The cyclic alternating pattern sequences in the dynamic organization of sleep

The cyclic alternating pattern (CAP) is a physiological component of normal NREM sleep, functionally correlated with long-lasting arousal oscillations. This EEG periodic activity, organized in sequences of two or more decasecond cycles, is detectable also in coma and in other neurologic disorders, appearing as a general modality of arousal organization. Within NREM sleep, the fluctuations of CAP alternate with sustained homogeneous EEG patterns, characterized by a greater stability of arousal and called non-CAP (NCAP). In 20 sleep records of 10 healthy young adults we analysed the chronological relationship between CAP and 3 fundamental states of arousal: wakefulness, NREM sleep, REM sleep. Sleep onset and sleep recoveries after nocturnal awakenings were closely linked to CAP sequences, indicating a functional linkage between cyclic fluctuations of arousal and the beginning of any sleep behavioural state. On the basis of their temporal relationship with CAP sequences, the waking to sleep and the waking transitions appeared a symmetrical events in the organization of arousal, whereas the NREM to REM transitions and the REM to NREM transitions occurred as asymmetrical events. Moreover, almost 50% of all NREM stage changes were accompanied by CAP sequences. The EEG and dynamic features of CAP sequences show morphological and behavioural analogies with some phasic phenomena (i.e., phase d'activation transitoire or micro-arousals) and EEG patterns reported in the literature (e.g., tracé alternant; phase transitionnelles; tracé intermittent). Our data suggest a functional correlation between the control mechanisms of CAP and the organization of sleep.