Effects of sleep quality on the default mode network and on anxiety-depression symptoms in premenstrual syndrome

Neuroimaging studies indicate a link between the aberrant default mode network (DMN) and anxiety-depression severity in premenstrual syndrome (PMS); however, ignoring the effects of sleep prevents understanding the pathophysiology of PMS.

Seventy-seven PMS patients and sixty-six healthy controls (HCs) underwent resting-state functional MRI, and clinical assessment included the Pittsburgh Sleep Quality Index (PSQI), the Self-Rating Anxiety Scale, and the Self-Rating Depression Scale. PSQI scores classified PMS patients into normal sleep quality (PMS-NSQ) and poor sleep quality (PMS-PSQ) groups. Resting-state functional connectivity (rsFC) within the DMN were compared among the three groups. Correlation and mediation analyses examined potential associations relating sleep quality, changes in brain function, and clinical variables.

Compared to HCs, both PMS-PSQ and PMS-NSQ groups exhibited increased rsFC between left inferior parietal lobule (IPL) and right middle occipital gyrus. Additionally, the PMS-NSQ group presented decreased FC of right ventromedial prefrontal cortex (VMPFC) and right posterior cingulate/precuneus (PCu), as well as lower degree centrality of right VMPFC. Combined correlation and mediation analyses showed that the relationship between the altered FC of right VMPFC-right PCu and anxiety-depression symptoms was mediated by sleep quality in PMS patients.

The findings reveal the potential neuropathology of sleep problems in PMS, which sleep quality may mediate the association between FC within DMN and anxiety-depression severity. The right VMPFC may prospectively serve as potential intervention targets for the treatment of sleep disturbances in PMS.

This study was registered in the Chinese Clinical Trial Registry (ChiCTR1900020642, https//www.chictr.org.cn) on 11th Jan 2019.