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Arousal and consumer in-store behavior.

From a psychophysiological point of view, arousal is a fundamental feature of behavior. As reported in different empirical studies based on insights from theories of consumer behavior, store atmosphere should evoke phasic arousal reactions to attract consumers. Most of these empirical investigations used verbal scales to measure consumers' perceived phasic arousal at the point-of-sale (POS). However, the validity of verbal arousal measurement is questioned; self-reporting methods only allow a time-lagged measurement. Furthermore, the selection of inappropriate items to represent perceived arousal is criticized, and verbal reports require some form of cognitive evaluation of perceived arousal by the individual, who might (in a non-measurement condition) not even be aware of the arousal. By contrast, phasic electrodermal reaction (EDR) has proven to be the most appropriate and valid indicator for measuring arousal [W. Boucsein, Physiologische Grundlagen und Messmethoden der dermalen Aktivität. In: F. Rösler (Ed.), Enzyklopädie der Psychologie, Bereich Psychophysiologie, Band 1: Grundlagen and Methoden der Psychophysiologie, Kapitel, Vol. 7, Hogrefe, Göttingen, 2001, pp. 551-623] that could be relevant to behavior. EDR can be recorded simultaneously to the perception of stimuli. Furthermore, telemetric online device can be used, which enables physiological arousal measurement while participants can move freely through the store and perform the assigned task in the experiments. The present paper delivers insights on arousal theory and results from empirical studies using EDR to measure arousal at the POS.

Arousal↗

Electroencephalogram characteristics of autonomic arousals during sleep in healthy men.

OBJECTIVE: Many sleep disorders involve frequent, brief arousals, not appreciated during conventional sleep stage scoring due to lack of electroencephalogram (EEG) desynchronization. We evaluated the temporal relation between heart rate (HR) changes, an index of autonomic activation, and EEG in seven healthy subjects during sleep. METHODS: We identified bouts of tachycardia-bradycardia and performed spectral analysis of EEG during these. We also identified cortical arousals by the appearance of EEG alpha activity. This allowed us to dichotomize bouts of tachycardia-bradycardia by presence or absence of cortical arousal. RESULTS: During non-rapid eye movement (REM) sleep, bouts with or without cortical arousal occurred with approximately equal frequency. Those with cortical arousals usually preceded onset of EEG changes. Those without cortical arousals were followed by increases in delta but not alpha power. EEG did not change during bouts in REM sleep. CONCLUSIONS: Capturing bouts of tachycardia-bradycardia is relatively easy via computerized algorithm. Bouts occur with cortical arousal or with slow wave synchronization suggestive of subcortical arousal. Thus, changes in HR may be useful index of arousal. SIGNIFICANCE: These brief bursts of tachycardia-bradycardia are consistent with autonomic arousal. Such a measure may be among the first in a continuum of arousal ending with frank awakening.

Adult↗

Effects of affiliation and power motivation arousal on salivary progesterone and testosterone.

Following up on earlier research suggesting a link between implicit affiliation motivation and progesterone (P) and implicit power motivation and testosterone [T; Schultheiss, O.C., Dargel, A., Rohde, W., 2003. Implicit motives and gonadal steroid hormones: Effects of menstrual cycle phase, oral contraceptive use, and relationship status. Horm. Behav. 43, 293-301.], we tested whether arousal of affiliation motivation increases P levels and whether arousal of power motivation increases T levels. Sixty subjects were randomly assigned to watch 30 min of either Bridges of Madison County (affiliation arousal) or The Godfather II (power arousal), or a documentary about the Amazon (control condition). Levels of P and T were assessed in saliva samples taken before (T1), immediately after (T2), and 45 min after the movie (T3). The efficacy of experimental conditions to differentially arouse motives was verified by assessment of changes in affiliation and power motive imagery expressed in imaginative stories written before and after the movie. After the movie, salivary P levels (T2 and T3) in the affiliation-arousal group were significantly higher than in the control group and marginally higher than in the power-arousal group. Subjects' postmovie T responses (T3) depended on premovie T levels: in men, higher premovie T levels predicted a greater likelihood of postmovie T increases in the Power Arousal condition but not in the other conditions, whereas in women, higher premovie T levels tended to be associated with postmovie T decreases in the Power Arousal condition but not in the other conditions. These findings suggest that aroused affiliation motivation has a specific stimulatory effect on P, whereas aroused power motivation has a specific stimulatory effect on T in men, but not in women, with high baseline T levels.

