Poor Sleep Quality Associated With Enlarged Perivascular Spaces in Patients With Lacunar Stroke

Abstract

Background and ObjectiveEnlarged perivascular spaces (EPVSs) are considered as an MRI marker of cerebral small vessel diseases and were reported to be associated with brain waste clearance dysfunction. A previous study found that interstitial fluid clearance in the mouse brain occurred mainly during sleep. However, the relationship between sleep quality and EPVS in humans has not been well-understood. Thus, we aimed to investigate the relationship between sleep and EPVS in humans.MethodsThis retrospective study was conducted in patients with lacunar stroke in the Neurology Department of Beijing Chaoyang Hospital. Patients with EPVS >10 on one side of the basal ganglia (BG) and white matter slice containing the maximum amount were defined as the BG-EPVS group and the white matter (WM)-EPVS group, respectively. Patients with EPVS <10 in the slice containing the maximum amount were defined as the control group. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) including seven components, where a score of 6 or higher indicated poor sleep quality. Spearman's correlation analysis and the binary logistic regression analysis were performed to analyze the relationship between poor sleep quality and BG-EPVS and WM-EPVS, respectively.ResultsA total of 398 patients were enrolled in this study, including 114 patients in the BG-EPVS group and 85 patients in the WM-EPVS group. The proportion of poor sleep quality in the BG-EPVS group was higher than that in the control group (58.8 vs. 32.5%, p < 0.001). The score of PSQI, subjective sleep quality, sleep latency, sleep duration, and sleep efficiency were higher in the BG-EPVS group than that in the control group (p < 0.05). The proportion of poor sleep quality was also higher in the WM-EPVS group than that in the control group (50.6 vs. 35.3%, p = 0.031). The score of sleep duration and sleep disturbances was higher in the WM-EPVS group than that in the control group. Spearman's correlation analysis showed that poor sleep quality was positively associated with BG-EPVS (ρ = 0.264, p < 0.001) and WM-EPVS (ρ = 0.154, p = 0.044). The binary logistic regression analysis showed that poor sleep quality, longer sleep latency, and less sleep duration were independently related to BG-EPVS and poor sleep quality, less sleep duration, and more serious sleep disturbances were independently related to WM-EPVS after adjusting for confounders (P < 0.05).ConclusionPoor sleep quality was independently associated with EPVS in BG and WM.

Assessment of factors influencing glymphatic activity and implications for clinical medicine

“…EPVS in white matter may reflect cerebral amyloid angiopathy, whereas EPVS in basal ganglia may indicates hypertensive arteriopathy. In the future, longitudinal studies should be conducted to assess the relationship ( 43 ). Consistent results were obtained by Opel et al, who investigated the relationship between sleep, traumatic brain injury (TBI) and enlarged perivascular spaces.…”

The associations between Enlarged Perivascular Spaces and partial Clinical symptoms: a meta-analysis

“…For movement disorders, 5 studies (n=1010) met our inclusion criteria [9,12,[35][36][37] . For sleep disturbances, 8 studies (n=1846) met our inclusion criteria [11,12,20,[38][39][40][41][42] . For depressive symptoms, 5 studies (n=3465) met our inclusion criteria [10,12,18,19,39] .…”

“…However, Zhang et al [19] found no significant correlation between EPVS and depressive symptoms in the study of CSVD and post-stroke depression. Similarly, in the study of EPVS and sleep disorders, Shuna Yang et al [20] and Melinda et al [12] found opposite results; in the study of EPVS and cognitive impairment, Francesco Arba et al [21] and Jae Eun Sim et al [22] also showed inconsistent results. In addition, the generation mechanism of EPVS in different regions and its possible consequences are also controversial issues [23] .…”

Perivascular Spaces

“…8 Poor sleep quality itself has been associated with enlarged PVS in patients with lacunar stroke. 9 This raises the possibility that improved sleep patterns might improve outcome in cSVD and other neurodegenerative diseases dependent on waste clearance through the PVS.…”