oliviero bruni - Dipartimento di Psicologia dei Processi di Sviluppo e

OLIVIERO BRUNI
RICERCATORE
SSD - MED/39
PRESENTAZIONE
LINEE DI RICERCA
Afferenza al Dipartimento di
Psicologia dei Processi di
Sviluppo e Socializzazione
Direttore Prof.ssa Emma
Baumgartner
Sapienza - Università di Roma
PIETRO
BENEDETTI
Professore Ordinario di
Neuropsichiatria
Infantile
(1926 – 2003)
Un giorno del 1990….
“OLIVIERO, TU DA DOMANI
TI OCCUPI DI SONNO…”
…Va bene Professore, ma da dove
comincio?
“SONO FATTI TUOI, FAI
COME TI PARE, MA FAI…”
TEOGONIA, ESIODO
Notte generò Moros, la nera
Kere e la Morte. Generò il
Sonno e la specie dei Sogni
Nyx (Notte) era la personificazione della notte terrestre, e il fratello
Erebo (Tenebre) rappresentava la notte del mondo infernale.
Da Notte nacquero:
…
Etere (la luce) ed Emera (il giorno)
…
Eris (discordia), Nemesis (vendetta), Moro (destino)
…
Hypnos (il sonno) e il gemello Thanatos (la morte)
Hypnos
Figlio delle Tenebre e della Notte,
fratello della Morte (Thanatos) e del
Destino (Moros) e padre dei Sogni
Come i suoi molti figli, tra cui Morfeo, il dio dei sogni,
Hypnos dormiva in una caverna in cui scorreva il
Lete, fiume dell'oblio (Stazio, Tebaide, X, 84-90), e
davanti alla quale crescevano piante di papavero
(Ovidio, Metamorfosi, XI, 604-607).
Era considerato un dio benefico che aiutava gli uomini
ad assopire il dolore
 Ovidio diede un nome ai tre figli di
Hypnos:
… Morfeo
 inviava i sogni popolati da forme
umane
… Phobetor (Fobetore)
 inviava i sogni popolati da animali
… Phantasos (Fantaso)
 inviava i sogni popolati da oggetti
inanimati
MORFEO
 E' il dio dei sogni, che provoca sfiorando un
mazzo di papaveri sulle palpebre di chi dorme.
 Possiede grandi e possenti ali che lo portano
rapidamente da una parte all'altra della terra.
 Il suo nome deriva dalla parola greca che
significa "forma": infatti era solito assumere la
forma degli esseri umani per mostrarsi agli
uomini addormentati durante i loro sogni.
I SOGNI PER GLI ANTICHI
 Nelle civiltà antiche la considerazione data ai
sogni era altissima: essi erano emissari divini e
avevano funzione premonitiva e terapeutica
 I sogni possono annunciare in anticipo, in
maniera più o meno simbolica, l'insorgenza o lo
sviluppo delle malattie, o di altri processi
fisiologici.
 Questi sogni, però, non rappresentano presagi di
malattie future, ma segnalano disturbi già
esistenti – non avvertiti dalla coscienza.
FUNZIONE TERAPEUTICA
DEL SOGNO
Tempio di Asclepio ad Epidauro
 Il sogno guaritore, che gli ammalati
attendevano nella calma della Klynè
del tempio di Asclepio ("grotte
dei sogni“), era inviato dagli Dei
benevoli
• Nel punto più oscuro della grotta,
l'ammalato restava a sognare a
lungo, e veniva riportato alla
luce, seduto sulla sedia del
ricordo, per raccontare ai
sacerdoti i sogni e le visioni
DANTE ALIGHIERI- LA DIVINA COMMEDIA
INFERNO – CANTO XXXIII
Breve pertugio dentro da la Muda,
la qual per me ha 'l titol de la fame,
e che conviene ancor ch'altrui si chiuda,
m'avea mostrato per lo suo forame
più lune già, quand' io feci 'l mal sonno
che del futuro mi squarciò 'l velame.
