The Brain in Chronic Insomnia and Anxiety Disorder: a Combined Structural and Functional FMRI Study

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2024 Jun 19

PMID 38895035

Authors

Minghe Xu

Bo Li

Shuang Wang

Chunlian Chen

Zhe Liu

Yuqing Ji

Kai Liu

Yujun Niu

Affiliations

Soon will be listed here.

Abstract

Background: Chronic insomnia disorder (CID) is usually associated with Generalized Anxiety Disorder (GAD), which may change brain structure and function. However, the possible brain markers, imaging characteristics, and pathophysiology are unknown.

Objective: To look at the probable brain markers, imaging characteristics, and pathogenesis of CID in combination with GAD.

Methods: A total of 57 patients with CID concomitant GAD and 57 healthy controls (HC) were enrolled. Voxel-based morphometry (VBM) and functional connectivity (FC) were utilized to measure gray matter volume (GMV) and functional changes. Correlation analysis was utilized to identify relationships between brain changes and clinical characteristics.

Results: Patients had decreased GMV in the left cerebellum, right cerebellar peduncle, and left insula; increased FC between the left cerebellum and right angular gyrus, as well as between the left insula and anterior left cingulate gyrus; and decreased FC in several areas, including the left cerebellum with the middle left cingulate gyrus and the left insula with the left superior postcentral gyrus. These brain changes related to CID and GAD. These data could be used to identify relevant brain markers, imaging features, and to better understand the etiology.

Conclusion: The intensity of insomnia in patients was strongly related to the severity of anxiety. The lower GMV in the cerebellum could be interpreted as an imaging characteristic of CID. Reduced GMV in the insula, as well as aberrant function in the cingulate gyrus and prefrontal lobe, may contribute to the pathophysiology of CID and GAD. Abnormal function in the postcentral gyrus and angular gyrus may be associated with patients' clinical complaints.

References

Hui P, Yang J, Wang J, Zhao L, Wang X, Su X . Association between 5-hydroxytryptamine gene polymorphism rs140700 and primary insomnia in Chinese population. Intern Med J. 2020; 51(5):732-738. DOI: 10.1111/imj.14813. View

Chauhan S, Barbanta A, Ettinger U, Kumari V . Pineal Abnormalities in Psychosis and Mood Disorders: A Systematic Review. Brain Sci. 2023; 13(5). PMC: 10216209. DOI: 10.3390/brainsci13050827. View

Scott A, Webb T, Martyn-St James M, Rowse G, Weich S . Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021; 60:101556. PMC: 8651630. DOI: 10.1016/j.smrv.2021.101556. View

Toschi N, Passamonti L, Bellesi M . Sleep quality relates to emotional reactivity via intracortical myelination. Sleep. 2020; 44(1). PMC: 7819832. DOI: 10.1093/sleep/zsaa146. View

Gehrlach D, Dolensek N, Klein A, Roy Chowdhury R, Matthys A, Junghanel M . Aversive state processing in the posterior insular cortex. Nat Neurosci. 2019; 22(9):1424-1437. DOI: 10.1038/s41593-019-0469-1. View

Reimann G, Kuppers V, Camilleri J, Hoffstaedter F, Langner R, Laird A . Convergent abnormality in the subgenual anterior cingulate cortex in insomnia disorder: A revisited neuroimaging meta-analysis of 39 studies. Sleep Med Rev. 2023; 71:101821. PMC: 10718478. DOI: 10.1016/j.smrv.2023.101821. View

Kim S, Lee K, Lee H, Jeon J, Lee M, Lee J . Negative life stress, sleep disturbance, and depressive symptoms: The moderating role of anterior insula activity in response to sleep-related stimuli. J Affect Disord. 2021; 299:553-558. DOI: 10.1016/j.jad.2021.12.072. View

Predatu R, Voinescu B, David D, Maffei A, Nechifor R, Gentili C . Emotion regulation difficulties in the relation between stress-related insomnia symptoms and brain response to emotional faces: An fMRI study. Sleep Med. 2022; 101:561-569. DOI: 10.1016/j.sleep.2022.11.033. View

Anastasiades P, de Vivo L, Bellesi M, Jones M . Adolescent sleep and the foundations of prefrontal cortical development and dysfunction. Prog Neurobiol. 2022; 218:102338. PMC: 7616212. DOI: 10.1016/j.pneurobio.2022.102338. View

10.

Torres-Herraez A, Watson T, Rondi-Reig L . Delta Oscillations Coordinate Intracerebellar and Cerebello-Hippocampal Network Dynamics during Sleep. J Neurosci. 2022; 42(11):2268-2281. PMC: 8936597. DOI: 10.1523/JNEUROSCI.1479-21.2021. View

11.

Yang Y, Liang W, Wang Y, Peng D, Gong L, Wang N . Hippocampal atrophy in neurofunctional subfields in insomnia individuals. Front Neurol. 2022; 13:1014244. PMC: 9618598. DOI: 10.3389/fneur.2022.1014244. View

12.

Sindermann L, Redlich R, Opel N, Bohnlein J, Dannlowski U, Leehr E . Systematic transdiagnostic review of magnetic-resonance imaging results: Depression, anxiety disorders and their co-occurrence. J Psychiatr Res. 2021; 142:226-239. DOI: 10.1016/j.jpsychires.2021.07.022. View

13.

Gibson M, Lawlor D, Millard L . Identifying the potential causal role of insomnia symptoms on 11,409 health-related outcomes: a phenome-wide Mendelian randomisation analysis in UK Biobank. BMC Med. 2023; 21(1):128. PMC: 10071698. DOI: 10.1186/s12916-023-02832-8. View

14.

Cox R, Olatunji B . Sleep in the anxiety-related disorders: A meta-analysis of subjective and objective research. Sleep Med Rev. 2020; 51:101282. DOI: 10.1016/j.smrv.2020.101282. View

15.

Hao S, Shi W, Liu W, Chen Q, Zhuo M . Multiple modulatory roles of serotonin in chronic pain and injury-related anxiety. Front Synaptic Neurosci. 2023; 15:1122381. PMC: 10151796. DOI: 10.3389/fnsyn.2023.1122381. View

16.

Blake M, Trinder J, Allen N . Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions. Clin Psychol Rev. 2018; 63:25-40. DOI: 10.1016/j.cpr.2018.05.006. View

17.

Marques D, Allen Gomes A, Caetano G, Castelo-Branco M . Insomnia Disorder and Brain's Default-Mode Network. Curr Neurol Neurosci Rep. 2018; 18(8):45. DOI: 10.1007/s11910-018-0861-3. View

18.

Kong Z, Zhu X, Chang S, Bao Y, Ma Y, Yu W . Somatic symptoms mediate the association between subclinical anxiety and depressive symptoms and its neuroimaging mechanisms. BMC Psychiatry. 2022; 22(1):835. PMC: 9798660. DOI: 10.1186/s12888-022-04488-9. View

19.

Zhou F, Li S, Xu H . Insomnia, sleep duration, and risk of anxiety: A two-sample Mendelian randomization study. J Psychiatr Res. 2022; 155:219-225. DOI: 10.1016/j.jpsychires.2022.08.012. View

20.

Song B, Zhu J . Cerebellar malfunction and postoperative sleep disturbances after general anesthesia: a narrative review. Sleep Breath. 2021; 26(1):31-36. DOI: 10.1007/s11325-021-02361-9. View