Thalamic involvement defines distinct slow-wave subtypes in NREM sleep.

Slow waves (0.5-4 Hz) are a key feature of non-rapid-eye-movement (NREM) sleep, traditionally believed to arise from neocortical circuits. However, growing evidence suggests that subcortical structures, particularly the thalamus, may play a crucial role in initiating and synchronizing slow waves. We tested the hypothesis that single slow waves may arise from distinct cortico-cortical and thalamo-cortical mechanisms using simultaneous EEG-fMRI in healthy adults. Spatial mapping based on thalamic fMRI responses revealed two types of slow waves. The first type (C1) characterized by an early thalamic fMRI-signal increase, corresponded to large, efficiently synchronized waves associated with sleep spindles and with markers of higher arousal and autonomic activation. The second type (C2) is marked by an initial negative fMRI response and corresponds to smaller slow waves potentially resulting from cortico-cortical synchronization. These waves occur more often during phases of stable NREM sleep. These findings highlight distinct slow-wave subtypes with different thalamic involvement and, potentially, synchronization mechanisms.