5 Hz; MatLab, MathWorks, Natick, MA). Spectral analysis was performed for the P3-P4 derivation and the EEG classified based on the mean dominant frequency (MDF) and the relative power of the delta and theta bands.28 Where obvious on visual inspection of the power spectrum, the frequency of the dominant peak was also obtained. Between 17:00 and 19:00 hours, subjects were placed in a quiet, dark, and shielded

hospital IDH inhibitor clinical trial room and given the opportunity to nap. The EEG was recorded as described above. In addition, the mastoids, submental electromyogram and ocular movements were also recorded. Sleep stages were scored visually for 20-second epochs (C3-A2 derivation) according to standard criteria12 BTK inhibitor (Rembrandt Analysis Manager, v. 8; Embla Systems, Broomfield, CO) by one of the authors (A.B.), who had no information on either the subject or the experimental condition. Blocks of consolidated non-REM sleep (sleep stages 2-4, without intervening epochs of wake or stage 1 sleep) of equal length in the two experimental conditions (minimal length: 8 minutes) were selected for subsequent spectral analysis. Power spectra were computed by Fast Fourier Transform (2-second epochs, Hanning window, frequency resolution 0.5 Hz). Artifacts were identified by visual inspection or whenever delta power exceeded a subject-specific threshold. The AAC was

administered at 07:00 hours on study days 4 or 8. It consisted of a flavored, 54 g amino acid mixture, mimicking the composition of the hemoglobin contained in 400 mL of blood.4 The mixture was dispersed in 50-100 mL of water and ingested over a period of 10-15 minutes. Capillary ammonia concentrations were measured prior to and at MCE hourly intervals for 8 hours after the AAC using the Ammonia Checker (Menarini Diagnostics, Firenze, Italy). Subjective

sleepiness was also monitored on an hourly basis using the Karolinska Sleepiness Scale (KSS)29 on both study days 4 and 8. The study protocol was approved by the Hospital of Padua Ethics Committee. All participants provided written, informed consent. The study was conducted according to the Declaration of Helsinki (Hong Kong Amendment) and Good Clinical Practice (European) guidelines. Data are presented as mean (SD) unless otherwise specified. The distribution of variables was assessed by the Shapiro-Wilks’ test and between group comparisons performed using Student’s t or Mann-Whitney U tests, as appropriate. Comparisons between pre- and post-AAC variables were performed by repeated measures analysis of variance (ANOVA) using the variable healthy volunteers versus patients as a “group” factor. Log-transformed average sleep EEG power spectra were analyzed with linear mixed model ANOVA. The factors group (patients versus healthy volunteers) and condition (AAC versus baseline), as well as their interaction, were tested.