| BackgroundMajor depressive disorder is a disabling disease with the main clinical manifestations of low spirits,loss of pleasure and reduced energy.It is also a common mental disease among teenagers.In recent years,the incidence of depression in adolescents has been increasing,with complex symptoms,high recurrence rate and continuous course of disease,which has a serious adverse impact on their growth and social function.Insomnia is one of the most common clinical symptoms of depression,and it is also an important risk factor for mental health problems in children and adolescents.The pathogenesis of depression with insomnia in adolescents is complex,and its neurobiological mechanism needs futher study.In recent years,the development of functional imaging technology provides new technical means for exploring the etiology and pathogenesis.Depression with insomnia in adolescents may have its unique psychological characteristics and neurobiological mechanisms.Therefore,it is necessary to further explore the clinical and brain functional characteristics of first-episode adolescent depression with insomnia in order to clarify its potential mechanism.Objective1.To analyze the clinical characteristics of first-episode adolescent depression patients with insomnia,such as sleep quality,sleep beliefs and attitudes,and to explore the influence of sleep cognition on insomnia symptom of depression patients.2.To analyze the zReHo value in first-episode adolescent depression patients with insomnia,and the correlation with clinical characteristics.3.To analyze the zALFF value in first-episode adolescent depression patients with insomnia,and the correlation with clinical features.To explore the possible neuropathological mechanism of first-episode adolescent depression with insomnia.Methods29 cases of first-episode adolescent depression with insomnia,30 cases of first-episode adolescent.depression without insomnia,and 29 healthy controls matched with gender,age,and years of education were scanned with resting state fMRI,completed the collection of general data and Hamilton Rating Scale for Depression(HAMD-17)at the same time.And the Pittsburgh Sleep Quality Index Questionnaire(PSQI)and Dysfunctional Beliefs and Attitudes about Sleep Scale(DBAS-16)were used to assess their sleep quality and sleep-related cognition.Statistical analysis of clinical data performed by SPSS 21.0.The fMRI data were preprocessed by Dpabi 4.0,and the differences of neuronal activities among the three groups were compared by Regional Homogeneity(ReHo)and Amplitude of Low Frequency Fluctuation(ALFF)methods.After Z-score standardization,the zReHo brain maps and zALFF brain maps of the three groups were analyzed by One-way ANOVA and post hoc test.Then the correlation between zReHo or zALFF values of each different brain area and the clinical characteristics were analyzed.Results1.There were no statistical differences in gender,age and years of education among the three groups(P>0.05),and there was no statistical difference between the depression patients with insomnia and without insomnia in HAMD-17 scores(P>0.05).PSQI scores of the depression patients with insomnia were significantly higher than those without insomnia(P<0.001),while DBAS-16 scores were significantly lower than those without insomnia(P=0.002).Pearson correlation analysis found that the PSQI scores were significantly correlated with the HAMD-17 scores in insomnia group(r=0.497,P=0.006),but there were no correlation between the PSQI and DBAS-16 scores.In the group without insomnia the PSQI scores had no relationship with HAMD-17 or DBAS-16 scores.2.There were statistically significant differences of zReHo values in multiple cerebral regions among the three groups(cluster level FWE correction,P<0.05).Post hoc test showed that,compared with healthy control group,the zReHo values of both depression patients with insomnia and without insomnia increased in the left medial superior frontal gyrus,right insula,left supplementary motor area,but decreased in the left calcarine area/cuneus,bilateral rectus,right fusiform,right cuneus/calcarine area.The group with insomnia exhibited higher zReHo values in the left supplementary motor area and lower values in the right insula than those of the group without insomnia(Bonferroni correction,P<0.05).The zReHo values of all ROIs had no correlation with clinical characteristics.3.There were statistically significant differences of zALFF values in multiple cerebral regions among the three groups(cluster level FWE correction,P<0.05).Post hoc test showed that,compared with healthy control group,the zALFF values of both the depression group with insomnia and without insomnia increased in the bilateral median cingulate and paracingulate gyrus,right middle frontal gyrus/triangular part of the inferior frontal gyrus,left inferior parietal lobule,right angular gyrus,right middle frontal gyrus,left middle frontal gyrus,while in the right fusiform gyrus,bilateral rectus,left calcarine area/lingual,left paracentral lobule,right precentral gyrus,right calcarine area/lingual the zALFF values decreased.Compared with the group without insomnia,the zALFF values in the left middle frontal gyrus were higher and the zALFF values in the left paracentral lobule were lower in the group with insomnia(Bonferroni correction,P<0.05).The zALFF values of all ROIs had no correlation with clinical characteristics.Conclusions1.Adolescents with first-episode depression and insomnia have poorer subjective sleep quality and more wrong sleep cognition.Sleep-related negative cognitions play an important role in the development of insomnia.2.Compared with those without insomnia,adolescents with first-episode depression and insomnia have different zReHo values in SMA and insula,which may be related to their insomnia symptoms;3.Compared with those without insomnia,adolescents with first-episode depression and insomnia have different zALFF values in the MFG and the paracentral lobule,which may be related to the neuropathological mechanism of first-episode adolescent depression with insomnia. |
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