Regional brain dysfunction in insomnia after ischemic stroke: A resting-state fMRI study

Aberrant regional neural fluctuations and functional connectivity in insomnia comorbid depression revealed by resting-state functional magnetic resonance imaging

Insomnia is a common mental illness seriously affecting people lives, that might progress to major depression. However, the neural mechanism of patients with CID comorbid MDD remain unclear. Combining fractional amplitude of low-frequency fluctuation (fALFF) and seed-based functional connectivity (FC), this study investigated abnormality in local and long-range neural activity of patients with CID comorbid MDD. Here, we acquired resting-state blood oxygenation level dependent (BOLD) data from 57 patients with CID comorbid MDD and 57 healthy controls (HC). Compared with the controls, patients with CID comorbid MDD exhibited abnormal functional activity in posterior cerebral cortex related to the visual cortex, including the middle occipital gyrus (MOG), the cuneus and the lingual gyrus, specifically, lower fALFF values in the right MOG, left cuneus, and right postcentral gyrus, increased FC between the right MOG and the left cerebellum, and decreased FC between the right MOG and the right lingual gyrus. Neuropsychological correlation analysis revealed that the decreased fALFF in the right MOG was negatively correlated with all the neuropsychological scores of insomnia and depression, reflecting common relationships with symptoms of CID and MDD. While the decreased fALFF of the left cuneus was distinctly correlated with the scores of depression related scales. The decreased FC between the right MOG and the right lingual gyrus was distinctly correlated with the scores of insomnia related scales. This study not only widened neuroimaging evidence that associated with insomnia and depressive symptoms of patients with CID comorbid MDD, but also provided new potential targets for clinical treatment.

Global, mesoscale and local investigation into resting state fMRI brain network attributes of sleep quality

Poor sleep quality has been found to be associated with functional abnormalities in a few regions of the human brain. However, the brain is a dynamic network cooperation system, and it is necessary to study the relationship between sleep quality and the whole-brain network activity at multiple levels. A total of 115 college students underwent resting-state fMRI (rs-fMRI) and completed the Pittsburgh Sleep Quality Index (PSQI). Students were divided into good-quality sleepers (N = 65, PSQI<5) and poor-quality sleepers (N = 50, PSQI≥5). The fMRI data were analyzed using graph theory and machine learning methods to compare between-group differences in functional network topology at different levels. Global analysis shows the poor sleep quality group had lower small-worldness and higher characteristic path length. The mesoscale analysis demonstrates the subnetwork functions of the right middle frontal gyrus, bilateral superior parietal gyrus, bilateral caudate nucleus, and right superior temporal gyrus are important indicators that distinguish between the two groups. Local analysis shows the nodal degree of the left inferior occipital gyrus and left postcentral gyrus significantly differed between the two groups. Taken together, these findings deepen the macroscopic understanding of the relationship between sleep quality and resting functional network topology patterns.

Functional connectivity and white matter microstructural alterations in patients with left basal ganglia acute ischemic stroke

Lesions in the basal ganglia present different neuroimaging manifestations compared to other regions. The functional connectivity and white matter (WM) microstructural alterations in patients with left basal ganglia acute ischemic stroke (AIS) remain unknown. This study aimed to explore the alterations of functional connectivity and WM microstructure, as well as their relationship with cognitive performance in patients with left basal ganglia AIS. We acquired resting-state functional MRI (rs-fMRI) and diffusion kurtosis imaging (DKI) data from 41 individuals with left basal ganglia AIS and 41 healthy controls (HC). The degree centrality (DC) method was applied to calculate the functional connectivity and Tract-Based Spatial Statistics was employed to evaluate the voxel-based group differences of diffusion metrics for the values of fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), radial diffusivity, mean kurtosis (MK), axial kurtosis, and radial kurtosis (RK). AIS showed attenuated DC in the bilateral precuneus and enhanced DC in the left caudate nucleus, compared with HC. In AIS, DC in the left caudate nucleus correlated positively with the Montreal Cognitive Assessment (MoCA) score (r = 0.681, p < 0.05). AIS had significantly decreased FA, AD, MK, and RK in WM tracts, including the internal capsule (IC), genu of corpus callosum (CC), body of CC, left superior longitudinal fasciculus (SLF), left cerebral peduncle, left corticospinal tract, anterior corona radiata (ACR), and left cingulum gyrus (CG). The MK in a cluster including the body of CC, right IC, left cingulate, SLF, ACR, and left CG was also significantly negatively correlated with MoCA scores (r = -0.508, p < 0.05). This study revealed that left basal ganglia AIS not only disrupted the functional connectivity of the whole brain but also had a pervasive impact on the WM microstructure of the whole brain. These findings provide novel insights into the underlying neural mechanisms of early cognitive decline in patients after AIS.

