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Recent Advances in Sleep and Chronobiology J.C INTRODUCTION Recent Advances in Sleep and Chronobiology J.C. Gillin, M.D. The hows and the whys of sleep and chronobiology year, two groups published papers in Cell within weeks remain among the leading scientific challenges to a full of each other, linking abnormalities in the hypocretin/ comprehension of the central nervous system and its orexin system to narcolepsy. In the first paper, a team behaviors. Nearly all but the “lowest” organisms ex- headed by Emmanuel Mignot reported a mutation of hibit daily periods of repose and action. Cycles of rest the hypocretin/orexin receptor 2 (Hcrtr 2) in canine and activity or sleep and wakefulness are carefully reg- narcolepsy (L. Lin et al.); in the second paper, the team ulated by both endogenous circadian “clocks” and ho- headed by M. Yanagisawa reported that hypocretin/or- meostatic processes. The circadian system adjusts the exin knockout mice appeared to have narcolepsy (R.M. timing of sleep or activity over the 24-hour day. Ho- Chemelli et al.). In this issue, Emmanuel Mignot, who meostatic processes reflect both the increased propen- directed for the past 15 years the only dedicated re- sity to sleep with extended duration of wakefulness search laboratory on the pathophysiology of narco- and the recovery or recuperative benefits of sleep itself. lepsy, comments on the neurobiology of the hypocre- In most mammals, three important processes regulate tin/orexin system. His paper reviews the diagnosis, states of consciousness and behavior: the circadian sys- treatment, neuropsychopharmacology, and genetics of tem, the homeostatic system, and ultradian rhythm of human narcolepsy. Finally, he speculates on the role of NonREM and REM sleep. hypocretin/orexin in sleep, sleep deprivation, and The basic and clinical sciences of sleep and chronobi- other physiological issues. Jerry Siegel and colleagues, ology have been the beneficiaries of recent advances in who have studied the electrophysiology of canine nar- neuroscience, including molecular neurobiology and colepsy for many years, discuss the role of hypocretin/ genomics, cellular physiology, functional brain imag- orexin in symptom variability, regulation of brainstem ing, computational neuroscience, topographical EEG, motor systems, and control of the locus coeruleus and immunology, and neuropsychopharmacology. The new nucleus magnocellularis. Both groups independently findings and methodologies have important implica- examined autopsied human narcoleptic brains and re- tions for understanding the pathophysiology and treat- ported low numbers of hypocretin/orexin cells in lat- ment of neuropsychiatric disorders. This special issue eral hypothalamus, but with some differences. In a of Neuropsychopharmacology contains 18 invited papers third paper in this issue, Rafael Salin-Pasqual and col- on recent advances in basic and clinical research, espe- leagues summarize the role of the whole hypothalamus cially in sleep and, to a lesser extent, in chronobiology. in the regulation of sleep and wakefulness. They also One of the most dramatic recent discoveries in neu- venture some conjectures about the role of hypocretin/ roscience is the identification of the hypocretin/orexin orexin in depression, the night eating syndrome, and neuropeptide system and its role in the pathophysiol- obstructive sleep apnea. ogy of narcolepsy. In 1998, two groups (L. De Lecea et A fundamental question has been whether behav- al., T. Sakurai et al.) independently identified this pep- ioral states—sleep, wakefulness, sleep deprivation, Non- tide system in the lateral hypothalamus. In the next REM sleep, and REM sleep—affect gene expression. Giulio Tononi and Chiara Cirelli have investigated thousands of transcripts in the brains of rats and, more From the Department of Psychiatry, University of California at recently, fruit flies, which appear to sleep according to San Diego (UCSD) Mental Health Clinical Research Center and Vet- accepted behavioral criteria. Their results suggest that erans Affairs San Diego Healthcare System, San Diego, CA. most of the genes upregulated during wakefulness or Address correspondence to: J.C. Gillin, Department of Psychiatry 116A, 3350 La Jolla Village Drive, San Diego, CA 92161, Tel.: (858) sleep deprivation are known; in contrast, most of the 534-2137, Fax: (858) 458-4201, E-mail: [email protected] genes upregulated during sleep are unknown at this time. NEUROPSYCHOPHARMACOLOGY 2001–VOL. 25, NO. S5 © 2001 American College of Neuropsychopharmacology Published by Elsevier Science Inc. 0893-133X/01/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0893-133X(01)00335-9 NEUROPSYCHOPHARMACOLOGY 2001–VOL. 25, NO. S5 Introduction S3 Two papers address the role of neurotransmitters