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VOLUME 37, ISSUE 03

ASSOCIATIONS BETWEEN SLEEP QUALITY AND BRAIN VOLUME IN GULF WAR VETERANS
Associations between Subjective Sleep Quality and Brain Volume in Gulf War Veterans

http://dx.doi.org/10.5665/sleep.3472

Linda L. Chao, PhD1,2,3; Brian S. Mohlenhoff, MD2,3; Michael W. Weiner, MD1,2,3; Thomas C. Neylan, MD2,4

Departments of 1Radiology and Biomedical Imaging; 2Psychiatry, University of California, San Francisco, CA; 3Center for Imaging of Neurodegenerative Diseases; 4Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, CA



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Study Objectives:

To investigate whether subjective sleep quality is associated with brain volume independent of comorbid psychiatric conditions.

Design:

Cross-sectional.

Setting:

Department of Veterans Affairs (VA) Medical Center.

Participants:

One hundred forty-four Gulf War Veterans (mean age 45 years; range: 31-70 years; 14% female).

Interventions:

None.

Measurements and Results:

Total cortical, lobar gray matter, and hippocampal volumes were quantified from 1.5 Tesla magnetic resonance images using Freesurfer version 4.5. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regressions were used to determine the association of sleep quality with total and regional brain volumes. The global PSQI score was positively correlated with lifetime and current posttraumatic stress disorder (PTSD) and current depressive symptoms (P < 0.001) and was higher in veterans with Gulf War Illness, trauma exposure, and those using psychotropic medication (P ≤ 0.03). After adjusting for these comorbid variables, age, intracranial volume, and multiple comparisons, global PSQI was inversely associated with total cortical and frontal gray matter volume (adjusted P ≤ 0.03). Within the frontal lobe, total PSQI was inversely associated with the superior and middle frontal, orbitofrontal, anterior cingulate, and frontal pole volumes (adjusted P ≤ 0.02). Examination of the 3-factor structure of the PSQI revealed that the associations were driven by perceived sleep quality.

Conclusions:

Poorer subjective sleep quality was associated with reduced total cortical and regional frontal lobe volumes independent of comorbid psychiatric conditions. Future work will be needed to examine if effective treatment of disturbed sleep leads to improved structural and functional integrity of the frontal lobes.

Citation:

Chao LL; Mohlenhoff BS; Weiner MW; Neylan TC. Associations between subjective sleep quality and brain volume in Gulf War Veterans. SLEEP 2014;37(3):445-452.

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