IL Conte Ugolino venne rinchiuso insieme a due figli e due nipoti nella Torre della Muda o
della Muta, così denominata perché in quel luogo i colombi viaggiatori vi mutavano il
piumaggio. Proprio nella torre, successivamente detta "della fame", dopo alcuni mesi di
prigionia, Ugolino ed i suoi discendenti furono lasciati morire di fame nel febbraio del 1289.
Dante Alighieri lo condanna a rodere - per l'eternità - il cranio dell'Arcivescovo Ruggieri, suo
principale accusatore.
Il sogno che Ugolino ha nella torre della fame, dopo lunga prigionia, è immediata premonizione
della realtà che si manifesterà l 'indomani, con l'ìnchiodamento della porta.
DANTE ALIGHIERI - LA DIVINA COMMEDIA
PURGATORIO – CANTO XXVII
Poco parer potea lì del di fori;
ma, per quel poco, vedea io le stelle
di lor solere e più chiare e maggiori.
Sì ruminando e sì mirando in quelle,
mi prese il sonno; il sonno che sovente,
anzi che 'l fatto sia, sa le novelle.
E’ vero, può capitare che un sogno offra la soluzione a
un problema. Quante volte romanzieri, inventori e
matematici, sfiniti dalla fatica, si sono coricati sconfitti
e hanno trovato nella notte le risposte che cercavano,
sotto forma di dono ricevuto in sogno
J. HILLMAN
Eureka moments. Sono quei momenti in cui, al
risveglio, si trova la soluzione ad un problema a cui
si pensava da giorni o da anni
Eureka moments
LINEE DI RICERCA PASSATE E ATTUALI
 Sonno ed epilessia
 Questionari sul sonno e sul sogno
 Sonno e cefalea
 Sonno e temperamento
 Neurofisiologia del sonno/ cyclic alternating
pattern
 Sonno e funzioni cognitive/ rendimento scolastico
 Sonno e autismo a basso ed alto funzionamento
45%
40%
Children with
seizures showed a
more disrupted
sleep architecture
compared with
seizure-free
children.
TS
CONTROL
35%
30%
25%
20%
15%
10%
5%
0%
WASO
1 NREM
2 NREM
3-4 NREM
REM
Sleep disorders in TS were mainly due to
sleep related epileptic events and were more
evident in children who showed large
bifrontal or temporal tubers onMRI.
•
•
•
•
•
Only child
Breast-fed
Absence of acute or chronic illness or neurological or
developmental disorders
Intact families
Absence of stressful events

4170 short structured interviews

2889/4170 (1523 M, 1366 F)
SLEEP HABITS IN 0 TO 6 YEARS OLD CHILDREN
EVOLUTION OF SLEEP-WAKE RHYTHM
100%
90%
80%
414
473
517
521
542
550
562
571
568
338
270
208
166
138
103
60
14
3
70%
60%
NIGHT SLEEP
818
855
869
4-5 YRS
5-6 YRS
715
787
3-4 YRS
697
760
2-3 YRS
20%
688
753
1-2 YRS
30%
10-12 M
WAKE
7-9 M
40%
4-6 M
DAYTIME SLEEP
0-3 M
50%
10%
0%
AGE TREND OF SOME SLEEP HABITS/DISORDERS
70%
60%
50%
40%
T. fall asleep > 30'
Parental presence
30%
Night wakings > 2
Allnight cosleeping
20%
10%
5-6 years
4-5 years
3-4 years
2-3 years
1-2 years
10-12
months
7-9 months
4-6 months
0-3 months
0%
SLEEP HABITS IN 0 TO 6 YEARS OLD CHILDREN
COMPARISON WITH EUROPEAN AND AMERICAN SURVEYS
 Shorter total nighttime sleep
 Later sleep onset time
 Shorter sleep latency
 Higher frequency of parental
presence at bedtime
 Lower incidence of cosleeping
Bruni et al.