Static and temporal dynamic changes in brain activity in patients with post-stroke balance dysfunction: a pilot resting state fMRI

Objective

The aim of this study was to investigate the characteristics of brain activity changes in patients with post-stroke balance dysfunction and their relationship with clinical assessment, and to construct a classification model based on the extreme Gradient Boosting (XGBoost) algorithm to discriminate between stroke patients and healthy controls (HCs).

Methods

In the current study, twenty-six patients with post-stroke balance dysfunction and twenty-four HCs were examined by resting-state functional magnetic resonance imaging (rs-fMRI). Static amplitude of low frequency fluctuation (sALFF), static fractional ALFF (sfALFF), static regional homogeneity (sReHo), dynamic ALFF (dALFF), dynamic fALFF (dfALFF) and dynamic ReHo (dReHo) values were calculated and compared between the two groups. The values of the imaging metrics for the brain regions with significant differences were used in Pearson correlation analyses with the Berg Balance Scale (BBS) scores and as features in the construction of the XGBoost model.

Results

Compared to HCs, the brain regions with significant functional abnormalities in patients with post-stroke balance dysfunction were mainly involved bilateral insula, right fusiform gyrus, right lingual gyrus, left thalamus, left inferior occipital gyrus, left inferior temporal gyrus, right calcarine fissure and surrounding cortex, left precuneus, right median cingulate and paracingulate gyri, right anterior cingulate and paracingulate gyri, bilateral supplementary motor area, right putamen, and left cerebellar crus II. XGBoost results show that the model constructed based on static imaging features has the best classification prediction performance.

Conclusion

In conclusion, this study provided evidence of functional abnormalities in local brain regions in patients with post-stroke balance dysfunction. The results suggested that the abnormal brain regions were mainly related to visual processing, motor execution, motor coordination, sensorimotor control and cognitive function, which contributed to our understanding of the neuropathological mechanisms of post-stroke balance dysfunction. XGBoost is a promising machine learning method to explore these changes.

Comparison of resting-state brain activity between insomnia and generalized anxiety disorder: A coordinate-based meta-analysis

Patients with insomnia disorder (ID) usually experience a greater burden of comorbid anxiety symptoms. However, the neural mechanism under the mutual relationship between ID and anxiety remains largely unclear. The meta-analysis aimed to explore the concordance and distinction of regional brain functional activity in patients with ID and those with generalized anxiety disorder (GAD) using coordinate-based activation likelihood estimation approach. Studies using resting-state regional homogeneity, amplitude of low-frequency fluctuations (ALFF), or fractional ALFF in patients with ID or GAD were included by searching multiple databases up to May 24, 2024. Using meta-analytic approach, 21 studies of ID vs. healthy controls (HC) and 16 studies of GAD vs. HC were included to illuminate the common and distinct patterns between the two disorders. Results showed that ID and GAD shared increased brain activities in the left posterior cingulate cortex and left precuneus, as well as decreased brain activity in the left medial prefrontal cortex. Additionally, compared with ID, GAD showed greater increased activities in the left superior frontal gyrus. Our study reveals both common and different activation patterns between ID and GAD, which may provide novel insights for understanding the neural basis of the two disorders and enlighten the possibility of the development of more targeted treatment strategies for ID and GAD.