Adult↗

Female sexual arousal: a behavioral analysis.

OBJECTIVE: This study was designed to assess female sexual arousal by using a combination of physiologic measures and self-reported level of arousal. DESIGN: Twenty subjects viewed a 23-minute sequence of randomly ordered relaxation and erotic tapes, both with and without auditory stimulus. The physiologic parameters of vaginal blood flow, galvanic skin resistance, respiration, pulse, and blood pressure, as well as self-reported level of arousal, were simultaneously recorded and correlated with video segments. SETTING: An academic teaching hospital. PATIENT(S): The 20 subjects (mean age +/- SD: 24.9 +/- 3.0 years) included Caucasian (10), Hispanic (2), Asian-American (4), and African-American (4) women. All women were screened for normal sexual function with the Female Sexual Function Index (FSFI) and with the Beck Anxiety Inventory and Beck Depression Inventory. INTERVENTION(S): Randomly ordered sequences of erotic and relaxation tapes with and without sound. MAIN OUTCOME MEASURE(S): Physiologic and behavioral data, as well as subjective arousal rating, were acquired. The resulting set of multichannel data was correlated with erotic segments and analyzed for sound vs. no sound and time to maximal physiologic arousal. RESULT(S): Four independent variables were found to have beta values that were significantly different from 0: respiration (mean = -0.239, SD = 0.177, range = -0.55-0.09, t = -6.04), VPP (mean = 0.158, SD = 0.37, range = -0.48-0.80, t = 1.91), rVPP (mean = 0.161, SD = 0.35, range = -0.537-0.686, t = 2.075), and erotic marker (mean = 0.582, SD = 0.191, range = 0.16-0.85, t = 13.6). Neither heart rate nor galvanic skin resistance beta values approached significance. Respiration period was correlated negatively with arousal rating, indicating that subjects breathed faster when aroused. Auditory stimuli during erotic segments did not increase subjective arousal, and for both subjective arousal rating as well as VPP measurement, maximal response occurred within 2 minutes. CONCLUSION(S): Simultaneous measurement of vaginal blood flow, respiration, pulse, and a variable accounting for the onset and offset of erotic video segments accounts for approximately 50% of the variance in predicting subjective female arousal. Regardless of the presence or absence of audio input, 2 minutes was the average minimum time required to reach maximal arousal in young, sexually functional women.

Arousal↗

Sexual arousal in response to aggression: ideological, aggressive, and sexual correlates.

In two experiments we assessed the impact of aggression on nonrapists' sexual arousal. In the first, both male subjects (n = 37) and female subjects (n = 43) reported more sexual arousal in response to nonaggressive than to aggressive depictions when the portrayals were sexually explicit, but the opposite occurred when the portrayals were nonsexual. Only male subjects (N = 359) participated in the second experiment. On the basis of their self-reported sexual arousal to the use of force, they were classified into the no arousal, moderate arousal or high arousal from force groups. To evaluate the veridicality of this classification, we assessed some subjects' (n = 118) penile tumescence in response to various depictions. The findings generally replicated those of the first experiment and confirmed the accuracy of the arousal-from-force classification. The no arousal and the moderate arousal from force subjects were less sexually aroused by aggressive than by nonaggressive portrayals, but the opposite was found for the high arousal from force group. Using the entire sample (N = 359), we also assessed differences on various factors among these three groups. We found strong differences on ideological factors, including acceptance of violence against and dominance over women. We also found differences in acceptance of nonsexual aggression and in subjects' beliefs that they might actually use force against women. In contrast, differences were not found on sexuality factors. The data's implications for theories on the causes of rape are discussed.

Adult↗

Female sexual arousal: relation between cognitive and genital assessments.

