Characteristics of the Basel Postpartum Hypertension Cohort (Basel-PPHT Cohort): An Interim Analysis.

Postpartum hypertension (PPHT) is hypertension that persists or develops after delivery and is a frequent cause of readmission, affecting 10% of pregnancies. This interim analysis aims to describe the cohort and to determine the feasibility and acceptance of a home-based telemonitoring management strategy (HBTMS) in PPHT patients. Enrollment at the University Hospital Basel began during the 2020 SARS-CoV-2 pandemic. Maternity-ward patients were screened for preexisting hypertension, hypertensive disorders of pregnancy, and de novo PPHT. In this pragmatic non-randomized prospective trial, the participants chose the HBTMS or standard of care (SOC), which consisted of outpatient hypertension clinic appointments. The HBTMS was a smartphone application or a programmed spreadsheet to report blood pressure (BP), followed by telephone consultations. Three months postpartum, the participants underwent a 24 h BP measurement and a blood, biomarker, and urine analysis. A total of 311 participants were enrolled between 06/20 and 08/23. The mean age was 34 (±5.3) years. The current pregnancy history demonstrated the following (≥1 diagnosis possible): 10% had preexisting hypertension, 27.3% gestational hypertension, 53% preeclampsia (PE), 0.3% eclampsia, 6% HELLP (hemolysis, elevated liver enzymes, and low platelets), and 18.3% de novo PPHT. A family history of cardiovascular disease and PE was reported in 49.5% and 7.5%, respectively. In total, 23.3% were high-risk for PE. A total of 68.5% delivered via c-section, the mean hospitalization was 6.3 days (±3.9), and newborn intrauterine growth restriction occurred in 21%. A total of 99% of the participants chose the HBTMS. This analysis demonstrated that the HBTMS was accepted. This is vital in the immediate postpartum period and pertinent when the exposure of hospital visits should be avoided.

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.

High-Density Electroencephalographic Recordings During Sleep in Children and Adolescents With Acquired Brain Injury.

BACKGROUND: Acquired brain injuries (ABI) such as traumatic brain injury (TBI) or stroke can result in motor, language, or cognitive impairments. Although a considerable number of studies have investigated functional recovery, underlying brain reorganization remains poorly understood. Accumulating evidence indicates that plastic processes in the brain are linked to changes in electroencephalographic (EEG) slow wave activity (SWA) during deep sleep (EEG spectral power 1-4.5 Hz). OBJECTIVE: We investigated sleep SWA in children and adolescents with ABI. METHODS: We used high-density EEG (128 electrodes) to record sleep in 22 young patients with ABI (age range = 4-16 years). We compared patients to 52 previously measured typically developing children and adolescents (age range = 4-16 years). RESULTS: The pattern of alterations in SWA differed between particular patient groups. In patients with bilateral stroke, SWA was globally reduced across the entire scalp. Patients with unilateral stroke showed a local reduction in SWA over lesion areas and an increase over perilesional and contralateral brain areas. In patients with severe TBI, we found a reduction in SWA over the midline and an increase over lateral brain areas. We found no consistent pattern in patients with mild to moderate TBI. CONCLUSIONS: Sleep SWA seems to be a sensitive measure to assess individual alterations in neural activity after ABI. Deviations from age norms might indirectly indicate plastic processes that have occurred since injury. Improving our understanding of neural activity after ABI could optimize clinical prognosis and guide the development of novel therapeutic interventions.

High-density electroencephalographic recordings during sleep in children with disorders of consciousness.

