Hippocampal Substructural Vulnerability to Sleep Disturbance and Cognitive Impairment in Patients with Chronic Primary Insomnia: Magnetic Resonance Imaging Morphometry
Hippocampal Substructural Vulnerability to Sleep Disturbance and Cognitive Impairment in Patients with Chronic Primary Insomnia: Magnetic Resonance Imaging Morphometry
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DOI：
10.5665/sleep.3836
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发表时间：
2014-07-01
期刊：
影响因子：
5.6
通讯作者：
Hong, Seung Bong
中科院分区：
文献类型：
--
作者：
Joo, Eun Yeon;Kim, Hosung;Hong, Seung Bong
研究目的：尽管令人信服的证据表明，从动物研究表明海马子场特定的脆弱性睡眠质量差和相关的认知障碍，有没有人类磁共振成像（MRI）研究调查海马子场体积和睡眠障碍之间的关系。我们的目的是研究原发性失眠患者相对于对照组海马子域的体积变化模式。设计：逐点形态测量法允许在T1加权MRI上测量海马区域的体积。设置：大学医院。患者：27名未服药的患者（年龄：51.2 +/- 9.6岁）和30名睡眠良好者作为对照组（50.4 +/- 7.1 y）。干预措施：N/A。测量：我们比较了患者和对照组之间的海马子区体积，并将体积与患者的临床和神经心理学特征相关联。患者在所有海马子区域均表现出双侧萎缩（P < 0.05校正）。海马CA 1区萎缩与睡眠质量差（匹兹堡睡眠质量指数和多导睡眠图觉醒指数较高）相关（r <-0.45，P < 0.005）。包括齿状回（DG）和CA 3 -4在内的联合区体积与患者的言语记忆、言语信息处理和言语流畅性呈负相关（竖条r竖条> 0.45，P < 0.05）。该区域的半球体积不对称性（左小于右）与言语域功能受损相关（r = 0.50，P < 0.005）。结论：慢性失眠症海马子区萎缩表明，在睡眠片段化和相关慢性应激条件下，齿状回（DG）神经发生减少，角区（CA）亚区神经元丢失。CA 3 -4-DG区域的萎缩与患者的认知功能受损相关。这些观察结果可能会提供深入了解的病理生理机制，使慢性睡眠障碍患者易受认知功能障碍。
Study Objectives: Despite compelling evidence from animal studies indicating hippocampal subfield-specific vulnerability to poor sleep quality and related cognitive impairment, there have been no human magnetic resonance imaging (MRI) studies investigating the relationship between hippocampal subfield volume and sleep disturbance. Our aim was to investigate the pattern of volume changes across hippocampal subfields in patients with primary insomnia relative to controls.Design: Pointwise morphometry allowed for volume measurements of hippocampal regions on T1-weighted MRI.Setting: University hospital.Patients: Twenty-seven unmedicated patients (age: 51.2 +/- 9.6 y) and 30 good sleepers as controls (50.4 +/- 7.1 y).Interventions: N/A.Measurements: We compared hippocampal subfield volumes between patients and controls and correlated volume with clinical and neuropsychological features in patients.Results: Patients exhibited bilateral atrophy across all hippocampal subfields (P < 0.05 corrected). Cornu ammonis (CA) 1 subfield atrophy was associated with worse sleep quality (higher Pittsburgh Sleep Quality Index and higher arousal index of polysomnography) (r < -0.45, P < 0.005). The volume of the combined region, including the dentate gyrus (DG) and CA3-4, negatively correlated with verbal memory, verbal information processing, and verbal fluency in patients (vertical bar r vertical bar > 0.45, P < 0.05). Hemispheric volume asymmetry of this region (left smaller than right) was associated with impaired verbal domain functions (r = 0.50, P < 0.005).Conclusion: Hippocampal subfield atrophy in chronic insomnia suggests reduced neurogenesis in the dentate gyrus (DG) and neuronal loss in the cornu ammonis (CA) subfields in conditions of sleep fragmentation and related chronic stress condition. Atrophy in the CA3-4-DG region was associated with impaired cognitive functions in patients. These observations may provide insight into pathophysiological mechanisms that make patients with chronic sleep disturbance vulnerable to cognitive impairment.