The Sleep Disturbance
Scale for Children
(SDSC). Construction
and validation of an
instrument to evaluate
sleep disturbances in
childhood and
adolescence.
J. Sleep Res 1996;
5: 251-61
T score
100+
99
98
97
95
94
93
90
89
88
86
85
84
82
81
80
79
77
76
75
73
72
70
69
68
67
66
64
63
62
60
59
58
56
55
54
53
51
50
49
47
46
45
42
41
40
38
DIMS
26+
25
SBD
11+
DA
8+
SWTD
21+
20
DOES
20+
19
19
10
18
18
9
17
24
SHY
7
23
10
22
17
21
9
16
16
20
6
15
8
19
8
15
14
18
14
17
7
13
7
16
15
14
5
13
12
6
11
5
12
6
11
10
10
9
13
12
5
4
11
4
9
8
4
3
10
8
9
7
3
6
8
3
7
2
5
7
6
2
4
1
TOTAL
74+
73
72
71
70
69
68
66
65
64
63
62
61
60
59
58
57
56
55
54
53
52
51
50
49
48
47
46
45
44
43
42
41
40
39
38
37
36
35
34
33
32
31
29
28
27
26
T score
100+
99
98
97
95
94
93
90
89
88
86
85
84
82
81
80
79
77
76
75
73
72
70
69
68
67
66
64
63
62
60
59
58
56
55
54
53
51
50
49
47
46
45
42
41
40
38
 Two instruments (SDIS and SDSC) fulfill all of the steps to
assess sleep-wake patterns and sleep behaviors. Each of
these tools provides T-scores and has an average range of
40-60, with 68% of the sample within that range.
 Factor analysis extracted 7 factors accounting for 52.81% of
the variance: 1. Aggression; 2. Friendliness; 3. Inhibition of
aggressiveness; 4. Characters and sexual interactions; 5.
Negative emotions; 6. Positive emotions; 7.
Bizarreness/Archetypal
 Personality traits correlated with several ChDCQ factors:
… Psychoticism with aggression and inhibition of aggressiveness,
friendly interactions and positive emotions;
… Extraversion with aggression, characters and sexual interactions
and archetypal;
… Neuroticism with inhibition of aggressiveness, negative emotions
and archetypal.
 The most frequently diagnosed comorbid disorders
were sleep dis. followed by anxiety disorders
 66% of pts with sleep disorders had enduring
headache
The most frequently diagnosed co-morbid dis. in CDH
in 1997 were sleep dis. followed by anxiety disorders
Bruni O, Fabrizi P, Ottaviano S, Cortesi F, Giannotti F and Guidetti V. Prevalence of
sleep disorders in childhood and adolescence headache: a case-control study.
Cephalalgia, 17:492-498, 1997
PREVALENCE OF SLEEP DISORDERS (> 1 episode/week)
Control
Migraine
Tensive
30%
20%
10%
0%
Sleep lat.> Sleep dur. F. asleep
30'
< 8h
anxiety
Control
Migraine
Bedtime
>2
F. asleep
struggles aw./night sweating
Hypnic
jerks
H. related
aw
35%
30%
25%
20%
15%
10%
5%
0%
Tensive
Bedtime Somnol. Bruxism Enuresis
diif
ST
SW
Snoring
OSA
Bruni O, Galli F, Guidetti V. Sleep hygiene and migraine in children
and adolescents. Cephalalgia, 19 (S25):58-60, 1999
Migraine attacks duration
A - sleep hygiene instructions
B- wait list
1st obs 3 mths 6 mths
234’
78’
65’
210’
162’
160’
Migraine attacks frequency (% >1 attack per week)
1st obs. 3 mths
A - sleep hygiene instructions
B- wait list
35%
42%
15%
37%
6 mths
11%
33%
Improving sleep determined an improvement
of frequency and duration of migraine
attacks but not severity
 18 s. with migraine
(10M 8F); mean age
9,8; range 8,3-11,4 yrs
 17 control chidren
(9M, 8F); mean age
9,6; range 8-11,6 yrs


Questionnaires
 sleep diary; symptom checklist;
headache diary
Actigraph (Ambulatory Monitoring,
USA) micro-computer attached to the
dominant wrist that differentiates
between sleep and wake based on the
amount of movements in the limb
Control child
No differences in M vs. C in
actigraphic parameters
Nocturnal motor
activity index showed
a typical trend with
the lowest values on
the night preceding
the attack which
increased slowly the
following nights
 1073 children and preadol (51% M)
 mean age=10.5 yrs (range 8-14)
 School Sleep Habits Survey
Linear increase in evening preference with age
M/E total scores correlated with sleep/wake problems and
daytime sleepiness indicating a higher prevalence of sleep
complaints in evening-type subjects.
