Changed Daytime State Of Brain Function And Its Correlation With Serum Biomarkers And Sleep Quality In The Patients With Chronic Insomnia Disorder

Background Chronic insomnia disorder(CID)refers to frequent and persistent difficulty in initiation and maintenance of sleep,resulting in individuals’ subjective experience of unsatisfactory sleep time or quality with impaired daytime function,but the consistency of subjective and objective evaluation of impaired daytime function is poor.Polysomnogram(PSG)has been widely used in sleep medicine and is suitable for the diagnosis of various sleep disorders.The subjective sleep experience of CID patients is often inconsistent with the objective sleep quality.PSG can accurately evaluate the sleep quality of insomnia patients from the objective level,which is considered as the "gold standard" for the diagnosis of sleep diseases,but it cannot evaluate the daytime functional impairment.Studies have shown that the severity of insomnia and functional impairment(especially cognitive function)can be determined by serum biological indicators,such as increased concentration of serum corticotrophin-dependent hormone(CRH)and glial fibrillary acidic protein(GFAP),but there are disadvantages such as difficulty in blood retrieval and insufficient time consumption.Therefore,it is urgent to develop a new measurement method that can not only evaluate objective sleep quality,but also evaluate daytime functional status,and has the advantages of convenience and quickness.Quantitative measurement technology of brain function state is a new technology that collects scalp EEG signals,carries out wavelet calculation,and finally converts them into dimensionless data after normalization to objectively reflect the current brain function state of CID patients.Brain function status measurement technology is a non-invasive operation with simple operation,small subjective impact,high repeatability,and low economic cost,and suitable for clinical,especially in primary hospitals to be widely promoted.Objective To investigate whether there are regular changes in daytime brain function status in patients with CID and its consistency with PSG and serum markers in measuring objective sleep quality and brain injury.Methods Sixty patients with insomnia as the chief complaint were enrolled in the outpatient and inpatient departments of sleep disorders of XXXX Hospital,and 30 healthy sleepers from the physical examination center were recruited as the control group.General data such as gender,age,years of education,family history and personal history were collected.All subjects’ sleep quality,anxiety and depression status,and cognitive function were assessed by 2 attending psychiatrists using the scales,i.e.,Pittsburgh Sleep Quality Index(PSQI);17-item Hamilton Depression Scale(HAMD-17);14-item Hamilton Anxiety Scale(HAMA-14)and Chinese Beijing version of the Montreal Cognitive Assessment Scale(MOCA-C).The CID group received overnight PSG monitoring to objectively assess sleep quality.Monitoring measures included apnea hypoventilation index(AHI),total sleep time(TST),sleep latency(SOL),sleep efficiency(SE),wakening time after sleep onset,time in non-rapid eye movement(REM)sleep phase 1,2 and 3(N1,N2 and N3),REM sleep duration and the percentage of different sleep pahses/stages in the TST(N1%,N2%,N3% and REM %).Serum concentrations of CRH and GFAP in all subjects were determined by ELISA.The brain function status of both groups was measured at 9:00 am on the day of enrollment.The final statistical result is that the data of normal distribution is represented by mean ± standard deviation,while the data of non-state distribution is represented by quaternary [M(Q1,Q3)].Results(1)Background information: there were no significant differences in gender,age and years of education between the two groups(P >0.05).(2)Sleep status: Compared with healthy controls,the PSQI scores of CID patients(Z=-29.446,P <0.001)were significantly higher.The PSG sleep parameters reported from CID were consistent with those from insomnia patient norm.(3)Cognitive and emotional status: compared with the healthy controls,the total score of MOCA-C in the CID group was significantly decreased(t= 8.865,P < 0.001),the total score of HAMA was significantly increased(t=-11.331,P < 0.001),and the total score of HAMD was also significantly increased(t=-11.061,P < 0.001).(4)Serological index levels: compared with the healthy control group,the serum levels of CRH(Z=-6.904,P < 0.001)and GFAP(Z=-7.638,P < 0.001)were significantly higher in the CID group.(5)Changes in brain function state: compared with the healthy controls,the CID group had significantly increased values of brain chaos(Z=-4.191,P<0.001),brain inertia(Z=-4.191,P<0.001),internal focus(Z=-4.029,P<0.001)and endogenous anxiety(Z=-3.811,P<0.001);and significantly decreased values of memory processing(Z=-3.662,P<0.001),reaction speed(Z=-3.180,P<0.001)and brain inhibition(Z=-3.203,P<0.001).(6)In the CID group,the cerebral inertia value was positively correlated with serum CRH concentration(r=0.299,P=0.031),the cerebral chaos value was positively correlated with serum GFAP concentration(r=0.374,P=0.006),and the cerebral inhibition value was positively correlated with PSG sleep latency(r=0.284,P=0.042).Internal attention value was negatively correlated with PSG sleep efficiency(r=-0.276,P=0.048)and N1 time(r=-0.341,P=0.024).Endogenous anxiety was positively correlated with HAMA score(r=0.383,P=0.005).There was no significant correlation between the indexes of brain functional state and PSQI scores.(7)Multiple linear regression analysis showed that sleep quality was influenced by daytime brain function(internal attention: β=0.049,P=0.042;Endogenous anxiety:β=0.188,P=0.001;Brain inhibition: β=-0.058,P=0.031;)And serum markers(GFAP:β=0.004,P=0.001).Conclusions The indexes of brain function detected using the Quantitative Measurement System of Brain Functional Status significantly change,and were associated with increased serum biomarkers and poor sleep quality.