Integrity of corpus callosum is essential for the cross-hemispheric propagation of sleep slow waves: a high-density EEG study in split-brain patients
Authors: Avvenuti Giulia , Handjaras Giacomo , Betta Monica , Cataldi Jacinthe , Imperatori Laura Sophie , Lattanzi Simona , Riedner Brady A. , Pietrini Pietro , Ricciardi Emiliano , Tononi Giulio , Siclari Francesca , Polonara Gabriele , Fabri Mara , Silvestrini Mauro , Bellesi Michele , Bernardi Giulio 
Published: September 2019

The slow waves of NREM-sleep (0.5-4Hz) reflect experience-dependent plasticity and play a direct role in the restorative functions of sleep. Importantly, slow waves behave as traveling waves and their propagation is assumed to reflect the structural properties of white matter connections. Based on this assumption, the corpus callosum (CC) may represent the main responsible for cross-hemispheric slow wave propagation. To verify this hypothesis, here we studied a group of patients who underwent total callosotomy due to drug-resistant epilepsy. Overnight high-density (hd)-EEG recordings (256 electrodes) were performed in five totally callosotomized in-patients (CP; 40-53y, 2F), in three control non-callosotomized neurological in-patients (NP; 44-66y, 2F, 1M epileptic), and in an additional sample of 24 healthy adult subjects (HS; 20-47y, 13F). Data were inspected to select NREM-sleep epochs and artefactual or non-physiological activity was rejected. Slow waves were detected using an automated algorithm and their properties and propagation patterns were computed. For each slow wave parameter and for each patient, the relative z-score and the corresponding p-value were calculated with respect to the distribution represented by the HS-group. Group differences were considered significant only when a Bonferroni corrected P < 0.05 was observed in all the CP and in none of the NP. A regression-based adjustment was used to exclude potential confounding effects of age. Slow wave density, amplitude, slope and propagation speed did not differ across CP and HS. In all CP slow waves displayed a significantly reduced probability of cross-hemispheric propagation and a stronger inter-hemispheric asymmetry. Moreover, we found that the incidence of large slow waves tended to differ across hemispheres within individual NREM epochs, with a relative predominance of the right over the left hemisphere in both CP and HS. The absolute magnitude of this inter-hemispheric difference was significantly greater in CP relative to HS. This effect did not depend on differences in slow wave origin within each hemisphere across groups. Present results indicate that the integrity of the CC is essential for the cross-hemispheric traveling of sleep slow waves, supporting the assumption of a direct relationship between white matter structural integrity and cross-hemispheric slow wave propagation. Our findings also imply a prominent role of cortico-cortical connections, rather than cortico-subcortico-cortical loops, in slow wave cross-hemispheric synchronization. Finally, this data indicate that the lack of the CC does not lead to differences in sleep depth, in terms of slow wave generation/origin, across brain hemispheres.