 The School Achievement index (SAI)
… negatively related to SDSC total score (DIMS and DOES factors)
… positively related to temperamental traits of task orientation
and personal–social flexibility.
 Temperament and sleep are important factors influencing
school achievement, and their assessment could help to
identify children at risk regarding school achievement
DEAD POETS
SOCIETY, 1989
Dead Poets Society2-MPEG-1 Movie.avi
Why do I stand up here? Anybody?
To feel taller?
No. Thank you for playing for Mr. Dalton.
I stand upon my desk to remind myself that we must
constantly look at things in a different way. You see, the
world looks very different from up here. You don't believe
me? Come see for yourselves, come on.
LOOK AT THINGS IN A
DIFFERENT WAY..
What do we mean?
LOOKING AT 10 SECONDS
LOOKING AT 30 SECONDS
LOOKING AT 60 SECONDS
LOOKING AT 120 SECONDS
LOOKING AT 300 SECONDS
• Cyclic Alternating Pattern (CAP) is a periodic EEG
activity of NREM sleep characterized by repeated
spontaneous sequences of transient events (phase A)
which clearly breaks away from the background rhythm,
with an abrupt frequency/amplitude variation, recurring
with a periodicity of 20– 40 s during NREM sleep
phase B identifies the interval between the phases A
CAP
Non CAP
CAP is an expression of arousal instability/ stability
AGE-RELATED CHANGES OF THE MAIN CAP
PARAMETERS
Age
Preschool-age
(Bruni et al., 2005)
School-age
(Bruni et al., 2002)
Peripubertal
(Lopes et al, 2005)
Adolescence
(Parrino, 1998)
Young adults
(Parrino, 1998)
Middle age
(Parrino, 1998)
Elderly
(Parrino, 1998)
Cap
rate%
A1 %
A2 %
A3 %
A1
index
A2
Index
A3
Index
↑
↓
↑
↑
↓
↑
↑
25.9
63.2
21.5
15.3
24.8
6.5
4
33.4
84.4
6.4
9.1
39.5
2.7
3.3
62.1
85.5
9.1
3.2
-
-
-
43.4
71.3
19.7
9.0
45
12.4
5.7
31.9
61.4
27.9
10.7
25.5
11.6
4.4
37.5
62.0
26.2
11.8
33.3
14.1
6.4
55.3
46.6
35.3
18.1
30.0
22.7
11.6
Computerized Analysis of CAP
HOW MANY LEGS DOES
THE ELEPHANT HAVE?
A1
Thalamocortical
connections
(Steriade et al.,
1993; Contreras
and Steriade,
1995)
Two different but
highly integrated
systems, whose
mechanism of
integration is not
known
A2 = ?
A3
Pyramidal
cortical
neurons in
layers IV and V
(Lopes da Silva and
Storm van Leeuwen,
1977)
CAP IS A COMPLEX DYNAMICAL PHENOMENON
HOW COULD SLOW OSCILLATIONS PROMOTE
THE PLASTIC NEURONAL CHANGES THAT
UNDERLIE SUCH MEMORY CONSOLIDATION?
