Dysregulated emotional interference processing in affective and cognitive control brain regions in insomnia disorder

This study investigated the behavioral and neural responses underlying affective and cognitive control during emotional interference and their association with sleep disturbance in insomnia disorder (ID) patients.

Forty-three ID patients and 43 aged- and sex-comparable healthy controls (HC) completed an emotional interference task (EIT) while undergoing functional magnetic resonance imaging (fMRI) scanning. Sleep disturbance was assessed using self-report questionnaires. Analyses of variances (ANOVAs) were conducted on behavioral measures and brain activations. Correlations were used to examine the relationships between sleep disturbance and the significantly activated brain regions.

Behaviorally, after controlling for trait anxiety, the ANOVA on reaction times (RTs) revealed a significant group × attention × emotion interaction. Specifically, compared with HC, ID patients exhibited significantly slower RTs when attending to neutral faces and ignoring fearful faces. For accuracy, a significant main effect of group indicated lower accuracy in ID patients than HC. Whole-brain ANOVA analysis revealed that under the ignore-fear condition, ID patients showed increased right dorsolateral prefrontal cortex (DLPFC) activation and reduced caudate nucleus activation, whereas under the attend-fear condition they showed reduced DLPFC and heightened caudate responses related to HC. Exploratory analyses indicated that, in ID patients, greater sleep disturbance was associated with less right caudate nucleus deactivation under the ignore-fear condition.

These findings suggest attention-dependent alterations in prefrontal control and striatal processing of emotional salience during emotional interference in ID, which may help explain how sleep disturbance is related to disrupted cognitive-emotional regulation in this condition.