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Mermer E, Arslan S. The effect of audiobooks on sleep quality and vital signs in intensive care patients. Intensive Crit Care Nurs 2024; 80:103552. [PMID: 37797438 DOI: 10.1016/j.iccn.2023.103552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/26/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Improving sleep quality in the intensive care unit is significant for the recovery process. This study investigated the effect of listening to audiobooks on sleep quality and vital signs in intensive care patients. METHODS This quasi-experimental study utilized the pre-posttest design, involving control and intervention groups. The study was conducted in the internal medicine intensive care unit of a hospital in Turkey between January-June 2022. Standard nursing care was given to both groups on the first night, and the Sleep Evaluation Form and Richard Campbell Sleep Scale were used to measure sleep quality in the morning. On the second day, the intervention group listened to a recorded story, and the control group had standard care. Sleep quality and vital signs were measured again. RESULTS Data from 56 participants were analyzed. Noise (96.4%), light (69.6%), unfamiliar environment (64.8%), concerns about illness (33.9%), and care and treatments (58.9%) are the main causes of sleep disruption. The effect of these factors decreased in the intervention group after the Audiobook Listening Practice, which significantly improved the sleep quality of the ICU patients (p < 0.001). Among the vital signs, a significant difference was found in pulse and blood pressure (p < 0.001), while no changes were observed in temperature and respiratory rate in time group interaction (p > 0.05). CONCLUSIONS The Audiobook Listening Practice improved sleep quality and life parameters in the ICU. Nurses can use the practice to improve sleep quality in intensive care units. IMPLICATIONS FOR CLINICAL PRACTICE Evidence-based studies are needed to improve the sleep quality of patients in intensive care units, to ensure clinical improvement, and to reduce the length of stay at hospital. The practice is effective in manipulating environmental stressors. This low-cost method significantly improves patient care activities. It is recommended to integrate such complementary activities into intensive care units, to train nurses about the practice, and to support the practice with new studies.
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Affiliation(s)
- Elmas Mermer
- Konya City Hospital, Intensive Care Unit, Konya Turkey.
| | - Selda Arslan
- Department of Internal Medicine Nursing, Nursing Faculty, Necmettin Erbakan University, Konya, Turkey.
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Leerssen J, Aghajani M, Bresser T, Rösler L, Winkler AM, Foster-Dingley JC, Van Someren EJW. Cognitive, Behavioral, and Circadian Rhythm Interventions for Insomnia Alter Emotional Brain Responses. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:60-69. [PMID: 36958474 DOI: 10.1016/j.bpsc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The highest risk of depression is conveyed by insomnia. This risk can be mitigated by sleep interventions. Understanding brain mechanisms underlying increased emotional stability following insomnia treatment could provide insight relevant to the prevention of depression. Here, we investigated how different sleep interventions alter emotion-related brain activity in people with insomnia at high risk of developing depression. METHODS Functional magnetic resonance imaging was used to assess how the amygdala response to emotional stimuli (negative facial expression) in 122 people with insomnia disorder differed from 36 control subjects and how the amygdala response changed after 6 weeks of either no treatment or internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS). Effects on depression, insomnia and anxiety severity were followed up for 1 year. RESULTS Only combined treatment (CBT-I+CRS) significantly increased the amygdala response, compared with no treatment, CBT-I, and CRS. Individual differences in the degree of response enhancement were associated with improvement of insomnia symptoms directly after treatment (r = -0.41, p = .021). Moreover, exclusively CBT-I+CRS enhanced responsiveness of the left insula, which occurred in proportion to the reduction in depressive symptom severity (r = -0.37, p = .042). CONCLUSIONS This functional magnetic resonance imaging study on insomnia treatment, the largest to date, shows that a combined cognitive, behavioral, and circadian intervention enhances emotional brain responsiveness and might improve resilience in patients with insomnia who are at high risk of developing depression.
