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The Vagus Nerve and Sleep Neurocircuitry
April 02, 2024
Guest contributors: emrysgoldsworthy
The neurocircuits connecting the solitary nuclei of the vagus nerve to the sleep centers and the suprachiasmatic nucleus (SCN) are complex and involve multiple pathways and neurotransmitter systems.
 
The solitary nucleus, also known as the nucleus tractus solitarius (NTS), is the primary visceral sensory relay station in the brainstem. It receives afferent information from the vagus nerve and other cranial nerves and projects to various regions of the brain.
Here's an overview of the connections:
  1. Solitary Nucleus to Sleep Centres: The sleep centres in the brain include the ventrolateral preoptic nucleus (VLPO) and the lateral hypothalamus which contains wake-promoting neurons, including those that produce orexin (hypocretin).
    The NTS sends GABAergic (inhibitory) projections to the VLPO. Activation of these pathways can promote sleep, as the VLPO plays a critical role in initiating and maintaining sleep by inhibiting wake-promoting regions. There may also be indirect connections from the NTS to other sleep-regulating areas, such as the parabrachial nucleus, which in turn projects to the hypothalamic sleep centres.
  2. Solitary Nucleus to Suprachiasmatic Nucleus: The SCN is the central circadian clock of the body, located in the hypothalamus. It is primarily responsible for controlling the timing of sleep and wakefulness, synchronized with the light-dark cycle.

    The NTS does not have a direct neuronal connection to the SCN. However, it can influence circadian rhythms indirectly through several mechanisms:The NTS projects to the paraventricular nucleus (PVN) of the hypothalamus, which in turn projects to the SCN. The NTS can influence the release of melatonin from the pineal gland via its projections to the PVN and the spinal cord, which then relays signals to the superior cervical ganglia innervating the pineal gland.
  3. Other Relevant Connections: The SCN sends projections to various hypothalamic nuclei, which can influence autonomic functions and hormonal secretion that are relevant to sleep regulation. The NTS also communicates with the baroreceptor reflex arc, which can influence sleep indirectly through cardiovascular modulation.
Neurotransmitters such as glutamate, GABA, and neuropeptides play an essential role in modulating these circuits. It's important to note that the neurocircuitry of sleep is still not entirely understood and is an active area of research. Additionally, these pathways are influenced by various factors, including stress, immune signals, and metabolic cues, making the system highly complex and dynamic.
 
Here are the key ways in which the vagus nerve can influence the sleep-wake cycle:
  1. Heart Rate and Blood Pressure Regulation: The vagus nerve innervates the heart and influences heart rate variability (HRV), which is higher during relaxed states and sleep. A lower heart rate and blood pressure, facilitated by vagal activity, are associated with the onset of sleep.
  2. Respiratory Rate: The vagus nerve also regulates the respiratory rate by modulating the activity of the respiratory centers in the brainstem. Slow, deep breathing, which is encouraged by vagal activity, can promote relaxation and facilitate the transition to sleep.
  3. Gastrointestinal Activity: Vagal activation increases gastrointestinal activity, which is more pronounced during restful states and can support the body's shift toward sleep.
  4. Stress and Anxiety Reduction: Vagal activity is associated with the release of acetylcholine, which can counteract the stress-response effects of the sympathetic nervous system.
    By dampening the stress response, the vagus nerve can promote relaxation and improve the quality of sleep.
  5. Influence on Neurotransmitters: The vagus nerve can affect the levels of neurotransmitters like GABA and serotonin, which are involved in sleep regulation.
  6. Circadian Rhythm Synchronization: While the vagus nerve does not directly set the circadian rhythms, its effects on overall body relaxation can help align the body's peripheral clocks with the central clock in the suprachiasmatic nucleus (SCN), leading to better synchronization of the sleep-wake cycle with environmental light-dark cycles.
  7. Inflammatory Response Modulation: The vagus nerve can inhibit the production of pro-inflammatory cytokines, which, when elevated, can disrupt sleep patterns and lead to fragmented sleep.
  8. Brain-Gut Axis: Through its role in the brain-gut axis, the vagus nerve may impact sleep by influencing gut health and the microbiome, which have been shown to have interactions with sleep quality and mood.
The overall effect of the vagus nerve on sleep is typically one of promoting sleep readiness and enhancing the quality of sleep. Vagal nerve stimulation (VNS), a treatment used for certain conditions like epilepsy and depression, has been observed to have effects on sleep architecture, potentially increasing deep sleep stages, although the exact outcomes can vary among individuals.
 
It's important to note that while the vagus nerve has these potential influences on the sleep-wake cycle, it is but one part of a complex network of systems that govern sleep. Sleep is regulated by the interaction of multiple neural structures, hormones, and environmental factors.
 
