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Title: Regional neurodegeneration correlates with sleep-wake dysfunction after stroke.
Austin Authors: Gottlieb, Elie;Egorova, Natalia;Khlif, Mohamed Salah;Khan, Wasim;Werden, Emilio ;Pase, Matthew P;Howard, Mark E ;Brodtmann, Amy 
Affiliation: Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Swinburne University of Technology, Melbourne, Australia
Austin Health, Heidelberg, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
University of Melbourne, Melbourne, Australia
Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, UK
Issue Date: 28-Mar-2020 2020-03-28
Publication information: Sleep 2020-03-28
Abstract: Sleep-wake disruption is a key modifiable risk factor and sequela of stroke. The pathogenesis of post-stroke sleep dysfunction is unclear. It is not known whether post-stroke sleep pathology is due to focal infarction to sleep-wake hubs, or to accelerated post-stroke neurodegeneration in subcortical structures after stroke. We characterise the first prospective post-stroke regional brain volumetric and whole-brain, fibre-specific, white matter markers of objectively measured sleep-wake dysfunction. We hypothesised that excessively long sleep (≥8 hr) duration and poor sleep efficiency (<80%) measured using the Sensewear Armband 3-months post-stroke (n=112) would be associated with reduced regional brain volumes of a priori selected sleep-wake regions of interest when compared to healthy controls with optimal sleep characteristics (n=35). We utilised a novel technique known as whole brain fixel-based analysis to investigate the fibre-specific white-matter differences in participants with long sleep duration. Stroke participants with long sleep (n=24) duration exhibited reduced regional volumes of the ipsilesional thalamus and contralesional amygdala when compared to controls. Poor sleep efficiency after stroke (n=29) was associated with reduced ipsilesional thalamus, contralesional hippocampus, and contralesional amygdala volumes. Whole-brain fixel-based analyses revealed widespread macrostructural degeneration to the cortico-ponto-cerebellar tract in stroke participants with long sleep, with fibre reductions of up to 40%. Neurodegeneration to subcortical structures, which appear to be vulnerable to accelerated brain volume loss after stroke, may drive sleep-wake deficiencies post-stroke, independent of lesion characteristics and confounding comorbidities. We discuss these findings in the context of the clinicopathological implications of sleep-related neurodegeneration and attempt to corroborate previous mechanistic-neuroanatomical findings.
DOI: 10.1093/sleep/zsaa054
Journal: Sleep
PubMed URL: 32249910
Type: Journal Article
Subjects: Ascending arousal system
Regional brain volume
Sleep duration
Sleep efficiency
Appears in Collections:Journal articles

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