In resting-state functional connectivity magnetic resonance imaging (fcMRI) studies, measures of functional connectivity are often calculated after the removal of a global mean signal component. While the application of the global signal regression approach has been shown to reduce the influence of physiological artifacts and enhance the detection of functional networks, there is considerable controversy regarding its use as the method can lead to significant bias in the resultant connectivity measures. In addition, evidence from recent studies suggests that the global signal is linked to neural activity and may carry clinically relevant information. For instance, in a prior study we found that the amplitude of the global signal was negatively correlated with EEG measures of vigilance across subjects and experimental runs. Furthermore, caffeine-related decreases in global signal amplitude were associated with increases in EEG vigilance. In this study, we extend the prior work by examining measures of global signal amplitude and EEG vigilance under eyes-closed (EC) and eyes-open (EO) resting-state conditions. We show that changes (EO minus EC) in the global signal amplitude are negatively correlated with the associated changes in EEG vigilance. The slope of this EO-EC relation is comparable with the slope of the previously reported relation between caffeine-related changes in the global signal amplitude and EEG vigilance. Our findings provide further support for a basic relationship between global signal amplitude and EEG vigilance.

Rationale: A low respiratory arousal threshold is a physiological trait involved in obstructive sleep apnea (OSA) pathogenesis. Trazodone may increase arousal threshold without compromising upper airway muscles, which should improve OSA.Objectives: We aimed to examine how trazodone alters OSA severity and arousal threshold. We hypothesized that trazodone would increase the arousal threshold and improve the apnea/hypopnea index (AHI) in selected patients with OSA.Methods: Subjects were studied on two separate nights in a randomized crossover design. Fifteen unselected subjects with OSA (AHI > 10/h) underwent a standard polysomnogram plus an epiglottic catheter to measure the arousal threshold. Subjects were studied after receiving trazodone (100 mg) and placebo, with 1 week between conditions. The arousal threshold was calculated as the nadir pressure before electrocortical arousal from approximately 20 spontaneous respiratory events selected randomly. Measurements and Main Results:Compared with placebo, trazodone resulted in a significant reduction in AHI (38.7 vs. 28.5 events/h, P = 0.041), without worsening oxygen saturation or respiratory event duration. Trazodone was not associated with a significant change in the non-REM arousal threshold (220.3 vs. 219.3 cm H 2 O, P = 0.51) compared with placebo. In subgroup analysis, responders to trazodone spent less time in N1 sleep (20.1% placebo vs. 9.0% trazodone, P = 0.052) and had an accompanying reduction in arousal index, whereas nonresponders were not observed to have a change in sleep parameters.Conclusions: These findings suggest that trazodone could be effective therapy for patients with OSA without worsening hypoxemia. Future studies should focus on underlying mechanisms and combination therapies to eliminate OSA.Clinical trial registered with www.clinicaltrials.gov (NCT 01817907).