{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T01:24:55Z","timestamp":1773797095415,"version":"3.50.1"},"reference-count":83,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Delta waves (0.1\u20134\u202fHz) are a hallmark of unconsciousness in both sleep and general anesthesia (GA). Closed-loop auditory stimulation (CLAS) delivers brief sounds phase-locked to ongoing slow oscillations and can modulate slow-wave activity (SWA) during sleep, but its efficacy and translational relevance under propofol anesthesia, particularly in the presence of nociceptive input, remain unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We describe a prospective, within-subject protocol in 30 neurologically healthy adults undergoing elective surgery under propofol GA. Intraoperative high-density electroencephalography (hd-EEG; 128 channels) is recorded while a real-time CLAS algorithm detects\n                      <jats:italic>\u03b4<\/jats:italic>\n                      -waves at the Fz electrode, and triggers pink-noise bursts in three conditions:\n                      <jats:italic>in-phase<\/jats:italic>\n                      (peak-locked),\n                      <jats:italic>anti-phase<\/jats:italic>\n                      (trough-locked), and\n                      <jats:italic>sham<\/jats:italic>\n                      . An extended\n                      <jats:italic>in-phase<\/jats:italic>\n                      block is then combined with a standardized tetanic nociceptive stimulus (100\u202fHz, 70\u202fmA, 30\u202fs) to test robustness under an arousal challenge. Depth of hypnosis is monitored with the Bispectral Index (BIS), and nociceptive\/autonomic reactivity with the Nociception Level (NOL) index. Primary outcomes quantify\n                      <jats:italic>\u03b4<\/jats:italic>\n                      -wave morphology and SWA (amplitude, slopes, duration\/frequency, transition frequency, density, power spectral density), along with topography, source estimation, and propagation. Secondary outcomes include depth of anesthesia (BIS), nociceptive balance (NOL), functional connectivity (weighted and directed phase-lag indices), graph-theoretical organization (global efficiency, clustering, modularity, small-worldness), and EEG microstates (duration, coverage, transitions).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Anticipated results<\/jats:title>\n                    <jats:p>\n                      We hypothesize that\n                      <jats:italic>in-phase<\/jats:italic>\n                      CLAS will increase amplitude, slope, duration, and density of\n                      <jats:italic>\u03b4<\/jats:italic>\n                      -waves, and decrease frequency and transition frequency relative to\n                      <jats:italic>sham<\/jats:italic>\n                      , whereas\n                      <jats:italic>anti-phase<\/jats:italic>\n                      CLAS will cause a disruption these parameters relative to\n                      <jats:italic>sham<\/jats:italic>\n                      . Under nociception,\n                      <jats:italic>in-phase<\/jats:italic>\n                      CLAS is expected to these parameters preserve\n                      <jats:italic>\u03b4<\/jats:italic>\n                      -wave integrity, with effects attenuated relative to non-nociceptive conditions. We anticipate BIS values to remain within the surgical range but trend lower during\n                      <jats:italic>in-phase<\/jats:italic>\n                      CLAS, alongside reduced nociceptive\/autonomic responses. At the network level, we expect CLAS-induced\n                      <jats:italic>\u03b4<\/jats:italic>\n                      -wave reinforcement to be associated with more locally coherent \u03b4-band activity and reduced frontoparietal integration, consistent with deeper unconsciousness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>\n                      If confirmed, these findings would position CLAS as a candidate neuromodulation strategy to reinforce anesthetic\n                      <jats:italic>\u03b4<\/jats:italic>\n                      -wave dynamics and help stabilize anesthesia without necessarily increasing pharmacological dose, while also providing a systems-level test of the role of slow oscillations in sustaining unconsciousness.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnhum.2026.1748528","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T06:46:28Z","timestamp":1773038788000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Protocol for modulating anesthesia delta oscillations using closed loop auditory stimulation"],"prefix":"10.3389","volume":"20","author":[{"given":"Clara","family":"Pic Roca","sequence":"first","affiliation":[{"name":"Center for Advanced Research in Sleep Medicine, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et des Services Sociaux du Nord-de-l\u2019\u00cele-de-Montr\u00e9al","place":["Montreal, QC, Canada"]},{"name":"Department of Neuroscience, Faculty of Medicine, Universit\u00e9 de Montr\u00e9al","place":["Montreal, QC, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanieh","family":"Bazregarzadeh","sequence":"additional","affiliation":[{"name":"Center for Advanced Research in Sleep Medicine, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et des Services Sociaux du Nord-de-l\u2019\u00cele-de-Montr\u00e9al","place":["Montreal, QC, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis","family":"Morisson","sequence":"additional","affiliation":[{"name":"Center for Advanced Research in Sleep Medicine, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et des Services Sociaux du Nord-de-l\u2019\u00cele-de-Montr\u00e9al","place":["Montreal, QC, Canada"]},{"name":"H\u00f4pital Maisonneuve-Rosemont, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et des Services Sociaux de l\u2019Est-de-l\u2019\u00cele-de-Montr\u00e9al","place":["Montreal, QC, Canada"]},{"name":"Department of Anesthesiology and Pain Medicine, Universit\u00e9 de Montr\u00e9al","place":["Montreal, QC, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Martin","sequence":"additional","affiliation":[{"name":"Center for Advanced Research in Sleep Medicine, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et des Services Sociaux du Nord-de-l\u2019\u00cele-de-Montr\u00e9al","place":["Montreal, QC, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Verdonck","sequence":"additional","affiliation":[{"name":"H\u00f4pital Maisonneuve-Rosemont, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et des Services Sociaux de l\u2019Est-de-l\u2019\u00cele-de-Montr\u00e9al","place":["Montreal, QC, Canada"]},{"name":"Department of Anesthesiology and Pain Medicine, Universit\u00e9 de Montr\u00e9al","place":["Montreal, QC, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Gibbs","sequence":"additional","affiliation":[{"name":"Center for Advanced Research in Sleep Medicine, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et des Services Sociaux du Nord-de-l\u2019\u00cele-de-Montr\u00e9al","place":["Montreal, QC, Canada"]},{"name":"Department of Neuroscience, Faculty of Medicine, Universit\u00e9 de Montr\u00e9al","place":["Montreal, QC, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Marc","family":"Lina","sequence":"additional","affiliation":[{"name":"Center for Advanced Research in Sleep Medicine, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et des Services Sociaux du Nord-de-l\u2019\u00cele-de-Montr\u00e9al","place":["Montreal, QC, Canada"]},{"name":"Department of Electrical Engineering, \u00c9cole de Technologie Sup\u00e9rieure","place":["Montreal, QC, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Carrier","sequence":"additional","affiliation":[{"name":"Center for Advanced Research in Sleep Medicine, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et des 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Opin. Neurobiol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1016\/j.ejpain.2004.11.001","article-title":"Human brain mechanisms of pain perception and regulation in health and disease","volume":"9","author":"Apkarian","year":"2005","journal-title":"Eur. J. Pain"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1016\/S1388-2457(01)00650-2","article-title":"Auditory information processing during human sleep as revealed by event-related brain potentials","volume":"112","author":"Atienza","year":"2001","journal-title":"Clin. Neurophysiol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1037\/bul0000053","article-title":"Sleep and mental disorders: a meta-analysis of polysomnographic research","volume":"142","author":"Baglioni","year":"2016","journal-title":"Psychol. Bull."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"208","DOI":"10.3389\/fnsys.2014.00208","article-title":"Enhancement of sleep slow waves: underlying mechanisms and practical consequences","volume":"8","author":"Bellesi","year":"2014","journal-title":"Front. Syst. Neurosci."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s10877-013-9487-9","article-title":"Monitoring the nociception level: a multi-parameter approach","volume":"27","author":"Ben-Israel","year":"2013","journal-title":"J. Clin. Monit. Comput."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1097\/aln.0000000000001275","article-title":"Resting-state network-specific breakdown of functional connectivity during ketamine alteration of consciousness in volunteers","volume":"125","author":"Bonhomme","year":"2016","journal-title":"Anesthesiology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e64337","DOI":"10.7554\/eLife.64337","article-title":"Sleeping at the switch","volume":"10","author":"Bouchard","year":"2021","journal-title":"eLife"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1097\/aln.0b013e3181f697f5","article-title":"Breakdown of within- and between-network resting state functional magnetic resonance imaging connectivity during Propofol-induced loss of consciousness","volume":"113","author":"Boveroux","year":"2010","journal-title":"Anesthesiology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2638","DOI":"10.1056\/nejmra0808281","article-title":"General anesthesia, sleep, and coma","volume":"363","author":"Brown","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref9001","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1023\/A:1012216600170","article-title":"Bispectral Index (BIS) and Burst Suppression: Revealing a Part of the BIS Algorithm","volume":"16","author":"Bruhn","year":"2000","journal-title":"Journal of Clinical Monitoring and Computing"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1146\/annurev-neuro-060909-153200","article-title":"General anesthesia and altered states of arousal: a systems neuroscience analysis","volume":"34","author":"Brown","year":"2011","journal-title":"Annu. Rev. Neurosci."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1126\/science.1169626","article-title":"The human K-complex represents an isolated cortical Down-state","volume":"324","author":"Cash","year":"2009","journal-title":"Science"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1093\/sleep\/28.2.255","article-title":"The K-complex: a 7-decade history","volume":"28","author":"Colrain","year":"2005","journal-title":"Sleep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1213\/ANE.0000000000006119","article-title":"Open reimplementation of the BIS algorithms for depth of anesthesia","volume":"135","author":"Connor","year":"2022","journal-title":"Anesth. Analg."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"16890","DOI":"10.1523\/JNEUROSCI.1953-14.2014","article-title":"Slow oscillations during sleep coordinate interregional communication in cortical networks","volume":"34","author":"Cox","year":"2014","journal-title":"J. Neurosci."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1089\/brain.2016.0476","article-title":"Electroencephalographic resting-state networks: source localization of microstates","volume":"7","author":"Custo","year":"2017","journal-title":"Brain Connect."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.sleep.2021.01.044","article-title":"Acoustic enhancement of slow wave sleep on consecutive nights improves alertness and attention in chronically short sleepers","volume":"81","author":"Diep","year":"2021","journal-title":"Sleep Med."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1038\/s41593-020-00744-x","article-title":"Parameterizing neural power spectra into periodic and aperiodic components","volume":"23","author":"Donoghue","year":"2020","journal-title":"Nat. Neurosci."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1097\/00000542-200207000-00012","article-title":"Patient state index: titration of delivery and recovery from propofol, alfentanil, and nitrous oxide anesthesia","volume":"97","author":"Drover","year":"2002","journal-title":"Anesthesiology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.bpa.2005.07.008","article-title":"Patient state index","volume":"20","author":"Drover","year":"2006","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e14179","DOI":"10.1111\/jsr.14179","article-title":"Closed-loop auditory stimulation of slow-wave sleep in chronic insomnia: a pilot study","volume":"33","author":"Dudysov\u00e1","year":"2024","journal-title":"J. Sleep Res."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1097\/ALN.0000000000001130","article-title":"Preliminary intraoperative validation of the nociception level index","volume":"125","author":"Edry","year":"2016","journal-title":"Anesthesiology"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"105379","DOI":"10.1016\/j.neubiorev.2023.105379","article-title":"Closed-loop auditory stimulation of sleep slow oscillations: basic principles and best practices","volume":"153","author":"Esfahani","year":"2023","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1038\/nrn2372","article-title":"General anaesthesia: from molecular targets to neuronal pathways of sleep and arousal","volume":"9","author":"Franks","year":"2008","journal-title":"Nat. Rev. Neurosci."