| Objective:To detect whether and where brain functional connectivity exists in resting state of insomnia related depression patients by using functional magnetic resonance imagingMethods:All patients with insomnia related depression (IRD) were diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Third Edition (CCMD-3) of Chinese Psychiatric Association. Twenty-eight IRD patients and twenty-five matched healthy subjects were selected and underwent fMRI in resting state. Posterior cingulate gyrus functional connectivity pattern were selected in twenty-four patients with IRD and twenty-five matched subjects using resting-state fMRI. For exploring the difference of functional connectivity between the IRD patients and subjects, a two-sample t test was performed on the voxel by voxel manner.Results:Compared with control group, brain functional connectivity of IRD patients in resting state is abnormal, including decreased functional connectivity and increased functional connectivity in various brain area. The abnormal area is distributed over the brain. The brain area of decreased functional connectivity includes posterior cingulate cortex, left precuneus, left paracentral lobule, left middle frontal gyrus, left inferior parietal lobule, left parahippocampal gyrus, ventral lateral nucleus. The brain area of increased functional connectivity included superior temporal gyrus, right inferior temporal gyrus, left insula, right fusiform gyrus, right supramarginal gyrus, left lingual gyrus.Conclusion:Insomnia related depression is a kind of disconnection syndrome. Abnormal posterior cingulate gyrus functional connectivity of IRD exist in resting state. Some regions mentioned may associated with default mode network. Depression has closed relationship with frontal lobe, cingulate gyrus and the limbic system (hippocampus, parahippocampal gyrus), and may exist structure and functional abnormalitles in limbic system-the cortex-striatum-the globus pallidus-thalamus neural circuit-based multiple neural circuit, such as depression (frontal, temporal lobe) attention disorder (parietal lobe), and memory impairment (temporal lobe), reduced capacity and the work plan hesitation (frontal lobe), work efficiency decreased (association cortex), etc. These emotional and cognitive as neurons and neural pathways are crossed, therefore depression and sleep function as a common injury, manifest in behavioral depression, cognitive decline, sleep disorder and other symptoms.The subdued functional connection between thalamus and default network reflect the wakened level of body decreased. The functional connection of thalamic neural nucleus have systemic decreased, perhaps the basis of abnormal brain neuron activity refer to some clinical symptoms.The function of cognitive control brain areas exist in the IRD patients'default mode network (such as medial prefrontal cortex, middle frontal gyrus, orbit-frontal gyrus, etc) decreased and the brain regions of emotional processing (such as fusiform gyrus, inferior temporal gyrusl, striatum, etc.) is activated, which may be connected with the signatures in the patients, just as long-term automatic awakening, emotional distress, negative and excessive cognitive activities.In terms of the negative model of insomnia maintained and depressive disorders happened, their both cognitive model of neural mechanism exist certain interoperability. It is speculated that there may be exist a peripheral and neural systems integration model of emotional physiology exist in two of them. The continuously accumulated of negative cognitive activities quantity and degree in insomnia formed a negative cognitive processing bias and may cause of depression. The activities of the human emotions may be involved in several psychological components and multi-level structure systems of brain function interaction network.
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