The Role of the Suprachiasmatic Nucleus in Cardiac Autonomic Control during Sleep

<div><p>Background</p><p>The suprachiasmatic nucleus (SCN) may play an important role in central autonomic control, since its projections connect to (para)sympathetic relay stations in the brainstem and spinal cord. The cardiac autonomic modifications during nighttime may therefore not only result from direct effects of the sleep-related changes in the central autonomic network, but also from endogenous circadian factors as directed by the SCN. To explore the influence of the SCN on autonomic fluctuations during nighttime, we studied heart rate and its variability (HRV) in a clinical model of SCN damage.</p><p>Methods</p><p>Fifteen patients in follow-up after surgical treatment for nonfunctioning pituitary macroadenoma (NFMA) compressing the optic chiasm (8 females, 26–65 years old) and fifteen age-matched healthy controls (5 females, 30–63 years) underwent overnight ambulatory polysomnography. Eleven patients had hypopituitarism and received adequate replacement therapy. HRV was calculated for each 30-second epoch and corrected for sleep stage, arousals, and gender using mixed effect regression models.</p><p>Results</p><p>Compared to controls, patients spent more time awake after sleep onset and in NREM1-sleep, and less in REM-sleep. Heart rate, low (LF) and high frequency (HF) power components and the LF/HF ratio across sleep stages were not significantly different between groups.</p><p>Conclusions</p><p>These findings suggest that the SCN does not play a dominant role in cardiac autonomic control during sleep.</p></div

Effects of mixed effects regression model coefficients on heart rate and heart rate variability.

<p>Effects of mixed effects regression model coefficients on heart rate and heart rate variability.</p

Clinical characteristics of patients with NFMA and healthy age-matched control subjects.

<p>Clinical characteristics of patients with NFMA and healthy age-matched control subjects.</p

Heart rate variability in patients and controls.

<p>Heart rate, low- and high frequency power and their ratio, in 15 NFMA patients and 15 healthy controls, stratified for wake and sleep stages. Data represent mean ± SD, calculated over averages for each subject. WBSO, wake before sleep onset; REM, rapid eye movement sleep; LF, low frequency power in ln(ms²/Hz); HF, high frequency power in ln(ms²/Hz). None of the differences reached statistical significance after correction for multiple testing (<i>P</i> < 0.01) in our secondary analysis.</p

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle.

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease