Clin. Transl. Neurosci., Volume 7, Issue 4 (December 2023) – 13 articles

Biological, environmental, behavioral, and social factors can influence sleep and lead to sleep disorders or diseases. Sleep disorders are common, numerous, and heterogeneous in terms of their etiology, pathogenesis, and symptomatology. The management of sleep–wake circadian disorders (SWCDs) includes education on sleep hygiene, behavioral strategies, psychotherapy (cognitive behavioral therapy (CBT), particularly), instrument-based treatments (i.e., positive airway pressure therapy, hypoglossal nerve stimulation), and pharmacotherapy. Depending on the disease, therapy varies and is executed sequentially or can be a combination of several forms of therapy. Drugs used for SWCDs include traditional sleep- or wake-promoting agents and chronotherapeutic agents. Recently, novel medications, which more precisely act on specific neurochemical systems (i.e., the orexin system) important for sleep and waking, are also increasingly being used. In this review, the pharmacotherapy of common sleep disorders (insomnia, sleep-related breathing disorder, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and sleep-related movement disorders) embedded in the overall therapeutic concept of each disorder is presented. There is also an outlook on possible future pharmacotherapies. Full article

Background: Hyperbaric oxygen therapy (HBOT) has been shown to improve the outcomes of certain stroke patients. Our objective was to assess the feasibility of employing HBOT in daily practice in unselected stroke patients with mild-to-moderate residual post-stroke symptoms, considering their ability to commute our center. Methods: This was an exploratory, interventional, prospective monocentric study on post-stroke patients who have completed their in-hospital stroke rehabilitation. We aimed to include 10 participants who were able to complete 40 daily HBOT sessions (2.0 ATA). Effectiveness was assessed using the National Institutes of Health Stroke Score (NIHSS) pre- and post-HBOT. Results: We recruited 13 patients (12 males) with a mean age of 61 years. Three patients dropped out (two never started HBOT and one withdrew after five sessions because of traveling distance). Post-stroke time was 4–251 months. Among the 10 patients completing the HBOT program, 8 improved their NIHSS by a mean of 1,3 (1–4), while 2 patients’ NIHSS remained unchanged. There were no serious adverse events and no side effects. Conclusions: HBOT was shown to be feasible for mobile post-stroke patients who have completed standard rehabilitation. In the absence of major safety concerns, HBOT seems to be an interesting option post-stroke, with the potential to further improve residual stroke severity. Full article

Rocking devices are widely used across different age groups to facilitate sleep. This review discusses the current literature on rocking devices and how passive vestibular stimulation influences sleep architecture, sleep oscillations, and cognitive performance. We included eight studies that conducted research with rocking devices in humans (7) and mice (1) during daytime naps and/or nighttime sleep, respectively. Overall, vestibular stimulation during sleep induced faster sleep onset, coupled with more N2 in daytime naps or N3 in nighttime sleep. Vestibular stimulation also led to more sleep spindles and better memory consolidation. Optimal stimulation intensity was around 25 cm/s², and lower intensities led to smaller effects. The findings suggest a sweet spot for vestibular stimulation intensity, promoting deeper sleep at the cost of wakefulness or N1 sleep without compromising REM sleep. While further studies are needed to thoroughly investigate the motion parameters that drive the impact on sleep and cognitive performance, rocking devices may present a promising therapeutic tool for people with disrupted sleep patterns. Full article

On behalf of the SNS and SSNS, we are pleased to present the abstracts of the Joint Annual Meeting to be held in Zurich, Switzerland, on 23–24 November, 2023. In total, 119 abstracts have been selected: 4 abstracts for the Plenary Sessions, 12 abstracts for Free Communications, 18 abstracts for Poster flash presentations, 6 abstracts for the SAYN GemSession, and 79 abstracts as ePosters. We congratulate all the presenters on their research work and contributions. Full article

The brain and its health are essential for our (physical mental, social, and spiritual) wellbeing, for being able to realize our potential as individuals, and also for a fair, well-functioning, and productive society. However, today the world is facing a healthcare crisis related to the very high (and increasing) burden of brain disorders. As a response to this crisis, the “Swiss Brain Health Plan” (SBHP) was conceptualized in the context of other initiatives launched to value, promote, and protect brain health over the entire life course. In the first section of this position paper, the following fundamental considerations of the SBHP are discussed: (1) the high (and increasing) burden of brain disorders in terms of prevalence (>50% of the population suffers from a brain disorder), disability, mortality, and costs; (2) the prevention of brain disorders; (3) the operational definition of brain health; (4) determinants of brain health; (5) international initiatives to promote brain (including mental) health including the World Health Organization (WHO) intersectorial global action plan on epilepsy and other neurological disorders (NDs) (IGAP) and the WHO comprehensive mental health action plan. In the second section of the paper, the five strategic objectives of the SBHP, which has the vision of promoting brain health for all across the entire life course, are presented: (1) to raise awareness; (2) strengthen cross-disciplinary and interprofessional training/educational programs for healthcare professionals; (3) foster research on brain health determinants and individualized prevention of brain disorders; (4) prioritize a holistic (non-disease-specific), integrated, person-centered public health approach to promote brain health and prevent brain disorders through collaborations across scientific, health care, commercial, societal and governmental stakeholders and insurance providers; (5) support, empower, and engage patients, caregivers, and patient organizations, and reduce the stigma and discrimination related to brain disorders. In the third section of the paper, the first (2024) steps in the implementation of the SHBP, which will be officially launched in Zurich on 22 November 2023, are presented: (1) a definition of the overall organization, governance, specific targets, and action areas of the SBHP; (2) the patronage and/or co-organization of events on such specific topics as brain research (Lausanne), dementia (Geneva), stroke (Basel), neurohumanities (Bellinzona), sleep (Lugano), and psychiatry (Zurich); (3) the conduction of a new study on the global burden of brain disorders in Switzerland; (4) the launching of an international Certificate of Advanced Studies (CAS) on Brain Health at the University of Bern. In the fourth section of the paper, there is a concise executive summary of the SBHP. Full article

