Assessment of cardiac autonomic nervous system during sleep and sleep stability in patients affected by Amyotrofic Lateral Sclerosis

Objective: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease, associated with an almost exclusive involvement of upper and lower motor neurons, although autonomic impairment has also been described. Often patients affected by ALS complain of disturbed sleep and sudden death during sleep has been reported. To date, few overnight polysomnographic studies have been performed and a complete evaluation of autonomic nervous system (ANS) during sleep has never been performed before in ALS subjects. The aim of our study was to assess macro- and microstructure of sleep, detect any sleep disorders and evaluate cardiac ANS in a cohort of ALS patients, in order to better characterize the disease and identify novel strategies to improve quality of life and possibly prolong life expectancy. Methods: 23 patients affected by ALS (16M/7 F, age 26-79, mean 61) were compared to 15 healthy controls matched for age and sex. Each subject underwent a full-night videopolysomnography. Sleep staging was performed according to AASM criteria, assessment of sleep stability was made by means of both CAP detection and CPC (cardiopulmonary coupling), evaluation of ANS was made with assessment of HRV. Results: Compared to controls, ALS patients showed a significant reduction of sleep efficiency and of total sleep time, longer sleep latency than controls, together with an increased number of WASO, increased N1 sleep and decreased N2, N3 and REM sleep. Moreover patients showed a significant reduction of CAP rate mainly due to a significant reduction in phase A1 and A2. Compared to controls, patients showed significant reductions in: total HRV power during non-REM (p=0.005), LF in non-REM (p=0.01) and REM (p=0.003) sleep, and wake after sleep onset (WASO) (p=0.06) and also in HF during non-REM (p=0.04) and REM (p=0.05) sleep and WASO (p=0.03). CPC analysis showed the patients with the most advanced pathology, i.e. those with ALS-FRS<30, had the most unstable sleep patterns, with high percentage of LFC and low percentage of HFC (<4%). Interpretation: Our results confirm that sleep structure and stability of ALS patients is altered, and that there is a subclinical alteration of cardiac autonomic control in both sleep and wakefulness, with an impairment of both vagal and sympathetic systems. Moreover reduction of CAP rate, analogously to the reduction of HRV, may reflect an alteration of cortical circuits wich underlie to the organization of sleep and autonomic functions, which are strongly interconnected, that in these patients seem to be characterized by a marked rigidity, with poor reactivity and reduced adaptability to external or internal stimuli. These findings suggest the potential importance of assessment of autonomic nervous system and sleep in ALS, in conjunction with standard motor system evaluations

Considering REM Sleep Behavior Disorder in the Management of Parkinson's Disease

Rapid eye movement (REM) sleep behavior disorder (RBD) is the result of the loss of physiological inhibition of muscle tone during REM sleep, characterized by dream-enacting behavior and widely recognized as a prodromal manifestation of alpha-synucleinopathies. Indeed, patients with isolated RBD (iRBD) have an extremely high estimated risk to develop a neurodegenerative disease after a long follow up. Nevertheless, in comparison with PD patients without RBD (PDnoRBD), the occurrence of RBD in the context of PD (PDRBD) seems to identify a unique, more malignant phenotype, characterized by a more severe burden of disease in terms of both motor and non-motor symptoms and increased risk for cognitive decline. However, while some medications (eg, melatonin, clonazepam, etc.) and non-pharmacological options have been found to have some therapeutic benefits on RBD there is no available treatment able to modify the disease course or, at least, slow down the neurodegenerative process underlying phenoconversion. In this scenario, the long prodromal phase may allow an early therapeutic window and, therefore, the identification of multimodal biomarkers of disease onset and progression is becoming increasingly crucial. To date, several clinical (motor, cognitive, olfactory, visual, and autonomic features) neurophysiological, neuroimaging, biological (biofluids or tissue biopsy), and genetic biomarkers have been identified and proposed, also in combination, as possible diagnostic or prognostic markers, along with a potential role for some of them as outcome measures and index of treatment response. In this review, we provide an insight into the present knowledge on both existing and future biomarkers of iRBD and highlight the difference with PDRBD and PDnoRBD, including currently available treatment options

Prevalence of sleep disruption and determinants of sleepiness in a cohort of Italian hospital physicians: The PRESOMO study

Nightshift work can cause daytime somnolence and decreased alertness, and can increase risk of medical errors, occupational injuries and car accidents. We used a structured questionnaire, including the Epworth Sleepiness Scale (ESS), to assess the prevalence and the determinants of sleep disruption in 268 Italian University hospital physicians from Cagliari (N&nbsp;=&nbsp;57), Milan (N&nbsp;=&nbsp;180) and Pisa (N&nbsp;=&nbsp;31), who participated in the multicentre study on the prevalence of sleep disturbance among hospital physicians (PRESOMO); 198 of them (74%) were engaged in nightshift work. We explored the association between history of nightshift work and poor sleep quality and daytime somnolence with multivariate logistic regression, adjusting by personal and lifestyle covariates. Age, female gender, taking medication interfering with sleep and an elevated ESS score were significant predictors of poor sleep quality and daytime somnolence. Nightshift work was associated with a higher prevalence of unrestful sleep (84% versus 70%; odds ratio [OR]&nbsp;=&nbsp;2.4, 95% confidence interval [CI] 1.18-5.05) and daytime dozing (57% versus 35%; OR&nbsp;=&nbsp;1.9, 95% CI 1.03-3.64), with an upward trend by years of engagement in nightshift work for both conditions (p&nbsp;=&nbsp;.043 and 0.017, respectively), and by number of nightshifts/year for unrestful sleep (p&nbsp;=&nbsp;.024). Such an association was not detected with the ESS scale. Our results suggest that nightshift work significantly affects sleep quality and daytime somnolence in hospital physicians, who might underestimate their daytime dozing problem, when asked to subjectively scale it

