The sleeping brain's connectivity and family environment: characterizing sleep EEG coherence in an infant cohort.

Brain connectivity closely reflects brain function and behavior. Sleep EEG coherence, a measure of brain's connectivity during sleep, undergoes pronounced changes across development under the influence of environmental factors. Yet, the determinants of the developing brain's sleep EEG coherence from the child's family environment remain unknown. After characterizing high-density sleep EEG coherence in 31 healthy 6-month-old infants by detecting strongly synchronized clusters through a data-driven approach, we examined the association of sleep EEG coherence from these clusters with factors from the infant's family environment. Clusters with greatest coherence were observed over the frontal lobe. Higher delta coherence over the left frontal cortex was found in infants sleeping in their parents' room, while infants sleeping in a room shared with their sibling(s) showed greater delta coherence over the central parts of the frontal cortex, suggesting a link between local brain connectivity and co-sleeping. Finally, lower occipital delta coherence was associated with maternal anxiety regarding their infant's sleep. These interesting links between sleep EEG coherence and family factors have the potential to serve in early health interventions as a new set of targets from the child's immediate environment

An infant sleep electroencephalographic marker of thalamocortical connectivity predicts behavioral outcome in late infancy

Infancy represents a critical period during which thalamocortical brain connections develop and mature. Deviations in the maturation of thalamocortical connectivity are linked to neurodevelopmental disorders. There is a lack of early biomarkers to detect and localize neuromaturational deviations, which can be overcome with mapping through high-density electroencephalography (hdEEG) assessed in sleep. Specifically, slow waves and spindles in non-rapid eye movement (NREM) sleep are generated by the thalamocortical system, and their characteristics, slow wave slope and spindle density, are closely related to neuroplasticity and learning. Spindles are often subdivided into slow (11.0-13.0 Hz) and fast (13.5-16.0 Hz) frequencies, for which not only different functions have been proposed, but for which also distinctive developmental trajectories have been reported across the first years of life. Recent studies further suggest that information processing during sleep underlying sleep-dependent learning is promoted by the temporal coupling of slow waves and spindles, yet slow wave-spindle coupling remains unexplored in infancy. Thus, we evaluated three potential biomarkers: 1) slow wave slope, 2) spindle density, and 3) the temporal coupling of slow waves with spindles. We use hdEEG to first examine the occurrence and spatial distribution of these three EEG features in healthy infants and second to evaluate a predictive relationship with later behavioral outcomes. We report four key findings: First, infants' EEG features appear locally: slow wave slope is maximal in occipital and frontal areas, whereas slow and fast spindle density is most pronounced frontocentrally. Second, slow waves and spindles are temporally coupled in infancy, with maximal coupling strength in the occipital areas of the brain. Third, slow wave slope, fast spindle density, and slow wave-spindle coupling are not associated with concurrent behavioral status (6 months). Fourth, fast spindle density in central and frontocentral regions at age 6 months predicts overall developmental status at age 12 months, and motor skills at age 12 and 24 months. Neither slow wave slope nor slow wave-spindle coupling predict later behavioral development. We further identified spindle frequency as a determinant of slow and fast spindle density, which accordingly, also predicts motor skills at 24 months. Our results propose fast spindle density, or alternatively spindle frequency, as early EEG biomarker for identifying thalamocortical maturation, which can potentially be used for early diagnosis of neurodevelopmental disorders in infants. These findings are in support of a role of sleep spindles in sensorimotor microcircuitry development. A crucial next step will be to evaluate whether early therapeutic interventions may be effective to reverse deviations in identified individuals at risk

Telefondolmetschen in der geburtshilflichen Nachbetreuung von fremdsprachigen Migrantinnen durch Hebammen zu Hause

