Cerebral Gray Matter May Not Explain Sleep Slow-Wave Characteristics after Severe Brain Injury

AI Summary

This study examines the relationship between gray matter volume (GMV) and slow-wave characteristics in patients with traumatic brain injury (TBI) compared to healthy controls. While GMV in specific brain regions was associated with slow-wave frequency and morphology in healthy individuals, this relationship was not observed in TBI patients, despite lower GMV. This challenges the assumption that GMV predicts slow-wave characteristics and suggests a difference in slow-wave generation and morphology in individuals with TBI.

Sleep slow waves are the hallmark of deeper non-rapid eye movement sleep. It is generally assumed that gray matter properties predict slow-wave density, morphology, and spectral power in healthy adults. Here, we tested the association between gray matter volume (GMV) and slow-wave characteristics in 27 patients with moderate-to-severe traumatic brain injury (TBI, 32.0 ± 12.2 years old, eight women) and compared that with 32 healthy controls (29.2 ± 11.5 years old, nine women). Participants underwent overnight polysomnography and cerebral MRI with a 3 Tesla scanner. A whole-brain voxel–wise analysis was performed to compare GMV between groups. Slow-wave density, morphology, and spectral power (0.4–6 Hz) were computed, and GMV was extracted from the thalamus, cingulate, insula, precuneus, and orbitofrontal cortex to test the relationship between slow waves and gray matter in regions implicated in the generation and/or propagation of slow waves. Compared with controls, TBI patients had significantly lower frontal and temporal GMV and exhibited a subtle decrease in slow-wave frequency. Moreover, higher GMV in the orbitofrontal cortex, insula, cingulate cortex, and precuneus was associated with higher slow-wave frequency and slope, but only in healthy controls. Higher orbitofrontal GMV was also associated with higher slow-wave density in healthy participants. While we observed the expected associations between GMV and slow-wave characteristics in healthy controls, no such associations were observed in the TBI group despite lower GMV. This finding challenges the presumed role of GMV in slow-wave generation and morphology.

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