Diffusion Tensor Imaging (DTI) Correlates of Self-Reported Sleep Quality and Depression Following Mild Traumatic Brain Injury

Abstract

Background: Mild traumatic brain injuries (mTBIs) are a significant social, sport, and military health issue. In spite of advances in the clinical management of these injuries, the underlying pathophysiology is not well-understood. There is a critical need to advance objective biomarkers, allowing the identification and tracking of the long-term evolution of changes resulting from mTBI. Diffusion-weighted imaging (DWI) allows for the assessment of white-matter properties in the brain and shows promise as a suitable biomarker of mTBI pathophysiology.Methods: 34 individuals within a year of an mTBI (age: 24.4 ± 7.4) and 18 individuals with no history of mTBI (age: 23.2 ± 3.4) participated in this study. Participants completed self-report measures related to functional outcomes, psychological health, post-injury symptoms, and sleep, and underwent a neuroimaging session that included DWI. Whole-brain white matter was skeletonized using tract-based spatial statistics (TBSS) and compared between groups as well as correlated within-group with the self-report measures.Results: There were no statistically significant anatomical differences between the two groups. After controlling for time since injury, fractional anisotropy (FA) demonstrated a negative correlation with sleep quality scores (higher FA was associated with better sleep quality) and increasing depressive symptoms in the mTBI participants. Conversely, mean (MD) and radial diffusivity (RD) demonstrated positive correlations with sleep quality scores (higher RD was associated with worse sleep quality) and increasing depressive symptoms. These correlations were observed bilaterally in the internal capsule (anterior and posterior limbs), corona radiata (anterior and superior), fornix, and superior fronto-occipital fasciculi.Conclusion: The results of this study indicate that the clinical presentation of mTBI, particularly with respect to depression and sleep, is associated with reduced white-matter integrity in multiple areas of the brain, even after controlling for time since injury. These areas are generally associated not only with sleep and emotion regulation but also cognition. Consequently, the onset of depression and sleep dysfunction as well as cognitive impairments following mTBI may be closely related to each other and to white-matter integrity throughout the brain.

ENIGMA‐Sleep: Challenges, opportunities, and the road map

“…Understanding the structural connectivity alterations of healthy subjects with sleep impairment or patients with sleep disorders are important features in sleep medicine (Raikes et al., 2018; Rostampour et al., 2020). DTI is a method to assess white matter brain integrity and identify microstructural abnormalities.…”

Blue-Light Therapy Strengthens Resting-State Effective Connectivity within Default-Mode Network after Mild TBI

“…11 Moreover, mTBIs are also commonly associated with mood dysregulation, fatigue, and sleep 2 Journal of Central Nervous System Disease problems, which can impede the recovery process. [12][13][14][15][16][17] One novel and promising approach to overcome these problems is the use of morning blue-wavelength light therapy (ie, at ~480 nm) (BLT). 17,18 Blue light stimulates intrinsically photosensitive retinal ganglion cells (ipRGCs) that project to the suprachiasmatic nucleus (SCN) of the hypothalamus, which serves as the primary regulator of the circadian rhythm.…”

The Prevalence and Stability of Sleep-Wake Disturbance and Fatigue throughout the First Year after Mild Traumatic Brain Injury

“…64 Earlier studies using DTI and DWI have indicated a link between disrupted white matter organization and SWD and fatigue after mTBI, but with small to modest sample sizes and varying time after injury. [65][66][67] Our future work will further investigate longitudinal associations between white matter organization and the development of SWD after mTBI using advanced MRI techniques, including DTI, DWI, and structural morphological measures.…”