Brown review the limited literature on the effects of which may regulate sleep. Wally Mendelson and An- sleep deprivation on performance in normal controls thony Basile review the data on oleamide, an endoge- who undergo functional brain imaging studies. Their nous fatty acid amide, which is synthesized in the mam- own studies with functional magnetic resonance imag- malian brain, interacts with cannabinergic, serotonergic, ing (FMRI) suggest that sleep deprivation may be asso- and GABAa receptors, and which may be an endoge- ciated with adaptive cerebral responses during some nous sleep-inducing compound. Polly Moore and col- but not all cognitive tasks. Joe Wu and colleagues re- leagues confirm that ipsapirone, a 5HT1A receptor ago- view the functional imaging literature of sleep depriva- nist, inhibits REM sleep in normal volunteers but fails to tion in depression. The studies more or less consistently replicate an earlier paper indicating that rapid trypto- report that metabolic activity in ventral anterior cingu- phan depletion (RTD) with the tryptophan free amino late and medial orbital prefrontal cortex is elevated prior acid drink disinhibits REM sleep. The latter finding to sleep deprivation and normalized in association with may suggest individual different responses to the RTD. the antidepressant effects after sleep deprivation. Camel- Michael Irwin reviews the intriguing relationships lia Clark and colleagues describe a potential FMRI between sleep, sleep deprivation, and immune pro- method for quantitative cerebral perfusion and illustrate cesses and nocturnal secretion of cytokines. Moreover, its usefulness in two depressed patients and one control his data suggest for the first time that alcohol depen- subject before and after sleep deprivation. dence and African-American ethnicity jointly contrib- Erich Seifritz provides a brief overview of the sleep ute to the reduction of Stages 3 and 4 sleep (low fre- disturbances associated with depression and their po- quency, high amplitude EEG measured also by spectral tential contributions to understanding the neurobiology analysis), reduced natural killer (NK) and stimulated of depression and sleep. In a 4-year longitudinal follow- NK activity, reduced pro-inflammatory cytokine IL-6, up survey of 1176 adolescents with notable depressive and increased Th2 IL-10. Since sleep deprivation is symptoms at baseline conducted by Christi Patten and common in our 24-hour society and in many psychiat- colleagues, persistent depressive symptoms were asso- ric, sleep, and medical illnesses, the question arises ciated with female gender, changes in sleep problems whether sleep disturbance is associated with clinically and cigarette smoking, and other variables. significant impairment in immune functioning. In a more chronobiological perspective, Kurt Kräu- Monte Buchsbaum and colleagues present a re- chi and Anna Wirz-Justice present physiological data analysis of their pioneering quantitative study of local supporting their new hypothesis that the onset of sleep cerebral glucose metabolism in wakefulness, nonREM depends upon a circadian upregulation of the distal to sleep, and REM sleep in normal volunteers, showing proximal skin temperature gradient, followed by de- dramatic global and regional differences among the creased core body temperature. For many years Ray three different stages of consciousness. Lam and colleagues have studied seasonal affective Applying new methods for topographical EEG (27 disorder (SAD), a disorder which may have a chronobi- EEG derivations) in normal volunteers before and after ological basis. In their current paper, catecholamine de- sleep deprivation for 40 hours, Luca Finelli and col- pletion induces a clinical relapse during the untreated, leagues demonstrate that the EEG power distribution in summer-remitted, state in these patients. In their re- nonREM sleep has a characteristic pattern (“finger print”) view paper, Barbara Parry and Ruth Newton argue for each individual. Furthermore, power in specific EEG that chronobiological disturbances may occur in pre- frequency bands increased or decreased in different corti- menstrual dysphoric disorder, pregnancy and post-par- cal regions during recovery sleep after sleep deprivation tum depression, and menopause and that all of these compared with normal sleep without prior sleep depriva- disorders respond to sleep deprivation, in some cases tion; this observation suggests that the recuperative func- for long periods of time. tions of sleep may vary between anatomically specific The future of sleep and chronobiology depends upon cortical areas. Hans-Peter Landolt and Lieselotte Post- basic and clinical neuroscience. Powerful new tools prom- huma de Boer studied three depressed patients with ise historic
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