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Abstract：
BACKGROUND: Poor sleep quality has been associated with changes in brain volume among veterans, particularly those who have experienced mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD). This study sought to investigate (1) whether poor sleep quality is associated with decreased cortical thickness in Iraq and Afghanistan war veterans, and (2) whether these associations differ topographically depending on the presence or absence of mTBI and PTSD.
METHODS: A sample of 440 post-9/11 era U.S. veterans enrolled in the Translational Research Center for Traumatic Brain Injury and Stress Disorders study at VA Boston, MA from 2010 to 2022 was included in the study. We examined the relationship between sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), and cortical thickness in veterans with mTBI (n = 57), PTSD (n = 110), comorbid mTBI and PTSD (n = 129), and neither PTSD nor mTBI (n = 144). To determine the topographical relationship between subjective sleep quality and cortical thickness in each diagnostic group, we employed a General Linear Model (GLM) at each vertex on the cortical mantle. The extent of topographical overlap between the resulting statistical maps was assessed using Dice coefficients.
RESULTS: There were no significant associations between PSQI and cortical thickness in the group without PTSD or mTBI (n = 144) or in the PTSD-only group (n = 110). In the mTBI-only group (n = 57), lower sleep quality was significantly associated with reduced thickness bilaterally in frontal, cingulate, and precuneus regions, as well as in the right parietal and temporal regions (β = -0.0137, P < 0.0005). In the comorbid mTBI and PTSD group (n = 129), significant associations were observed bilaterally in frontal, precentral, and precuneus regions, in the left cingulate and the right parietal regions (β = -0.0094, P < 0.0005). Interaction analysis revealed that there was a stronger relationship between poor sleep quality and decreased cortical thickness in individuals with mTBI (n = 186) compared to those without mTBI (n = 254) specifically in the frontal and cingulate regions (β = -0.0077, P < 0.0005).
CONCLUSIONS: This study demonstrates a significant relationship between poor sleep quality and lower cortical thickness primarily within frontal regions among individuals with both isolated mTBI or comorbid diagnoses of mTBI and PTSD. Thus, if directionality is established in longitudinal and interventional studies, it may be crucial to consider addressing sleep in the treatment of veterans who have sustained mTBI.
METHODS: A sample of 440 post-9/11 era U.S. veterans enrolled in the Translational Research Center for Traumatic Brain Injury and Stress Disorders study at VA Boston, MA from 2010 to 2022 was included in the study. We examined the relationship between sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), and cortical thickness in veterans with mTBI (n = 57), PTSD (n = 110), comorbid mTBI and PTSD (n = 129), and neither PTSD nor mTBI (n = 144). To determine the topographical relationship between subjective sleep quality and cortical thickness in each diagnostic group, we employed a General Linear Model (GLM) at each vertex on the cortical mantle. The extent of topographical overlap between the resulting statistical maps was assessed using Dice coefficients.
RESULTS: There were no significant associations between PSQI and cortical thickness in the group without PTSD or mTBI (n = 144) or in the PTSD-only group (n = 110). In the mTBI-only group (n = 57), lower sleep quality was significantly associated with reduced thickness bilaterally in frontal, cingulate, and precuneus regions, as well as in the right parietal and temporal regions (β = -0.0137, P < 0.0005). In the comorbid mTBI and PTSD group (n = 129), significant associations were observed bilaterally in frontal, precentral, and precuneus regions, in the left cingulate and the right parietal regions (β = -0.0094, P < 0.0005). Interaction analysis revealed that there was a stronger relationship between poor sleep quality and decreased cortical thickness in individuals with mTBI (n = 186) compared to those without mTBI (n = 254) specifically in the frontal and cingulate regions (β = -0.0077, P < 0.0005).
CONCLUSIONS: This study demonstrates a significant relationship between poor sleep quality and lower cortical thickness primarily within frontal regions among individuals with both isolated mTBI or comorbid diagnoses of mTBI and PTSD. Thus, if directionality is established in longitudinal and interventional studies, it may be crucial to consider addressing sleep in the treatment of veterans who have sustained mTBI.
