Origin and significance of the cyclic alternating pattern (CAP)

Sleep Medicine Reviews

Volumn 4, Issue 1, 2000, Pages 101-123

  Terzano, Mario Giovanni ^a   Parrino, Liborio ^a  

^a UNIVERSITY OF PARMA   (Italy)

Author keywords

Arousals; Cyclic alternating pattern; K complexes; Oscillations; Sleep microstructure

Indexed keywords

AROUSAL; BRAIN ELECTROPHYSIOLOGY; CLASSIFICATION; ELECTROENCEPHALOGRAM; HUMAN; OSCILLATION; REM SLEEP; REVIEW; SLEEP;

EID: 0034073199     PISSN: 10870792     EISSN: None     Source Type: Journal    
DOI: 10.1053/smrv.1999.0083     Document Type: Review

References (65)

1. Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Brain Information Service/Brain Research Institute, University of California at Los Angeles, Los Angeles. 1968.
2. Terzano MG, Parrino L, Mennuni GF. Phasic events and microstructure of sleep. Consensus Conference, Italian Association of Sleep Medicine (AIMS). Lecce: Martano Editore. 1997;1-161.
3. ASDA (American Sleep Disorders Association). EEG arousals: scoring rules and examples. A preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep. 15:1992;174-184.
4. Boselli M, Parrino L, Smerieri A, Terzano MG. Effect of age on EEG arousals in normal sleep. Sleep. 21:1998;361-367.
5. Carskadon MA, Brown ED, Dement WC. Sleep fragmentation in the elderly: relationship to daytime sleep tendency. Neurobiol Aging. 3:1982;321-327.
6. Schiber JP, Muzet A, Ferriere PJR. Les phases d'activation transitoire spontanées au cours du sommeil chez l'homme. Arch Sci Physiol. 25:1971;443-465.
7. Halasz P, Kundra O, Rajna P, Pal I, Vargha M. Microarousals during nocturnal sleep. Acta Physiol Acad Sci Hung. 54:1979;11-12.
8. Nicolas A. Microstructure du sommeil: physiologie. In O. Benoit and F. Goldenberg (eds). Exploration du sommeil et de la vigilance chez l'adulte. Cachan: Editions Médicales Internationales. 1997;173-201.
9. Hornyak M, Cejnar M, Elam M, Matousek M, Wallin G. Sympathetic muscle nerve activity during sleep in man. Brain. 114:1991;1281-1295.
10. Guilleminault C, Stoohs R. Arousal, increased respiratory efforts, blood pressure and obstructive sleep apnoea. J Sleep Res. 4 (Suppl. 1):1995;117-124.
11. Sassin JF, Johnson LC. Body motility during sleep and its relation to the K-complex. Exp Neurol. 22:1968;13-144.
12. Stradling JR, Pitson DJ, Bennett L, Barbour C, Davies RJO. Variation in the arousal pattern after obstructive events in obstructive sleep apnea. Am J Respir Crit Care Med. 159:1999;130-136.
13. Halasz P. Hierarchy of micro-arousals and the microstucture of sleep. Neurophysiol Clin. 28:1998;461-475.
14. Amzica F, Steriade M. The K-complex: its slow (<1 Hz) rhythmicity and relation to delta waves. Neurology. 49:1997;952-959.
15. Amzica F, Steriade M. Cellular substrates and laminar profile of sleep K-complex. Neurosci. 82:1997;671-686.
16. Paiva T, Rosa AC. The K-complex variability in normal subjects. In MG Terzano, P Halasz and AC Declerck (eds). Phasic events and dynamic organization of sleep. New York: Raven Press. 1991;167-184.
17. Terzano MG, Parrino L, Spaggiari MC. The cyclic alternating pattern sequences in the dynamic organization of sleep. Electroenceph clin Neurophysiol. 69:1988;437-447.
18. Mckeown MJ, Humphries C, Achermann P, Borbely AA, Sejnowski TJ. A new method for detecting state changes in the EEG: exploratory application to sleep data. J Sleep Res. 7 (Suppl. 1):1998;48-56.
19. Achermann P, Borbely AA. Low-frequency (<1 Hz) oscillations in the human sleep electroÍencephalogram. Neurosci. 81:1997;213-222.
20. Terzano MG, Mancia D, Salati MR, Costani G, Decembrino A, Parrino L. The cyclic alternating pattern as a physiologic component of normal NREM sleep. Sleep. 8:1985;137-145.
21. Gaches J. Activités périodiques en EEG. Rev EEG Neurophysiol. 1:1971;9-33.
22. Fischgold H, Mathis P. Obnubilations, comas et stupeurs. Etudes électroéncephalographiques. Electroenceph clin Neurophysiol. (Suppl. 11):1959;1-126.