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Affiliation(s)
- Jeanne Leerssen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands.
| | - Moji Aghajani
- Section Forensic Family and Youth Care, Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Tom Bresser
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands; Department of Clinical Genetics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Lara Rösler
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Anderson M Winkler
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Jessica C Foster-Dingley
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, VU University, Amsterdam, the Netherlands
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Altena E, Ellis J, Camart N, Guichard K, Bastien C. Mechanisms of cognitive behavioural therapy for insomnia. J Sleep Res 2023; 32:e13860. [PMID: 36866434 DOI: 10.1111/jsr.13860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 03/04/2023]
Abstract
Although much is known now about behavioural, cognitive and physiological consequences of insomnia, little is known about changes after cognitive behavioural therapy for insomnia on these particular factors. We here report baseline findings on each of these factors in insomnia, after which we address findings on their changes after cognitive behavioural therapy. Sleep restriction remains the strongest determinant of insomnia treatment success. Cognitive interventions addressing dysfunctional beliefs and attitudes about sleep, sleep-related selective attention, worry and rumination further drive effectiveness of cognitive behavioural therapy for insomnia. Future studies should focus on physiological changes after cognitive behavioural therapy for insomnia, such as changes in hyperarousal and brain activity, as literature on these changes is sparse. We introduce a detailed clinical research agenda on how to address this topic.
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Affiliation(s)
| | - Jason Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle, UK
| | - Nathalie Camart
- UR CLIPSYD, UFR SPSE, Département de psychologie, Université Paris Nanterre, Nanterre, France
- Cabinet Pôle Psy République, Bordeaux, France
- Nouvelle Clinique Bel Air- PEAS, Bordeaux, France
| | - Kelly Guichard
- Nouvelle Clinique Bel Air- PEAS, Bordeaux, France
- CHU Bordeaux, Centre Hypersomnies Rares, Bordeaux, France
| | - Célyne Bastien
- Ecole de Psychologie, Université Laval, Québec, Québec, Canada
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Sabot D, Baumann O. Neuroimaging Correlates of Cognitive Behavioral Therapy for Insomnia (CBT-I): A Systematic Literature Review. J Cogn Psychother 2023; 37:82-101. [PMID: 36787999 DOI: 10.1891/jcpsy-d-21-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard non-pharmacological treatment for insomnia, a complex disorder that comprises psychological, behavioral, and physiological components. This systematic literature review aimed to evaluate a growing body of exploratory studies that have examined CBT-I treatment effects using neuroimaging assessment. Nine studies met current review selection criteria, of which six studies compared insomnia groups with good sleepers, waitlist, and/or control groups. CBT-I administration varied in treatment length and duration across the studies, as did neuroimaging assessment, which included task-based and resting-state functional magnetic resonance imaging (fMRI), and structural magnetic resonance imaging (MRI). Functional connectivity abnormalities were observed in participants, including reduced engagement in task-related brain regions and apparent difficulties in regulating default mode brain areas that appeared to reverse following CBT-I treatment. Taken together, the neuroimaging results complement behavioral measures of treatment efficacy, indicating support for the effectiveness of CBT-I treatment in the recovery of brain function and structure.
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Affiliation(s)
- Debbie Sabot
- School of Psychology, Bond University, Robina QLD 4226 Australia
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5
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Lee MH, Lee KH, Oh SM, Seo MC, Lee H, Jeon JE, Lee YJ. The moderating effect of prefrontal response to sleep-related stimuli on the association between depression and sleep disturbance in insomnia disorder. Sci Rep 2022; 12:17739. [PMID: 36272992 DOI: 10.1038/s41598-022-22652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/18/2022] [Indexed: 01/18/2023] Open
Abstract
We investigated differences in brain activity in response to sleep-related pictures between chronic insomnia disorder (CID) patients and good sleepers (GS), and examined whether brain activity moderated the relationship between depressive symptoms and sleep disturbance in CID patients and GS. This study included 43 patients diagnosed with CID, based on the International Classification of Sleep Disorders-3, and 42 GS. The participants kept a sleep diary, underwent nocturnal polysomnography to measure sleep parameters, and completed self-report questionnaires to assess sleep and psychiatric symptoms. They underwent functional magnetic resonance imaging (fMRI) to examine differences in brain activity in response to sleep-related pictures compared to neutral pictures. A moderated moderation analysis was performed to investigate the moderating role of brain responses to sleep-related pictures in the association between depressive symptoms and sleep disturbance. Compared to GS, the brain responses to sleep-related stimuli were significantly lower in CID patients in the right lateral prefrontal cortex (LPFC) and dorsomedial prefrontal cortex (DMPFC). More severe depressive symptoms were significantly associated with longer sleep latency only when LPFC activity was low in CID patients, but not in GS. LPFC hypoactivity in response to sleep-related stimuli in CID patients could moderate the relationship between depression and sleep disturbance.