 The stimulation induced a conjunct increase in
slow oscillation and frontal spindle activity
 Spindle activity is probably associated with
massive Ca influx into neocortical pyramidal
cells, and can trigger long-term potentiation in
neocortical synapses
 Slow-oscillation-driven spindle activity might
contribute to the strengthening of synaptic
connections in neocortical circuitry
CAP STUDIES IN CHILDREN’S DISEASES
 Pediatric Sleep Disordered Breathing
 Childhood Narcolepsy
 CAP in Neuropsychological Disabilities
… Neuropsychological Disabilities with MR
… Neuropsychological Disabilities without MR
 CAP in Benign Epilepsy with Rolandic Spikes
 CAP in children with GH deficit
 Parasomnias / Disorders of Arousal (DOA)
CAP IN NEUROPSYCHOLOGICAL DISABILITIES
WITHOUT MENTAL RETARDATION - ADHD
SLEEP 2006;29:797-803
ADHD had ↓ A1% during N2 with normal CAP in SWS
This may represent a neurophysiological marker of ADHD
SLEEP 2009;32(10):1333-1340
HOW DO DYSLEXIC CHILDREN READ
EVIDENCES FROM FMRI STUDIES (SHAYWITZ SE, SHAYWITZ BA, 2008)
 The non impaired
reader activates
neural
systems
that are mostly in
the back of the
left side of the
brain

Dyslexic readers show a disruption of the posterior
reading systems in the left P-T and O-T areas, but
develop compensatory systems in the left and right
anterior areas and in the right-hemisphere homolog of
the left-hemisphere Visual Word Form Area (VWFA)
SLEEP ARCHITECTURE
Dyslexia
Controls
TIB, min
Mean
557.97
SD
33.12
Mean
547.14
SD
43.10
M-W
80.50
p
NS
SPT, min
528.44
33.24
515.73
40.37
74.00
NS
SL, min
19.63
18.62
22.23
15.12
70.00
NS
RL, min
117.09
49.29
107.59
32.29
84.00
NS
SS/h
Few
5.43
1.06patients,
8.31 similar
2.04
14.00
0.000
changes in dyslexic
to those
AWN/h
0.31
0.24
60.50
NS
reported in Mercier0.20
et al.0.29
study (1993):
SE%
93.19
5.12
93.07
3.35
80.00
NS
 increase in stage 2 during the first NREM cycle
N° of R
6.56
1.46
9.27
2.15
26.00
0.002
 increase in SWS1.67
W%
3.21
1.33
1.41
60.00
NS
N1%
5.71 of2.45
8.23
4.15
52.00
NS
 decrease in number
REM periods
N2%
48.82
3.85
43.55
5.34
36.00
0.01
 decrease in number
of
stage
shifts3.81
(indicating
an
N3%
21.49
3.57
25.17
34.50
0.008
stability)4
R% increased sleep22.29
3.58
21.71
5.19
82.00
NS
NREM Arousal index
6.39
REM Arousal index
5.05
1.88
2.53
7.21
5.67
70.00
NS
7.81
2.63
39.00
0.015
Spindle Activity
↑ Spindle
density in N2
6.18 vs 3.43
(p<0.0001)
= mean
duration
1.04 vs 1.07
(NS)
Bruni O. et al. Sleep spindle activity is correlated with reading abilities in developmental
dyslexia. Sleep, 2009
Power Spectral Analysis
N2: power at 0.5 – 3 Hz and 1112 Hz (slow spindle) increased in
dyslexic subjects
N3: Power in the band 0.5 – 1 Hz
increased in dyslexic subjects
Bruni O. et al. Sleep spindle activity is correlated with reading abilities in developmental
dyslexia. Sleep, 2009
Correlation with cognitive and
reading performance
Delta
Theta
Alpha
Sigma
Spindle
density
MT Reading test
0.04
0.18
0.13
0.55
0.17
Word Reading test
0.05
0.01
0.11
0.63
0.66
Non-Word test
-0.16
-0.17
-0.22
0.24
0.26
Word writing
-0.14 spindle
0.03
0.23
0.41
Sigma
band in-0.02
N2 and
density
were
Non-Word writing
-0.07
0.03
0.31
0.28
positively
correlated
with
the0.05degree
of dyslexic
Sentences writing
-0.08
-0.09
-0.03
0.05
0.18
impairment
Verbal IQ
0.02
-0.04
-0.02
0.05
-0.04
Performance IQ
-0.09
-0.18
-0.09
0.03
0.03
Full scale IQ
0.04
-0.05
0.00
0.05
-0.06
Bruni O. et al. Sleep spindle activity is correlated with reading abilities in
developmental dyslexia. Sleep, 2009
Bruni O. et al. Slow EEG amplitude oscillations during NREM sleep and reading
disabilities in children with dyslexia. Dev Neuropsychol, 2009; 34: 539 -551
Dyslexia (n=16)
Controls (n=11)
Mann-Whitney test
Mean
S.D.
