Sleep Medicine and Psychophysiology (수면정신생리)

KOREAN ACADEMY OF SLEEP MEDICINE (대한수면의학회)
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Functional Magnetic Resonance Imaging of Brain Reactivity to Insomnia-Related vs. General Anxiety-Inducing Stimuli in Insomnia Patients with Subjective-Objective Discrepancy of Sleep

주관적-객관적 수면시간 차이를 보이는 불면증 환자에서 일반적 불안에 비해 불면증 관련 자극으로 인한 뇌활성에 관한 기능적 자기공명영상 연구

  • Kim, Nambeom (Department of Biomedical Engineering Research Center, Gachon University) ;
  • Lee, Jae Jun (Gachon University College of Medicine) ;
  • Cho, Seo-Eun (Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine) ;
  • Kang, Seung-Gul (Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine)
  • 김남범 (가천대학교 의용생체공학연구소) ;
  • 이재준 (가천대학교 의과대학) ;
  • 조서은 (가천대학교 의과대학 길병원 정신건강의학교실) ;
  • 강승걸 (가천대학교 의과대학 길병원 정신건강의학교실)
  • Received : 2020.06.04
  • Accepted : 2020.06.20
  • Published : 2020.06.30
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Abstract

Objectives: Subjective-objective discrepancy of sleep (SODS) is a common symptom and one of the major phenotypes of insomnia. A distorted perception of sleep deficit might be related to abnormal brain reactivity to insomnia-related stimuli. We aimed to investigate differences in brain activation to insomnia-related stimuli vs. general anxiety-inducing stimuli among insomnia patients with SODS, insomnia patients without SODS, and healthy controls (HCs). Methods: All participants were evaluated for subjective sleep status using a sleep diary and questionnaires; occult sleep disorders and objective sleep status were assessed using polysomnography and actigraphy. Task functional magnetic resonance imaging was performed during insomnia-related stimuli (Ins) and general anxiety-inducing stimuli (Gen). Brain reactivity to Ins versus Gen was compared among insomnia with SODS, insomnia without SODS, and HC groups, and a combined insomnia disorder group (ID, insomnia with and without SODS) was also compared with HCs. Results: In the insomnia with SODS group compared to the insomnia without SODS group, the right precuneus and right supplementary motor areas showed significantly increased BOLD signals in response to Ins versus Gen. In the ID group compared to the HC group, the left anterior cingulate cortex showed significantly increased BOLD signals in response to Ins versus Gen. Conclusion: The insomnia with SODS and ID groups showed higher brain activity in response to Ins versus Gen, while this was not observed in the insomnia without SODS and HC groups, respectively. These results suggest that insomnia patients with sleep misperception are more sensitive to sleep-related threats than general anxiety-inducing threats.

목 적 : 주관적-객관적 수면시간의 차이는 불면증의 흔한 증상이자 주요한 유형이다. 본 연구는 주관적-객관적 수면시간 차이가 있는 불면증군, 주관적-객관적 수면시간 차이가 없는 불면증군, 건강대조군을 대상으로 전반적 불안-유발 자극에 대비하여 불면-관련 자극에 대한 뇌활성의 군간 차이가 있는지를 밝히고자 하였다. 방 법 : 모든 피험자들은 수면일기와 임상척도로 주관적 수면상태를, 수면다원검사와 활동기록기로 객관적 수면상태와 불면증 외의 수면장애를 확인하였다. 기능적 뇌영상 촬영동안 불면증-관련 문장 자극과 일반 불안-유발 문장자극을 피험자들에게 주어 유발되는 뇌활성의 세 군간 차이가 있는지를 비교하였다. 뇌활성은 전체 불면증군(주관적-객관적 수면시간의 차이 여부에 상관없이)과 건강대조군 두 군간에도 비교되었다. 결 과 : 주관적-객관적 수면시간 차이가 없는 불면증 군에 비해 차이가 있는 불면증 군에서 일반적 불안-유발 자극 대비 불면-관련 자극에 대해 우측 설전부와 보조운동영역에서 유의하게 증가된 blood oxygen level dependent (BOLD) 신호를 보였다. 또한, 같은 자극에 대해 통합 불면증군이 대조군 보다 좌측 앞 대상회 영역에서 유의하게 증가된 BOLD 신호를 보였다. 결 론 : 본 연구의 결과는 주관적-객관적 수면시간 차이를 가지는 불면증이 주관적-객관적 수면시간 차이가 없는 불면증에 비해 일반적 불안-유발 자극보다 불면-관련 자극에 대해 더 선택적인 집중과 불안을 가지고 증가된 뇌활성을 보인다는 결과로 수면상태 오지각이 증가된 불면증 자극에 선택적인 불안을 보임을 시사한다.