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/s12630-010-9420-3","article-title":"Sleep and general anesthesia","volume":"58","author":"Franks","year":"2011","journal-title":"Can. J. Anesth."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1126\/science.aax5440","article-title":"Coupled electrophysiological, hemodynamic, and cerebrospinal fluid oscillations in human sleep","volume":"366","author":"Fultz","year":"2019","journal-title":"Science"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.pnpbp.2017.10.007","article-title":"Pain and consciousness","volume":"87","author":"Garcia-Larrea","year":"2018","journal-title":"Prog. Neuro-Psychopharmacol. Biol. Psychiatry"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"303","DOI":"10.2147\/NSS.S293160","article-title":"Closed-loop acoustic stimulation during sedation with Dexmedetomidine (CLASS-D): protocol for a within-subject, crossover, controlled, interventional trial with healthy volunteers","volume":"13","author":"Guay","year":"2021","journal-title":"Nat. Sci. Sleep"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1046\/j.1365-2044.1999.00300.x","article-title":"Cortical responses to auditory stimuli during isoflurane burst suppression anaesthesia","volume":"54","author":"Hartikainen","year":"1999","journal-title":"Anaesthesia"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"ENEURO.0306-19.2019","DOI":"10.1523\/ENEURO.0306-19.2019","article-title":"Closed-loop acoustic stimulation enhances sleep oscillations but not memory performance","volume":"6","author":"Henin","year":"2019","journal-title":"Eneuro"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1007\/s00221-003-1611-5","article-title":"Functional organization of lemniscal and nonlemniscal auditory thalamus","volume":"153","author":"Hu","year":"2003","journal-title":"Exp. Brain Res."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e0002051","DOI":"10.1371\/journal.pone.0002051","article-title":"Network \u2018small-world-ness\u2019: a quantitative method for determining canonical network equivalence","volume":"3","author":"Humphries","year":"2008","journal-title":"PLoS One"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"ejn.16132","DOI":"10.1111\/ejn.16132","article-title":"The neurophysiology of closed-loop auditory stimulation in sleep: a magnetoencephalography study","volume":"59","author":"Jourde","year":"2023","journal-title":"Eur. J. Neurosci."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1006\/nimg.2002.1070","article-title":"Millisecond by millisecond, year by year: normative EEG microstates and developmental stages","volume":"16","author":"Koenig","year":"2002","journal-title":"NeuroImage"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.smrv.2015.08.005","article-title":"Sleep function: toward elucidating an enigma","volume":"28","author":"Krueger","year":"2016","journal-title":"Sleep Med. Rev."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"198701","DOI":"10.1103\/PhysRevLett.87.198701","article-title":"Efficient behavior of small-world networks","volume":"87","author":"Latora","year":"2001","journal-title":"Phys. Rev. Lett."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1097\/ALN.0000000000002228","article-title":"Role of network science in the study of anesthetic state transitions","volume":"129","author":"Lee","year":"2018","journal-title":"Anesthesiology"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1097\/ALN.0b013e3182a8ec8c","article-title":"Reconfiguration of network hub structure after propofol-induced unconsciousness","volume":"119","author":"Lee","year":"2013","journal-title":"Anesthesiology"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/0013-4694(87)90025-3","article-title":"EEG alpha map series: brain micro-states by space-oriented adaptive segmentation","volume":"67","author":"Lehmann","year":"1987","journal-title":"Electroencephalogr. Clin. Neurophysiol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e55092","DOI":"10.7554\/eLife.55092","article-title":"An electrophysiological marker of arousal level in humans","volume":"9","author":"Lendner","year":"2020","journal-title":"eLife"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"CD003843","DOI":"10.1002\/14651858.cd003843.pub4","article-title":"Bispectral index for improving intraoperative awareness and early postoperative recovery in adults","volume":"9","author":"Lewis","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref43","first-page":"399","article-title":"Balanced anesthesia","volume":"9","author":"Lundy","year":"1926","journal-title":"Minn. Med."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.jsmc.2019.11.002","article-title":"Brain stimulation for improving sleep and memory","volume":"15","author":"Malkani","year":"2020","journal-title":"Sleep Med. Clin."