23. Ingvar DH, Lundberg N. Paroxysmal symptoms in intracranial hypertension, studies with ventricular fluid pressure recording and EEG. Brain. 84:1961;446-459.
24. Terzano MG, Gatti PL, Manzoni CG, Formentini E, Mancia D. Is the EEG cyclic alternating pattern a true autonomous entity? Eur Neurol. 21:1982;324-334.
25. Cooper R, Hulme A. Changes of the EEG, intracranial pressure and other variables during sleep in patients with intracranial lesions. Electroenceph clin Neurophysiol. 27:1969;564-570.
26. Lugaresi E, Coccagna G, Mantovani M, Lebrun R. Some periodic phenomena arising during drowsiness and sleep in man. Electroenceph clin Neurophysiol. 32:1972;701-705.
27. Evans BM. Cyclic EEG changes in subacute spongiform and anoxic encephalopathy. ElectroÍenceph clin Neurophysiol. 39:1975;587-598.
28. Bonvallet M, Dell P, Hiebel G. Tonus sympathique et activité électrique corticale. Electroenceph clin Neurophysiol. 6:1954;119-144.
29. Evans BM. Periodic activity in cerebral arousal mechanisms - the relationship to sleep and brain damage. Electroenceph clin Neurophysiol. 83:1992;130-137.
30. Delamont RS, Julu POO, Jamal GA. Periodicity of a noninvasive measure of cardiac vagal tone during non-rapid eye movement sleep in non-sleep deprived and sleep-deprived normal subjects. J Clin Neurophysiol. 16:1999;146-153.
31. Parrino L, Boselli M, Spaggiari MC, Smerieri A, Terzano MG. Cyclic alternating pattern (CAP) in normal sleep: polysomnographic parameters in different age groups. Electroenceph clin Neurophysiol. 107:1998;439-450.
32. Terzano MG, Parrino L, Fioriti G, Orofiamma B, Depoortere H. Modifications of sleep structure induced by increasing levels of acoustic perturbation in normal subjects. Electroenceph clin Neurophysiol. 76:1990;29-38.
33. Terzano MG, Parrino L. Evaluation of EEG cyclic alternating pattern during sleep in insomniacs and controls under placebo and acute treatment with zolpidem. Sleep. 15:1992;64-70.
34. Terzano MG, Parrino L. Clinical applications of cyclic alternating pattern. Physiol Behav. 54:1993;807-813.
35. Parrino L, Terzano MG. Polysomnographic effects of hypnotic drugs: a review. PsychoÍpharmacology. 126:1996;1-16.
36. Parrino L, Boselli M, Spaggiari MC, Smerieri A, Terzano MG. Multi-drug comparison (lorazepam, triazolam, zolpidem, zopiclone) in situational insomnia: polysomnographic analysis by means of the cyclic alternating pattern (CAP). Clin Neuropharmacol. 20:1997;253-263.
37. Terzano MG, Parrino L, Boselli M, Spaggiari MC, Di Giovanni G, Smerieri A. Sensitivity of cyclic alternating pattern to prolonged pharmacotherapy: a 5-week study evaluating zolpidem in insomniac patients. Clin Neuropharmacol. 20:1997;447-454.
38. Parrino L, Spaggiari MC, Boselli M, Di Giovanni G, Terzano MG. Clinical and polyÍsomnographic effects of trazodone CR in chronic insomnia associated with dysthymia. Psychopharmacology. 116:1994;389-395.
39. Terzano MG, Parrino L, Boselli M, Dell'Orso S, Moroni M, Spaggiari MC. Changes of cyclic alternating pattern (CAP) parameters in situational insomnia under brotizolam and triazolam. Psychopharmacology. 120:1995;237-243.
40. Moruzzi G, Magoun H. Brain stem reticular formation and activation of the EEG. Electroenceph clin Neurophysiol. 1:1949;455-473.
41. Steriade M. Arousal: revising the reticular activating system. Science. 272:1996;225-226.
42. Halasz P. Arousals without awakening-dynamic aspect of sleep. Physiol Behav. 54:1993;795-802.
43. Medori R, Tritschler HJ, Le Blanc A. Fatal familial insomnia, a prion disease with a mutation at codon 178 of the prion protein gene. N Engl J Med. 326:1992;444-449.
44. Tobler I, Deboer T, Fischer M. Sleep and sleep regulation in normal and prion protein-deficient mice. J Neurosci. 17:1997;1869-1879.
45. Garay A, Blanco S, Rosso O, Spire J-P. Evidence of a cyclic alternating pattern during abnormal rapid eye movement sleep in fatal familial insomnia. Neurology. 46:1996;A121.