Mean
S.D.
“U”
p≤*
CAP Rate%
30.06
6.65
31.65
9.90
78.50
NS
in N1
8.86
7.37
14.81
17.27
60.50
NS
in N2
12.16
6.43
24.19
11.62
33.00
NS
in N3
76.46
13.87
50.25
13.59
17.00
0.0095
A1, %
87.23
4.62
86.21
3.96
74.00
NS
A2, %
1.11
0.78
5.65
2.31
0.00
0.0002
A3, %
11.68
4.68
8.15
4.46
53.00
NS
A1 index
39.67
10.94
37.54
11.70
82.00
NS
in N1
2.83
3.99
13.42
20.60
51.00
NS
in N2
21.39
10.38
37.00
12.73
33.00
NS
in N3
109.72
21.46
69.66
15.35
13.00
0.004
A2 index
0.46
0.39
2.15
1.23
16.00
0.0072
in N1
1.16
1.31
3.35
3.78
57.00
NS
in N2
0.47
0.53
2.91
1.64
13.00
0.004
in N3
0.73
0.73
2.85
1.68
12.50
0.0036
A3 index
2.76
1.43
2.58
2.16
73.50
NS
in N1
25.76
8.61 oscillations
18.01
11.90
NS
 Increase
in
EEG slow
(A1) in50.50
N3
in N2
4.49
2.46
3.15
3.19
53.50
NS
 Decrease
in
A2 (low-power
in N3
3.53
1.88
2.16arousals)
1.72 in N2
47.00and N3NS
*Bonferroni-corrected values.
Correlation between CAP and cognitive and
reading performance
Verbal
IQ
Perfor
mance
IQ
FullScale IQ
MT
Reading
test
Word
Reading
test
NonWord
test
CAP Rate N3
0.58
0.19
0.41
0.47
0.02
0.31
A2 %
0.06
-0.21
0.05
0.01
0.42
0.18
A1 index N3
0.74
0.29
0.61
0.55
0.04
0.23
A2 index
0.10
-0.33
0.02
-0.16
0.15
0.15
in N2
0.35
-0.23
0.17
0.18
0.27
0.23
in N3
-0.07
-0.31
-0.04
-0.31
0.07
0.10
CAP rate in N3 with verbal IQ
A1 index in N3 with Verbal IQ, full-scale IQ, and
Memory and Learning Transfer reading test
Bruni O. et al. Slow EEG amplitude oscillations during NREM sleep and reading
disabilities in children with dyslexia. Dev Neuropsychol, 2009; 34: 539 -551
 Increase of CAP rate in SWS vs. autistics
 Increase of A1 phases and duration vs. autistics
and vs. normal controls
INCREASE OF
SLOW
OSCILLATIONS
(A1) IN AS
CORRELATIONS BETWEEN CAP AND IQ IN AS
Positive correlations between CAP rate in SWS,
A1 index in SWS and verbal IQ support the
hypothesis of the role of NREM and of EEG slow
oscillations (A1) in cognition
WISC_T
WISC_V
WISC_P
CAP rate
• in SWS
0.54
0.54
0.99
0.99
0.46
0.46
A1_index
• in S1
• in S2
• in SWS
0.37
0.65
0.37
0.14
0.90
0.00
0.55
0.78
0.32
0.66
0.29
0.03
CAP IN NEUROPSYCHOLOGICAL
DISABILITIES WITH MENTAL
RETARDATION
AUTISM
FRAGILE X SYNDROME
DOWN SYNDROME
ASD patients vs. controls showed:
 lower CAP rate during slow wave sleep
 decreased A1 index in SWS
 increased A3 and A2 indexes mainly in S1 and S2
The reduction of A1 subtypes during SWS
might play a role in the impairment of
cognitive functioning in AS
Miano S, Bruni O, Elia M, et al. Sleep phenotypes of intellectual disability: a