Evidence from the literature concerning the relation between subjective and physiologic assessment of sexual arousal in women is sparse and inconsistent. This study assessed the relation between self-report of arousal and changes in vaginal vasocongestion in 30 nondysfunctional women during the follicular, ovulatory and luteal phases of one menstrual month. Sexual arousal, a woman's emotional response to an erotic situation, was defined as the current momentary level of excitation in response to standardized stimuli. Dependent measures of sexual arousal included a scaled subjective assessment, genital pulse amplitude, and time above a criterion level of increased vasocongestion. Significant individual differences in sexual arousal were found with all measures. Evidence of construct validity was found for the concept of sexual arousability: arousal responses were found to be highly correlated across three stimulus conditions in each laboratory session. Erotic tape recordings elicited more arousal than fantasies. Subjective reports of degree of sexual arousal were all positively correlated with objective assessments of sexual arousal, but few correlations reached significant levels; subjective-physiologic correlations were higher when arousal was elicited by fantasy than when the stimulus was an erotic tape and during the luteal phase of the menstrual cycle.

Adult↗

Arousals and nocturnal respiration in symptomatic snorers and nonsnorers.

The purpose of the present investigation was to examine the relationship among upper airway resistance, snoring, and arousals, all measured simultaneously, in nonapneic snorers complaining of excessive daytime sleepiness (EDS). To accomplish this task, we selected a group of nine nonapneic snorers who presented because of snoring, EDS, tiredness, or fatigue. Ten healthy, alert, nonapneic, nonsnoring subjects recruited from among the hospital personnel acted as a comparison group. All subjects had nocturnal polysomnography, which included measurements of snoring, nasal and pharyngeal airway pressure, esophageal pressure, and total respiratory flow. Each polysomnogram was analyzed to identify all arousals and all respiratory events, i.e. apneas, hypopneas, and periods of increased upper airway resistance. Each arousal was examined to determine whether it was associated with a respiratory event, and each respiratory event was examined to determine whether it was associated with an arousal. The results were compared between snorers and nonsnorers. There was no significant difference between the two groups in the total sleep time (182+/-61 minutes in controls vs. 188+/-50 minutes in patients) or the total number of arousals per hour of sleep (24+/-12 in controls vs. 28+/-10 in snorers). However, the distribution of arousals, i.e. electroencephalogram (EEG) vs. respiratory, was different in snorers and nonsnorers. In snorers 55% of arousals were respiratory, whereas in nonsnorers only 17% of arousals were associated with respiratory events. Not unexpectedly, the snorers had significantly more respiratory events during the night (512) than controls (112). However, the relative proportion of these events that was accompanied by arousals was similar in both groups. We conclude that the difference in daytime function between symptomatic snorers and asymptomatic nonsnorers is unlikely to be due strictly to the number of arousals during the night; however, it is possible that respiratory and EEG arousals have different impacts on daytime performance, which may explain the difference in daytime function between our two groups.

Adult↗

Spontaneous arousals during quiet sleep in piglets: a visual and wavelet-based analysis.

