Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea.
Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Psychiatry Clin Neurosci. 2019 May;73(5):254-261. doi: 10.1111/pcn.12822. Epub 2019 Feb 21.
Patients with psychophysiological insomnia (PI) experience hyperarousal, especially as a reaction to sound stimuli. In the current study, we explored brain activity changes in response to sleep-related sounds (SS) in patients with insomnia after cognitive behavioral therapy for insomnia (CBT-I).
In 14 drug-free PI patients, regional brain activity in response to SS, and to white noise sound (NS) as neutral stimuli, was investigated before and after individual CBT-I using functional magnetic resonance imaging. Blood oxygen level-dependent (BOLD) signals to SS and NS were compared before and after CBT-I. In addition, the association between clinical improvement after CBT-I and changes in brain activity in response to SS and NS was analyzed.
Compared with baseline, regional brain activity in response to SS after CBT-I decreased in the left middle temporal and left middle occipital gyrus. In regression analysis, a reduction in the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) Scale score after CBT-I was associated with decrease in brain activity in response to SS in both thalami. However, brain activity in response to NS showed no BOLD signal changes and no association with DBAS change.
Cortical hyperactivity, which may cause hyperarousal in PI, was found to decrease after CBT-I. CBT-I targeting changes in beliefs and attitudes about sleep may induce its therapeutic effects by reducing thalamic brain activity in response to sleep-related stimuli.
心理生理性失眠（PI）患者表现出过度兴奋，特别是对声音刺激的反应。在目前的研究中，我们探讨了失眠认知行为疗法（CBT-I）后，PI 患者对睡眠相关声音（SS）的大脑活动变化。
在 14 名未服用药物的 PI 患者中，使用功能磁共振成像在个体 CBT-I 前后研究 SS 和白噪声（NS）（作为中性刺激）对 SS 反应的局部大脑活动。比较 CBT-I 前后 SS 和 NS 的血氧水平依赖（BOLD）信号。此外，分析 CBT-I 后临床改善与 SS 和 NS 反应的大脑活动变化之间的关系。
与基线相比，CBT-I 后 SS 反应的大脑区域活动在左中颞叶和左中枕叶减少。在回归分析中，CBT-I 后睡眠障碍信念和态度量表（DBAS）评分的降低与两个丘脑对 SS 的大脑活动减少相关。然而，NS 反应的大脑活动没有 BOLD 信号变化，也与 DBAS 变化无关。
发现 CBT-I 后皮质过度活跃（可能导致 PI 过度兴奋）减少。针对睡眠信念和态度变化的 CBT-I 通过减少对睡眠相关刺激的丘脑大脑活动，可能会产生其治疗效果。
