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Updated: May 12, 2026

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder
Published on: April 26, 2024
Insomnia severity impact dynamic connectivity and modulate connectivity-cognitive links in major depressive disorder
Weijie Bao1, Yingxue Gao1, Hailong Li1
1Department of Radiology, Huaxi MR Research Center (HMRRC), Institute of Radiology and Medical Imaging, https://ror.org/007mrxy13West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Background:
Insomnia is common in major depressive disorder (MDD), and varying severity of insomnia may be associated with distinct neural alterations in MDD. Dynamic functional connectivity can capture time-varying brain network interactions and may help disentangle insomnia-related mechanisms in MDD.
Methods:
We recruited 203 drug-naïve adult MDD patients, divided into high- (HI-MDD, n = 133) and low-insomnia (LI-MDD, n = 70) groups using the Hamilton Depression Rating Scale insomnia subscale, along with 122 health controls (HCs). Independent component analysis and a sliding-window approach were applied to explore static and dynamic functional network connectivity (FNC).
Results:
While static FNC revealed no significant group difference, dynamic analysis identified distinct connectivity states between two groups. Compared to HCs, HI-MDD displayed more frequent occurrence of state I and less of state IV, a pattern was absent in LI-MDD. Both MDD groups showed increased default mode network (DMN)-lateral ventral attention network (VAN) connectivity in states I and II, accompanied by decreased dorsal attention network-cerebellar/DMN connectivity in state I relative to HCs. Compared with LI-MDD, HI-MDD exhibited enhanced DMN-medial VAN connectivity in state II, along with increased DMN connectivity with visual and sensorimotor networks in state I, suggesting insomnia-related changes. In addition, we identified insomnia-related memory deficits and depression-related processing speed impairment in MDD. Insomnia significantly moderated the association between altered DMN-lateral VAN connectivity in state I and logical memory impairment in MDD.
Conclusions:
These findings suggest that insomnia severity in MDD is associated with distinct temporal patterns of brain network alterations beyond shared depression-related changes and moderate cognitive functions in MDD.
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