Resting-state functional abnormalities in ischemic stroke: a meta-analysis of fMRI studies

Ischemic stroke is a leading neurological cause of severe disabilities and death in the world and has a major negative impact on patients' quality of life. However, the neural mechanism of spontaneous fluctuating neuronal activity remains unclear. This meta-analysis explored brain activity during resting state in patients with ischemic stroke including 22 studies of regional homogeneity, amplitude of low-frequency fluctuation, and fractional amplitude of low-frequency fluctuation (692 patients with ischemic stroke, 620 healthy controls, age range 35-80 years, 41% female, 175 foci). Results showed decreased regional activity in the bilateral caudate and thalamus and increased regional activity in the left superior occipital gyrus and left default mode network (precuneus/posterior cingulate cortex). Meta-analysis of the amplitude of low-frequency fluctuation studies showed that increased activity in the left inferior frontal gyrus was reduced across the progression from acute to chronic phases. These findings may indicate that disruption of the subcortical areas and default mode network could be one of the core functional abnormalities in ischemic stroke. Altered brain activity in the inferior frontal gyrus could be the imaging indicator of brain recovery/plasticity after stroke damage, which offers potential insight into developing prediction models and therapeutic strategies for ischemic stroke rehabilitation and recovery.

Altered static brain activity and functional connectivity after heat stroke

This study aimed to investigate the alteration of brain function based on resting-state functional MRI in patients after heat stroke. This study included 10 cases of patients after heat stroke and 10 cases of healthy controls. Abnormal brain function was calculated using amplitude of low-frequency fluctuations (ALFF) and degree centrality analysis, as well as functional connectivity analysis based on regions of interest (ROI). Correlation analyses were performed to evaluate the association between brain function changes and clinical scales. Combining ALFF and degree centrality results, the decreased brain regions included the left cuneus and the right angular gyrus, while the increased brain regions included the right cerebellar_Crus1. Using the left cuneus with significant differences in ALFF and degree centrality as ROI, the functional connectivity results revealed decreased brain regions including bilateral lingual gyrus, bilateral postcentral cingulate gyrus, and left precentral gyrus. The degree centrality value of the right cerebellar_Crus1 was positively correlated with glasgow coma scale (GCS) scores ( r  = 0.726, P  = 0.027), and the functional connectivity value of the right posterior cingulate gyrus was positively correlated with GCS scores ( r  = 0.717, P  = 0.030). Heat stroke patients exhibit abnormal activity in multiple brain regions, which has important clinical significance for evaluating the severity of the disease.

Sex disparity in stroke risk among patients with insomnia: a 19-year prospective cohort study

STUDY OBJECTIVES

Considering the increased prevalence and more severe manifestations of insomnia among females along with established sex differences in ischemic stroke (IS) occurrence, this research aimed to examine the potential effects of the interaction between insomnia and sex on the incidence and outcome of IS.

METHODS

We used data from the Korean Genome and Epidemiology Study. The main exposure variables were insomnia history and sex. The main outcome was the occurrence of IS observed in biennial follow-up surveys. Cox proportional regression analysis was performed to estimate the effects of insomnia and sex on IS incidence. We also conducted interaction analysis to investigate the interaction effects between insomnia and sex on IS incidence.

RESULTS

During 19 years of follow-up involving 8,933 individuals, we documented 370 cases of new-onset stroke (2.88 cases per 1,000 person-years). Cox proportional regression analysis showed that insomnia and female sex did not increase the risk of IS (hazard ratio: 1.13 [95% confidence interval: 0.86-1.51] and hazard ratio: 0.86 [95% confidence interval: 0.63-1.17], respectively). Interaction analysis demonstrated that stroke risk was increased only among females with insomnia (hazard ratio: 1.34 [95% confidence interval: 1.05-1.80]) compared with those without insomnia.