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Hwang Y, Lee KH, Kim N, Lee J, Lee HY, Jeon JE, Lee YJ, Kim SJ. Cognitive Appraisal of Sleep and Brain Activation in Response to Sleep-Related Sounds in Healthy Adults. Nat Sci Sleep 2022; 14:1407-1416. [PMID: 35996417 PMCID: PMC9391942 DOI: 10.2147/nss.s359242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Sounds play important roles in promoting and disrupting sleep. How our brain processes sleep-related sounds and individual differences in processing sleep-related sounds must be determined to understand the role of sound in sleep. We investigated neural responses to sleep-related sounds and their associations with cognitive appraisals of sleep. PARTICIPANTS AND METHODS Forty-four healthy adults heard sleep-related and neutral sounds during functional magnetic resonance imaging using a 3T scanner. They also completed the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) questionnaire, which was used to assess cognitive appraisals of sleep. We conducted a voxel-wise whole-brain analysis to compare brain activation in response to sleep-related and neutral sounds. We also examined the association between the DBAS score and brain activity in response to sleep-related sounds (vs neutral sounds) using region of interest (ROI) and whole-brain correlation analyses. The ROIs included the anterior cingulate cortex (ACC), anterior insula (AI), and amygdala. RESULTS The whole-brain analysis revealed increased activation in the temporal regions and decreased activation in the ACC in response to sleep-related sounds compared to neutral sounds. The ROI and whole-brain correlation analyses showed that higher DBAS scores, indicating a negative appraisal of sleep, were significantly correlated with increased activation of the ACC, right medial prefrontal cortex, and brainstem in response to sleep-related sounds. CONCLUSION These results indicate that the temporal cortex and ACC, which are implicated in affective sound processing, may play important roles in the processing of sleep-related sounds. The positive association between the neural responses to sleep-related sounds and DBAS scores suggest that negative and dysfunctional appraisals of sleep may be an important factor in individual differences in the processing of sleep-related sounds.
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Affiliation(s)
- Yunjee Hwang
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Kyung Hwa Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nambeom Kim
- Department of Biomedical Engineering Research Center, Gachon University, Incheon, Republic of Korea
| | - Jooyoung Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ha Young Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Jeong Eun Jeon
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
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Lee MH, Kim N, Yoo J, Kim HK, Son YD, Kim YB, Oh SM, Kim S, Lee H, Jeon JE, Lee YJ. Multitask fMRI and machine learning approach improve prediction of differential brain activity pattern in patients with insomnia disorder. Sci Rep 2021; 11:9402. [PMID: 33931676 PMCID: PMC8087661 DOI: 10.1038/s41598-021-88845-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/19/2021] [Indexed: 11/26/2022] Open
Abstract
We investigated the differential spatial covariance pattern of blood oxygen level-dependent (BOLD) responses to single-task and multitask functional magnetic resonance imaging (fMRI) between patients with psychophysiological insomnia (PI) and healthy controls (HCs), and evaluated features generated by principal component analysis (PCA) for discrimination of PI from HC, compared to features generated from BOLD responses to single-task fMRI using machine learning methods. In 19 patients with PI and 21 HCs, the mean beta value for each region of interest (ROIbval) was calculated with three contrast images (i.e., sleep-related picture, sleep-related sound, and Stroop stimuli). We performed discrimination analysis and compared with features generated from BOLD responses to single-task fMRI. We applied support vector machine analysis with a least absolute shrinkage and selection operator to evaluate five performance metrics: accuracy, recall, precision, specificity, and F2. Principal component features showed the best classification performance in all aspects of metrics compared to BOLD response to single-task fMRI. Bilateral inferior frontal gyrus (orbital), right calcarine cortex, right lingual gyrus, left inferior occipital gyrus, and left inferior temporal gyrus were identified as the most salient areas by feature selection. Our approach showed better performance in discriminating patients with PI from HCs, compared to single-task fMRI.
