levels decreased during the entire period of REM SD. These levels did not return to baseline after three nights of sleep recovery. Levels of monocytes, eosinophils, basophils and cytokines (IL-1β, IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ) remained unchanged by both protocols of SD. Our findings suggest that both protocols affected the human immune profile, although in different parameters, and that CD4(+) T-cells and IgA levels were not re-established after sleep recovery.