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We investigated differences in brain activity in response to sleep-related pictures between chronic insomnia disorder (CID) patients and good sleepers (GS), and examined whether brain activity moderated the relationship between depressive symptoms and sleep disturbance in CID patients and GS. This study included 43 patients diagnosed with CID, based on the International Classification of Sleep Disorders-3, and 42 GS. The participants kept a sleep diary, underwent nocturnal polysomnography to measure sleep parameters, and completed self-report questionnaires to assess sleep and psychiatric symptoms. They underwent functional magnetic resonance imaging (fMRI) to examine differences in brain activity in response to sleep-related pictures compared to neutral pictures. A moderated moderation analysis was performed to investigate the moderating role of brain responses to sleep-related pictures in the association between depressive symptoms and sleep disturbance. Compared to GS, the brain responses to sleep-related stimuli were significantly lower in CID patients in the right lateral prefrontal cortex (LPFC) and dorsomedial prefrontal cortex (DMPFC). More severe depressive symptoms were significantly associated with longer sleep latency only when LPFC activity was low in CID patients, but not in GS. LPFC hypoactivity in response to sleep-related stimuli in CID patients could moderate the relationship between depression and sleep disturbance., (© 2022. The Author(s).)

Study Objectives: In the present study, factors associated with sleep perception were identified by comparing clinical characteristics and polysomnographic variables between insomnia patients with negative and positive sleep state misperception (NSSM and PSSM, respectively)., Methods: Self-reported and objective sleep measures were retrospectively collected, including the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory, and a questionnaire on "morning feeling" after nocturnal polysomnography in 150 patients with insomnia. Based on the misperception index (MI), participants were classified into NSSM (MI > 0, n = 115) and PSSM (MI < 0, n = 35) groups., Results: The PSSM group had more N3 sleep on nocturnal polysomnography than the NSSM group ( P = .002). The NSSM group showed a higher PSQI score ( P < .001), longer self-reported sleep-onset latency (SOL) ( P = .001), and a greater SOL discrepancy ( P = .001). Self-reported feelings of tiredness and morning awakenings in the morning were higher in the NSSM group ( P = .029 and P = .038). The MI negatively correlated with a proportion of N3 sleep ( P = .005) and positively correlated with PSQI ( P < .001), morning awakenings ( P = .01), self-reported SOL ( P < .001), and SOL discrepancy ( P < .001) in patients with insomnia. Multiple regression analysis showed that N3 sleep, PSQI, and morning awakenings were significantly associated with MI in patients with insomnia., Conclusions: The proportion of slow-wave sleep and self-reported measures may be associated with perception of sleep in patients with insomnia. Objective and self-reported characteristics of patients with insomnia should be carefully evaluated and managed because they may influence the perception of sleep., Citation: Yoon G, Lee MH, Oh SM, Choi J-W, Yoon SY, Lee YJ. Negative and positive sleep state misperception in patients with insomnia: factors associated with sleep perception. J Clin Sleep Med . 2022;18(7):1789-1795., (© 2022 American Academy of Sleep Medicine.)

We investigated the differential spatial covariance pattern of blood oxygen level-dependent (BOLD) responses to single-task and multitask functional magnetic resonance imaging (fMRI) between patients with psychophysiological insomnia (PI) and healthy controls (HCs), and evaluated features generated by principal component analysis (PCA) for discrimination of PI from HC, compared to features generated from BOLD responses to single-task fMRI using machine learning methods. In 19 patients with PI and 21 HCs, the mean beta value for each region of interest (ROIbval) was calculated with three contrast images (i.e., sleep-related picture, sleep-related sound, and Stroop stimuli). We performed discrimination analysis and compared with features generated from BOLD responses to single-task fMRI. We applied support vector machine analysis with a least absolute shrinkage and selection operator to evaluate five performance metrics: accuracy, recall, precision, specificity, and F2. Principal component features showed the best classification performance in all aspects of metrics compared to BOLD response to single-task fMRI. Bilateral inferior frontal gyrus (orbital), right calcarine cortex, right lingual gyrus, left inferior occipital gyrus, and left inferior temporal gyrus were identified as the most salient areas by feature selection. Our approach showed better performance in discriminating patients with PI from HCs, compared to single-task fMRI.

Aim: Patients with psychophysiological insomnia (PI) experience hyperarousal, especially as a reaction to sound stimuli. In the current study, we explored brain activity changes in response to sleep-related sounds (SS) in patients with insomnia after cognitive behavioral therapy for insomnia (CBT-I)., Methods: In 14 drug-free PI patients, regional brain activity in response to SS, and to white noise sound (NS) as neutral stimuli, was investigated before and after individual CBT-I using functional magnetic resonance imaging. Blood oxygen level-dependent (BOLD) signals to SS and NS were compared before and after CBT-I. In addition, the association between clinical improvement after CBT-I and changes in brain activity in response to SS and NS was analyzed., Results: Compared with baseline, regional brain activity in response to SS after CBT-I decreased in the left middle temporal and left middle occipital gyrus. In regression analysis, a reduction in the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) Scale score after CBT-I was associated with decrease in brain activity in response to SS in both thalami. However, brain activity in response to NS showed no BOLD signal changes and no association with DBAS change., Conclusion: Cortical hyperactivity, which may cause hyperarousal in PI, was found to decrease after CBT-I. CBT-I targeting changes in beliefs and attitudes about sleep may induce its therapeutic effects by reducing thalamic brain activity in response to sleep-related stimuli., (© 2019 The Authors. Psychiatry and Clinical Neurosciences © 2019 Japanese Society of Psychiatry and Neurology.)