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Night-to-night arousal variability and interscorer reliability of arousal measurements.

STUDY OBJECTIVES: Measurement of arousals from sleep is clinically important, however, their definition is not well standardized, and little data exist on reliability. The purpose of this study is to determine factors that affect arousal scoring reliability and night-to-night arousal variability. DESIGN: The night-to-night arousal variability and interscorer reliability was assessed in 20 subjects with and without obstructive sleep apnea undergoing attended polysomnography during two consecutive nights. Five definitions of arousal were studied, assessing duration of electroencephalographic (EEG) frequency changes, increases in electromyographic (EMG) activity and leg movement, association with respiratory events, as well as the American Sleep Disorders Association (ASDA) definition of arousals. SETTING: NA. PATIENTS: NA. INTERVENTIONS: NA. RESULTS: Interscorer reliability varied with the definition of arousal and ranged from an Intraclass correlation (ICC) of 0.19 to 0.92. Arousals that included increases in EMG activity or leg movement had the greatest reliability, especially when associated with respiratory events (ICC 0.76 to 0.92). The ASDA arousal definition had high interscorer reliability (ICC 0.84). Reliability was lowest for arousals consisting of EEG changes lasting <3 seconds (ICC 0.19 to 0.37). The within subjects night-to-night arousal variability was low for all arousal definitions CONCLUSION: In a heterogeneous population, interscorer arousal reliability is enhanced by increases in EMG activity, leg movements, and respiratory events and decreased by short duration EEG arousals. The arousal index night-to-night variability was low for all definitions.

Arousal

Prediction of physiological arousability: a validation of the Arousal Predisposition Scale.

The Arousal Predisposition Scale (APS) is a brief (12-item) scale, that purportedly measures arousability, and has already been shown to predict task related arousal changes measured via self-report indexes. To determine if APS scores could predict individual differences in physiological measures of arousal, it was administered to 239 subjects. From this group, 9 highly arousable subjects and 9 low arousable subjects (based on APS scores) were selected. Each subject was repeatedly exposed to an arousing stimulus consisting of a 105 dB white noise. Electrodermal activity and the electromyographic response were used as indexes of change in autonomic and affective arousal. Subjects who scored highly arousable on the APS showed a greater change in electrodermal and electromyographic response than subjects judged low on arousability. This appears to validate the usefulness of the APS as a measure of individual differences in predisposition toward arousability.

Adolescent

Self-report and cardiovascular measures of arousal: fractionation during residual arousal.

Residual arousal has been conceptualized as a state of physiological activation that is amenable to misattribution-like processes because individuals are unaware of their aroused physiological state (Zillmann, 1978). Although there is considerable evidence showing that people in the state labeled "residual arousal" rate excitatory stimuli in a more polarized fashion (see review by Zillmann, 1983), the available evidence for the notion that residual arousal is imperceptible can alternatively be interpreted as evidence of an inability to discriminate the cause of the residual arousal. To determine the nature of the cognitive representation of residual arousal (and, hence, whether excitation transfer is likely to be a nonconscious rather than conscious misattributional process), cardiac activity and reported arousal were tracked before, during, and following exercise. Results replicated previous research showing that exercise-induced cardiac activity remained significantly elevated when subjects ceased to report feeling aroused due to the exercise. These findings were extended through the joint use of magnitude estimation and psychophysiological procedures to index what level of exercise-induced bodily activation was reportable. Results indicated that residual arousal is unperceived rather than perceived and mistaken as to its cause. Implications of the present research range from theories of arousal and of misattribution to the effects of stress-related variations in cardiac performance on cardiac detection.

Adolescent

Sexual arousal and arousability in a sexual offender population.

Assessed penile erections in response to descriptions of consenting sex, rape, and nonsexual assault among 78 inpatient male sexual offenders. All forms of sexual arousal were positively correlated, and sexual arousal to consenting stimuli exceeded arousal to coercive stimuli. Subjects who were able to completely inhibit their arousal exhibited less arousal to sexual assault stimuli than did subjects who were unable to completely inhibit arousal when both groups were not instructed to inhibit arousal. Inhibitory ability covaried with victim maturity, and with months spent in a treatment program. The maturity of the victims in the subjects' sexual offenses was not significantly related to sexual arousal. Thus, sexual offenders' sexual arousal as assessed by physiological measures may be more a function of arousability variables than of actual offending behaviors.

Adult

Physiological arousal, dissonance, and attitude change: evidence for a dissonance-arousal link and a "don't remind me" effect.

