Autonomic regulation during sleep and wakefulness: a review with implications for defining the pathophysiology of neurological disorders

Abstract

Cardiovascular and respiratory parameters change during sleep and wakefulness. This observation underscores an important, albeit incompletely understood, role for the central nervous system in the differential regulation of autonomic functions. Understanding sleep/wake-dependent sympathetic modulations provides insights into diseases involving autonomic dysfunction. The purpose of this review was to define the central nervous system nuclei regulating sleep and cardiovascular function and to identify reciprocal networks that may underlie autonomic symptoms of disorders such as insomnia, sleep apnea, restless leg syndrome, rapid eye movement sleep behavior disorder, and narcolepsy/cataplexy. In this review, we examine the functional and anatomical significance of hypothalamic, pontine, and medullary networks on sleep, cardiovascular function, and breathing.

Autonomic dysfunction in sleep disorders: introduction to the series

“…Although sleep is not traditionally considered a function regulated by the autonomic nervous system, it is evident that there are overlapping areas in the central nervous system (CNS) that regulate both systems, resulting in interesting and relevant interactions that can potentially impact morbidity and mortality. These interactions are concisely summarized in the review by Fink and colleagues [6], which highlights how specific CNS nuclei play a critical role in regulating cardiovascular autonomic function during both rapid eye movement (REM) and non-REM sleep.The sleep-autonomic interactions can occur, broadly speaking, under three different scenarios, which are not mutually exclusive and can overlap:(1) A common etiology impairs both the autonomic and sleep systems. The α-synucleinopathies, disorders caused by the abnormal accumulation of misfolded α-synuclein, are a very good example of this scenario, as reviewed by Chiaro and colleagues in this issue [5].…”

“…Although sleep is not traditionally considered a function regulated by the autonomic nervous system, it is evident that there are overlapping areas in the central nervous system (CNS) that regulate both systems, resulting in interesting and relevant interactions that can potentially impact morbidity and mortality. These interactions are concisely summarized in the review by Fink and colleagues [6], which highlights how specific CNS nuclei play a critical role in regulating cardiovascular autonomic function during both rapid eye movement (REM) and non-REM sleep.…”

“…(2) Failure of sleep-related cardio-respiratory control mechanisms and impaired arousal response cause or aggravate autonomic dysfunction. In this context, autonomic dysfunction can occur in sleep apnea, as reviewed by Fink and colleagues [6], or in the sudden infant death syndrome, as explained by Horne in her authoritative review [9]. These disorders can potentially result in prolonged hypoxia during sleep, cardiac arrhythmias and death.…”

Sleep Physiology, Circadian Rhythms, Waking Performance and the Development of Sleep-Wake Therapeutics

“…Sleep is a major determinant of well-being, mental and physical health and understanding sleep-health relations, and sleep disorders are dependent on adequate quantification of sleep. Sleep and wake states are characterised by constellations of variables representing nearly all levels of system organisation ranging from gene expression (O'Callaghan et al 2018), neuronal firing patterns (McKillop and Vyazovskiy 2018), neurotransmitter release (Zant et al 2016;Luppi and Fort 2018), endocrine and autonomic nervous system status (Morris et al 2012;Fink et al 2018), body and brain temperature (Landolt et al 1995), responsiveness to external stimuli (Ermis et al 2010), motor behaviour (Horner and Peever 2017) to changes in consciousness (Casali et al 2013). Which variables are essential to sleep quality and how these variables contribute to sleep's associations with well-being, physical health and brain function remain, however, largely unknown even though several hypotheses have been proposed.…”

<p>Changes in Heart Rate Variability and Baroreflex Sensitivity During Daytime Naps</p>

“…The overall interaction between these neuronal groups mediates the central sympathetic and parasympathetic outputs to the cardiovascular and respiratory system. 3,5 The physiological decrease of BP during NREM sleep is caused by generalized cardiovascular suppression and baroreflex resetting as a consequence of central autonomic effect with parasympathetic dominance. In contrast, BP increases during REM sleep because of sympathetic outflow changes, thereby causing a net effect of increased peripheral vascular resistance.…”