STUDY OBJECTIVES: The objectives of the study were to characterize spontaneous arousals during NREM sleep in piglets and to compare two methods of identifying these events: a "visual" technique using spectral analysis and an automated technique using wavelets. Our goal was to understand the benefits and limits of these methods when applied to sleep in human infants. DESIGN: Arousals were identified by evaluating rapid changes in EEG low frequency activity, blood pressure (BP), and heart rate (HR). A cortical arousal was defined as a rapid decrease in EEG low frequency activity. An autonomic arousal was defined by a transient increase in heart rate or a transient change in mean arterial BP (MAP). SETTING: Laboratory study in sleeping and awake piglets. PARTICIPANTS: Five 1-2 week old piglets. INTERVENTIONS: Chronically instrumented with a femoral arterial line, EEG, EOG, EMG electrodes, and a micro-dialysis probe with its tip located in the rostral ventral medulla. Artificial CSF (aCSF) was dialyzed into the RVM throughout the experiments Measurements: For the visual analysis, the average delta power (0.5-4 Hz) for each 5-second epoch was determined using spectral analysis. MAP and HR were analyzed in 1-second bins. Video images were analyzed for body movements and eye openings. Transient changes in blood pressure, HR, and delta power were then visually identified. For the wavelet analysis, a quantitative, automated technique with a defined "wakefulness threshold" was used to identify rapid decreases in EEG low frequency activity and the rate of change of MAP. RESULTS: Using the visual method, 117 episodes associated with stereotypical hemodynamic, EEG, and behavioral changes (startle) were identified. Seventy five events occurred in isolation or were first in a series of "multiple" events, 41 "multiple" events were defined as events occurring <20 seconds following a previous event. Eighteen events were associated with the termination of apnea. In isolated events or those occurring first in a series, the onset of changes in HR and BP clearly preceded the decrease in EEG amplitude and delta power. Using wavelet analysis, 73 EEG arousals and 115 MAP transients were identified independently; 62% of the EEG events were associated with a transient change in MAP and HR, and in these cases the onset of the hemodynamic events preceded EEG arousals. EEG arousals and MAP transients, however, also occurred alone and not associated with a stereotypical pattern of a startle, changes in MAP and HR and the EEG. CONCLUSIONS: Many of these spontaneous arousals represent integrated EEG, hemodynamic, and behavioral processes similar to arousal phenomena described in adult rats and human infants, but the pattern of spontaneous arousals appears to be more heterogeneous than has been described for arousals induced by exogenous stimuli. Both the visual and wavelet analysis identified these events, but the wavelet technique has the potential advantage of better time resolution and automation of the analysis.

Animals↗

Experimentally induced arousals during sleep: a cross-modality matching paradigm.

Micro-arousals occur spontaneously or in response to exogenous and endogenous sensory input during sleep. The function of micro-arousals remains unclear, for example, whether it reflects a disturbance or a preparatory response to environmental changes. The goal of this study was to assess arousal responsiveness when two types of sensory stimulations were used: auditory (AD) alone and the addition of a vibrotactile (VT) sensation. Ten normal sleepers participated in three nights of polygraphic recordings. The first night was for habituation and to rule out sleep disorders, and the second to collect baseline sleep data. During the third night, AD and VT + AD stimuli, with three levels of intensities for auditory and vibratory signals, were randomly given to induce arousal responses in sleep stages 2, 3 and 4 and rapid eye movement (REM). The frequency of the arousal responses increased with stimulus intensity for all sleep stages and was lowest in stages 3 and 4. In non-REM (NREM) sleep, combined VT + AD stimulation induced more frequent and more intense arousal responses than AD alone. In REM sleep, more frequent micro-arousals rather than awakenings were triggered by combined stimulations. In stage 2, the response rate of total induced K-complexes did not differ between both types of stimulations while more K-complexes followed by arousals were evoked by the combined VT + AD stimulation than by the AD alone. The induced arousals were associated with an increase in heart rate in all sleep stages. An increase in suprahyoid muscle tone was observed in NREM sleep only, REM being not associated with a rise in muscle tone following experimental stimulation. Most leg and body movements occurred in response to induced awakenings. These results suggest that the cross-modality sensory stimuli triggered more arousal responses in comparison with single-modality stimuli. In an attempt to wake a sleeping subject, the addition of a tactile stimulation, such as shaking the shoulder, is an effective strategy that increases the arousal probability.

Acoustic Stimulation↗

Autonomic arousal as a cognitive cue in stressful situations.

The need for further investigation and integration in a real world situation is demonstrated in a critical review of the literature on autonomic feedback and attribution of arousal in stressful situations. In the present study, actual autonomic arousal, arbitrary feedback of arousal, and attributions for arousal were manipulated in a dental clinic where the subjects were awaiting oral surgery. The main prediction was that cognized arousal (due either to perception of actual arousal or to arbitrary feedback about arousal level) in the absence of a nonemotional attribution for that cognized arousal would lead to higher subjective report of anxiety and to greater avoidance than would be found with either of these conditions unmet. The results on the subjective report measure generally supported this hypothesis. In addition, arbitrary feedback about arousal level did not interact with the actual arousal manipulation; nor did it produce changes in pulse rate or blood pressure, further supporting a cognitive interpretation of the effects of autonomic arousal on subjective report. However, the study illustrates difficulties in inducing beneficial beliefs in the real world. And the manipulations generally did not affect the behavioral measure, probably due to the expected consequences of that behavior.