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Affiliation(s)
- Mi Hyun Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nambeom Kim
- Department of Biomedical Engineering Research Center, Gachon University, Inchon, Republic of Korea
| | - Jaeeun Yoo
- Department of Biomedical Engineering, Gachon University, Inchon, Republic of Korea
| | - Hang-Keun Kim
- Department of Biomedical Engineering, Gachon University, Inchon, Republic of Korea
| | - Young-Don Son
- Department of Biomedical Engineering, Gachon University, Inchon, Republic of Korea
| | - Young-Bo Kim
- Department of Neurosurgery, Gachon University Gil Hospital, Inchon, Republic of Korea
| | - Seong Min Oh
- Department of Psychiatry, Dongguk University Hospital, Ilsan, Republic of Korea
| | - Soohyun Kim
- Department of Neurology, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Hayoung Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Eun Jeon
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Ebben MR, Yan P, Krieger AC. The effects of white noise on sleep and duration in individuals living in a high noise environment in New York City. Sleep Med 2021; 83:256-259. [PMID: 34049045 DOI: 10.1016/j.sleep.2021.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/07/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Undisturbed sleep has been shown to be important for both health and quality of life (Medic et al. [7]). The World Health Organization estimates that nearly 25% of the population suffers from disturbed sleep due to environmental noise (Health TWECfEa, [2]). Sleep disturbance associated with elevated noise levels is particularly prevalent in metropolitan areas. Our study tested the hypothesis that white noise would improve sleep in New Yorkers complaining of sleep difficulty due to elevated sound levels. METHODS Ten adult participants were included in this study. All participants were recruited from a New York City based sleep clinic. Inclusion criteria was based on the presence of sleep disturbance and the reporting of high levels of environmental noise in participants' sleep location. The study was conducted using a within-subject, ABA design, with baseline, treatment phase, followed by another baseline (washout) period. Each phase lasted one-week, during which noise level and sleep were assessed. The treatment consisted of the application of a white noise device (Dohm Classic by Marpac, LLC) in the participants' bedroom. Sleep parameters were measured subjectively using the Consensus Sleep Diary (Carney et al. [15]), and objectively using a Motionlogger Actigraph. RESULTS Paired sample t-tests were conducted to evaluate the hypothesis that white noise improves sleep in a high noise environment. Significance was found on the variables WASO, as measured by actigraphy, t(9) = 3.438, p = 0.007 and sleep latency as measured by sleep diary, t(9) = 2.947, p = 0.016. There was a trend toward significance on the number of awakenings during the night, as measured by sleep diary, t(9) = 2.622, p = 0.028 (Holm's sequential correction of p-value required a value of <0.01 to find significance on this comparison) and sleep efficiency (actigraph), t(9) = -2.121, p = 0.063. CONCLUSION Our data show that white noise significantly improved sleep based on subjective and objective measurements in subjects complaining of difficulty sleeping due to high levels of environmental noise. This suggests that the application of white noise may be an effective tool in helping to improve sleep in those settings.