Perinatal health disadvantage of migrants is exacerbated in presence of language barriers. Interpreting has the potential to optimize both, communication and outcome of mother and child. In Switzerland, a regional midwifery network provides access to telephone interpreting services although it is not remunerated by health insurances, and thus, is often impeded. This study examined usefulness, areas of use and difficulties of telephone interpreting in home postpartum care by midwives. Data was collected between September 2013 and March 2016 by midwives of the network. The questionnaire contained multiple- choice questions, a visual analogue scale and free-text fields. 46 questionnaires were evaluated. 10 out of 29 specially trained midwives exerted the service. Telephone interpreting was primarily used to record women’s concerns and provide information. The main topics were the somatic health of mother and child, breastfeeding, and more rarely psychosocial issues and information on care provision. Achieved understanding, increased women’s satisfaction and improved health competence were the perceived advantages in using the service. Difficulties, especially with the extra time needed for the consultation, insufficient telephone connection and professionality of the telephone interpreter, were stated less often. Overall, the midwives estimated the benefits of telephone interpreting for the quality of care with 7.4 out of 10 possible points. Although telephone interpreting improved the quality of care, midwives did infrequently use it. Specific training and video interpreting have the potential to increase the quality of the interpreted conversations and to minimize possible hurdles. Psychosocial issues should be addressed more intensively.Die gesundheitliche Benachteiligung von Migrantinnen in der geburtshilflichen Versorgung verschärft sich, wenn Sprachbarrieren vorliegen. Dolmetschen optimiert die Verständigung und das Outcome von Mutter und Kind, ist aber für viele Fachpersonen und Migrantinnen unzugänglich. Ein regionales Hebammennetzwerk stellt die in der Schweiz nicht krankenkassenpflichtigen Telefondolmetschdienste zur Verfügung. In dieser Untersuchung wurden der von Hebammen wahrgenommene Nutzen, die Einsatzbereiche und Schwierigkeiten des Telefondolmetschens im Rahmen der häuslichen Wochenbettnachsorge untersucht. Die Daten wurden bei jedem gedolmetschten Gespräch zwischen September 2013 und März 2016 durch die Hebammen des Netzwerkes erhoben. Der Fragebogen enthielt deskriptiv analysierte Fragen mit Mehrfachantworten, eine Frage mit visueller Analogskala sowie Freitextfelder. Insgesamt wurden 46 Fragebogen ausgewertet. Zehn von 29 eigens dazu geschulte Hebammen nutzten den Telefondolmetschdienst, und zwar vorwiegend zur Erfassung der Anliegen der Frau und zur Vermittlung von Informationen. Thema waren vor allem die somatische Gesundheit von Mutter und Kind und das Stillen, seltener die psychosoziale Situation und Informationen zu Versorgungsangeboten. Die erreichte Verständigung, die Zufriedenheit der Klientin und eine Verbesserung der Gesundheitskompetenz wurden als Vorteile gesehen. Schwierigkeiten, insbesondere mit dem zusätzlichen Zeitaufwand, der Telefonverbindungsqualität und der Qualität der Übersetzung, wurden seltener erlebt. Insgesamt schätzten die Hebammen den Nutzen des Telefondolmetschens für die Betreuungsqualität mit 7,4 von 10 möglichen Punkten ein. Obschon Telefondolmetschen die Qualität der Versorgung verbessert, wurde es von den Hebammen verhältnismässig wenig genutzt. Schulungen und möglicherweise Videodolmetschen haben das Potenzial, die Qualität der gedolmetschten Gespräche zu erhöhen und mögliche Hürden bei der Anwendung zu minimieren. Psychosoziale Themen sollten vermehrt besprochen werden

Bedtime to the brain: how infants’ sleep behaviours intertwine with non‐rapid eye movement sleep electroencephalography features

SummaryAdequate sleep is critical for development and facilitates the maturation of the neurophysiological circuitries at the basis of cognitive and behavioural function. Observational research has associated early life sleep problems with worse later cognitive, psychosocial, and somatic health outcomes. Yet, the extent to which day‐to‐day sleep behaviours (e.g., duration, regularity) in early life relate to non‐rapid eye movement (NREM) neurophysiology—acutely and the long‐term—remains to be studied. We measured sleep behaviours in 32 healthy 6‐month‐olds assessed with actimetry and neurophysiology with high‐density electroencephalography (EEG) to investigate the association between NREM sleep and habitual sleep behaviours. Our study revealed four findings: first, daytime sleep behaviours are related to EEG slow‐wave activity (SWA). Second, night‐time movement and awakenings from sleep are connected with spindle density. Third, habitual sleep timing is linked to neurophysiological connectivity quantified as delta coherence. And lastly, delta coherence at 6 months predicts night‐time sleep duration at 12 months. These novel findings widen our understanding that infants’ sleep behaviours are closely intertwined with three particular levels of neurophysiology: sleep pressure (determined by SWA), the maturation of the thalamocortical system (spindles), and the maturation of cortical connectivity (coherence). The crucial next step is to extend this concept to clinical groups to objectively characterise infants’ sleep behaviours ‘at risk’ that foster later neurodevelopmental problems

Acute sleep restriction increases dietary intake in preschool‐age children

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/136000/1/jsr12450_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136000/2/jsr12450.pd

