Correlation Between Attention And Sleep Architecture And White Matter Changes In Chronic Insomniacs

ObjectiveIn order to explore the correlation between alterations of sleep architecture and impairments of daytime function in the patients with chronic insomnia disorder(CID),we put forward the following critical thinkings:(1)To investigate the relationship between changes of sleep pattern and deficits of attention function;(2)To analysize the relationship between alterations of sleep architecture and white matter changes(WMCs);(3)To study the potential mechanism of attention dysfunction in the patients with chronic insomnia disorder,we come up with an assumption that the latent mechanism may be associated with white matter changes.The aforesaid opinion will provide a novel research thinking for further studying and preventing the attention detriments as a result of chronic insomnia disorder.In the meantime,newer researches and developments of the insomnia medications will be performed based on this focus in the future.Methods(1)This study registered thirty-one patients with chronic insomnia disorder(containing ten males and twenty-one females)and twenty-six good sleepers(containing nine males and seventeen females)meeting the inclusion criteria by recruiting volunteers and collecting the patients in the outpatient clinic of sleep disorder.(2)All the participants were subjected to the PSQI,ISI,and ESS for evaluating the subjective sleep quality,the severity of insomnia,and the hypersomnia extent of daytime,respectively.(3)All the subjects underwent the overnight PSG test for monitoring the objective sleep quality,sleep architecture,respiratory events and other paramenters during sleep,at the same time,for excluding the complaints related to sleep disorders such as OSA(obstructive sleep apnea)and PLMS(periodic limb movements of sleep).(4)All the participants were measured using HAMA and HAMD-17 version for assessing psychiatric status.(5)The attention tests of MoCA and WMS-R were used to evaluate the attention function in different perspectives.(6)White matter changes were observed using MRI consisting of axial T2WI and T2-FLAIR,and were quantified using a visual rating scale–the Fazekas scale.Results1.Demographic Data and Clinic Characteristics between the Two GroupsThere were no significantly statistical differences in sex,age,and educational attainment between the patients with CID and good sleepers.However,the scores of PSQI,ISI,ESS,HAMA,HAMD-17 in the patients with chronic insomnia disorder were higher than that of the healthy controls(HC),with a P-value being less than 0.05.2.Comparison of PSG Parameters in the CID Patients and HC GroupsIt was showed that there was an obvious declining in TST,N3%,PSE in CID groups compared with the HC groups,with a significant statistical difference.Nevertheless,compared to the HC groups,prolonged SL,increased WASO,ArI,N1%,and N2%were found in CID patients,with a P-value being less than 0.05.In addition,the extended SRL and decreased R%were performed in CID groups,while there was no apparently difference between the two groups(P>0.05).3.Comparison of Attention Function between the CID Groups and HC GroupsThe total scores of attention of the MoCA test in CID patients were obviously lower than that of the HC groups,with an obvious statistical significance(P<0.05).Moreover,there were greater scores in the mental test such as the number sequencing from one to one hundred forward and backward tasks,as well as the add arithmetic task,and visual memory span test containing visual regeneration task of the Wechsler Memory Scale-Revised test in HC groups,compared with CID patients(P<0.05).4.White Matter Changes in the CID Patients and Good SleepersThe percent of white matter changes in CID patients was more than that in good sleepers,with a significant difference(χ~2=7.356,P=0.007).5.Correlation between Sleep Parameters and Attention FunctionScores of PSQI and ISI were negatively associated with attention of the MoCA test,the mental test and visual memory,with an obvious statistical significance(P<0.05).In addition,performances were worse in mental test,visual memory span test,and visual regeneration of the Wechsler Memory Scale-Revised test,with the more prolonged SL and increased WASO(P<0.05).Besides,scores of the number from one to one hundred task were negatively related with WASO.However,visual memory span test,visual regeneration and continuous accumulating tests were poor positively associated with N3%(P<0.05).In addition,scores of visual memory span test and visual regeneration test were negatively correlated with N2%(P<0.05).In the present study,it was found that scores of attention of MoCA test were negatively with SL(r=-0.33,P<0.05),but positively correlated with N3%(r=0.42,P<0.01).6.Correlation between Sleep Parameters and White Matter ChangesIn our study,it showed that PSQI,ISI,SL,N2%were positively associated with the score of Fazekas rating scale for white matter changes(P<0.01).Nevertheless,N3%was negatively related with the score of the Fazekas rating scale(r=-0.32,P<0.05).7.Correlation between White Matter Changes and Attention FunctionThe total scores of attention of the MoCA test were negatively correlated with the scores of the Fazekas rating scale for white matter changes,with a significant statistical difference(P<0.01).However,there was no significant difference between scores of the Fazekas rating scale for white matter changes and scores of the Wechsler Memory Scale-Revised test.ConclusionsThe nocturnal sleep architecture of chronic insomniacs was abnormal and disordered,with the partial detrimental attention function.Besides,our study demonstrated that the impairments of attention function in chronic insomniacs were associated with the changes of white matter.In addition,There was a vital influence between alterations of the sleep patterns such as the prolonged sleep latency,the increased N2%as well as the decreased N3%and the changes of white matter.SignificancesThe present study illustrates that the disordered nocturnal sleep architecture in the patients with chronic insomnia disorder results in the partial deficits of attention function,interestingly,may be linked to the changes of white matter.More importantly,the results of the study will lay a foundation for further investigating the underlying mechanism of cognitive disorders in chronic insomnia disorder.Moreover,it will provide a novel study thinking for the development of insomnia medication.Thus we ought to highlight the regular and comprehensive research in the future,so as to illuminate the latent mechanism of cognitive impairments in CID patients as soon as possible.