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Sono pobre e diminuição da espessura cortical em veteranos com lesão cerebral traumática leve e transtorno de estresse pós-traumático

  • role： First author第一作者
  • Affiliation：

    Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA

    Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA

Murray J. Andrews12,  
  • Affiliation：

    Department of Psychiatry, Harvard Medical School, Boston, MA 02138, USA

    Department f Psychiatry, Boston University School of Medicine, Boston, MA 02130, USA

    Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA 02130, USA

    Anthinoula A. Martinos Center for Biomedical Imaging, Boston, MA 02129, USA

David H. Salat3456,  
  • Affiliation：

    Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA

    Department of Psychiatry, Harvard Medical School, Boston, MA 02138, USA

    Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA

William P. Milberg237,  
  • Affiliation：

    Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA

    Department of Psychiatry, Harvard Medical School, Boston, MA 02138, USA

    Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA

Regina E. McGlinchey237,  
  • role： Corresponding author通信作者
  • Affiliation：

    Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA

    Department of Psychiatry, Harvard Medical School, Boston, MA 02138, USA

    Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA

  • Email：catherine_fortier@hms.harvard.edu
  • Introduction：* catherine_fortier@hms.harvard.edu
Catherine B. Fortier237*

Resumo

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 with 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.

Palavras-chave

Trauma;Brain injury;Sleep;Veterans;Cortical thickness

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