J Clin Neurol.  2019 Oct;15(4):438-447. 10.3988/jcn.2019.15.4.438.

Altered Regional Cerebral Blood Flow Associated with Mood and Sleep in Shift Workers: Cerebral Perfusion Magnetic Resonance Imaging Study

• Park YK
• Kim JH
• Choi SJ
• Kim ST
• Joo EY

• KMID: 2467751
• DOI: http://doi.org/10.3988/jcn.2019.15.4.438

Abstract

BACKGROUND AND PURPOSE
Shift work disrupts the body's circadian rhythms and increases the risk of health problems. Despite evidence of neuropsychological disturbances in shift workers (SW), the brain functional status as measured by brain perfusion in chronic shift work has not been evaluated previously. We investigated the regional cerebral blood flow (rCBF) in SW using perfusion MRI (pMRI) and evaluated the relationships between altered rCBF and sleep, mood, psychometric measures, and quality of life.
METHODS
Fifteen rotational SW and 15 day workers (DW) were enrolled. The participants were all female nurses working at a university-affiliated hospital. During 2 weeks of actigraphy they underwent pMRI scanning and psychometric testing on the last day immediately after working. Demographic characteristics, insomnia, daytime sleepiness, and mood were compared between the groups.
RESULTS
The participants were aged 35.3±2.9 years (mean±SD) and had been performing their current work for more than 2 years. The demographic characteristics did not differ between SW and DW, but the levels of insomnia, anxiety, depression, and hyperactivity-restlessness in psychometric measures were higher in SW than in DW. Cerebral perfusion in SW was significantly decreased in the cuneus, fusiform/parahippocampal gyri, and cerebellum of the right hemisphere, while it was increased in the inferior occipital gyrus of the left hemisphere. Perfusion changes in SW were significantly correlated with depression and insomnia severity. The onset and duration irregularity of sleep among SW were related to insomnia, mood, hyperactivity/ restlessness, and quality of life.
CONCLUSIONS
SW experience considerably more insomnia and mood disturbances than do DW, and this is significantly related to perfusion changes in multiple brain areas.

Keyword

shift work; perfusion magnetic resonance imaging; sleep; insomnia; mood

MeSH Terms

Actigraphy
Anxiety
Brain
Cerebellum
Cerebrovascular Circulation*
Circadian Rhythm
Depression
Female
Humans
Magnetic Resonance Angiography*
Magnetic Resonance Imaging
Occipital Lobe
Perfusion*
Psychometrics
Psychomotor Agitation
Quality of Life
Sleep Initiation and Maintenance Disorders

Figure

• 

  Fig. 1 Diagrammatic representation of work schedule and timeline. The work schedule of DW was constant while that of SW involved rotational three shifts. Participants wore an actigraph for 2 weeks and underwent MRI scanning immediately after working. In the case of SW, MRI scanning was performed on the day after two consecutive night shifts. AW: awakening, D: day work, DW: day workers, E: evening work, N: night work, SW: shift workers.

• 

  Fig. 2 Flowchart for quantifying the DSC-MRI data. A: DSC-MRI data. B: Concentration of contrast agent. DSC-MRI data were converted into the concentration of contrast agent. C: Concentration–time curves in a large vessel (red box in B) and tissue. The arterial input function was manually determined in large voxels. D: The tissue impulse response function [R(t)] multiplied by the CBF was computed using deconvolution. The regional CBF was computed as the maximum of the deconvolved tissue impulse response, the regional CBV was computed as the ratio of the AUC in a tissue to the AUC of the arterial input function, and the MTT was computed as the ratio of CBV to CBF. E: Observed Ct(t) (blue dots) and fitted curve using the estimated tissue impulse response function and CBF (red line). AUC: area under the curve, CBF: cerebral blood flow, CBV: cerebral blood volume, Cp: concentration of contrast agent in a large vessel, Ct: concentration of contrast agent in tissue, DSC: dynamic susceptibility contrast, MTT: mean transit time, TR: repetition time.

• 

  Fig. 3 Plots of actigraphy data. Light blue boxes indicate sleeping periods, dark blue boxes indicate where actigraphy recording was started, and arrows indicate working periods.

• 

  Fig. 4 Comparison of regional perfusion MRI data between SW and DW. Left inferior occipital gyrus (A), right cerebellum (B), right fusiform/parahippocampal gyri (C), and right cuneus (D). Red color indicates areas with lower CBF in SW compared to DW, and blue color indicates areas with higher CBF. Statistical images are displayed with a cluster probability threshold of p<0.05, corrected for multiple comparisons. CBF: cerebral blood flow, DW: day workers, SW: shift workers.

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