Two experiments replicated and extended research by Croyle and Cooper (1983) indicating that cognitive dissonance involves physiological arousal. In Experiment 1, subjects wrote counterattitudinal essays under conditions of high or low choice, and, to assess arousal effects owing to effort, with or without a list of arguments provided by the experimenter. In high-choice conditions only, and regardless of effort, subjects showed both arousal (heightened galvanic skin response) and attitude change. Arousal, however, did not decline following attitude change. The more effortful task (no arguments provided) produced increased arousal but not greater attitude change. In Experiment 2, the opportunity to change one's attitude following a freely chosen counterattitudinal essay was manipulated. As in Experiment 1, arousal increased following the essay but did not decline following a postessay attitude change opportunity. When subjects were not given an attitude change opportunity, however, arousal did decline. Thus, dissonance seems to create arousal, but attitude change sustains rather than reduces the arousal. It is suggested that if dissonance is a drive state, drive reduction typically may be accomplished through gradual cognitive change or forgetting.

Arousal

Determinants of subjective experience of sexual arousal in women: feedback from genital arousal and erotic stimulus content.

Sixty-two women participated in a study designed to explore the association between genital and subjective sexual arousal. Four stimulus conditions were created, designed to evoke differential patterns of genital arousal over time. Subjects were instructed to report sensations in their genitalia while being exposed to the same erotic stimulus on repeated trials or to a series of varying erotic stimuli. Detection of genital arousal was facilitated by the occurrence of changes in genital arousal over trials. That is, genital and subjective sexual arousal were linearly related in conditions that resulted in large differences in genital arousal over trials, whereas such a relation was absent in conditions in which genital arousal levels remained relatively constant. In women, peripheral feedback from consciously detected genital arousal seems to be a relatively unimportant determinant of subjective sexual arousal.

Adolescent

Sleep disorders: disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in "dreaming sleep".

In summary, the classical sleep disorders of nocturnal enuresis, somnambulism, the nightmare, and the sleep terror occur preferentially during arousal from slow-wave sleep and are virtually never associated with the rapid-eye-movement dreaming state. Original data are reported here which indicate that physiological differences from normal subjects, of a type predisposing the individual to a particular attack pattern, are present throughout the night. The episode, at least in the case of enuresis, appears to be simply a reinforcement of these differences to a clinically overt level. A number of features are common to all four sleep disorders. These had been shown previously to be attributable to the arousal itself. New data obtained by means of evoked potential techniques suggest that these common symptoms of the confusional period that follows non-REM sleep are related to alterations of cerebral reactivity, at least of the visual system. The symptoms which distinguish the individual attack types (that is, micturition, prolonged confusional fugues, overt terror) appear to be based upon physiological changes present throughout sleep which are markedly accentuated during arousal from slow-wave sleep. These changes may in some way be related to diurnal psychic conflicts. But, to date, it has proved impossible to demonstrate potentially causal psychological activity, dreaming or other forms of mental activity, or even a psychological void in sleep just preceding the attacks. The presence of all-night or even daytime predisposing physiological changes and the difficulty in obtaining any solid evidence of a preceding psychological cause explain, no doubt, why the results of efforts to cure the disorders at the moment of their occurrence (for example, by conditioning procedures in nocturnal enuresis) have been far from satisfactory. I stress the points that the attacks are best considered disorders of arousal and that the slow-wave sleep arousal episode which sets the stage for these attacks is a normal cyclic event. Indeed it is the most intense recurrent arousal that an individual regularly experiences. The most fruitful possibilities for future research would appear to be more detailed studies of those physiological changes that predispose individuals to certain types of attacks when they undergo intense arousal or stress; the reversal of these changes by psychological or pharmacological means; and more refined investigations of the physiological and psychological characteristics of the process of cyclic arousal from non-REM sleep.

Adolescent

Penile erection: a reflection of sexual arousal and arousability in male chimpanzees.

A study was conducted to determine if sexual motivation in male chimpanzees, defined by the two components, sexual arousal and arousability, could be quantified by measuring penile erection during laboratory pair-tests of sexual behavior. Sexual arousal, the momentary level of sexual excitation, was quantified by single measurements on a scale of penile erection. Sexual arousability, the propensity for arousal, was quantified by the rate of approach to full erection and by mean erection scores. Sexual arousability, as defined, was related to the frequency of male courtship displays, copulations, and ejaculations, which were highest at midcycle and positively correlated with a quantitative measure of female anogenital swelling. Sexual arousal was negatively correlated with continued exposure to the female and least variable during midcycle. These operational definitions of sexual motivation in the male chimpanzee facilitate comparative research in which analogous indexes of sexual motivation are required such as when extrapolating from animal to human.