46. Montagna P, Cortelli P, Avoni P. Clinical features of fatal familial insomnia: phenotypic variability in relation to a polymorphism at codon 129 of the prion protein gene. Brain Pathol. 8:1998;515-520.
47. Terzano MG, Parrino L, Boselli M, Spaggiari MC, Di Giovanni G. Polysomnographic analysis of arousal responses in OSAS by means of the cyclic alternating pattern (CAP). J Clin Neurophysiol. 13:1996;145-155.
48. Terzano MG, Parrino L, Pietrini V, Mancia D, Spaggiari MC, Rossi G, Tagliavini F. Precocious loss of physiological sleep in a case of Creutzfeldt-Jakob disease: a serial polygraphic study. Sleep. 18:1995;849-858.
49. Ferrillo F, Gabarra M, Nobili L, Parrino L, Schiavi G, Stubinski B, Terzano MG. Comparison between visual scoring of cyclic alternating pattern (CAP) and computerized assessment of slow EEG oscillations in the transition from light to deep non-REM sleep. J Clin Neurophysiol. 14:1997;210-216.
50. Terzano MG, Parrino L, Boselli M, Spaggiari MC, Ferrillo F, Di Giovanni G. The cyclic alternating pattern (CAP) as a physiological mechanism of EEG synchronization during NREM sleep. J Sleep Res. 3 (Suppl. 1):1994;251.
51. McCarley RW, Hobson JA. Neuronal excitability modulation over the sleep cycle: a structural and mathematical model. Science. 189:1975;58-60.
52. Terzano MG, Parrino L, Boselli M, Smerieri MC. CAP components and EEG synchronization in the first three sleep cycles. Clin Neurophysiol. 111:2000;283-290.
53. Amzica F, Steriade M. Electrophysiological correlates of sleep delta waves. Electroenceph clin Neurophysiol. 107:1998;69-83.
54. Terzano MG, Parrino L, Anelli S, Halasz P. Modulation of generalized spike-and-wave discharges during sleep by cyclic alternating pattern. Epilepsia. 30:1989;772-781.
55. Terzano MG, Parrino L. Functional relationship between micro- and macrostructure of sleep. In Terzano MG, Halasz P, Declerck AC (eds). Phasic events and dynamic organization of sleep. New York: Raven Press. 1991;101-119.
56. Parmeggiani PL. Regulation of physiological functions during sleep. Experientia. 38:1982;1405-1408.
57. Ferini-Strambi L, Bellodi L, Oldani A, Bertella S, Smirne S, Battaglia M. Cyclic alternating pattern of sleep electroencephalogram in patients with panic disorders. Biol Psychiatry. 40:1996;225-227.
58. Parrino L, Boselli M, Buccino GP, Spaggiari MC, Di Giovanni G, Terzano MG. The cyclic alternating pattern plays a gate-control on periodic limb movements during non-rapid eye movement sleep. J Clin Neurophysiol. 13:1996;314-323.
59. Droste DW, Krauss JK, Hagedorn G, Kaps M. Periodic leg movements are part of the B-wave rhythm and the cyclic alternating pattern. Acta Neurol Scand. 94:1996;347-352.
60. Ferini-Strambi L, Oldani A, Tirloni G, Zucconi M, Castagna A, Lazzarin A, Smirne S. Slow wave sleep and cyclic alternating pattern (CAP) in HIV-infected asymptomatic men. Sleep. 18:1995;446-450.
61. Zucconi M, Oldani A, Ferini-Strambi L, Smirne S. Arousal fluctuations in non-rapid eye movement parasomnias: the role of cyclic alternating pattern as a measure of arousal instability. J Clin Neurophysiol. 12:1995;147-154.
62. Terzano MG, Monge-Strauss MF, Mikol F, Spaggiari MC, Parrino L. Cyclic alternating pattern as a provocative factor in nocturnal paroxysmal dystonia. Epilepsia. 38:1997;1015-1025.
63. Depoortere H, Francon D, Granger P, Terzano MG. Evaluation of the stability and quality of sleep using Hjorth's descriptors. Physiol Behav. 54:1993;785-793.
64. Barcaro U, Novarra C, Belloli S, Bonanni E, Gneri C, Murri L. A simple method for the quantitative description of sleep microstructure. Electroenceph clin Neurophysiol. 106:1998;429-432.
65. Rosa AC, Parrino L, Terzano MG. Automatic detection of cyclic alternating pattern (CAP) sequences in sleep: preliminary results. Electroenceph clin Neurophysiol. 110:1999;585-592.