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Affiliation(s)
- Matthew R Ebben
- Weill Cornell Medical College, Cornell University, New York, NY, USA.
| | - Peter Yan
- Weill Cornell Medical College, Cornell University, New York, NY, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ana C Krieger
- Weill Cornell Medical College, Cornell University, New York, NY, USA
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Zhang Y, Zhang Z, Wang Y, Zhu F, Liu X, Chen W, Zhu H, Zhu H, Li J, Guo Z. Dysfunctional beliefs and attitudes about sleep are associated with regional homogeneity of left inferior occidental gyrus in primary insomnia patients: a preliminary resting state functional magnetic resonance imaging study. Sleep Med 2021; 81:188-193. [PMID: 33714848 DOI: 10.1016/j.sleep.2021.02.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The neural mechanisms of sleep beliefs and attitudes in primary insomnia (PI) patients at resting state remain unclear. The aim of this study was to investigate the features of regional homogeneity (ReHo) in PI using resting-state functional magnetic resonance imaging (rsfMRI). METHODS Thirty-two PI patients and 34 normal controls (NC) underwent rsfMRI using a 3 T scanner at Tongde Hospital of Zhejiang Province. Participants were assessed with the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16) and Pittsburgh Sleep Quality Index (PSQI). Statistical analyses were performed to determine the regions in which ReHo differed between the two groups. Correlation analyses were performed between the ReHo index of each of these regions and DBAS-16 in PI patients. RESULTS PI patients showed increased ReHo values in the right superior frontal gyrus, and decreased ReHo values in the left cerebellar gyrus, left inferior occipital gyrus (IOG) and left amygdala compared with those of NC. ReHo values in the left IOG were negatively correlated with total DBAS-16 scores, and scores for "consequences of insomnia" and"worry/helplessness about sleep"in PI patients. CONCLUSIONS These results suggest that ReHo alterations in the left IOG may play an important role in the dysfunctional beliefs and attitudes about sleep in PI.
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Affiliation(s)
- Yingchun Zhang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang 310016, Hangzhou, China
| | - Zhenzhong Zhang
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China
| | - Yunling Wang
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China
| | - Feiyan Zhu
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China
| | - Xiaozheng Liu
- Department of Radiology of the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang 310016, Hangzhou, China
| | - Hong Zhu
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China
| | - Haokai Zhu
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Zhejiang 310000, China
| | - Jiapeng Li
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China.
| | - Zhongwei Guo
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China.
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Kim YB, Kim N, Lee JJ, Cho SE, Na KS, Kang SG. Brain reactivity using fMRI to insomnia stimuli in insomnia patients with discrepancy between subjective and objective sleep. Sci Rep 2021; 11:1592. [PMID: 33452376 DOI: 10.1038/s41598-021-81219-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/21/2020] [Indexed: 12/03/2022] Open
Abstract
Subjective–objective discrepancy of sleep (SODS) might be related to the distorted perception of sleep deficit and hypersensitivity to insomnia-related stimuli. We investigated differences in brain activation to insomnia-related stimuli among insomnia patients with SODS (SODS group), insomnia patients without SODS (NOSODS group), and healthy controls (HC). Participants were evaluated for subjective and objective sleep using sleep diary and polysomnography. Functional magnetic resonance imaging was conducted during the presentation of insomnia-related (Ins), general anxiety-inducing (Gen), and neutral (Neu) stimuli. Brain reactivity to the contrast of Ins vs. Neu and Gen vs. Neu was compared among the SODS (n = 13), NOSODS (n = 15), and HC (n = 16) groups. In the SODS group compared to other groups, brain areas including the left fusiform, bilateral precuneus, right superior frontal gyrus, genu of corpus callosum, and bilateral anterior corona radiata showed significantly increased blood oxygen level dependent (BOLD) signal in the contrast of Ins vs. Neu. There was no brain region with significantly increased BOLD signal in the Gen vs. Neu contrast in the group comparisons. Increased brain activity to insomnia-related stimuli in several brain regions of the SODS group is likely due to these individuals being more sensitive to sleep-related threat and negative cognitive distortion toward insomnia.
