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Lack of hippocampal volume differences in primary insomnia and good sleeper controls: an MRI volumetric study at 3
John W Winkelman1, Kathleen L Benson, Orfeu M Buxton
1Division of Sleep Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, MA 02115, USA. jwwinkelman@partners.org
Background:
A recent pilot study reported that hippocampal volume (HV) was reduced in patients with primary insomnia (PI) relative to normal sleepers. Loss of HV in PI might be due to chronic hyperarousal and/or chronic sleep debt. The aim of this study was to replicate the earlier pilot report while employing a larger sample, more rigorous screening criteria, and objective sleep data.
Methods:
This cross-sectional design included community recruits meeting DSM-IV criteria for PI (n=20, 10 males, mean age 39.3+/-8.7) or good sleeper controls (n=15, 9 males, mean age 38.8+/-5.3). All subjects were unmedicated and rigorously screened to exclude comorbid psychiatric and medical illness. PI subjects underwent overnight polysomnography to screen for sleep-related breathing and movement disorders. HV and total brain volumes were derived by MRI employing a Siemens/Trio scanner operating at 3 Tesla. Data also included 2 weeks of sleep diaries and wrist actigraphy.
Results:
Mean HV was 4322.0+/-299.7 mm(3) for the good sleeper controls and 4601.55+/-537.4 mm(3) for the PI group. The dependent variable, HV, was analyzed by ANCOVA. Main effects were diagnosis and gender; whole brain volume served as the covariate. Although the overall model was significant (F=6.3, p=0.001), the main effects of diagnosis (F=2.14) and gender (F=0.04) were not significant. The covariate of whole brain volume was significant (F=5.74, p=0.023) as was the interaction of diagnosis with gender (F=10.22, p=0.003), with male insomniacs having larger HVs than male controls.
Conclusions:
This study did not replicate a previously published report of HV loss in primary insomnia. Differences between our finding and the previous report might be due to sample composition and method of MRI assessment. Furthermore, we demonstrated no objective differences between the controls and PIs in actigraphic measures of sleep maintenance. Within the PIs, however, actigraphic measures of poor sleep maintenance were associated with smaller HV.
Insights
This study found no significant difference in hippocampal volume (HV) between individuals with primary insomnia (PI) and good sleepers. However, poorer sleep maintenance in PI was linked to smaller HV.
Area of Science:
- Neuroscience
- Sleep Medicine
- Radiology
Background:
- A prior pilot study suggested reduced hippocampal volume (HV) in primary insomnia (PI).
- Potential causes for HV loss in PI include chronic hyperarousal and sleep debt.
- This study aimed to replicate findings with a larger sample and objective sleep data.
Purpose of the Study:
- To replicate a previous report of reduced hippocampal volume in primary insomnia.
- To investigate the relationship between objective sleep measures and hippocampal volume in PI.
- To examine gender differences in hippocampal volume in PI.
Main Methods:
- Cross-sectional study of 20 primary insomnia patients and 15 good sleepers.
- Exclusion of unmedicated subjects with comorbid psychiatric or medical conditions.
- Magnetic Resonance Imaging (MRI) at 3 Tesla for hippocampal and total brain volumes.
- Two weeks of sleep diaries and wrist actigraphy for objective sleep assessment.
Main Results:
- No significant difference in mean hippocampal volume between primary insomnia and good sleeper groups.
- Whole brain volume was a significant covariate; diagnosis and gender were not significant main effects.
- A significant interaction between diagnosis and gender was observed, with male insomniacs showing larger HVs than male controls.
Conclusions:
- This study did not replicate prior findings of hippocampal volume loss in primary insomnia.
- Differences from previous studies may be due to sample characteristics and MRI methods.
- No objective sleep differences were found between groups, but within the PI group, poorer sleep maintenance correlated with smaller HV.
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Computed Tomography (CT) scan:
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