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/bja\/67.1.41","article-title":"Pharmacokinetic model driven infusion of PROPOFOL in children","volume":"67","author":"Marsh","year":"1991","journal-title":"Br. J. Anaesth."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1553","DOI":"10.1016\/j.neuron.2024.03.002","article-title":"Anesthesia and the neurobiology of consciousness","volume":"112","author":"Mashour","year":"2024","journal-title":"Neuron"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.tins.2018.01.003","article-title":"Neural correlates of unconsciousness in large-scale brain networks","volume":"41","author":"Mashour","year":"2018","journal-title":"Trends Neurosci."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1097\/ALN.0b013e31826904a6","article-title":"Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial","volume":"117","author":"Mashour","year":"2012","journal-title":"Anesthesiology"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"6862","DOI":"10.1523\/jneurosci.1318-04.2004","article-title":"The sleep slow oscillation as a traveling wave","volume":"24","author":"Massimini","year":"2004","journal-title":"J. Neurosci."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/B978-0-444-64032-1.00006-0","article-title":"EEG source localization","volume":"160","author":"Michel","year":"2019","journal-title":"Handb. Clin. Neurol."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1016\/j.neuroimage.2017.11.062","article-title":"EEG microstates as a tool for studying the temporal dynamics of whole-brain neuronal networks: a review","volume":"180","author":"Michel","year":"2018","journal-title":"NeuroImage"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/00000542-199701000-00004","article-title":"Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil: I","volume":"86","author":"Minto","year":"1997","journal-title":"Model Dev. Anesthesiol."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1093\/sleep\/34.3.283","article-title":"Propofol anesthesia and sleep: a high-density EEG study","volume":"34","author":"Murphy","year":"2011","journal-title":"Sleep"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1073\/pnas.0807933106","article-title":"Source modeling sleep slow waves","volume":"106","author":"Murphy","year":"2009","journal-title":"Proc. Natl. Acad. Sci."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"zsz315","DOI":"10.1093\/sleep\/zsz315","article-title":"Examining the optimal timing for closed-loop auditory stimulation of slow-wave sleep in young and older adults","volume":"43","author":"Navarrete","year":"2020","journal-title":"Sleep"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"8577","DOI":"10.1073\/pnas.0601602103","article-title":"Modularity and community structure in networks","volume":"103","author":"Newman","year":"2006","journal-title":"Proc. Natl. Acad. Sci."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.neuron.2013.03.006","article-title":"Auditory closed-loop stimulation of the sleep slow oscillation enhances memory","volume":"78","author":"Ngo","year":"2013","journal-title":"Neuron"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"6630","DOI":"10.1523\/JNEUROSCI.3133-14.2015","article-title":"Driving sleep slow oscillations by auditory closed-loop stimulation\u2014a self-limiting process","volume":"35","author":"Ngo","year":"2015","journal-title":"J. Neurosci."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.neuroimage.2017.02.061","article-title":"Electrocorticographic delineation of human auditory cortical fields based on effects of propofol anesthesia","volume":"152","author":"Nourski","year":"2017","journal-title":"NeuroImage"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.sleep.2015.10.016","article-title":"Effects of phase-locked acoustic stimulation during a nap on EEG spectra and declarative memory consolidation","volume":"20","author":"Ong","year":"2016","journal-title":"Sleep Med."},{"key":"ref61","doi-asserted-by":"publisher","first-page":"zsy031","DOI":"10.1093\/sleep\/zsy031","article-title":"Auditory stimulation of sleep slow oscillations modulates subsequent memory encoding through altered hippocampal function","volume":"41","author":"Ong","year":"2018","journal-title":"Sleep"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3389\/fnhum.2017.00109","article-title":"Acoustic enhancement of sleep slow oscillations and concomitant memory improvement in older adults","volume":"11","author":"Papalambros","year":"2017","journal-title":"Front. 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Sci."