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Emamian F, Mahdipour M, Noori K, Rostampour M, Mousavi SB, Khazaie H, Khodaie-Ardakani M, Tahmasian M, Zarei M. Alterations of Subcortical Brain Structures in Paradoxical and Psychophysiological Insomnia Disorder. Front Psychiatry 2021; 12:661286. [PMID: 34025484 PMCID: PMC8139557 DOI: 10.3389/fpsyt.2021.661286] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022] Open
Abstract
Insomnia disorder (ID) is a common illness associated with mood and cognitive impairments. Subtyping ID is an ongoing debate in sleep medicine, but the underlying mechanisms of each subtype is poorly understood. Growing evidence suggests that subcortical brain structures play the key roles in pathophysiology of ID and its subtypes. Here, we aimed to investigate structural alteration of subcortical regions in patients with two common ID subtypes i.e., paradoxical and psychophysiological insomnia. Fifty-five patients and 49 healthy controls were recruited for this study and T1-weighted images and subjective and objective sleep parameters (i.e., Pittsburgh Sleep Quality Index and polysomnography) were collected from participants. Subcortical structures including the hippocampus, amygdala, caudate, putamen, globus pallidus, nucleus accumbens, and thalamus were automatically segmented in FSL. Volume and shape (using surface vertices) of each structure were compared between the groups, controlled for covariates, and corrected for multiple comparisons. In addition, correlations of sleep parameters and surface vertices or volumes were calculated. The caudate's volume was smaller in patients than controls. Compared with controls, we found regional shrinkage in the caudate, nucleus accumbens, posterior putamen, hippocampus, thalamus, and amygdala in paradoxical insomnia and shrinkage in the amygdala, caudate, hippocampus, and putamen in psychophysiological insomnia. Interestingly, comparing two patients groups, shape alteration in the caudate, putamen, and nucleus accumbens in paradoxical insomnia and shrinkage in the thalamus, amygdala, and hippocampus in psychophysiological insomnia were observed. Both subjective and objective sleep parameters were associated with these regional shape alterations in patients. Our results support the differential role of subcortical brain structures in pathophysiology of paradoxical and psychophysiological insomnia.
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Affiliation(s)
- Farnoosh Emamian
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Mahdipour
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Khadijeh Noori
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoumeh Rostampour
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Bentolhoda Mousavi
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
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Zabrecky G, Shahrampour S, Whitely C, Alizadeh M, Conklin C, Wintering N, Doghramji K, Zhan T, Mohamed F, Newberg A, Monti D. An fMRI Study of the Effects of Vibroacoustic Stimulation on Functional Connectivity in Patients with Insomnia. Sleep Disord 2020; 2020:7846914. [PMID: 32089894 DOI: 10.1155/2020/7846914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/23/2020] [Indexed: 11/25/2022]
Abstract
Background It is well known that vibratory and auditory stimuli from vehicles such as cars and trains can help induce sleep. More recent literature suggests that specific types of vibratory and acoustic stimulation might help promote sleep, but this has not been tested with neuroimaging. Thus, the purpose of this study was to observe the effects of vibroacoustic stimulation (providing both vibratory and auditory stimuli) on functional connectivity changes in the brain using resting state functional magnetic resonance imaging (rs-fMRI), and compare these changes to improvements in sleep in patients with insomnia. Methods For this study, 30 patients with insomnia were randomly assigned to receive one month of a vibroacoustic stimulation or be placed in a waitlist control. Patients were evaluated pre- and postprogram with qualitative sleep questionnaires and measurement of sleep duration with an actigraphy watch. In addition, patients underwent rs-fMRI to assess functional connectivity. Results The results demonstrated that those patients receiving the vibroacoustic stimulation had significant improvements in measured sleep minutes as well as in scores on the Insomnia Severity Index questionnaire. In addition, significant changes were noted in functional connectivity in association with the vermis, cerebellar hemispheres, thalamus, sensorimotor area, nucleus accumbens, and prefrontal cortex. Conclusions The results of this study show that vibroacoustic stimulation alters the brain's functional connectivity as well as improves sleep in patients with insomnia.
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