Sleep disturbance is associated with reduced DTI-ALPS index and altered functional-network efficiency in internet gaming disorder

Sleep disturbance is common in internet gaming disorder (IGD), but its possible involvement in the pathophysiology of IGD remains unclear. Therefore, we aimed to investigate the glymphatic system-related function in IGD patients and to establish the associations among glymphatic system, human brain network, and clinical features.

This study recruited 66 IGD patients and 35 healthy controls (HC), who underwent magnetic resonance imaging (MRI) scanning and clinical assessment. The glymphatic system-related diffusivity and network efficiency were calculated based on diffusion images along the perivascular space (DTI-ALPS) method and resting-state functional MRI, respectively. Differences between groups, neural/clinical correlations, and mediation analyses were further explored.

Compared with HC, IGD patients showed a significantly lower ALPS index and global network efficiency. The partial correlation analysis showed that the ALPS index in IGD patients was associated with PSQI, HAMA, and HAMD scores. Moreover, the ALPS index partially mediated the association between global brain efficiency and sleep quality in exploratory cross-sectional mediation analysis.

The current study revealed abnormalities of ALPS index and network efficiency in IGD patients and suggested that the cross-sectional associations among global brain efficiency, sleep quality, and ALPS index were consistent with an indirect pathway, which may reveal the neuropathological mechanisms of IGD.