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Published on: September 8, 2021
Neural substrates underlying REM sleep duration in patients with major depressive disorder: A longitudinal study
Cun Zhang1, Dao-Min Zhu2, Yu Zhang2
1Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China.
Introduction:
Prior studies have discussed rapid eye movement (REM) sleep disturbance as a potential endophenotype of major depressive disorder (MDD). However, the neural substrates underlying the percentage of REM sleep duration (REM%) and its association with disease progression in MDD remain unclear.
Methods:
One hundred and fourteen MDD patients and 74 healthy controls (HCs) underwent resting-state functional and perfusion magnetic resonance imaging (MRI) scans as well as overnight polysomnography examination to assess brain function and REM%, with 48 patients completing follow-up visits. Correlation and mediation analyses were conducted to investigate the associations among baseline REM%, multimodal brain imaging measures, and the improvement of depressive symptoms at follow-up in MDD.
Results:
We found voxel-wise correlations between baseline REM% and multimodal brain imaging metrics in many brain regions involved in sensorimotor, visual processing, emotion, and cognition in patients with MDD. Moreover, the baseline REM% was correlated with the improvement of depressive symptoms from acute to remitted status in patients through regulating brain activity in the left inferior temporal gyrus and cerebral blood flow in the bilateral paracentral lobule.
Conclusion:
Our findings help to identify the neural underpinnings of REM% in depression and highlight REM% as a potential prognostic biomarker to predict disease progression. These may inform future novel interventions of MDD from the perspective of regulating REM sleep.
Insights
Major depressive disorder (MDD) patients show altered brain activity linked to rapid eye movement (REM) sleep duration (REM%). This REM% may serve as a prognostic biomarker for predicting depression symptom improvement.
Area of Science:
- Neuroscience
- Psychiatry
- Sleep Medicine
Background:
- Rapid eye movement (REM) sleep disturbance is a potential endophenotype of major depressive disorder (MDD).
- The neural mechanisms connecting REM sleep duration (REM%) and MDD progression are not fully understood.
Purpose of the Study:
- To investigate the neural substrates of REM% in MDD patients.
- To explore the association between baseline REM% and brain imaging metrics.
- To determine if REM% can predict depressive symptom improvement in MDD.
Main Methods:
- Resting-state functional and perfusion MRI and polysomnography were used in 114 MDD patients and 74 healthy controls.
- Correlation and mediation analyses examined relationships between REM%, brain imaging, and symptom improvement at follow-up.
Main Results:
- Significant correlations were found between REM% and brain imaging metrics in regions related to sensorimotor, visual, emotional, and cognitive processing in MDD patients.
- Baseline REM% correlated with symptom improvement, mediated by changes in left inferior temporal gyrus activity and bilateral paracentral lobule cerebral blood flow.
Conclusions:
- REM% is associated with specific neural underpinnings in MDD.
- REM% shows potential as a prognostic biomarker for predicting disease progression and treatment response in MDD.
- Targeting REM sleep may offer novel therapeutic strategies for MDD.
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