Physiopathologie du somnambulisme : étude de l’activité cérébrale en sommeil lent profond via la Tomographie d’Émission Monophotonique (TEMP) et l'analyse de connectivité fonctionnelle cérébrale

Somnambulism is characterized by the occurrence of complex motor behaviours during NREM sleep in a state in which consciousness, judgement and cognitive functions are altered. Although the disorder affects up to 4% of adults, its pathophysiology remains poorly understood. Initially viewed as a disorder reflecting an incomplete transition from sleep to wakefulness, sleepwalking is now also conceptualized as reflecting key anomalies in slow-wave sleep. The main objective of this thesis was to characterize the cerebral activity of sleepwalkers during wakefulness and during slow-wave sleep in order to elucidate the nature of episode occurrence as well as the disorder’s pathophysiology. EEG functional connectivity analysis and single-photon emission computed tomography (SPECT) are two innovative methods that have been widely used to describe normal sleep. However, these methods had not yet been used to investigate sleepwalkers’ slow wave sleep.  In study 1, EEG functional connectivity analyses were used to investigate changes in EEG signal synchronization and interdependency in a group of 27 sleepwalkers who experienced a somnambulistic episode during slow-wave sleep. The 20-sec segment of sleep EEG immediately preceding each patient’s episode was compared with the 20-sec segment occurring two minutes prior to episode onset. Results show that episode onset is preceded by changes in EEG functional connectivity, including decreased delta connectivity in parietal and occipital regions and increased beta connectivity in symmetric inter-hemispheric networks implicating frontal, parietal and occipital areas. These results indicate that somnambulistic episodes are preceded by brain processes characterized by the co-existence of arousal and deep sleep and provide new insights into sleepwalking’s pathophysiology while bolstering its conceptualization as a disorder of arousal. In study 2, SPECT was used to investigate recovery slow-wave sleep and wakefulness following sleep deprivation in 10 sleepwalkers and 10 matched controls. When compared to controls, sleepwalkers showed decreased rCBF in frontal and parietal areas, regions previously associated with slow-wave sleep generation and episode occurrence. Additionally, reduced rCBF was found in the dorsolateral prefrontal cortex and insula during recovery slow-wave sleep, which is consistent with several clinical features of somnambulistic episodes. Reduced rCBF found during sleepwalkers’ resting-state wakefulness in frontal and parietal regions may be related to daytime cognitive and functional anomalies previously described in this population. Taken as a whole, the results from this thesis suggest that sleepwalking is characterized by cerebral functional anomalies that extend well beyond the episodes themselves. In fact, not only are such anomalies observed immediately preceding episode onset, but also more generally during sleepwalkers’ recovery slow-wave sleep and resting-state wakefulness following sleep deprivation. These findings highlight the importance of conceptualizing sleepwalking’s pathophysiology in a way that adequately accounts for how the disorder manifests itself outside of actual behavioural episodes.

Keyphrases: EEG, somnambulism, brain imaging, Slow-wave sleep, pathophysiology, functional connectivity