Ref
Bottari SA, Lamb DG, Porges EC, Murphy AJ, Tran AB, Ferri R, Jaffee MS, Davila MI, Hartmann S, Baumert M, Williamson JB. Preliminary evidence of transcutaneous vagus nerve stimulation effects on sleep in veterans with post-traumatic stress disorder. J Sleep Res. 2023 Apr 11:e13891. doi: 10.1111/jsr.13891. Epub ahead of print. PMID: 37039398
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The Controversy Surrounding PCR Testing: An In-Depth Look

The Polymerase Chain Reaction (PCR) test, created by Dr. Kary Mullis in 1985, has become a vital tool in genetic research and diagnostics. This method allows for the amplification of small DNA segments, making detailed study possible. However, its application, especially in diagnosing viral infections like COVID-19, has stirred significant debate. Critics claim that the science behind its widespread use lacks sufficient backing. This post aims to explore these criticisms and examine the scientific arguments against using PCR tests as a diagnostic tool for COVID-19.

 

Understanding PCR Testing

Dr. Kary Mullis designed the PCR test to replicate genetic material, enabling detailed scientific study. The process involves cycles of amplification, where each cycle doubles the DNA amount. While this technology has revolutionized molecular biology, its use in diagnosing viral infections presents several concerns.

 

Potential for Misinterpretation

A key criticism of PCR testing, particularly for COVID-19, is the risk of misinterpretation due to over-amplification. Dr. Mullis himself noted that the PCR test is intended for research, not for diagnosing illnesses. He highlighted that with enough amplification, one can find almost anything in any sample, which doesn’t necessarily indicate disease.

Experts echo this concern, emphasizing the cycle threshold (CT)—the number of cycles needed to detect the virus—as a critical factor in test reliability. High CT values can detect non-infectious viral fragments, leading to false positives. The World Health Organization (WHO) recommends a CT value below 35, but many labs have used higher thresholds, adding to the controversy.

 

Development of the COVID-19 PCR Test

The rapid development of the PCR test for COVID-19 by virologist Christian Drosten has also faced scrutiny. Critics argue that Drosten's test, created shortly after the Chinese government published viral genomic sequences, was not adequately validated against real viral samples. They claim the test relied on theoretical constructs and assumptions, raising questions about its accuracy and reliability.

 

Amplification and False Positives

False positives are a significant concern. When the sequences used in PCR tests are compared with the human genome database, overlaps with human and bacterial/fungal genetic material are found. This non-specific detection can lead to many positive results that may not reflect actual infections. Furthermore, the cycle thresholds used in various laboratories vary widely, with some exceeding 40-45 cycles, which critics argue is scientifically unsound and leads to unreliable results.

 

Issues with Primer Sequences and Business Interests

Drosten's PCR test has faced criticism for using degenerate primer sequences, which are not 100% specific and can react with various sequences, increasing false positives. Additionally, allegations of conflicts of interest have arisen, as Drosten developed the test for Roche, a company with substantial interest in the test's success. Critics suggest this relationship may have influenced the test’s rapid and widespread adoption without adequate validation.

 

Lack of Proper Validation

A significant criticism is that the PCR test used for COVID-19 diagnosis did not undergo rigorous validation, essential for clinical diagnostics. Typically, a new test should be validated against a "gold standard" to ensure accuracy. Drosten's PCR test, however, was released under Emergency Use Authorization (EUA) without thorough validation, leading to doubts about its scientific credibility.

 

Misinterpretation of Positive Results

The variability in PCR test results, where asymptomatic individuals test positive while symptomatic individuals test negative, further complicates matters. This discrepancy may stem from the test's sensitivity in detecting minute viral RNA fragments that do not indicate an active infection. As a result, the test might identify non-infectious viral debris, especially in asymptomatic individuals or those recovered from infection, leading to a high rate of false positives.

 

Expert Opinions and Sources

Numerous experts and studies have raised concerns about the PCR tests for diagnosing COVID-19:

  1. Statements from CDC and WHO: Both organizations have noted that detecting viral RNA through PCR does not necessarily indicate the presence of an infectious virus and should not be solely relied upon for COVID-19 diagnosis.
  2. Legal and Medical Opinions: Over 1,000 lawyers and 10,000 doctors have filed lawsuits citing the Nuremberg Code, arguing that PCR tests are unsuitable for pathogen detection and are inaccurate at higher cycle thresholds. 
  3. Scientific Review: A review by 21 scientists, including former Pfizer VP Michael Yeadon, criticizes the COVID-19 PCR test for being based on theoretical sequences without proper validation against live or inactivated virus samples.

Conclusion

The use of PCR testing for diagnosing COVID-19 is highly contentious. While the technology is crucial in genetic research, its application as a diagnostic tool for viral infections has significant flaws.

Misinterpretation risks, issues with over-amplification, and questions about the test's development and validation highlight the need for re-evaluating its use. This post will continue to delve into these issues, considering the implications for public health and future diagnostic practices.

 

References

  • World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) statements on PCR testing.
  • Review by 21 scientists on the validation of PCR tests
  • Legal and scientific analyses from experts, including former Pfizer VP Michael Yeadon.
  • Mullis, Kary
  • Cowan, Tom
  • Diaz, Jacob
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