Adolescent↗

Circadian clock resetting by arousal in Syrian hamsters: the role of stress and activity.

Circadian rhythms in the Syrian hamster can be markedly phase shifted by 3 h of wheel running or arousal stimulation during their usual daily rest period ("subjective day"). Continuous wheel running is predictive but not necessary for phase shifts of this "nonphotic" type; hamsters aroused by gentle handling without running can also show maximal shifts. By contrast, physical restraint, a standard stress procedure and thus presumably arousing, is ineffective. To resolve this apparent paradox, phase-shifting effects of 3-h sessions of restraint or other stress procedures were assessed. In a preliminary study, phase shifts to arousal by gentle handling were significantly potentiated by the cortisol synthesis inhibitor metyrapone, suggesting that stress-related cortisol release may inhibit phase shifts to arousal. Next, it was confirmed that restraint in the subjective day does not induce phase shifts, but behavioral observations revealed that it also does not sustain arousal. Restraint combined with noxious compressed air blasts did sustain arousal and induced a significant cortisol response compared with arousal by gentle handling but did not induce shifts. Restraint combined with continuous horizontal rotation was also ineffective, as was EEG-validated arousal via confinement to a pedestal over water. However, 3 h of resident-intruder interactions (an intense psychosocial stress) or exposure to an open field (a mild stress) did induce large shifts that were positively correlated with indexes of forward locomotion. The results indicate that large phase shifts associated with arousal in the usual sleep period are neither induced nor prevented by stress per se, but are dependent on the expression of at least low levels of locomotor activity. Sustained arousal alone is not sufficient.

Animals↗

Hypoxic arousal in intact and carotid chemodenervated sleeping cats.

To determine whether the carotid chemoreceptors or hyperpnea are required for arousal from sleep by hypoxia, 14 sleep-deprived cats were studied during slow-wave (SWS) and rapid-eye-movement (REM) sleep. Rapid hypoxia was produced by inhalation of 5% O2 in N2 or 6% CO in 40% O2 by intact cats and 5% O2 in N2 after carotid body denervation. Preliminary studies identified a period of SWS unassociated with spontaneous arousals. In 69 studies during SWS unassociated with spontaneous arousals, arterial O2 saturation (SaO2) values at arousal were: 47.1 +/- 1.5% (mean +/- SE) (5% O2, intact); 48.9 +/- 1.4% (6% CO, intact); and 49.9 +/- 2.0% (5% O2, denervated). During SWS associated with spontaneous arousals, SaO2 values at arousal were 71.6 +/- 1.8% (5% O2, intact). Arousal from REM occurred at significantly lower values: 31.7 +/- 3.9% (6% CO, intact) and 43.5 +/- 2.3% (5% O2, intact). During both SWS and REM, inhalation of 5% O2 by intact animals caused a substantial increase in ventilation while 6% CO did not. We conclude that more severe hypoxia is required for arousal from SWS when studies are done in a period unassociated with spontaneous arousals than from SWS associated with spontaneous arousals. Hypoxic arousal does not appear to require activation of the carotid bodies or hyperpnea.

Animals↗

Arousal responses to airway occlusion in sleeping dogs: comparison of nasal and tracheal occlusions.