摘要：
背景：睡眠质量差与退伍军人的脑容量变化有关，特别是那些经历过轻度创伤性脑损伤（mTBI）和创伤后应激障碍（PTSD）的人。这项研究试图调查（1）睡眠质量差是否与伊拉克和阿富汗退伍军人的皮质厚度减少有关，和（2）这些关联是否根据mTBI和PTSD的存在或不存在而在地形上有所不同。
方法：在波士顿弗吉尼亚州的创伤性脑损伤和应激障碍转化研究中心注册的440名9/11时代后美国退伍军人的样本，2010年至2022年的MA被纳入研究。我们检查了睡眠质量之间的关系，根据匹兹堡睡眠质量指数(PSQI)衡量，mTBI退伍军人的皮层厚度（n=57），PTSD（n=110），MTBI和PTSD并存（n=129），PTSD和mTBI都没有（n=144）。为了确定每个诊断组的主观睡眠质量与皮质厚度之间的地形关系，我们在皮质膜上的每个顶点处采用了通用线性模型（GLM）。使用Dice系数评估了所得统计图之间的地形重叠程度。
结果：在无PTSD或mTBI组（n=144）或单纯PTSD组（n=110）中，PSQI与皮质厚度之间无显著关联。在仅mTBI组中（n=57），较低的睡眠质量与双侧额叶厚度减少显著相关，扣带回,和前条地区，以及右侧顶叶和颞叶区域（β=-0.0137，P<0.0005）。在mTBI和PTSD合并症组中(n=129)，在额叶两侧观察到显著的关联，前中心,和前条地区，在左侧扣带回和右侧顶叶区域（β=-0.0094，P<0.0005）。相互作用分析显示，与没有mTBI的人（n=254）相比，患有mTBI的人（n=186）的睡眠质量差与皮质厚度降低之间存在更强的关系，特别是在额叶和扣带回区域（β=-0.0077，P<0.0005）。
结论：这项研究表明，在患有孤立性mTBI或患有mTBI和PTSD的合并症的个体中，睡眠质量差与主要在额叶区域的皮质厚度较低之间存在显著关系。因此，如果在纵向和介入研究中建立了方向性，在治疗患有mTBI的退伍军人时，考虑解决睡眠问题可能是至关重要的。
方法：在波士顿弗吉尼亚州的创伤性脑损伤和应激障碍转化研究中心注册的440名9/11时代后美国退伍军人的样本，2010年至2022年的MA被纳入研究。我们检查了睡眠质量之间的关系，根据匹兹堡睡眠质量指数(PSQI)衡量，mTBI退伍军人的皮层厚度（n=57），PTSD（n=110），MTBI和PTSD并存（n=129），PTSD和mTBI都没有（n=144）。为了确定每个诊断组的主观睡眠质量与皮质厚度之间的地形关系，我们在皮质膜上的每个顶点处采用了通用线性模型（GLM）。使用Dice系数评估了所得统计图之间的地形重叠程度。
结果：在无PTSD或mTBI组（n=144）或单纯PTSD组（n=110）中，PSQI与皮质厚度之间无显著关联。在仅mTBI组中（n=57），较低的睡眠质量与双侧额叶厚度减少显著相关，扣带回,和前条地区，以及右侧顶叶和颞叶区域（β=-0.0137，P<0.0005）。在mTBI和PTSD合并症组中(n=129)，在额叶两侧观察到显著的关联，前中心,和前条地区，在左侧扣带回和右侧顶叶区域（β=-0.0094，P<0.0005）。相互作用分析显示，与没有mTBI的人（n=254）相比，患有mTBI的人（n=186）的睡眠质量差与皮质厚度降低之间存在更强的关系，特别是在额叶和扣带回区域（β=-0.0077，P<0.0005）。
结论：这项研究表明，在患有孤立性mTBI或患有mTBI和PTSD的合并症的个体中，睡眠质量差与主要在额叶区域的皮质厚度较低之间存在显著关系。因此，如果在纵向和介入研究中建立了方向性，在治疗患有mTBI的退伍军人时，考虑解决睡眠问题可能是至关重要的。
