Bilateral choroid plexus hypertrophy without CSF volume changes predicts sleep disruption in young alcohol users

The choroid plexus (ChP) maintains blood-CSF barrier integrity, regulates cerebrospinal fluid (CSF) production, modulates neuro-immune signaling, and supports brain homeostasis. ChP structural abnormalities have been reported in aging, neurodegenerative disease, and several psychiatric disorders, and animal and neonatal studies suggest that alcohol can alter ChP structure and function. Whether habitual alcohol use is associated with ChP morphometry in adults, and whether any such alteration relates to sleep, is not known. We examined ChP volume, CSF volume, alcohol consumption, and sleep quality in young adults who were moderate-to-heavy drinkers (HD) or light-to-non-drinkers (LD).

Structural MRI and behavioral data from the Human Connectome Project (HCP) were analyzed in 796 participants (399 HD, 165 female; 397 LD, 248 female) aged 22-37 years (mean 30.3 ± 3.3). Alcohol use was characterized using the Achenbach Adult Self-Report (ASR) and the Semi-Structured Assessment for the Genetics of Alcoholism, version II (SSAGA-II). Bilateral ChP and total CSF volumes were extracted with FreeSurfer and adjusted for intracranial volume (ICV). Subjective sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI). Group differences in ChP and CSF volume were tested with ANCOVA (covariates: ICV, age, sex); correlations used Spearman's ρ.

HD showed significantly larger bilateral ChP volumes than LD (left ChP: F(1, 791) = 7.3, p = 0.007; right ChP: F(1, 791) = 4.8, p = 0.029). Total CSF volume did not differ between groups. On the PSQI, HD males scored significantly higher (worse) than LD males on sleep latency, with several other components trending in the same direction; HD females showed significantly lower scores (better) than LD females on habitual sleep efficiency and sleep duration. Within the HD group, bilateral ChP volumes correlated with sleep-latency and sleep-disturbance components and, in males, with the PSQI total score. Malt-liquor consumption in HD females correlated with bilateral ChP volumes.

Moderate-to-heavy alcohol use in young adulthood is associated with bilateral ChP hypertrophy in the absence of a global CSF volume difference, together with sex-specific patterns of subjective sleep disturbance. The dissociation between ChP volume and overall CSF volume argues against a passive atrophy explanation and is consistent with a localized, potentially neuro-immune remodeling of the ChP. These findings identify the ChP as a candidate early structural marker of alcohol-related brain change in non-dependent young adults.