Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine - University of Pisa, Pisa, Italy.
Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.
J Sleep Res. 2023 Dec;32(6):e14030. doi: 10.1111/jsr.14030. Epub 2023 Sep 20.
Over the last decades, neuroimaging has become a substantial component of insomnia research. While theoretical underpinnings of different studies vary just like methodological choices and the experimental design, it is suggested that major features of insomnia disorder rely on the impaired function, structure, metabolism and connectivity of brain areas involved in sleep generation, emotion regulation, self-processing/-awareness and attentional orientation. However, neuroimaging research on insomnia often suffers from small sample sizes, heterogeneous methodology and a lack of replicability. With respect to these issues, the field needs to address the questions: (1a) how sufficiently large sample sizes can be accumulated within a reasonable economic framework; (1b) how effect sizes in insomnia-related paradigms can be amplified; (2a) how a higher degree of standardisation and transparency in methodology can be provided; and (2b) how an adequate amount of flexibility/complexity in study design can be maintained. On condition that methodological consistency and a certain degree of adaptability are given, pooled data/large cohort analyses can be considered to be one way to answer these questions. Regarding experimental single-centre trials, it might be helpful to focus on insomnia-related transdiagnostic concepts. In doing so, expectable effect sizes (in between-subjects designs) can be increased by: (a) comparing groups that are truly distinct regarding the variables examined in a concept-specific paradigm; and (b) facilitated, intensified and precise elicitation of a target symptom.
在过去的几十年里，神经影像学已成为失眠研究的重要组成部分。虽然不同研究的理论基础各不相同，方法选择和实验设计也存在差异，但据认为，失眠症的主要特征依赖于睡眠产生、情绪调节、自我处理/意识和注意力导向相关脑区功能、结构、代谢和连通性的受损。然而，失眠症的神经影像学研究往往受到样本量小、方法学异质性和可重复性差的困扰。针对这些问题，该领域需要解决以下问题：（1a）如何在合理的经济框架内积累足够大的样本量；（1b）如何放大与失眠相关范式中的效应大小；（2a）如何提供更高程度的方法学标准化和透明度；以及（2b）如何在研究设计中保持足够的灵活性/复杂性。在方法学一致性和一定程度的适应性的前提下，可以考虑汇总数据/大型队列分析来回答这些问题。对于实验性单中心试验，关注与失眠相关的跨诊断概念可能会有所帮助。通过以下方式，可以增加预期的效应大小（在被试间设计中）：（a）比较在特定概念范式中针对所检查变量真正不同的组；以及（b）促进、增强和精确引发目标症状。
