A hemodynamic network involving the insula, the cingulate, and the basal forebrain correlates with EEG synchronization phases of sleep instability

Vasileios Kokkinos; Serge Vulliémoz; Andreas M Koupparis; Michalis Koutroumanidis; George K Kostopoulos; Louis Lemieux; Kyriakos Garganis

doi:10.1093/sleep/zsy259

A hemodynamic network involving the insula, the cingulate, and the basal forebrain correlates with EEG synchronization phases of sleep instability

Sleep. 2019 Apr 1;42(4):zsy259. doi: 10.1093/sleep/zsy259.

Authors

Vasileios Kokkinos^{1

2

3}, Serge Vulliémoz^{4

5

6}, Andreas M Koupparis^{3

7}, Michalis Koutroumanidis^{8

9}, George K Kostopoulos³, Louis Lemieux^{4

5}, Kyriakos Garganis²

Affiliations

¹ Department of Neurological Surgery, School of Medicine, University of Pittsburgh, PA.
² Epilepsy Center of Thessaloniki, St. Luke's Hospital, Thessaloniki, Greece.
³ Neurophysiology Unit, Department of Physiology, Medical School, University of Patras, Greece.
⁴ Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
⁵ MRI Unit, Epilepsy Society, Chalfont St. Peter, UK.
⁶ EEG and Epilepsy Unit, Neurology, University Hospital and Faculty of Medicine, Geneva, Switzerland.
⁷ Montreal Neurological Institute, McGill University, Montreal, Canada.
⁸ Department of Clinical Neurophysiology and Epilepsies, Guy's, St. Thomas' and Evelina Hospital for Children, NHS Foundation Trust, London, UK.
⁹ Department of Neuroscience, Institute of Psychiatry, Kings College London, UK.

PMID: 30566659
DOI: 10.1093/sleep/zsy259

Abstract

The cyclic alternating pattern (CAP) encompasses the pseudoperiodic appearance of synchronized brain waves and rhythms and is considered a regulator of the nonrapid eye movement (NREM) sleep vigilance level, reflecting sleep instability. To determine the brain regions responsible for this phenomenon, we scored and analyzed sleep functional magnetic resonance imaging data acquired with simultaneous electroencephalography (EEG-fMRI). Group analysis revealed a set of brain areas showing statistically significant blood oxygen-level dependent signal correlated positively with the synchronization phase of the CAP, most prominent being the insula, the middle cingulate gyrus, and the basal forebrain. These areas may form a network acting as a synchronization pacemaker, controlling the level of NREM sleep vigilance and the sleeper's arousability.

Keywords: EEG-fMRI; basal forebrain; cingulate; cyclic alternating pattern; insula; sleep.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Basal Forebrain / physiology*
Brain Waves / physiology*
Electroencephalography / methods
Female
Hemodynamics / physiology
Humans
Magnetic Resonance Imaging / methods
Male
Polysomnography / methods
Sleep / physiology*
Sleep Stages / physiology*
Wakefulness / physiology