polysomnographic evaluation in subjects with Down syndrome and Fragile X
syndrome. Clin Neurophysol., 2008
Sleep macrostructure more disrupted in Down sy
Sleep microstructure more disrupted in Fragile X sy
*
*
THE SIGNIFICANT REDUCTION OF CAP RATE AND OF A1%
MAINLY IN SWS COULD BE RELATED TO THE DEGREE OF MR
GROWTH HORMONE DEFICIT
PRADER WILLY SYNDROME
NARCOLEPSY
Verrillo E, Bruni O, Franco P, Ferri R, Pavone M, Petrone A, Paglietti MG, Crinò
A, Cutrera R. Analysis of NREM sleep in children with Prader-Willi Syndrome
and the effect of Growth Hormone treatment. Sleep Medicine 2009;10:646-50
 PWS noGH vs. Controls
… ↓ CAP rate total and A1 index in S1, S2 and in SWS
 PWS GH vs. Controls
… ↓CAP rate total and A1 index in S1, S2 but not in SWS
 PWS GH vs. PWS noGH
… GH determined increase of CAP rate and A1 index in SWS
 PWS children showed a decrease of NREM
sleep instability in agreement with the
reported generalized hypoarousal state
 GH therapy is able to increase EEG slow
oscillations in SWS (A1) at normal level
 GH secretion was strictly related to the EEG
SWA in the first part of the night and 70% of
GH pulses during sleep occurred during SWS
 In GHD children we found a general
decrease in NREM instability expressed by
the significant reduction of CAP parameters,
particularly the CAP rate and A1 index,
mainly in SWS
 Reduction of CAP rate and A1%, and increase of A3%
 The decrease of NREM sleep instability reinforces the
hypothesis of a deficit of the arousal
 ST vs. controls showed abnormalities in
SWS:
… increase of CAP rate and of A1 index in SWS
… decreased duration of B phases in SWS
 This means that children with ST had faster
alternations of the amplitude of slow EEG
bursts during SWS possibly associated with
the occurrence of parasomnias
CAP IN DISORDERS OF AROUSAL (DOA)
B
B
B
B
B
Bruni O, Novelli L, Luchetti A, Zarowski M, Meloni M, Cecili M, Villa MP,
Ferri R. Reduced NREM Sleep Instability In Benign Childhood Epilepsy With
Centrotemporal Spikes. Clinical Neurophysiology 2010, 121: 665–671
 Despite the high burst frequency during NREM,
interictal discharges of BERS are not modulated by the
arousal-related mechanisms of CAP (Terzano et al.,
1991)
 In children with BERS decrease of NREM instability (↓
CAP rate and A1 and A2 indexes) in N2
 The decrease of NREM sleep instability in N2 might be
linked to the inhibitory action of spindling activity on
EEG slow oscillations and on arousals (Bruni et al.,
2010 ).
