Restoring Spindle and Thalamocortical Efficiency in Early-Course Schizophrenia Patients Using Auditory Stimulation

Official title

Restoring Spindle and Thalamocortical Efficiency in Early-Course Schizophrenia Patients Using Closed-Loop Auditory Stimulation

Overview

The purpose of this research is to identify differences in brain activity during sleep between health individuals and individuals with schizophrenia, schizophreniform, or schizoaffective disorder. This study will also investigate whether tones played during deep sleep can enhance specific features of sleep and whether enhancing such features is related to an improvement in cognitive performance.

Detailed description

The overarching goal of the proposed study is to establish sleep spindle and slow wave abnormalities as early pathophysiological biomarkers of schizophrenia (SCZ). The investigators also seek to enhance spindle and slow wave deficits in EC-SCZ by utilizing a closed-loop auditory stimulation during sleep. The investigators will assess improvement of deficits with the use of a memory consolidation task before and after sleeping.

Participants will include early-course schizophrenia (EC-SCZ) subjects and healthy controls (HC). Participants will complete several assessments, including clinical evaluation, an IQ assessment (WASI), and at least 2 nights of sleep EEG recordings in the sleep clinic of UPMC Western Psychiatric Hospital with a polysomnography test (PSG) each night. Study participants will also fill out a Pittsburgh Sleep Quality Index (PSQI) which reports sleep habits. On one of the nights, EC-SCZ participants will receive active closed-loop auditory stimulation, while on another night they will receive sham closed-loop auditory stimulation. On all nights beside the adaptation night (night 1) participants will complete the motor sequence task (MST) and the AX-continuous performance task (AXCPT) before going to sleep. They will also repeat the task the following morning. There will be \~1 week between nights 2 and 3 and \~1 week between nights 3 and 4.

Aim 1. Establish sleep spindle and slow wave deficits in EC-SCZ patients relative to HC using a wireless ambulatory monitor.

H1a. EC-SCZ patients will have reduced sleep spindle duration and density compared to HC.

H1b. Slow wave density will be decreased in EC-SCZ patients relative to HC.

Aim 2. Determine that spindle and slow wave impairments can be acutely improved in EC-SCZ patients using closed-loop auditory stimulation during sleep.

H2a. Sleep spindle duration and density will increase during closed-loop auditory stimulation nights compared to baseline and sham intervention.

H2b. Slow wave density will increase during stimulation nights relative to baseline and sham intervention.

Aim 3. Examine the relationship between spindle and slow wave deficits and memory consolidation before and after their acute improvement in EC-SCZ patients relative to HC.

H3a. At baseline, sleep spindles and slow waves will predict memory consolidation in EC-SCZ patients and HC.

H3b. An increase in sleep spindles and slow waves during stimulating night will be associated with task-assessed memory consolidation improvement in EC-SCZ patients relative to baseline performance.

Interventions

• Device Closed-loop auditory stimulation
  Closed-loop auditory stimulation will be administered by a wearable EEG device (Philips SmartSleep Deep Sleep Headband). The EEG device will deliver auditory stimulation when slow-wave (deep) sleep is detected. Auditory stimulation will consist of 50ms long tones separated from each other by a fixed one-second inter-tone interval. The volume of each tone will be linearly modulated by sleep-depth such that louder (or softer) tones were played during deeper (or shallower) sleep.
• Device Sham auditory stimulation
  Sham auditory stimulation consists of closed-loop auditory stimulation not being administered. A wearable EEG device (Philips SmartSleep Deep Sleep Headband) will not deliver closed-loop auditory stimulation and tones will not be played.

Primary outcome measures

• Deficits in sleep spindle and slow wave density in early-course schizophrenia patients (EC-SCZ). [Time frame: baseline (pre closed-loop auditory stimulation)]
• Deficits in sleep spindle and slow wave duration in early-course schizophrenia patients (EC-SCZ). [Time frame: baseline (pre closed-loop auditory stimulation)]
• Deficits in sleep spindle and slow wave amplitude in early-course schizophrenia patients (EC-SCZ). [Time frame: baseline (pre closed-loop auditory stimulation)]
• Improvement in sleep spindle and slow wave density. [Time frame: baseline (pre closed-loop auditory stimulation), study completion (up to 6 weeks)]
• Improvement in sleep spindle and slow wave duration. [Time frame: baseline (pre closed-loop auditory stimulation), study completion (up to 6 weeks)]
• Improvement in sleep spindle and slow wave amplitude. [Time frame: baseline (pre closed-loop auditory stimulation), study completion (up to 6 weeks)]
• Relationship between spindle and slow wave deficits and memory consolidation. [Time frame: baseline (pre closed-loop auditory stimulation), study completion (up to 6 weeks)]

Eligibility criteria

Inclusion criteria

Early-course schizophrenia (EC-SCZ):

• ages 18-40 years
• current DSM-IV defined diagnosis of schizophrenia, schizophreniform or schizoaffective disorder, not drug-induced, with no previously reported psychotic episode
• duration of ≤5 years from beginning of psychosis, defined by report of symptoms and/or history of treatment according to clinical guidelines employed in our University of Pittsburgh Medical Center (UPMC) psychoses clinics in Pittsburgh
• lifetime exposure to antipsychotic medications ≤5 years

Healthy controls (HC):

• ages 18-40 years
• no lifetime history of psychiatric disorders
• no first-degree family history of schizophrenia spectrum disorder or mood disorder with psychotic features.

Exclusion criteria

General exclusion criteria:

• DSM-IV intellectual disability
• significant head injury
• medical illness affecting brain function or structure
• pregnancy or postpartum (<6 weeks after delivery or miscarriage)
• significant neurological disorder (e.g. seizure disorder)
• inability to provide informed consent
• current or past co-morbidity for alcohol or psychoactive substance dependence
• substance abuse other than cannabis and/or alcohol within the past one year

For EC-SCZ:

a) a psychotic illness with a temporal relation to substance use or head injury

For healthy controls (HC):

• difficult falling and/or staying asleep for more than half the nights of a week, on average
• diagnosis of sleep apnea or restless leg syndrome
• sleeping less than 5 hours or more than 10 hours daily, on average

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Crossover

Masking

Triple blind

Primary purpose

Basic science

Study locations

United States · 1 center

• University of Pittsburgh — Pittsburgh

Identifiers

NCT: NCT05956951 · STUDY20010236 · R01MH130376

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