INTRODUCTION: A large number of studies have investigated neural correlates of consciousness in adults. However, knowledge about brain function in children with disorders of consciousness (DOC) is very limited. We suggest that EEG recordings during sleep are a promising approach. In healthy adults as well as in children, it has been shown that the activity of sleep slow waves (EEG spectral power 1-4.5 Hz), the primary characteristic of deep sleep, is dependent on use during previous wakefulness. Thus the regulation of slow wave activity (SWA) provides indirect insights into brain function during wakefulness. METHODS: In the present study, we investigated high-density EEG recordings during sleep in ten healthy children and in ten children with acquired brain injury, including five children with DOC and five children with acquired brain injury without DOC. We used the build-up of SWA to quantify SWA regulation. RESULTS: Children with DOC showed a global reduction in the SWA build-up when compared to both, healthy children and children with acquired brain injury without DOC. This reduction was most pronounced over parietal brain areas. Comparisons within the group of children with DOC revealed that the parietal SWA build-up was the lowest in patients showing poor outcome. Longitudinal measurements during the recovery period showed an increase in parietal SWA build-up from the first to the second sleep recording. CONCLUSIONS: Our results suggest that the reduced parietal SWA regulation may represent a characteristic topographical marker for brain network dysfunction in children with DOC. In the future, the regulation of SWA might be used as a complementary assessment in adult and paediatric patients with DOC.

Local increase of sleep slow wave activity after three weeks of working memory training in children and adolescents.

STUDY OBJECTIVES: Evidence is accumulating that electroencephalographic (EEG) sleep slow wave activity (SWA), the key characteristic of deep sleep, is regulated not only globally, but also locally. Several studies have shown local learning- and use-dependent changes in SWA. In vitro and in vivo animal experiments and studies in humans indicate that these local changes in SWA reflect synaptic plasticity. During maturation, when synaptic changes are most prominent, learning is of utmost importance. Thus, in this study, we aimed to examine whether intensive working memory training for 3 w would lead to a local increase of sleep SWA using high-density EEG recordings in children and young adolescents. SETTING: Sleep laboratory at the University Children's Hospital Zurich. PARTICIPANTS: Fourteen healthy subjects between 10 and 16 y. INTERVENTIONS: Three weeks of intensive working memory training. MEASUREMENTS AND RESULTS: After intensive working memory training, sleep SWA was increased in a small left frontoparietal cluster (11.06 ± 1.24%, mean ± standard error of the mean). In addition, the local increase correlated positively with increased working memory performance assessed immediately (r = 0.66) and 2 to 5 mo (r = 0.68) after the training. CONCLUSIONS: The increase in slow wave activity (SWA) correlates with cognitive training-induced plasticity in a region known to be involved in working memory performance. Thus, in future, the mapping of sleep SWA may be used to longitudinally monitor the effects of working memory training in children and adolescents with working memory deficiencies.

Sleep spindles are related to schizotypal personality traits and thalamic glutamine/glutamate in healthy subjects.

BACKGROUND: Schizophrenia is a severe mental disorder affecting approximately 1% of the worldwide population. Yet, schizophrenia-like experiences (schizotypy) are very common in the healthy population, indicating a continuum between normal mental functioning and the psychosis found in schizophrenic patients. A continuum between schizotypy and schizophrenia would be supported if they share the same neurobiological origin. Two such neurobiological markers of schizophrenia are: (1) a reduction of sleep spindles (12-15 Hz oscillations during nonrapid eye movement sleep), likely reflecting deficits in thalamo-cortical circuits and (2) increased glutamine and glutamate (Glx) levels in the thalamus. Thus, this study aimed to investigate whether sleep spindles and Glx levels are related to schizotypal personality traits in healthy subjects. METHODS: Twenty young male subjects underwent 2 all-night sleep electroencephalography recordings (128 electrodes). Sleep spindles were detected automatically. After those 2 nights, thalamic Glx levels were measured by magnetic resonance spectroscopy. Subjects completed a magical ideation scale to assess schizotypy. RESULTS: Sleep spindle density was negatively correlated with magical ideation (r = -.64, P < .01) and thalamic Glx levels (r = -.70, P < .005). No correlation was found between Glx levels in the thalamus and magical ideation (r = .12, P > .1). CONCLUSIONS: The common relationship of sleep spindle density with schizotypy and thalamic Glx levels indicates a neurobiological overlap between nonclinical schizotypy and schizophrenia. Thus, sleep spindle density and magical ideation may reflect the anatomy and efficiency of the thalamo-cortical system that shows pronounced impairment in patients with schizophrenia.

