Reviewer #1 (Public review):
In this meta-analysis, Ng and colleagues review the association between slow-oscillation spindle coupling during sleep and overnight memory consolidation. The coupling of these oscillations (and also hippocampal sharp-wave ripples) have been central to theories and mechanistic models of active systems consolidation, that posit that the coupling between ripples, spindles, and slow oscillations (SOs) coordinate and drive the coordinated reactivation of memories in hippocampus and cortex, facilitating cross-regional information and ultimately memory strengthening and stabilisation.
Given the importance that these coupling mechanisms have been given in theory, this is a timely and important contribution to the literature in terms of determining whether these theoretical assumptions hold true in human data. The results show that the timing of sleep spindles relative to the SO phase, and the consistency of that timing, predicted overnight memory consolidation in meta-analytic models. The overall amount of coupling events did not show as strong a relationship. The coupling phase in particular was moderated by a number of variables including spindle type (fast, slow), channel location (frontal, central, posterior), age, and memory type. The main takeaway is that fast spindles that consistently couple close to the peak of the SO in frontal channel locations are optimal for memory consolidation, in line with theoretical predictions.
I did not follow the logic behind including spindle amplitude in the meta-analysis. This is not a measure of SO-spindle coupling (which is the focus of the review), unless the authors were restricting their analysis of the amplitude of coupled spindles only. It doesn't sound like this is the case though. The effect of spindle amplitude on memory consolidation has been reviewed in another recent meta-analysis (Kumral et al, 2023, Neuropsychologia). As this isn't a measure of coupling, it wasn't clear why this measure was included in the present meta-analysis. You could easily make the argument that other spindle measures (e.g., density, oscillatory frequency) could also have been included, but that seems to take away from the overall goal of the paper which was to assess coupling.
At the end of the first paragraph of section 3.1 (page 13), the authors suggest their results "... further emphasise the role of coupling compared to isolated oscillation events in memory consolidation". This had me wondering how many studies actually test this. For example, in a hierarchical regression model, would coupled spindles explain significantly more variance than uncoupled spindles? We already know that spindle activity, independent of whether they are coupled or not, predicts memory consolidation (e.g., Kumral meta-analysis). Is the variance in overnight memory consolidation fully explained by just the coupled events? If both overall spindle density and coupling measures show an equal association with consolidation, then we couldn't conclude that coupling compared to isolated events is more important.
It was very interesting to see that the relationship between the fast spindle coupling phase and overnight consolidation was strongest in the frontal electrodes. Given this, I wonder why memory promoting fast spindles shows a centro-parietal topography? Surely it would be more adaptive for fast spindles to be maximally expressed in frontal sites. Would a participant who shows a more frontal topography of fast spindles have better overnight consolidation than someone with a more canonical centro-parietal topography? Similarly, slow spindles would then be perfectly suited for memory consolidation given their frontal distribution, yet they seem less important for memory.
The authors rightly note the issues with multiple comparisons in sleep physiology and memory studies. Multiple comparison issues arise in two ways in this literature. First are comparisons across multiple electrodes (many studies now use high-density systems with 64+ channels). Second are multiple comparisons across different outcome variables (at least 3 ways to quantify coupling (phase, consistency, occurrence) x 2 spindle types (fast, slow). Can the authors make some recommendations here in terms of how to move the field forward, as this issue has been raised numerous times before (e.g., Mantua 2018, Sleep; Cox & Fell 2020, Sleep Medicine Reviews for just a couple of examples). Should researchers just be focusing on the coupling phase? Or should researchers always report all three metrics of coupling, and correct for multiple comparisons? I think the use of pre-registration would be beneficial here, and perhaps could be noted by the authors in the final paragraph of section 3.5, where they discuss open research practices.