1 Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
Brain. 2014 Feb;137(Pt 2):610-20. doi: 10.1093/brain/awt329. Epub 2013 Nov 26.
Insomnia is prevalent, severe and partially heritable. Unfortunately, its neuronal correlates remain enigmatic, hampering the development of mechanistic models and rational treatments. Consistently reported impairments concern fragmented sleep, hyper-arousal and executive dysfunction. Because fronto-striatal networks could well play a role in sleep, arousal regulation and executive functioning, the present series of studies used an executive task to evaluate fronto-striatal functioning in disturbed sleep. Patients with insomnia showed reduced recruitment of the head of the left caudate nucleus during executive functioning, which was not secondary to altered performance or baseline perfusion. Individual differences in caudate recruitment were associated with hyper-arousal severity. Seed-based functional connectivity analysis suggested that attenuated input from a projecting orbitofrontal area with reduced grey matter density contributes to altered caudate recruitment in patients with insomnia. Attenuated caudate recruitment persisted after successful treatment of insomnia, warranting evaluation as a potential vulnerability trait. A similar selective reduction in caudate recruitment could be elicited in participants without sleep complaints by slow-wave sleep fragmentation, providing a model to facilitate investigation of the causes and consequences of insomnia.
失眠症普遍存在、严重且具有部分遗传性。不幸的是，其神经相关仍然难以捉摸，这阻碍了机械模型和合理治疗方法的发展。一致报道的损伤涉及碎片化睡眠、过度觉醒和执行功能障碍。由于额纹状体网络可能在睡眠、觉醒调节和执行功能中发挥作用，本系列研究使用执行任务来评估睡眠障碍患者的额纹状体功能。失眠症患者在执行功能期间显示出左侧尾状核头部的募集减少，这不是由于表现或基线灌注改变引起的。尾状核募集的个体差异与过度觉醒严重程度相关。基于种子的功能连接分析表明，投射眶额区的传入减少与灰质密度降低，导致失眠症患者尾状核募集减少。失眠症成功治疗后，尾状核募集减少仍然存在，有必要将其评估为潜在的脆弱性特征。通过慢波睡眠碎片化，可以在没有睡眠抱怨的参与者中诱发类似的尾状核募集选择性减少，为研究失眠症的原因和后果提供了模型。