Working memory training shows immediate and long-term effects on cognitive performance in children.

Working memory is important for mental reasoning and learning processes. Several studies in adults and school-age children have shown performance improvement in cognitive tests after working memory training. Our aim was to examine not only immediate but also long-term effects of intensive working memory training on cognitive performance tests in children and adolescents. Fourteen healthy male subjects between 10 and 16 years trained a visuospatial n-back task over 3 weeks (30 min daily), while 15 individuals of the same age range served as a passive control group. Significant differences in immediate (after 3 weeks of training) and long-term effects (after 2-6 months) in an auditory n-back task were observed compared to controls (2.5 fold immediate and 4.7 fold long-term increase in the training group compared to the controls). The improvement was more pronounced in subjects who improved their performance during the training. Other cognitive functions (matrices test and Stroop task) did not change when comparing the training group to the control group. We conclude that spatial working memory training in children and adolescents boosts performance in similar memory tasks such as the auditory n-back task. The sustained performance improvement several months after the training supports the effectiveness of the training.

Brain tissue oxygen saturation increases during the night in adolescents.

How does the oxygen metabolism change during sleep? We aimed to measure the change in brain tissue oxygen saturation (StO2) before and after sleep with near-infrared spectroscopy (NIRS) using an in-house developed sensor. According to the synaptic homeostasis hypothesis [1], synaptic downscaling during sleep would result in reduced energy consumption. Thus, this reduced energy demands should be reflected in the oxygen metabolism and StO2. Thirteen nights of 7 male subjects (age 11-16 years, one subject contributed only one night, all others two) were included in the analysis. We performed NIRS measurements throughout the entire night. The NIRS sensor was placed close to electrode position Fp1 (international 10/20 system), over the left frontal cortex. Absolute StO2 and total haemoglobin (tHb) were calculated from the NIRS measurements using a self-calibrating method [2]. StO2 and tHb during the awake period prior to sleep and after awakening were compared. The subjects were instructed to lie in bed in the same position before and after sleep. Values of the two nights were averaged for each subject. Furthermore, a linear regression line was fit through the all-night StO2 recordings. We found an increase in StO2 by 4.32 ± 1.76 % (mean ± SD, paired t-test p < 0.001, n = 7) in the morning compared to evening, while tHb did not change (1.02 ± 6.81 µM p = 0.704, n = 7). Since the tHb remained at a similar level after sleep, this increase in StO2 indicates that in the morning more oxygenated blood and less deoxygenated blood was present in the brain compared to the evening. The slope of the regression line was 0.37 ± 0.13 % h(-1) leading to a similar increase of StO2 in the course of sleep. This may be interpreted as a reduced oxygen consumption or energy metabolism after sleep.

Interindividual differences in circadian rhythmicity and sleep homeostasis in older people: effect of a PER3 polymorphism.

Aging is associated with marked changes in the timing, consolidation and structure of sleep. Older people wake up frequently, get up earlier and have less slow wave sleep than young people, although the extent of these age-related changes differs considerably between individuals. Interindividual differences in homeostatic sleep regulation in young volunteers are associated with the variable-number, tandem-repeat (VNTR) polymorphism (rs57875989) in the coding region of the circadian clock gene PERIOD3 (PER3). However, predictors of these interindividual differences have yet to be identified in older people. Sleep electroencephalographic (EEG) characteristics and circadian rhythms were assessed in 26 healthy older volunteers (55-75 years) selected on the basis of homozygosity for either the long or short allele of the PER3 polymorphism. Homozygosity for the longer allele (PER3(5/5)) associated with a phase-advance in the circadian melatonin profile and an earlier occurrence of the melatonin peak within the sleep episode. Furthermore, older PER3(5/5) participants accumulated more nocturnal wakefulness, had increased EEG frontal delta activity (0.75-1.50 Hz), and decreased EEG frontal sigma activity (11-13 Hz) during non-rapid eye movement (REM) sleep compared with PER3(4/4) participants. Our results indicate that the polymorphism in the clock gene PER3 may contribute to interindividual differences in sleep and circadian physiology in older people.