title: Neurobiology of Sleep Disturbances in PTSD Patients and Traumatized Controls: MRI and SPECT Findings.
abstract: OBJECTIVE
  Sleep disturbances such as insomnia and nightmares are core components of post-traumatic stress disorder (PTSD), yet their neurobiological relationship is still largely unknown. We investigated brain alterations related to sleep disturbances in PTSD patients and controls by using both structural and functional neuroimaging techniques.
  
  
  METHODS
  Thirty-nine subjects either developing (n = 21) or not developing (n = 18) PTSD underwent magnetic resonance imaging and a symptom-provocation protocol followed by the injection of 99mTc-hexamethylpropyleneamineoxime. Subjects were also tested with diagnostic and self-rating scales on the basis of which a Sleep Disturbances Score (SDS; i.e., amount of insomnia/nightmares) was computed.
  
  
  RESULTS
  Correlations between SDS and gray matter volume (GMV)/regional cerebral blood flow (rCBF) were computed in the whole sample and separately in the PTSD and control groups. In the whole sample, higher sleep disturbances were associated with significantly reduced GMV in amygdala, hippocampus, anterior cingulate, and insula; increased rCBF in midbrain, precuneus, and insula; and decreased rCBF in anterior cingulate. This pattern was substantially confirmed in the PTSD group, but not in controls.
  
  
  CONCLUSIONS
  Sleep disturbances are associated with GMV loss in anterior limbic/paralimbic, PTSD-sensitive structures and with functional alterations in regions implicated in rapid eye movement-sleep control, supporting the existence of a link between PTSD and sleep disturbance.
authors.affiliation: Neuroimaging Laboratory, Santa Lucia Foundation , Rome , Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Nardo
authors.affiliation: Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Högberg
authors.affiliation: Department of Nuclear Medicine, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Cathrine
authors.initials: C
authors.lastname: Jonsson
authors.affiliation: Department of Nuclear Medicine, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Jacobsson
authors.affiliation: Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden ; Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
authors.forename: Tore
authors.initials: T
authors.lastname: Hällström
authors.affiliation: Department of Nuclear Medicine, Karolinska University Hospital , Stockholm , Sweden ; Institute of Cognitive Sciences and Technologies, National Research Council , Rome , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pagani
keywords: PTSD; SPECT; insomnia; nightmares; sleep; voxel-based morphometry