慢性原发性失眠患者海马亚结构对睡眠障碍和认知损害的易损性：磁共振成像形态学
Hippocampal substructural vulnerability to sleep disturbance and cognitive impairment in patients with chronic primary insomnia: magnetic resonance imaging morphometry.
作者信息
Joo Eun Yeon, Kim Hosung, Suh Sooyeon, Hong Seung Bong
机构信息
Sleep Center, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute, Seoul, Korea.
Department of Neurology and Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
出版信息
Sleep. 2014 Jul 1;37(7):1189-98. doi: 10.5665/sleep.3836.
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 (|r| > 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.
CITATION
Joo EY, Kim H, Suh S, Hong SB. Hippocampal substructural vulnerability to sleep disturbance and cognitive impairment in patients with chronic primary insomnia: magnetic resonance imaging morphometry.
研究目的
尽管动物研究中有令人信服的证据表明海马亚区对睡眠质量差及相关认知障碍具有特定易损性，但尚无人类磁共振成像（MRI）研究调查海马亚区体积与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亚区体积变化的模式。
设计
逐点形态测量法用于在T1加权MRI上测量海马区域的体积。
地点
大学医院。
患者
27名未用药患者（年龄：51.2±9.6岁）和30名睡眠良好的对照者（50.4±7.1岁）。
干预措施
无。
测量方法
我们比较了患者和对照者之间的海马亚区体积，并将体积与患者的临床和神经心理学特征进行关联。
结果
患者在所有海马亚区均表现出双侧萎缩（校正后P<0.05）。海马1区（CA1）萎缩与较差的睡眠质量相关（匹兹堡睡眠质量指数更高以及多导睡眠图的觉醒指数更高）（r<-0.45，P<0.005）。包括齿状回（DG）和CA3-4在内的联合区域的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（|r|>0.45，P<0.05）。该区域的半球体积不对称（左侧小于右侧）与言语领域功能受损相关（r = 0.50，P<0.005）。
结论
慢性失眠患者的海马亚区萎缩表明在睡眠碎片化及相关慢性应激状态下，齿状回（DG）的神经发生减少以及海马（CA）亚区的神经元丢失。CA3-4-DG区域的萎缩与患者的认知功能受损相关。这些观察结果可能有助于深入了解使慢性睡眠障碍患者易患认知障碍的病理生理机制。
引用文献
Joo EY, Kim H, Suh S, Hong SB. Hippocampal substructural vulnerability to sleep disturbance and cognitive impairment in patients with chronic primary insomnia: magnetic resonance imaging morphometry.
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