Animals

Combined modulating effects of the general arousal and the specific hunger arousal on the olfactory bulb responses in the rat.

The combined modulating effects of the general level of arousal and specific hunger arousal on the olfactory bulb responses were investigated in the rat. Vigilance state parameters and multi-unit mitral cell activity were recorded in freely moving animals stimulated by control odours and by their usual food odour, either in the hungry or the satiated state. The nutritionally modulated bulb responses towards food odour were observed only for high arousal level (wakefulness). In rapid eye movement sleep (REMS), no olfactory response occurred. In slow wave sleep (SWS), one observed either a high bulb responsiveness to stimuli with neocortical arousal, or a general inexcitability. Each odorous stimulus in SWS elicited a higher neocortical arousal rate in the hungry than in the satiated state, as did food odour compared with control odours in both nutritional states. In SWS, a progressive alteration of the nutritionally modulated responses occurred at first at the bulb level and later for inner structures. Rats fed 2 h a day displayed a reversed circadian sleep-waking cycle and a lower SWS proportion compared with rats fed ad libitum. The hunger arousal could quantitatively and qualitatively modulate the activity of structures regulating the sleep-waking pattern.

Animals

Autonomic markers of arousal during sleep in patients undergoing investigation for obstructive sleep apnoea, their relationship to EEG arousals, respiratory events and subjective sleepiness.

Estimating the degree of sleep fragmentation is an important part of a respiratory sleep study and is conventionally measured using EEG micro arousals or is inferred indirectly from respiratory abnormalities such as apnoeas and desaturations. There is a need for less labour-intensive measures of sleep fragmentation, and transient rises in blood pressure and heart rate may fulfil this role. Forty unselected sleep clinic referrals undergoing investigation for possible obstructive sleep apnoea (OSA) were studied with one night of polysomnography. Three conventional indices of sleep fragmentation (EEG micro arousals, apnoea/hypopnoea index (AHI) and oxygen saturation dip rate (SaO2 dips)) and two autonomic indices (heart rate and blood pressure rises) have been compared. Correlations between these five indices ranged from r=0.38 to r=0.73. Of the two autonomic indices, the correlations for blood pressure rises with SaO2 dips and EEG micro arousals were stronger (r=0.71 and r=0.65, respectively) than those for heart rate rises (0.55 and 0.51). All indices of sleep fragmentation, apart from heart rate rises, were similar in their correlation with subjective sleepiness (r-values 0.21-0.36). Arousals implied from blood pressure rises (using pulse transit time) can be measured easily, are objective, and appear no worse at predicting subjective sleepiness than either EEG micro arousals or AHI. They may therefore provide a useful alternative to manual scoring of micro arousals from the EEG as an index of sleep fragmentation in sleep clinic patients undergoing investigation for possible OSA.

Adult

Horizontal component of electro-oculogram as a parameter of arousal in dementia: relationship between intellectual improvement and increasing arousal under pharmacotherapy.

Although nootropics and metabolically active compounds sometimes attenuate intellectual deficits of dementia patients, this mechanism has not been discussed or investigated. The authors hypothesized that these compounds act to enhance attention and/or concentration by increasing the arousal level, and then improve intellectual functions. Based on this hypothesis, the authors investigated the arousal level and the improvement of intellectual functions in ten patients with Alzheimer type dementia and ten patients with multi-infarct dementia before and after 3 months pharmacotherapy using bifemelane hydrochloride. They then analyzed whether the increases in arousal level involves or relates to the improvement of intellectual functions. On the 20 patients, psychological tests were carried out, and the arousal level was evaluated using the frequency of rapid eye movements in the electro-oculogram (EOG) before and after 3 months administration of bifemelane hydrochloride. As a result, a significant positive correlation was observed between the improvement on the Hasegawa's dementia scale and the rate of increase in rapid eye movements in the EOG. The EOG monitoring can be a great help in establishing an objective evaluation method on drug efficacy.

Aged

Effectiveness of arousal and arousal plus overcorrection to reduce nocturnal bruxism.

This study investigated the effectiveness of arousal and arousal + overcorrection to treat bruxism in a 28-year-old male with a 6-month history of bruxing and a 24-year-old female with a 3-month history of bruxing. An A-B-A-B-A-BC-A multiple baseline design across subjects with follow-ups was used to evaluate the effectiveness of the interventions. Results indicated that, although arousal reduced the frequency of bruxing in both subjects, it did not completely eliminate the behavior. The addition of overcorrection to arousal resulted in a complete cessation of bruxing. The discussion focuses on the possible mechanisms of action and directions for further evaluation of the combined procedure.

