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. 2024 Jun 4:15:1364713.
doi: 10.3389/fpsyt.2024.1364713. eCollection 2024.

The brain in chronic insomnia and anxiety disorder: a combined structural and functional fMRI study

Minghe Xu  1 , Bo Li  2 , Shuang Wang  1 , Chunlian Chen  1 , Zhe Liu  2 , Yuqing Ji  2 , Kai Liu  2 , Yujun Niu  1
Affiliations

The brain in chronic insomnia and anxiety disorder: a combined structural and functional fMRI study

Minghe Xu et al. Front Psychiatry. .

Abstract

Background: Chronic insomnia disorder (CID) is usually associated with Generalized Anxiety Disorder (GAD), which may change brain structure and function. However, the possible brain markers, imaging characteristics, and pathophysiology are unknown.

Objective: To look at the probable brain markers, imaging characteristics, and pathogenesis of CID in combination with GAD.

Methods: A total of 57 patients with CID concomitant GAD and 57 healthy controls (HC) were enrolled. Voxel-based morphometry (VBM) and functional connectivity (FC) were utilized to measure gray matter volume (GMV) and functional changes. Correlation analysis was utilized to identify relationships between brain changes and clinical characteristics.

Results: Patients had decreased GMV in the left cerebellum, right cerebellar peduncle, and left insula; increased FC between the left cerebellum and right angular gyrus, as well as between the left insula and anterior left cingulate gyrus; and decreased FC in several areas, including the left cerebellum with the middle left cingulate gyrus and the left insula with the left superior postcentral gyrus. These brain changes related to CID and GAD. These data could be used to identify relevant brain markers, imaging features, and to better understand the etiology.

Conclusion: The intensity of insomnia in patients was strongly related to the severity of anxiety. The lower GMV in the cerebellum could be interpreted as an imaging characteristic of CID. Reduced GMV in the insula, as well as aberrant function in the cingulate gyrus and prefrontal lobe, may contribute to the pathophysiology of CID and GAD. Abnormal function in the postcentral gyrus and angular gyrus may be associated with patients' clinical complaints.

Keywords: anxiety disorder; brain function; brain structure; comorbidity; insomnia disorder; magnetic resonance imaging.

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Conflict of interest statement

The authors declare the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overview of this study. (A) The process and steps of this study. (B) The purpose of this study. CID, chronic insomnia disorder; GAD, generalized anxiety disorder; VBM, voxel-based morphometry; FC, functional connectivity.
Figure 2
Figure 2
The results of clinical characteristics. (A) Age, gender, and education years of participants. (B) The relationship between CID and GAD. ISI, insomnia severity index scale; PSQI, pittsburgh sleep quality index; HAMA, hamilton anxiety scale; SAS, self-rating anxiety scale. *p < 0.05, **p < 0.01.
Figure 3
Figure 3
The difference of GMV in brain regions between groups. (A) The GMV of Cerebelum_8_L, Cerebelum_Crus1_R, Insula_L was significantly reduced in the group of CID comorbid GAD. (B) The difference of GMV values between groups. Errors bar showed standard error.
Figure 4
Figure 4
The difference of FC in brain regions between groups. (A) The FC of Cerebelum_8_L-Cingulum_Mid_L, Cerebelum_8_L-Frontal_Sup_Medial_L, Insula_L-Parietal_Sup_L was significantly reduced in the group of CID comorbid GAD. The FC of Cerebelum_8_L-Angular_R, Insula_L-Cingulum_Ant_L was significantly increased in the group of CID comorbid GAD. (B) The difference of FC z-values between groups. Errors bar showed standard error.
Figure 5
Figure 5
The correlation of clinical characteristics with GMV or FC. (A) The correlation of GMV values with insomnia or anxiety scale scores in the group of CID comorbid GAD. (B) The correlation of FC z-values with insomnia or anxiety scale scores in the group of CID comorbid GAD. * p < 0.05, ** p < 0.01.
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