The main actors involved in parasitization of Heliothis virescens larva

At the moment of parasitization by another insect, the host Heliothis larva is able to defend itself by the activation of humoral and cellular defenses characterized by unusual reactions of hemocytes in response to external stimuli. Here, we have combined light and electron microscopy, staining reactions, and immunocytochemical characterization to analyze the activation and deactivation of one of the most important immune responses involved in invertebrates defense, i.e., melanin production and deposition. The insect host/parasitoid system is a good model to study these events. The activated granulocytes of the host insect are a major repository of amyloid fibrils forming a lattice in the cell. Subsequently, the exocytosed amyloid lattice constitutes the template for melanin deposition in the hemocel. Furthermore, cross-talk between immune and neuroendocrine systems mediated by hormones, cytokines, and neuromodulators with the activation of stress-sensoring circuits to produce and release molecules such as adrenocorticotropin hormone, alpha melanocyte-stimulating hormone, and neutral endopeptidase occurs. Thus, parasitization promotes massive morphological and physiological modifications in the host insect hemocytes and mimics general stress conditions in which phenomena such as amyloid fibril formation, melanin polymerization, pro-inflammatory cytokine production, and activation of the adrenocorticotropin hormone system occur. These events observed in invertebrates are also reported in the literature for vertebrates, suggesting that this network of mechanisms and responses is maintained throughout evolution

Periodic leg movements during sleep and cardiovascular and/or cerebrovascular morbidity

Purpose of Review To evaluate if periodic leg movements during sleep (PLMS) may be associated with increased cardiovascular or cerebrovascular morbidity Recent Findings PLMS are accompanied by rises in hear rate and blood pressure and by important transient EEG changes indicating sleep fragmentation; in addition, PLMS have been related to elevated levels of inflammatory markers that are associated with increased cardiovascular and cerebrovascular risk and several reports have suggested that PLMS may play an important role in increasing cardiovascular risk, resulting in hypertension, cardiac ischemic disease, and cerebrovascular disease. Summary Although a body of evidence suggests that PLMS are involved in increasing cardiovascular risk, additional studies are needed to establish the contributory role of PLMS to cardiovascular homeostasis and morbidity in patients with and without RLS, and to evaluate the role of the specific PLMS treatment to reduce the risk

Sleep, Sleep Structure and Sleep Disorders in a Cohort of Patients Affected by ALS

Amyotrophic Lateral Sclerosis is a neurodegenerative disease, mostly due to progressive loss of motor neurons, with poor prognosis. Although motor involvement is predominant, other systems may be altered, and, among these, also sleep. The aim of this study is to evaluate sleep in a cohort of patients affected by ALS. We consecutively enrolled 48 patients, whom underwent to clinical and instrumental evaluation, including a full night video-PSG. They were compared to 15 control subjects. Respect to controls, patients had fragmented sleep, with poor sleep efficiency, higher amount of WASO and N1 sleep stage, and lower percentage of N2 and REM sleep stages, despite they perceived a sleep of good quality. Moreover, 33% of patients underwent video-PSG was diagnosed with OSAS, and 14, 28% with nocturnal respiratory insufficiency. Start NIV early is known to raise QOL, prolong life expectancy, and improve compliance to subsequent 24h NIV and tracheal ventilation. Furthermore, sleep of bad quality is a cardiovascular risk factor. In conclusion, in patients with ALS, instrumental assessment of sleep in early stages of the disease should be mandatory

Overlap Parasomnia Disorder in a case of Creutzfeldt-Jakob Disease

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The effect of Leptomastix dactylopii parasitism and venom injection on host Planococcus citri

10One of the major alterations observed in mealybug Planococcus citri parasitized by Leptomastix dactylopii is a strong reduction of laid eggs, which is evident soon after parasitization. Venom injection in unparasitized hosts determines a drastic reduction of fecundity indicating that this female secretion injected at the oviposition plays a key-role in host regulation. In order to assess the impact of parasitism and venom injection on host reproductive tissues, ovaries were dissected at different time intervals after these treatments and observed by light and transmission electron microscopy. The developing eggs showed clear symptoms of degeneration, already half an hour after parasitization or venom injection. Heat and protease treatments of venom nearly suppressed its effects on host reproduction, indicating that proteins are likely responsible for the observed alterations. The electrophoretic profile of venom proteins covers a wide range of molecular masses between 15 to 200 kDa but five major bands having a molecular mass of about 27, 30, 40, 90 and 120 kDa respectively were more evident. Moreover, to establish any parasitoid preference in host selection, among the adult female mealybugs at different stages of maturation and a possible relation with fecundity reduction in the host, the parasitoid behavior was observed.openBattaglia, D.; Colella, T.; Laurino, S.; Grossi, G.; Salvia, R.; Riviello, L.; Grimaldi, A.; Congiu, T.; de Eguileor, M.; Falabella, P.Battaglia, D.; Colella, T.; Laurino, S.; Grossi, G.; Salvia, R.; Riviello, L.; Grimaldi, Annalisa; Congiu, Terenzio; DE EGUILEOR, MAGDA ANNA; Falabella, P