Adult

Biochemical and morphometric studies of heart, liver and skeletal muscle from the hibernating, arousing and aroused big brown bat, Eptesicus fuscus.

Heart, liver, pectoralis major, and plasma of hibernating, arousing and aroused bats were studied. The activities of four mitochondrial enzymes and three morphometric parameters of mitochondria did not change in the heart. Mitochondrial enzyme activities in the liver and pectoralis major did not change. Lactate dehydrogenase activity and isoenzyme content in heart, liver and pectoralis major did not change. Heart lipid content determined morphometrically decreased transiently after 30 min arousal from hibernation. Plasma free fatty acid concentration increased significantly by 7.5 min and peaked at 15 min after arousal from hibernation. Concentrations of heart free fatty acids, triglycerides, glycerol, and cholesterol and liver triglycerides did not change.

Animals

Wakefulness and arousal in neonates born to women with schizophrenia: diminished arousal and its association with neurological deviations.

Arousal at 3-4 days of age was blindly assessed during the course of a standardized neurological examination of offspring born to index women with schizophrenic (n = 20), schizo-affective (n = 12), affective (n = 19) and unspecified functional (n = 4) psychoses, as well as 70 offspring born to control women with no history of psychosis. The offspring of women with schizophrenia was the only index group to differ from controls in showing significantly reduced arousal. Among the offspring of schizophrenics, reduced arousal was associated with neurological abnormality and deviant sensitivity to stimulation but not with obstetric complications. Only a subgroup of schizophrenics' offspring showed these characteristics. Deviations in arousal, neurological status and sensitivity may be part of a more generalized pattern representing a possibly genetically based neurodevelopmental disorder evident within this particular group at heightened risk for schizophrenia.

Adult

Arousal and cognition: Picture Vocabulary performance and individual differences in physiological arousal.

The contribution of individual differences in physiological arousal to intellective assessment in learning disabled children was studied. Arousal was measured by salivary response and intellective function (receptive vocabulary) by the Peabody Picture Vocabulary Test. It was predicted that best performance would be found at intermediate levels of arousal. Peabody scores of learning disabled subjects of high, middle, and low arousal showed a non-significant trend in the predicted direction. Reasons for the lack of significance of this hypothesized trend were proposed and needed research outlined.

Arousal

Arousability and stress-related physical symptoms: a validation study of Coren's arousal predisposition scale.

Coren's Arousal Predisposition Scale was validated against 249 college students' self-ratings of stress-related physical symptoms and an item that assessed general level of health. As we predicted, the 126 high-arousability subjects were substantially higher in mean stress-related symptoms score and lower in general health than the 123 peers low in arousability. These data suggest that the Arousal Predisposition Scale may be a useful instrument in the study of human stress.

Adult

Understanding the effects of fear-arousing communications: the role of cognitive factors and amount of fear aroused.

This paper reports an experimental study investigating the role of cognitive factors and fear in mediating the effects of "fear-arousing" health threat communications. Seventy-seven cigarette smokers were shown either a videotape about smoking or a control videotape on a different health topic before completing a questionnaire assessing their intentions to try to quit, the level of fear aroused, and three cognitive factors: (a) probability difference (perceived reduction in risk of health damage that follows from successful cessation), (b) utility of health damage, and (c) confidence. The smoking videotape influenced probability difference, utility, intentions, and follow-up reports of attempts at cessation. As predicted, both probability difference and utility influenced intention, which in turn influenced behavior. Neither confidence nor the amount of fear aroused by the videotape had significant effects on intention.

Adult

Sexual anxiety and female sexual arousal: a comparison of arousal during sexual anxiety stimuli and sexual pleasure stimuli.

Sexual arousal occurring during sexual anxiety stimuli was compared to sexual arousal occurring during sexual pleasure stimuli in 19 sexually functional women. Stimuli were individualized narratives based on descriptions given by each subject. Sexual arousal was measured by monitoring vaginal blood flow with a vaginal photoplethysmograph. Results showed significant increases in vaginal blood flow in response to both sexual anxiety and sexual pleasure. However, increases in the pleasure condition were significantly greater than those in the anxiety condition. Analysis of the blood flow across time showed a significant linear increasing trend in the pleasure condition and a lack of such a trend in the anxiety condition.

Adolescent