Keywords

References

  1. American Academy of Sleep Medicine. International classification of sleep disorders. Diagnostic and Coding Manual 2005:51-55.
  2. American Academy of Sleep Medicine. International Classification of Sleep Disorders-Third Edition (ICSD-3). AASM Resource Library 2014.
  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5(R)), American Psychiatric Pub;2013.
  4. Baglioni C, Spiegelhalder K, Regen W, Feige B, Nissen C, Lombardo C, et al. Insomnia disorder is associated with increased amygdala reactivity to insomnia-related stimuli. Sleep 2014;37:1907-1917. https://doi.org/10.5665/sleep.4240
  5. Benjamins JS, Migliorati F, Dekker K, Wassing R, Moens S, Blanken TF, et al. Insomnia heterogeneity: characteristics to consider for data-driven multivariate subtyping. Sleep Med Rev 2017;36:71-81. https://doi.org/10.1016/j.smrv.2016.10.005
  6. Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, et al. AASM scoring manual updates for 2017 (version 2.4). J Clin Sleep Med 2017;13:665-666. https://doi.org/10.5664/jcsm.6576
  7. Cavanna AE. The precuneus and consciousness. CNS Spectr 2007;12:545-552. https://doi.org/10.1017/S1092852900021295
  8. Cho YW, Song ML, Morin CM. Validation of a Korean version of the insomnia severity index. J Clin Neurol 2014;10:210-215. https://doi.org/10.3988/jcn.2014.10.3.210
  9. Clark DM. Anxiety disorders: why they persist and how to treat them. Behav Res Ther 1999;37 Suppl 1:S5-27. https://doi.org/10.1016/S0005-7967(99)00048-0
  10. Coleman RM, Roffwarg HP, Kennedy SJ, Guilleminault C, Cinque J, Cohn MA, et al. Sleep-wake disorders based on a polysomnographic diagnosis: a national cooperative study. JAMA 1982;247:997-1003. https://doi.org/10.1001/jama.1982.03320320033026
  11. Edinger JD, Fins AI, Glenn DM, Sullivan RJ Jr, Bastian LA, Marsh GR, et al. Insomnia and the eye of the beholder: are there clinical markers of objective sleep disturbances among adults with and without insomnia complaints? J Consult Clin Psychol 2000;68:586-593. https://doi.org/10.1037/0022-006X.68.4.586
  12. Fletcher PC, Frith CD, Baker SC, Shallice T, Frackowiak RS, Dolan RJ. The mind's eye--precuneus activation in memory-related imagery. Neuroimage 1995;2:195-200. https://doi.org/10.1006/nimg.1995.1025
  13. Harvey AG. A cognitive model of insomnia. Behav Res Ther 2002;40:869-893. https://doi.org/10.1016/S0005-7967(01)00061-4
  14. Harvey AG, Tang NK. (Mis)perception of sleep in insomnia: a puzzle and a resolution. Psychol Bull 2012;138:77-101. https://doi.org/10.1037/a0025730
  15. Kang K, Park KS, Kim JE, Kim SW, Kim YT, Kim JS, et al. Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study. Sleep Breath 2013;17:803-810. https://doi.org/10.1007/s11325-012-0767-2
  16. Kay DB, Karim HT, Soehner AM, Hasler BP, James JA, Germain A, et al. Subjective-Objective Sleep Discrepancy Is Associated With Alterations in Regional Glucose Metabolism in Patients With Insomnia and Good Sleeper Controls. Sleep 2017;40:zsx155.
