Brain structural connectivity network alterations in insomnia disorder reveal a central role of the right angular...

Insomnia Disorder (ID) is a prevalent and persistent condition, yet its neural substrate is not well understood. The cognitive, emotional, and behavioral characteristics of ID suggest that vulnerability involves distributed brain networks rather than a single brain area or connection. The present study utilized probabilistic diffusion tractography to compare the whole-brain structural connectivity networks of people with ID and those of matched controls without sleep complaints. Diffusion-weighted images and T1-weighed images were acquired in 51 people diagnosed with ID (21-69 years of age, 37 female) and 48 matched controls without sleep complaints (22-70 years of age, 31 female). Probabilistic tractography was performed to construct the whole-brain structural connectivity network of each participant. Case-control differences in connectivity strength and network efficiency were evaluated with permutation tests. People with ID showed structural hyperconnectivity within a subnetwork that spread over frontal, parietal, temporal, and subcortical regions and was anchored at the right angular gyrus. The result was robust across different edge-weighting strategies. Moreover, converging support was given by the finding of heightened right angular gyrus nodal efficiency (harmonic centrality) across varying graph density in people with ID. Follow-up correlation analyses revealed that subnetwork connectivity was associated with self-reported reactive hyperarousal. The findings demonstrate that the right angular gyrus is a hub of enhanced structural connectivity in ID. Hyperconnectivity within the identified subnetwork may contribute to increased reactivity to stimuli and may signify vulnerability to ID.