Endocrine responses during CPAP withdrawal in obstructive sleep apnoea: data from two randomised controlled trials

The aim of this investigation was to elucidate the effect of CPAP withdrawal on neurometabolic and cardiometabolic markers in patients with obstructive sleep apnoea. We evaluated 70 patients (mean age 61 +/- 10 years, 82% men) treated with CPAP in two 2-week, parallel, randomised controlled trials. CPAP withdrawal resulted in elevated 3,4-dihydroxyphenylglycol, norepinephrine and cortisol after 2 weeks of CPAP withdrawal;however, no statistically significant changes of the renin-angiotensin-aldosterone system (RAAS) determinants were documented. In summary, CPAP withdrawal may be more prominently linked to short-term increases in sympathetic activation than hypothalamic-pituitary-adrenal axis or RAAS activation. ClinicalTrials.gov Identifier: NCT02493673 and NCT02050425

Sleep EEG slow-wave activity in medicated and unmedicated children and adolescents with attention-deficit/hyperactivity disorder

Slow waves (1-4.5 Hz) are the most characteristic oscillations of deep non-rapid eye movement sleep. The EEG power in this frequency range (slow-wave activity, SWA) parallels changes in cortical connectivity (i.e., synaptic density) during development. In patients with attention-deficit/hyperactivity disorder (ADHD), prefrontal cortical development was shown to be delayed and global gray matter volumes to be smaller compared to healthy controls. Using data of all-night recordings assessed with high-density sleep EEG of 50 children and adolescents with ADHD (mean age: 12.2 years, range: 8-16 years, 13 female) and 86 age- and sex-matched healthy controls (mean age: 12.2 years, range: 8-16 years, 23 female), we investigated if ADHD patients differ in the level of SWA. Furthermore, we examined the effect of stimulant medication. ADHD patients showed a reduction in SWA across the whole brain (-20.5%) compared to healthy controls. A subgroup analysis revealed that this decrease was not significant in patients who were taking stimulant medication on a regular basis at the time of their participation in the study. Assuming that SWA directly reflects synaptic density, the present findings are in line with previous data of neuroimaging studies showing smaller gray matter volumes in ADHD patients and its normalization with stimulant medication

Sleep spindles across youth affected by schizophrenia or anti-N-methyl-D-aspartate-receptor encephalitis

BackgroundSleep disturbances are intertwined with the progression and pathophysiology of psychotic symptoms in schizophrenia. Reductions in sleep spindles, a major electrophysiological oscillation during non-rapid eye movement sleep, have been identified in patients with schizophrenia as a potential biomarker representing the impaired integrity of the thalamocortical network. Altered glutamatergic neurotransmission within this network via a hypofunction of the N-methyl-D-aspartate receptor (NMDAR) is one of the hypotheses at the heart of schizophrenia. This pathomechanism and the symptomatology are shared by anti-NMDAR encephalitis (NMDARE), where antibodies specific to the NMDAR induce a reduction of functional NMDAR. However, sleep spindle parameters have yet to be investigated in NMDARE and a comparison of these rare patients with young individuals with schizophrenia and healthy controls (HC) is lacking. This study aims to assess and compare sleep spindles across young patients affected by Childhood-Onset Schizophrenia (COS), Early-Onset Schizophrenia, (EOS), or NMDARE and HC. Further, the potential relationship between sleep spindle parameters in COS and EOS and the duration of the disease is examined.MethodsSleep EEG data of patients with COS (N = 17), EOS (N = 11), NMDARE (N = 8) aged 7–21 years old, and age- and sex-matched HC (N = 36) were assessed in 17 (COS, EOS) or 5 (NMDARE) electrodes. Sleep spindle parameters (sleep spindle density, maximum amplitude, and sigma power) were analyzed.ResultsCentral sleep spindle density, maximum amplitude, and sigma power were reduced when comparing all patients with psychosis to all HC. Between patient group comparisons showed no differences in central spindle density but lower central maximum amplitude and sigma power in patients with COS compared to patients with EOS or NMDARE. Assessing the topography of spindle density, it was significantly reduced over 15/17 electrodes in COS, 3/17 in EOS, and 0/5 in NMDARE compared to HC. In the pooled sample of COS and EOS, a longer duration of illness was associated with lower central sigma power.ConclusionsPatients with COS demonstrated more pronounced impairments of sleep spindles compared to patients with EOS and NMDARE. In this sample, there is no strong evidence that changes in NMDAR activity are related to spindle deficits