Previous studies have shown that the arousal threshold to hypoxia, hypercapnia, and tracheal occlusions is greatly depressed in rapid-eye-movement (REM) sleep compared with slow-wave sleep (SWS). The aim of this study was to compare the arousal thresholds in SWS and REM sleep in response to an upper airway pressure stimulus. We compared the waking responses to tracheal (T) vs. nasal (N) occlusion in four unanesthetized, naturally sleeping dogs. The dogs either breathed through a tracheal fistula or through the snout using a fiberglass mask. A total of 295 T and 160 N occlusion tests were performed in SWS and REM sleep. The mean time to arousal during N and T tests was variable in the same dog and among the dogs. The mean time to arousal in SWS-tracheal occlusion was longer than that in N tests in only two of the four dogs. The total number of tests inducing arousal within the first 15 s of SWS-nasal occlusion tests was significantly more than that of T tests (N: 47%; T: 27%). There was a marked depression of arousal within the initial 15 s of REM sleep in T tests compared with N tests (N: 21%; T: 0%). The frequency of early arousals in REM tests was less than that of SWS for both N and T tests. The early arousal in N occlusion is in sharp contrast to the well-described depressed arousal responses to hypoxia, hypercapnia, and asphyxia. This pattern of arousal suggests that the upper airway mechanoreceptors may play an important role in the induction of an early arousal from nasal occlusion.

Airway Obstruction↗

Effects of prematurity on arousal from sleep in the newborn infant.

The incidence of sudden infant death syndrome has been found to be consistently higher in preterm and low birth weight infants than in infants born at term. Failure to arouse from sleep is one possible mechanism for sudden infant death syndrome. This study compared the arousal responses to nasal air-jet stimulation in a longitudinal study between groups of healthy preterm and term infants. Preterm infants (n = 9) were born at 31-35 wk gestation with normal birth weights for gestational age and studied on three occasions: a preterm study at 36 wk, at 2-3 wk post-term, and at 2-3 mo post-term. Term infants (n = 22) were born at 37-42 wk and were studied at 2-3 wk and 2-3 mo post-term. Arousal thresholds were determined in both active sleep (AS) and quiet sleep (QS). In preterm infants, there was no state-related difference in arousal thresholds at either the 36 wk or 2-3 wk study; however, at 2-3 mo, arousal threshold was significantly greater in QS than AS (p < 0.05). In contrast, in term infants, arousal thresholds were significantly elevated in QS compared with AS at both 2-3 wk and 2-3 mo (p < 0.001). Arousal thresholds in AS were not different between the two groups of infants, with both groups of infants remaining readily arousable. However, in QS at 2-3 mo, arousal thresholds were significantly lower in the preterm infants (p < 0.05). This study has demonstrated that arousability is altered by gestational and postnatal age. The lower arousability that characterizes QS in term infants regardless of age is not evident in preterm infants until 2-3 mo post-term age.

Adult↗

Pulse transit time as a measure of arousal and respiratory effort in children with sleep-disordered breathing.

The upper airway resistance syndrome (UARS) is associated with neurobehavioral morbidity in children. The diagnostic gold standard for UARS is esophageal manometry. However, this is invasive. Furthermore, upper airway obstructive events in sleeping children frequently terminate without visible electrocortical (EEG) arousal. The pulse transit time (PTT) is a noninvasive marker of blood pressure and, therefore, subcortical arousal. Blood pressure elevation, associated with respiratory arousal from sleep, results in a drop in the PTT. We hypothesized that: 1) the PTT is a more sensitive measure of respiratory arousal than EEG; and 2) the PTT arousal index can distinguish children with UARS from those with primary snoring. Polysomnography, including esophageal manometry and PTT, was measured prospectively in 24 symptomatic children and 10 normal controls. Apnea, hypopnea, and respiratory effort-related arousal events terminated in a PTT arousal 91%, 83%, and 80% of the time, and in an EEG arousal in 55%, 51%, and 43% (all p < 0.05), respectively. The PTT arousal index was significantly greater in children with UARS (6.8 events/h) than primary snoring (2.2 events/h) (p < 0.05). We conclude that, in children, PTT arousals are a more sensitive measure of obstructive events than visible EEG arousals.

Adult↗

Effect of arousal and retention delay on memory: a meta-analysis.

