青春期首发失眠障碍学生脑区比率低频振幅特征与睡眠信念的相关性

Evaluation of the correlation between the fractional amplitude of low frequency fluctuation and sleep belief in adolescents with drug-naive first-episode insomnia disorder

目的使用静息态功能磁共振成像(resting-state fMRI)技术,探讨青春期首发失眠障碍学生的脑区比率低频振幅特点及其与睡眠信念的相关性,为失眠障碍发病机制及诊疗思路提供参考。方法招募南京医科大学符合美国精神障碍诊断与统计手册第5版(DSM-5)失眠障碍诊断标准的首发未服药青春期失眠障碍学生为失眠组(21人);与失眠组年龄、性别、教育背景相匹配的正常受试者为对照组(20人)。对两组进行匹兹堡睡眠质量指数量表(PSQI)、简式睡眠信念与态度问卷(DBAS-16)、24项汉密尔顿抑郁量表(HAMD-24)、14项汉密尔顿焦虑量表(HAMA-14)评估,以及三维脑结构及静息态功能磁共振扫描。采用比率低频振幅(fALFF)技术分析,应用Pearson相关分析法将两组有明显差异的脑区的fALFF值与量表评分进行相关分析。结果与对照组比较,失眠组fALFF值显著降低(Alphaism矫正,P<0.01)的脑区位于左侧背外侧前额叶(L-DLPFC,MNI坐标值:-12,60,21,t=-3.85,K=495),左侧楔前叶(left precuneus,MNI坐标值:-3,-54,51,t=-4.29,K=417)。相关分析显示,失眠组左侧背外侧前额叶fALFF值与DBAS-16评分呈正相关(r=0.47,P=0.04)。结论青春期失眠障碍学生左侧背外侧前额叶区域异常,可能存在睡眠相关情感认知活动的调节功能受损。

Objective To investigate the brain function and their correlation with sleep beliefs and attitudes in adolescents with drug-naive insomnia by using fractional amplitude of low frequency fluctuation,so as to provide a reference for the mechanism and treatment of insomnia.Methods An insomnia group(n=21)recruited first-episode,drug-naive,adolescents with insomnia who met the diagnostic criteria of the American Diagnostic and Statistical Manual of Mental Disorders(DSM-V).Healthy subjects matched with age,gender,and educational background were selected as the control group(n=20).Pittsburgh Sleep Quality Index Scale(PSQI),Brief Version of Dysfunctional Beliefs and Attitudes about Sleep(DBAS-16),24 Items-Hamilton Depression Scale(HAMD-24),14 Items-Hamilton Anxiety Scale(HAMA-14)were evaluated.Fractional amplitude of low-frequency fluctuation was used for analysis,and Pearson correlation analysis was employed to quantify the correlation between peak values of brain regions with significant differences and the clinical scale scores of the two groups.Results Compared with the control group,ractional amplitude of low frequency fluctuation(fALFF)values in the insomnia group were significantly decreased(P<0.01,Alphaism corrected)in the left dorsolateral prefrontal lobe(L-DLPFC,MNI coordinates:-12,60,21,t=-3.85,K=495)and the left precuneus(MNI coordinates:-3,-54,51,t=-4.29,K=417).The fALFF value of L-DLPFC in the insomnia group was positively correlated with DBAS-16 score(r=0.47,P=0.04).Conclusion Abnormalities in the L-DLPFC region suggest that adolescents with insomnia may suffer from impaired regulation of emotional and cognitive activities related to sleep.