Sleep studies in psychiatric disorders date back to the first half of the 20th century. So far, success in establishing disease-specific sleep-related biomarkers has been quite limited. This is particularly obvious regarding insomnia, where there is no reliable correlation between subjective complaints and physiological measures of sleep. Finally, it must be acknowledged that the physiology of sleep and wakefulness and their subjective perception are essentially independent dimensions. Still, however, these dimensions are mixed up in clinical practice and research. This creates confusion, can be harmful for patients, and is identified as a major obstacle for successful psychiatric sleep research. It is proposed here that future sleep research should treat physiological sleep as a variable in psychiatric disorders which, independently of patient perception, has a transdiagnostic value, as was already proposed a decade ago by the Research Domain Criteria. Full article

The thalamus, and its projections to the cerebral cortex, are crucial for regulating sleep rhythms, such as sleep spindles, and for maintaining arousal and sleep homeostasis. Moreover, they play a significant role in memory, executive functioning, and attention. Altered thalamocortical circuitry caused by vascular lesions affects sleep–wake architecture and may contribute to cognitive deficits observed in thalamic stroke patients. This review summarizes the biology of the thalamus and current knowledge regarding the impact of thalamic circuitry on sleep regulation and cognition, drawing from clinical and pre-clinical studies. Furthermore, deep brain stimulation and transcranial magnetic stimulation are discussed as possible therapeutic approaches targeting thalamic circuits. Understanding the role of the thalamus in sleep and cognition opens new avenues for developing novel therapeutic strategies to improve sleep and cognitive functions in affected individuals. Full article

Although parasomnias are nocturnal phenomena occurring during sleep or during arousals from sleep, there is increasing evidence that they are associated with daytime dysfunction as well. However, systematic studies in this field are scarce. The aim of the current case series was to investigate the sleep–wake, neuropsychological and emotional profiles of patients with parasomnias. Thirty patients with parasomnia (13 NREM, 17 REM) and 30 healthy subjects matched for age, sex and educational status were included. All participants underwent comprehensive neuropsychological, cognitive and behavioral evaluation. We found that parasomnia patients scored higher in all neuropsychological, emotional, sleep–wake and quality of life scales compared to healthy subjects. The presence of a parasomnia was associated with major impact on daytime functioning across several domains with increased levels of fatigue (FSS > 4) in 56%, sleepiness (ESS > 10) in 47%, depressive symptoms (BDI > 20) in 17%, anxiety (PSWQ > 52) in 17%, anger expression out (STAXI A > 16) in 27% and anger expression in (STAXI B > 16) in 23%, as well as a reduced average quality of life score (RAND derived from SF-36). Sleep–wake disturbances were significantly correlated with QoL scores. In the intergroup analysis between REM/NREM, we found that the REM group had worse cognitive performance and lower levels of fatigue/energy compared to NREM patients. These findings suggest that parasomnia is associated with difficulties in several aspects of daytime functioning (cognitive, affective/emotional and physical) and, therefore, parasomnia diagnostic workup should not be limited only to nocturnal phenomena. Full article

Corrugator muscle activity with pressure pain stimulation has not yet been studied. We recorded corrugator muscle activity at rest and before, during and after pressure pain stimulation to the shoulder three times each in 14 healthy adults (20.0 ± 2.1 years of age (mean ± SD)) without pain using surface electromyography. Corrugator muscle activity with pressure pain and the relationships between corrugator muscle activity and pressure pain or unpleasantness intensity on a visual analogue scale measured three times were examined. The corrugator muscle activity during pressure pain stimulation was significantly higher than that before (p < 0.001) and after (p = 0.019) stimulation. There were significant differences among the three measurements examining reproducibility in pain (p = 0.037) and unpleasantness (p = 0.014) but not among corrugator muscle activities before (p = 0.526), during (p = 0.145) and after (p = 0.109) stimulation. Significant correlations were revealed for corrugator muscle activity vs. pain (ρ = 0.465, p = 0.002) and corrugator muscle activity vs. unpleasantness (ρ = 0.558, p < 0.001). Pressure pain increased corrugator muscle activity with reproducibility and correlated with subjective pain assessments, which indicates the utility of corrugator muscle activity as an objective indication of pain assessment. Full article