Two meta-analyses were conducted to examine the magnitude of the interaction between arousal and retention delay on various types of memory, e.g., verbal, visual, etc., as initially reported by Kleinsmith and Kaplan in 1963 and 1964. Results of the first meta-analysis (29 studies, N = 2,637) indicated that the interaction was robust (d = .779), with low arousal leading to better immediate memory than high arousal, whereas high arousal led to better delayed memory than low arousal. Incorporating additional studies, a subsequent meta-analysis (48 studies, N = 3,143) on the effect of arousal on memory, taking retention delay as a moderator, provided further support. At a 2-min. delay, low arousal led to better immediate memory than high arousal (d = -.459). This difference decreased at a 20-min. delay (d = .106), when directions of high and low arousal effects on memory appeared to reverse. At longer delays than 20 min., high arousal led to better delayed memory than low arousal (ds = .753, .219, and .472, for delays of 45-min., 1-day, and more than 1-day, respectively).

Arousal↗

Relationship of temporal lobe seizures to sleep and arousal: a combined scalp-intracranial electrode study.

STUDY OBJECTIVES: The role of arousal from sleep in promoting epileptic seizures is controversial. To examine the question of whether seizures precede or follow arousals from sleep, we defined the timing of temporal lobe seizures in relation to sleep and arousal using combined scalp-intracranial electrodes. DESIGN: Retrospective review of 67 sleep-related mesial temporal lobe seizures in 14 subjects. SETTING: Inpatient epilepsy monitoring laboratory. PATIENTS: Subjects with medically refractory mesial temporal lobe seizures undergoing epilepsy surgery evaluations. INTERVENTIONS: None MEASUREMENTS AND RESULTS: Electroencephalographic (EEG) and/or polygraphic recordings and videotapes were independently reviewed to determine intracranial electrode seizure onset times and time of initial arousal from sleep. In 60 seizures in 13 subjects, intracranial ictal onsets always preceded clinical arousals from sleep. Electrographic signs of arousal in the scalp EEG, defined by the presence of sustained alpha or theta activity, either coincided with or followed, but never preceded, intracranial ictal onsets. In seven seizures in one subject with known seizures upon awakening, intracranial ictal onsets always followed clinical arousals and electrographic signs of arousal from sleep. Seven of the 14 subjects had electrooculogram and chin electromyogram monitoring; in these subjects, no seizures occurred during REM sleep with the majority occurring during NREM stage 2 sleep. CONCLUSIONS: Most sleep-related temporal lobe seizures occurred during NREM sleep and preceded arousals, supporting the premise that processes involved in the initiation and maintenance of NREM sleep play a greater role in facilitating temporal seizures than those involved in promoting REM sleep and arousal. However, arousal from sleep may provoke seizures in exceptional cases.

Electrodes↗

Arousal responses in babies at risk of sudden infant death syndrome at different postnatal ages.

Hypercarbic and hypoxic arousal responses during sleep were measured in healthy term infants, infants where a previous sibling died from sudden infant death syndrome (SIDS) and infants suffering a clearly defined apparent life threatening event (ALTE) requiring vigorous or mouth to mouth resuscitation. Groups of infants were tested at approximately one, six and 13 weeks postnatally. Arousal was defined as gross body movement with eyes opening and moving or crying. Hypercarbic arousal was by step increases in F1 Co2 until arousal occurred or until endtidal (PETCO2) reached 8.7 KpA (65 mm Hg) Hypoxic arousal was by step decreases in FIO2 until arousal occurred or until an FIO2 of 0.15 had been maintained for 20 minutes. There was no difference in hypercaribic arousal threshold with age in any group. Hypercarbic arousal threshold was significantly higher in siblings (mean 53.4, 53.6, 54.7 mmHg. [7.12, 7.14, 7.29 KPA] at 0, 6, 13 postnatal weeks) compared to controls (mean 50.9, 52.3, 53.0mm Hg. [6.78, 6.97, 7.29 KPS respectively). ALTE infants differed only at 12 weeks having a significantly lower threshold (51.0mmHg. [6.80 KPA] V 53.0mm Hg. (7.06 KPA]) compared to controls. There was no difference in hypoxic arousal response with age in any group. An arousal response to hypoxia occurred in only 22% of ALTE infants and 40% of siblings compared to 67% of normal infants. Deficient sleep arousal, especially to hypoxia, is common in infants and especially those considered at increased risk from SIDS. This deficiency is present in the first postnatal week and did not vary overy the first three months of postnatal life.

Arousal↗