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Updated: Aug 24, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Subjective sleep disturbances are associated with reduced MRI-derived perivascular-space diffusivity in multiple
Matteo Jiang1,2,3, Martina Rubin1,2,3,4, Loredana Storelli1
1Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
Background And Objective:
Sleep modulates brain-fluid transport and glymphatic clearance. In multiple sclerosis (MS), lower diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index has been reported, but whether sleep quality contributes to DTI-ALPS variability is unknown. We assessed whether sleep disturbances are associated with a lower DTI-ALPS index in MS.
Methods:
77 MS patients and 84 age- and sex-matched healthy controls (HC) underwent 3 T brain MRI. In MS patients, disability was assessed with the expanded disability status scale (EDSS), sleep quality with the Pittsburgh sleep quality index (PSQI; >5 defining sleep disturbances), and fatigue with the modified fatigue impact scale (MFIS). DTI-ALPS index was derived from fractional anisotropy (FA) maps after lesion exclusion.
Results:
Sleep disturbances were reported in 32 (41.6%) MS patients. Disease duration, clinical phenotype, treatment status, and EDSS score did not differ between patients with and without sleep disturbances (p ≥ 0.181). Compared with HC, both MS groups showed a higher T2-hyperintense lesion volume, a lower brain volume, a lower FA and a higher mean diffusivity in normal-appearing white matter, and a lower DTI-ALPS index (p-FDR≤0.007). DTI-ALPS index was lower in patients with sleep disturbances than those without (p-FDR=0.029), with no differences in other MRI variables. In MS patients, a higher PSQI score was associated with a lower DTI-ALPS index (r=-0.356, p-FDR=0.003) and a higher MFIS score (r=0.461, p-FDR<0.001), but not with conventional MRI measures (p-FDR≥0.189).
Conclusions:
Sleep disturbances are associated with reduced MRI-derived perivascular-space diffusivity in MS, independent of clinical disability and conventional MRI measures. Sleep quality should be considered when interpreting DTI-ALPS measures in MS.
Insights
Sleep disturbances are linked to reduced perivascular space diffusivity in multiple sclerosis (MS) patients, independent of disability. Poor sleep quality may impact MRI measures like DTI-ALPS in MS.
Area of Science:
- Neuroscience
- Radiology
- Sleep Medicine
Background:
- Sleep is crucial for brain-fluid transport and glymphatic clearance.
- Reduced diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index is observed in multiple sclerosis (MS).
- The impact of sleep quality on DTI-ALPS variability in MS remains unclear.
Purpose of the Study:
- To investigate the association between sleep disturbances and DTI-ALPS index in MS patients.
- To determine if sleep quality influences perivascular space diffusivity measures in MS.
Main Methods:
- 77 MS patients and 84 healthy controls (HC) underwent 3T brain MRI.
- Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
- DTI-ALPS index was calculated from fractional anisotropy (FA) maps, excluding lesions.
Main Results:
- 41.6% of MS patients reported sleep disturbances.
- MS patients with sleep disturbances had a lower DTI-ALPS index compared to those without (p-FDR=0.029).
- Higher PSQI scores correlated with lower DTI-ALPS index (r=-0.356, p-FDR=0.003) and higher fatigue scores (MFIS) in MS patients.
Conclusions:
- Sleep disturbances are associated with reduced perivascular space diffusivity in MS.
- This association is independent of clinical disability and conventional MRI measures.
- Sleep quality is an important factor to consider when interpreting DTI-ALPS measures in MS.