CONCLUSIONS

Our study highlights the significance of considering sex-specific factors when evaluating the relationship between insomnia and IS risk, particularly emphasizing the unique role of insomnia in IS risk among females.

CITATION

Jung E, Kim DK, Lee SY, Ryu HH. Sex disparity in stroke risk among patients with insomnia: a 19-year prospective cohort study. J Clin Sleep Med. 2024;20(10):1669-1674.

Insomnia-related brain functional correlates in first-episode drug-naïve major depressive disorder revealed by resting-state fMRI

Introduction

Insomnia is a common comorbidity symptom in major depressive disorder (MDD) patients. Abnormal brain activities have been observed in both MDD and insomnia patients, however, the central pathological mechanisms underlying the co-occurrence of insomnia in MDD patients are still unclear. This study aimed to explore the differences of spontaneous brain activity between MDD patients with and without insomnia, as well as patients with different level of insomnia.

Methods

A total of 88 first-episode drug-naïve MDD patients including 44 with insomnia (22 with high insomnia and 22 with low insomnia) and 44 without insomnia, as well as 44 healthy controls (HC), were enrolled in this study. The level of depression and insomnia were evaluated by HAMD-17, adjusted HAMD-17 and its sleep disturbance subscale in all subjects. Resting-state functional and structural magnetic resonance imaging data were acquired from all participants and then were preprocessed by the software of DPASF. Regional homogeneity (ReHo) values of brain regions were calculated by the software of REST and were compared. Finally, receiver operating characteristic (ROC) curves were conducted to determine the values of abnormal brain regions for identifying MDD patients with insomnia and evaluating the severity of insomnia.

Results

Analysis of variance showed that there were significant differences in ReHo values in the left middle frontal gyrus, left pallidum, right superior frontal gyrus, right medial superior frontal gyrus and right rectus gyrus among three groups. Compared with HC, MDD patients with insomnia showed increased ReHo values in the medial superior frontal gyrus, middle frontal gyrus, triangular inferior frontal gyrus, calcarine fissure and right medial superior frontal gyrus, medial orbital superior frontal gyrus, as well as decreased ReHo values in the left middle occipital gyrus, pallidum and right superior temporal gyrus, inferior temporal gyrus, middle cingulate gyrus, hippocampus, putamen. MDD patients without insomnia demonstrated increased ReHo values in the left middle frontal gyrus, orbital middle frontal gyrus, anterior cingulate gyrus and right triangular inferior frontal gyrus, as well as decreased ReHo values in the left rectus gyrus, postcentral gyrus and right rectus gyrus, fusiform gyrus, pallidum. In addition, MDD patients with insomnia had decreased ReHo values in the left insula when compared to those without insomnia. Moreover, MDD patients with high insomnia exhibited increased ReHo values in the right middle temporal gyrus, and decreased ReHo values in the left orbital superior frontal gyrus, lingual gyrus, right inferior parietal gyrus and postcentral gyrus compared to those with low insomnia. ROC analysis demonstrated that impaired brain region might be helpful for identifying MDD patients with insomnia and evaluating the severity of insomnia.

Conclusion

These findings suggested that MDD patients with insomnia had wider abnormalities of brain activities in the prefrontal-limbic circuits including increased activities in the prefrontal cortex, which might be the compensatory mechanism underlying insomnia in MDD. In addition, decreased activity of left insula might be associated with the occurrence of insomnia in MDD patients and decreased activities of the frontal-parietal network might cause more serious insomnia related to MDD.

The abnormalities of brain function in females with primary insomnia: a resting-state functional magnetic resonance imaging study

Background

The neuropathologic mechanism of primary insomnia (PI) of females remains unclear. This study aims to investigate the features of amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) in females with PI using functional magnetic resonance imaging (fMRI), and then explore the abnormalities of functional connectivity (FC).