},{"key":"ref66","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1097\/ALN.0000000000000841","article-title":"Clinical electroencephalography for anesthesiologists: part I: background and basic signatures","volume":"123","author":"Purdon","year":"2015","journal-title":"Anesthesiology"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1097\/00000542-199810000-00023","article-title":"A primer for EEG signal processing in anesthesia","volume":"89","author":"Rampil","year":"1998","journal-title":"Anesthesiology"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1038\/79848","article-title":"Cellular and network mechanisms of rhythmic recurrent activity in neocortex","volume":"3","author":"Sanchez-Vives","year":"2000","journal-title":"Nat. Neurosci."},{"key":"ref69","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1037\/a0028830","article-title":"Sleep, memory, and aging: the link between slow-wave sleep and episodic memory changes from younger to older adults","volume":"28","author":"Scullin","year":"2013","journal-title":"Psychol. Aging"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1097\/ALN.0b013e31825683dc","article-title":"Hospital stay and mortality are increased in patients having a \u201ctriple low\u201d of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia","volume":"116","author":"Sessler","year":"2012","journal-title":"Anesthesiology"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1007\/bf01618421","article-title":"An introduction to bispectral analysis for the electroencephalogram","volume":"10","author":"Sigl","year":"1994","journal-title":"J. Clin. Monit."},{"key":"ref72","doi-asserted-by":"publisher","first-page":"100276","DOI":"10.1016\/j.bjao.2024.100276","article-title":"Daytime dexmedetomidine sedation with closed-loop acoustic stimulation alters slow wave sleep homeostasis in healthy adults","volume":"10","author":"Smith","year":"2024","journal-title":"BJA Open"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1016\/j.neuroimage.2012.05.050","article-title":"Go with the flow: use of a directed phase lag index (dPLI) to characterize patterns of phase relations in a large-scale model of brain dynamics","volume":"62","author":"Stam","year":"2012","journal-title":"NeuroImage"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1126\/science.8235588","article-title":"Thalamocortical oscillations in the sleeping and aroused brain","volume":"262","author":"Steriade","year":"1993","journal-title":"Science"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"3266","DOI":"10.1523\/JNEUROSCI.13-08-03266.1993","article-title":"Intracellular analysis of relations between the slow (< 1 Hz) neocortical oscillation and other sleep rhythms of the electroencephalogram","volume":"13","author":"Steriade","year":"","journal-title":"J. Neurosci."},{"key":"ref76","doi-asserted-by":"publisher","first-page":"3252","DOI":"10.1523\/JNEUROSCI.13-08-03252.1993","article-title":"A novel slow (< 1 Hz) oscillation of neocortical neurons in vivo: depolarizing and hyperpolarizing components","volume":"13","author":"Steriade","year":"","journal-title":"J. Neurosci."},{"key":"ref77","doi-asserted-by":"publisher","first-page":"2457","DOI":"10.2174\/156802611797470376","article-title":"Thalamocortical oscillations: local control of EEG slow waves","volume":"11","author":"Timofeev","year":"2011","journal-title":"Curr. Top. Med. Chem."},{"key":"ref79","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1196\/annals.1417.024","article-title":"Why does consciousness fade in early sleep?","volume":"1129","author":"Tononi","year":"2008","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref80","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/j.tics.2013.09.012","article-title":"Network hubs in the human brain","volume":"17","author":"Van Den Heuvel","year":"2013","journal-title":"Trends Cogn. Sci."},{"key":"ref81","doi-asserted-by":"publisher","first-page":"1548","DOI":"10.1016\/j.neuroimage.2011.01.055","article-title":"An improved index of phase-synchronization for electrophysiological data in the presence of volume-conduction, noise and sample-size bias","volume":"55","author":"Vinck","year":"2011","journal-title":"NeuroImage"},{"key":"ref82","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1038\/30918","article-title":"Collective dynamics of \u2018small-world\u2019 networks","volume":"393","author":"Watts","year":"1998","journal-title":"Nature"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1093\/bja\/aeu105","article-title":"Association between intraoperative electroencephalographic suppression and postoperative mortality \u2021","volume":"113","author":"Willingham","year":"2014","journal-title":"Br. J. 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