The Role of NREM Sleep Instability in Child Cognitive
Performance
Bruni O, Kohler M, Novelli L, Kennedy D, Lushington K,
Martin J, Ferri R. Sleep, 2011 In Press
CAP Rate
A1 I ndex
A2 index
A3 index
Total
S1
S2
SWS
Total
S1
S2
SWS
Total
Total
FSI Q
0.11
0.17
0.1
0.09
0.06
0.06
0.05
0.07
0.1
0.17
VI Q
0.01
0.21
0.01
-0.02
-0.05
0.01
-0.06
-0.06
0.08
0.29
NVI Q
0.17
0.13
0.15
0.15
0.15
0.09
0.12
0.16
0.1
0.05
V Fluid Reasoning
0.1
0.16
0.02
0.14
0.07
-0.04
0.04
0.11
-0.02
0.05
NV Fluid Reasoning
0.47†
-0.03
0.34
0.48†
0.44†
0.07
0.31
0.46†
0.18
-0.04
V Knowledge
0.02
0.25
-0.01
-0.02
-0.05
-0.06
-0.08
-0.09
0.14
0.33
NV Knowledge
-0.09
0.11
-0.08
-0.01
-0.08
0.06
-0.08
0.04
-0.01
0.1
V Quantitative Reasoning
-0.1
0.26
-0.12
-0.05
-0.11
-0.07
-0.11
-0.02
0.02
0.07
NV Quantitative Reasoning
-0.15
0.12
-0.09
-0.2
-0.16
0.04
-0.1
-0.2
0.01
0.06
V Visual Spatial
0.04
0.06
0.09
-0.05
-0.01
0.14
-0.01
-0.08
0.06
0.26
NV Visual Spatial
0.17
-0.03
0.12
0.19
0.14
-0.01
0.09
0.18
0.17
-0.04
V Working M emory
-0.02
-0.03
0.08
-0.05
-0.05
0.05
0.01
-0.09
0.07
0.23
NV Working M emory
0.08
0.23
0.14
-0.01
0.07
0.11
0.11
0
-0.01
0.09
-0.003
0.12
0.14
-0.13
0.003
0.1
0.22
-0.13
-0.05
-0.19
Language
0.07
-0.01
0.14
0.06
0.04
0.03
0.18
0.01
0.1
-0.21
Sensorimotor
0.16
0.29
0.29
0.02
0.1
-0.01
0.17
0.04
0.21
-0.18
Stanford Binet test
NEPSY domain
Executive Attention/Executive
M emory
-0.19
0.03
-0.13
-0.14
-0.17
0.21
-0.03
-0.12
-0.21
-0.17
†<0.005. FSIQ = Full Scale IQ, VIQ = Verbal IQ, NVIQ = Non-verbal IQ, V = Verbal, NV = Non-verbal, S1 = stage 1 sleep, S2 = Stage 2 sleep, SWS = Slow Wave
Sleep.
Le
oscillazioni
lente
durante il sonno correlano
positivamente
con
le
performance cognitive
lo
studio
della
miscrostruttura
del
sonno, in particolare delle
oscillazioni lente, potrebbe
trovare una importante
applicazione in ambito
clinico
ACKNOWLEDGMENTS
AIMS – The Sleep Mafia
ACKNOWLEDGMENTS
My first collaborators…….
Elena
Vittori
Elisabetta
Verrillo
Me
Silvia
Miano
My biggest friend
LINEE DI RICERCA FUTURE
 Sviluppo normale e patologico del sonno dei bambini ( sleep
deprivation)
 Tecnologia, mobile devices e loro impatto sul sonno
 Analisi dei disturbi del sonno come possibile sintomo precoce di
disagio psicologico del bambino
 Studio delle relazioni fra sonno, funzioni cognitive e apprendimento
in età prescolare e scolare in bambini normali e con disturbi del
linguaggio e/o disturbi di apprendimento
 Analisi delle conseguenze sul piano familiare e sociale, e sulla
qualità della vita del bambino
 Studio delle relazioni fra sonno e temperamento
 Ricerca sui rapporti fra stile parentale, sonno, e attaccamento
 Prevenzione dei disturbi del sonno attraverso interventi psico-
educativi