Materials and methods

A total of 39 female PI patients and 31 female healthy controls (HC) were enrolled in the study. The sleep condition was assessed using the Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI), and their depressive symptom was evaluated using the Hamilton Depression Scale (HAMD-24). The rs-fMRI was once conducted for every subject. ReHo, ALFF, and ROI-based FC were used to analyze the changes of brain function.

Results

ALFF values were increased in the Cerebelum_4_5_L, as well as decreased ALFF in the bilateral Frontal_Sup_Medial (SFGmed), Angular_L (ANG.L), Parietal_Inf_R (IPL.R), SupraMarginal_R (SMG.R), and Postcentral_R (PoCG.R). ReHo values were increased in the Temporal_Pole_Mid_R (TPOsup.R), as well as decreased ReHo in the Insula_R (INS.R), Frontal_Inf_Oper_R (ORBinf.R), Putamen_R (PUT.R), Rolandic_Oper_R (ROL.R), bilateral Cingulum_Post (PCG), bilateral Frontal_Sup_Medial (SFGmed), bilateral anterior cingulate and paracingulate gyri (ACG), and the bilateral precuneus (PCUN). Across the entire brain, there was a decline in the FC between Angular_R and Frontal_Sup_Medial_L.

Conclusion

Alterations in brain regions of female patients with PI involved multiple functional networks, including the default mode network, the salience network, the central executive network, and the limbic network. Reduced coordination between functional networks may be an important mechanism for insomnia and may lead to reduced cognitive function and decision-making ability.

Abnormal degree centrality as a potential imaging biomarker for ischemic stroke: A resting-state functional magnetic resonance imaging study

OBJECTIVE

To explore degree centrality (DC) abnormalities in ischemic stroke patients and determine whether these abnormalities have potential value in understanding the pathological mechanisms of ischemic stroke patients.

METHODS

Sixteen ischemic stroke patients and 22 healthy controls (HCs) underwent resting state functional magnetic resonance imaging (rs-fMRI) scanning, and the resulting data were subjected to DC analysis. Then we conducted a correlation analysis between DC values and neuropsychological test scores, including Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). Finally, extracted the abnormal DC values of brain regions and defined them as features for support vector machine (SVM) analysis.

RESULTS

Compared with HCs, ischemic stroke patients showed increased DC in the bilateral supplementary motor area, and median cingulate and paracingulate gyri and decreased DC in the left postcentral gyrus, right calcarine fissure and surrounding cortex, lingual gyrus, and orbital parts of the right superior frontal gyrus and bilateral cuneus. Correlation analyses revealed that DC values in the right lingual gyrus, calcarine fissure and surrounding cortex, and orbital parts of the right superior frontal gyrus were positively correlated with the MMSE scores. The SVM classification of the DC values achieved an area under the curve (AUC) of 0.93, an accuracy of 89.47%.

CONCLUSION

Our research results indicate that ischemic stroke patients exhibit abnormalities in the global connectivity mechanisms and patterns of the brain network. These abnormal changes may provide neuroimaging evidence for stroke-related motor, visual, and cognitive impairments, contribute to a deeper comprehension of the underlying pathophysiological mechanisms implicated in ischemic stroke.

Role of vitamin D in the association between pre-stroke sleep quality and poststroke depression and anxiety

PURPOSE

Poor sleep quality, mood disorders, and vitamin D deficiency are common in stroke. We investigated the association between serum vitamin D levels and pre-stroke sleep quality and the occurrence of poststroke depression (PSD) and poststroke anxiety (PSA) in acute ischemic stroke (AIS).

METHODS

This prospective cross-sectional study included hospitalized patients with AIS and age- and sex-matched controls. Vitamin D levels were measured within 24 h of admission. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at admission. The severity of depression and anxiety symptoms was evaluated according to Beck Depression Inventory and Beck Anxiety Inventory scores, respectively, within 72 h after admission.

