Sleep Med Psychophysiol.  2020 Jun;27(1):24-31. 10.14401/KASMED.2020.27.1.24.

Functional Magnetic Resonance Imaging of Brain Reactivity to Insomnia-Related vs. General Anxiety-Inducing Stimuli in Insomnia Patients with Subjective-Objective Discrepancy of Sleep

  • 1Department of Biomedical Engineering Research Center, Gachon University, Incheon, Korea
  • 2Gachon University College of Medicine, Incheon, Korea
  • 3Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea


Subjective-objective discrepancy of sleep (SODS) is a common symptom and one of the major phenotypes of insomnia. A distorted perception of sleep deficit might be related to abnormal brain reactivity to insomnia-related stimuli. We aimed to investigate differences in brain activation to insomnia-related stimuli vs. general anxiety-inducing stimuli among insomnia patients with SODS, insomnia patients without SODS, and healthy controls (HCs).
All participants were evaluated for subjective sleep status using a sleep diary and questionnaires; occult sleep disorders and objective sleep status were assessed using polysomnography and actigraphy. Task functional magnetic resonance imaging was performed during insomnia-related stimuli (Ins) and general anxiety-inducing stimuli (Gen). Brain reactivity to Ins versus Gen was compared among insomnia with SODS, insomnia without SODS, and HC groups, and a combined insomnia disorder group (ID, insomnia with and without SODS) was also compared with HCs.
In the insomnia with SODS group compared to the insomnia without SODS group, the right precuneus and right supplementary motor areas showed significantly increased BOLD signals in response to Ins versus Gen. In the ID group compared to the HC group, the left anterior cingulate cortex showed significantly increased BOLD signals in response to Ins versus Gen.
The insomnia with SODS and ID groups showed higher brain activity in response to Ins versus Gen, while this was not observed in the insomnia without SODS and HC groups, respectively. These results suggest that insomnia patients with sleep misperception are more sensitive to sleep-related threats than general anxiety-inducing threats.


Brain reactivity; Insomnia; Insomnia-related stimuli; Sleep; Subjective-objective discrepancy; Task fMRI
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