  17. Kim N, Kang SG, Lee YJ, Kim SJ, Kim S, Choi JW, et al. Decreased regional brain activity in response to sleep-related sounds after cognitive behavioral therapy for psychophysiological insomnia. Psychiatry Clin Neurosci 2019;73:254-261. https://doi.org/10.1111/pcn.12822
  18. Kim SJ, Lee YJ, Kim N, Kim S, Choi JW, Park J, et al. Exploration of changes in the brain response to sleep-related pictures after cognitive-behavioral therapy for psychophysiological insomnia. Sci Rep 2017;7:12528. https://doi.org/10.1038/s41598-017-13065-0
  19. Lou HC, Luber B, Crupain M, Keenan JP, Nowak M, Kjaer TW, et al. Parietal cortex and representation of the mental Self. Proc Natl Acad Sci U S A 2004;101:6827-32. https://doi.org/10.1073/pnas.0400049101
  20. Matsuoka T, Imai A, Fujimoto H, Kato Y, Shibata K, Nakamura K, et al. Neural correlates of sleep disturbance in Alzheimer's disease: role of the precuneus in sleep disturbance. J Alzheimers Dis 2018;63:957-964. https://doi.org/10.3233/JAD-171169
  21. Moon HJ, Song ML, Cho YW. Clinical Characteristics of Primary Insomniacs with Sleep-State Misperception. J Clin Neurol 2015;11:358-363. https://doi.org/10.3988/jcn.2015.11.4.358
  22. Morin CM, Belanger L, LeBlanc M, Ivers H, Savard J, Espie CA, et al. The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med 2009;169: 447-453. https://doi.org/10.1001/archinternmed.2008.610
  23. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002;6:97-111. https://doi.org/10.1053/smrv.2002.0186
  24. Park S, Kang I, Edden RAE, Namgung E, Kim J, Kim J. Shorter sleep duration is associated with lower GABA levels in the anterior cingulate cortex. Sleep Med 2020;71:1-7. https://doi.org/10.1016/j.sleep.2020.02.018
  25. Salin-Pascual RJ, Roehrs TA, Merlotti LA, Zorick F, Roth T. Longterm study of the sleep of insomnia patients with sleep state misperception and other insomnia patients. Am J Psychiatry 1992;149:904-908. https://doi.org/10.1176/ajp.149.7.904
  26. Spiegelhalder K, Baglioni C, Regen W, Kyle SD, Nissen C, Hennig J, et al. Brain reactivity and selective attention to sleep-related words in patients with chronic insomnia. Behav Sleep Med 2018;16:587-600. https://doi.org/10.1080/15402002.2016.1253014
  27. Sugerman JL, Stern JA, Walsh JK. Daytime alertness in subjective and objective insomnia: some preliminary findings. Biol Psychiatry 1985;20:741-750. https://doi.org/10.1016/0006-3223(85)90153-2
  28. Vogt BA, Laureys S. Posterior cingulate, precuneal and retrosplenial cortices: cytology and components of the neural network correlates of consciousness. Prog Brain Res 2005;150:205-217. https://doi.org/10.1016/S0079-6123(05)50015-3
  29. Winkelman JW, Plante DT, Schoerning L, Benson K, Buxton OM, O'Connor SP, et al. Increased rostral anterior cingulate cortex volume in chronic primary insomnia. Sleep 2013;36:991-998. https://doi.org/10.5665/sleep.2794
  30. Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord 2013;150:384-388. https://doi.org/10.1016/j.jad.2013.04.028