RESULTS

Comparing 214 AIS patients with 103 controls, patients had significantly higher scores of Beck Depression Inventory, Beck Anxiety Inventory, and PSQI and lower vitamin D levels (p < 0.001). Among AIS patients, Beck Depression Inventory (p = 0.004) and Beck Anxiety Inventory (p = 0.018) scores were significantly higher in bad sleepers (PSQI score ≥ 6) than in good sleepers (PSQI score ≤ 5). Correlation analysis revealed negative correlations between serum vitamin D levels and Beck Depression Inventory (r =  - 0.234; p < 0.001), Beck Anxiety Inventory (r =  - 0.135; p = 0.016), and PSQI (r =  - 0.218; p < 0.001) scores.

CONCLUSION

Decreased serum vitamin D levels at admission are associated with a high risk for PSD and PSA in patients with poor pre-stroke sleep quality during the early stages of AIS.

Multimodal transformer graph convolution attention isomorphism network (MTCGAIN): a novel deep network for detection of insomnia disorder

Background

In clinic, the subjectivity of diagnosing insomnia disorder (ID) often leads to misdiagnosis or missed diagnosis, as ID may have the same symptoms as those of other health problems.

Methods

A novel deep network, the multimodal transformer graph convolution attention isomorphism network (MTGCAIN) is proposed in this study. In this network, graph convolution attention (GCA) is first employed to extract the graph features of brain connectivity and achieve good spatial interpretability. Second, the MTGCAIN comprehensively utilizes multiple brain network atlases and a multimodal transformer (MT) to facilitate coded information exchange between the atlases. In this way, MTGCAIN can be used to more effectively identify biomarkers and arrive at accurate diagnoses.

Results

The experimental results demonstrated that more accurate and objective diagnosis of ID can be achieved using the MTGCAIN. According to fivefold cross-validation, the accuracy reached 81.29% and the area under the receiver operating characteristic curve (AUC) reached 0.8760. A total of nine brain regions were detected as abnormal, namely right supplementary motor area (SMA.R), right temporal pole: superior temporal gyrus (TPOsup.R), left temporal pole: superior temporal gyrus (TPOsup.L), right superior frontal gyrus, dorsolateral (SFGdor.R), right middle temporal gyrus (MTG.R), left middle temporal gyrus (MTG.L), right inferior temporal gyrus (ITG.R), right median cingulate and paracingulate gyri (DCG.R), left median cingulate and paracingulate gyri (DCG.L).

Conclusions

The brain regions in the default mode network (DMN) of patients with ID show significant impairment (occupies four-ninths). In addition, the functional connectivity (FC) between the right middle occipital gyrus and inferior temporal gyrus (ITG) has an obvious correlation with comorbid anxiety (P=0.008) and depression (P=0.005) among patients with ID.

The multifaceted aspects of sleep and sleep-wake disorders following stroke

Sleep-wake disorders (SWD) are acknowledged risk factors for both ischemic stroke and poor cardiovascular and functional outcome after stroke. SWD are frequent following stroke, with sleep apnea (SA) being the most frequent SWD affecting more than half of stroke survivors. While sleep disturbances and SWD are frequently reported in the acute phase, they may persist in the chronic phase after an ischemic stroke. Despite the frequency and risk associated with SWD following stroke, screening for SWD remains rare in the clinical setting, due to challenges in the assessment of post-stroke SWD, uncertainty regarding the optimal timing for their diagnosis, and a lack of clear treatment guidelines (i.e., when to treat and the optimal treatment strategy). However, little evidence support the feasibility of SWD treatment even in the acute phase of stroke and its favorable effect on long-term cardiovascular and functional outcomes. Thus, sleep health recommendations and SWD treatment should be systematically embedded in secondary stroke prevention strategy. We therefore propose that the management of SWD associated with stroke should rely on a multidisciplinary approach, with an integrated diagnostic, treatment, and follow-up strategy. The challenges in the field are to improve post-stroke SWD diagnosis, prognosis and treatment, through a better appraisal of their pathophysiology and temporal evolution.