Sleep stability, emotional memory and risk for neurodegeneration in World Trade Center Responders

项目摘要 世界贸易中心（WTC）的受访者自我报告睡眠质量很差， 阻塞性睡眠呼吸暂停（OSA）和失眠等睡眠障碍的患病率。研究 调查这一人群的大脑健康表明，他们存在早期认知障碍， 与WTC现场颗粒神经毒素物理暴露相关的神经变性 和慢性创伤后应激障碍（PTSD）。有证据表明，睡眠质量差， 与认知障碍相关，神经退行性疾病和痴呆的生物标志物， 疾病和一般社区。然而，目前尚不清楚睡眠质量差是否会导致 WTC应答者神经退行性变的风险增加。睡眠质量是一个术语， 睡眠的启动、维持、数量和觉醒后的恢复的多个方面。是 通常使用问卷进行主观评估， 睡眠相关的生活质量、睡眠行为或症状。一个潜在的有用的，客观的 衡量睡眠质量的指标是睡眠稳定性。睡眠稳定性的改善可以通过 中枢神经系统（CNS）的透镜与脑电图（EEG）或相应的 自主神经系统（ANS）活动使用心肺耦合（CPC）。EEG快速测量 眼动（REM）和非REM（NREM）睡眠不稳定是失眠和OSA的特征。 阻塞性睡眠呼吸暂停引起的睡眠不稳定导致睡眠依赖性记忆受损和标记物增加 神经退行性疾病REM不稳定的表现，REM减少和延迟， 在一个大的社区队列中痴呆症的风险增加。高质量的脑电信号难以获得 在家里，但更新，可穿戴的CPC测量设备可以提供睡眠质量和障碍的严重程度 从家里的措施。CPC测量的睡眠显示出夸大的夜间变化， 失眠高度可变的睡眠时间表预测对认知治疗的成功反应 失眠行为疗法（CBTi）我们计划招募40名WTC响应者，他们将接受2次 周的家庭CPC睡眠监测，随后进行夜间实验室PSG，包括睡眠前/后 情绪记忆图片任务和血液采样。目的1a是测试一夜快速眼动睡眠是否 由EEG活动测量的不稳定性与受损的情绪记忆有关。探索性目标 1b是测试受损的夜间记忆处理和夜间记忆之间的任何潜在联系。 血浆生物标志物Tau和NFL的变化。目的二是测试不一致的睡眠质量 通过CPC的夜间变异性测量， 程度.

Project Summary World Trade Center (WTC) Responders self-report high levels of poor sleep quality and exhibit a high prevalence of sleep disorders such as obstructive sleep apnea (OSA) and insomnia. Research investigating brain health in this population indicates early-age cognitive impairments and neurodegeneration associated with both physical exposures of particulate neurotoxins at the WTC site and chronic post-traumatic stress disorder (PTSD). There is evidence that poor sleep quality is associated with cognitive impairments, biomarkers of neurodegeneration and dementia in both sleep disorders and the general community. However, it is not known if poor sleep quality contributes to increased risk of neurodegeneration in WTC Responders. Sleep quality is a term that encompasses multiple aspects of sleep initiation, maintenance, quantity, and refreshment upon awakening. It is typically assessed subjectively using questionnaires that evaluate general satisfaction with current sleep-related quality of life, sleep behaviors or symptoms. A potentially useful, and objectively measured, proxy for sleep quality is sleep stability. Metrics of sleep stability can be obtained through the lens of the central nervous system (CNS) with electroencephalography (EEG) or the corresponding autonomic nervous system (ANS) activity using cardiopulmonary coupling (CPC). EEG-measured rapid eye movement (REM) and non-REM (NREM) sleep instability is characteristic of insomnia and OSA. Sleep instability caused by OSA results in impaired sleep-dependent memory and increases in markers of neurodegeneration. Reduced and delayed REM, manifestations of REM instability, are associated with increased risk of dementia in a large community cohort. Quality EEG signals are difficult to obtain at-home but newer, wearable CPC-measuring devices can provide sleep quality and disorder severity measures from the home. CPC measured sleep demonstrates exaggerated night-to-night variability in insomnia. Highly variable sleep schedules predict successful response to treatment with cognitive behavioral therapy for insomnia (CBTi). We plan to enroll 40 WTC Responders who will undergo 2 weeks at-home CPC sleep monitoring followed by an overnight in-lab PSG with pre/post-sleep emotional memory picture task and blood sampling. Aim 1a is to test whether single-night REM sleep instability measured by EEG activity is associated with impaired emotional memory. Exploratory Aim 1b is to test any potential association between impaired overnight memory processing and overnight change in plasma biomarkers Tau and NFL. Aim 2 is to test whether inconsistent sleep quality measured by night-to-night variability in CPC is associated with greater evening plasma Tau and NFL levels.