Shift workers are vulnerable to circadian misalignment, sleep disturbance and increased risk of impaired health. Studies concerning the sleep and health of individuals working shifts in the financial sector are lacking. We investigated sleep quality, sleep duration and associations with health in a UK financial organisation. Employees (n = 178; 61% male) completed an online survey comprising the SSI, PSQI, GAD-7, PHQ-9, WAFCS, EMQ-R and BMI. Three-quarters of employees reported poor sleep quality. Poorer sleep quality and shorter sleep duration were both associated with greater anxiety and depression symptoms. However, sleep quality demonstrated greater explained variance with symptom severity (anxiety: R_s² difference = 13.2%; depression: R_s² difference = 21.8%). Poorer sleep quality was associated with higher BMI, greater work-to-family conflict and poorer everyday memory (r_s = 0.26–0.29), while shorter sleep duration was only significantly associated with higher BMI. Sleep quality did not differ depending on the nightshift type (“permanent”/“other”). Sleep achieved was shorter than perceived sleep-need for all consecutive shift types—especially night shifts (40 min–1 h 24 min). This preliminary study suggests that sleep quality, and to a lesser extent sleep duration, are associated with a range of health outcomes for shift workers within the financial sector, highlighting the need to increase organisational awareness of the importance of sleep for employee health. Full article

PAPT syndrome is a rare neurologic disorder characterized by progressive ataxia and palatal tremor (rhythmic movements of the soft palate). The first large study of PAPT patients was published in 2004, included a total of 28 sporadic PAPT cases, and suggested a neurodegenerative origin. In the last several years, case reports and small case series followed, underlining the heterogeneity of the clinical picture and underlying aetiology (including neurodegenerative, vascular, infectious/autoimmune, and genetic). As a contribution to the literature, we report on four new patients with PAPT syndrome from Bern. Our study highlights the diverse clinical presentation (pyramidal, extrapyramidal, bulbar, cognitive, psychiatric symptoms, and autonomic features), summarizes the known literature, and extends it by findings on sleep studies (obstructive/central sleep apnoea, sleep disturbance). Possible aetiologies and management aspects are discussed in light of the current literature. Full article

The Swiss Narcolepsy Network (SNaNe) was founded in 2017 as a non-profit organization with the vision of improving the care of patients with narcolepsy, central disorders of hypersomnolence (CDH), and rare sleep disorders. The SNaNe aims at maximizing the speed of diagnosis, minimizing difficulties stemming from the rare nature of these conditions, and providing patients with optimum health care throughout the course of their disease. In addition, the SNaNe promotes education, awareness, and research on CDH and rare sleep disorders. The article reports the current structure, organization, and the following main activities of the SNaNe: (1) the discussion of complex patient cases; (2) the organization of the Swiss Narcolepsy Days; (3) the coordination of multicenter research projects (e.g., SPHYNCS and iSPHYNCS studies); (4) the establishment of an anonymous Swiss registry for CDH patients (SNaNe Data Registry); (5) the collaboration with the national patients’ organization (SNAG); and (6) the collaboration with other national and international scientific, professional, and patients’ (eNAP) organizations. Full article

Chronic insomnia (insomnia disorder—ID) afflicts up to 10% of the adult population, increases with age and affects more women than men. ID is associated with significant daytime impairments and an increased risk for developing major somatic and mental disorders, especially depression and anxiety disorders. Almost all insomnia models assume persistent hyperarousal on cognitive, emotional, cortical and physiological levels as a central pathophysiological component. The marked discrepancy between only minor objective alterations in polysomnographic parameters of sleep continuity and the profound subjective impairment in patients with insomnia is still puzzling. We and others have proposed that alterations in the microstructure of sleep, especially in REM sleep (REM sleep instability), may explain this discrepancy and be at the core of the experience of fragmented and poor sleep in ID. The REM sleep instability concept is based on evidence showing REM time to be related to subjective wake time in insomnia as well as increased micro- and macro-arousals during REM sleep in insomnia patients compared to good-sleeper controls. Our own work showed that ID patients awoken from REM sleep more frequently reported the perception of having been awake than good sleepers as well as having had more negative ideations. The continuous measurement of event-related potentials throughout the whole night demonstrated reduced P2 amplitudes specifically during phasic REM sleep in insomnia, which points to a mismatch negativity in ID reflecting automatic change detection in the auditory system and a concomitant orienting response. REM sleep represents the most highly aroused brain state during sleep and thus might be particularly prone to fragmentation in individuals with persistent hyperarousal, resulting in a more conscious-like wake experience reflecting pre-sleep concerns of patients with ID, i.e., worries about poor sleep and its consequences, thus leading to the subjective over-estimation of nocturnal waking time and the experience of disrupted and non-restorative sleep. Chronic REM sleep instability might also lead to a dysfunction in a ventral emotional neural network, including limbic and paralimbic areas activated during REM sleep. Along with a postulated weakened functioning in a dorsal executive neural network, including frontal and prefrontal areas, this might contribute to emotional and cognitive alterations and an elevated risk of developing depression and anxiety. Full article