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Purpose: Primary insomnia (PI) is the second most common mental disorder. However, the topologic alterations in structural brain connectome in patients with PI remain largely unknown.Methods: A total of 44 PI patients and 46 age-, gender-, and education level matched healthy control (HC) participants were recruited in this study. Diffusion tensor imaging (DTI) and resting state MRI were used to construct structural connectome for each participant, and the network parameters were employed by non-parametric permutations to evaluate the significant differences between the two groups. Relationships between abnormal network metrics and clinical characteristics, including the disease duration, the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS), were investigated with Spearman’s correlation analysis in PI patients.Results: PI patients demonstrated small-world architecture with lower global (P = 0.005) and local (P = 0.035) efficiencies compared with the HC group. The unique hub nodal properties in PI patients were mainly in the right limbic cortico-basal-ganglia circuit. Five disrupted subnetworks in PI patients were observed in the limbic cortico-basal-ganglia circuit and left default-mode networks (DMN) (P < 0.05, NBS corrected). Moreover, most unique hub nodal properties in the right limbic cortico-basal-ganglia circuit were significantly correlated with disease duration, and clinical characteristics (SAS, SDS, ISI scores) in PI processing.Conclusion: These findings suggested the abnormal anatomical network architecture may be closely linked to clinical characteristics in PI. The study provided novel insights into the neural substrates underlying symptoms and neurophysiologic mechanisms of PI.

Background: Resting-state functional magnetic resonance imaging (fMRI) studies have uncovered the disruptions of functional brain networks in primary insomnia (PI) patients. However, the etiology and pathogenesis underlying this disorder remains ambiguous, and the insomnia related symptoms are influenced by a complex network organization in the brain. The purpose of this study was to explore the abnormal intrinsic functional hubs in PI patients using a voxel-wise degree centrality (DC) analysis and seed-based functional connectivity (FC) approach.Methods: A total of 26 PI patients and 28 healthy controls were enrolled, and they underwent resting-state fMRI. Degree centrality was measured across the whole brain, and group differences in DC were compared. The peak points, which significantly altered DC between the two groups, were defined as the seed regions and were further used to calculate FC of the whole brain. Later, correlation analyses were performed between the changes in brain function and clinical features.Results: Primary insomnia patients showed DC values lower than healthy controls in the left inferior frontal gyrus (IFG) and middle temporal gyrus (MTG) and showed a higher DC value in the right precuneus. The seed-based analyses demonstrated decreased FC between the left MTG and the left posterior cingulate cortex (PCC), and decreased FC was observed between the right precuneus and the right lateral occipital cortex. Reduced DC in the left IFG and decreased FC in the left PCC were positively correlated with the Pittsburgh sleep quality index and the insomnia severity index.Conclusions: This study revealed that PI patients exhibited abnormal intrinsic functional hubs in the left IFG, MTG, and the right precuneus, as well as abnormal seed-based FC in these hubs. These results contribute to better understanding of how brain function influences the symptoms of PI.

Background: Recently, there have been many reports about abnormalities regarding structural and functional brain connectivity of the patients with primary insomnia. However, the alterations in functional interaction between the left and right cerebral hemispheres have not been well understood. The resting-state fMRI approach, which reveals spontaneous neural fluctuations in blood-oxygen-level-dependent signals, offers a method to quantify functional interactions between the hemispheres directly.Methods: We compared interhemispheric functional connectivity (FC) between 26 patients with primary insomnia (48.85 ± 12.02 years) and 28 healthy controls (49.07 ± 11.81 years) using a voxel-mirrored homotopic connectivity (VMHC) method. The patients with primary insomnia and healthy controls were matched for age, gender, and education. Brain regions, which had significant differences in VMHC maps between the primary insomnia and healthy control groups, were defined as seed region of interests. A seed-based approach was further used to reveal significant differences of FC between the seeds and the whole contralateral hemisphere.Results: The patients with primary insomnia showed higher VMHC than healthy controls in the anterior cingulate cortex (ACC) bilaterally. The seed-based analyses demonstrated increased FC between the left ACC and right thalamus (and the right ACC and left orbitofrontal cortex) in patients with primary insomnia, revealing abnormal connectivity between the two cerebral hemispheres. The VMHC values in the ACC were positively correlated with the time to fall asleep and Self-Rating Depression Scale scores (SDS).Conclusions: The results demonstrate that there is abnormal interhemispheric resting-state FC in the brain regions of patients with primary insomnia, especially in the ACC. Our finding demonstrates valid evidence that the ACC is an area of interest in the neurobiology of primary insomnia.

Introduction: Insomnia is the most commonly reported sleep problem, which profoundly affects the person’s quality of life. In Ayurveda various non-pharmacological methods related with dietary modifications, physical and psychological factors are well described for the effective management of Nidranasha (primary insomnia) and to improve the quality of life. Aim: To explore the non-pharmacological strategies for the effective management of Nidranasha (primary insomnia) from the perspective of Ayurveda. Comparison with Pharmacologic Treatments: Various pharmacological compounds are effectively used for the symptomatic treatment of insomnia such as hypnotics, antidepressants, neuroleptics etc., however, their safety, dependency and adverse effect remains a matter of concern among physicians, when used for the long-term. Ayurvedic approaches can be a better choice in this situation. Materials and Methods: For this, Ayurevda classics have been thoroughly studied, PubMed was searched using key words, Anidra, Nidranasha and non-pharmacological treatment for insomnia from Ayurveda, the free full text article published during 2000 to 2017 were reviewed. The information was also taken from the modern medical science article from the same year and from the official web page of Centers for Disease Control and Prevention. Results: A total of 5 free full text articles from Ayurveda and 40 from modern medicine were found in the PubMed search. Information from the classical Ayurveda texts and published articles both were utilized in this review. Conclusion: Ayurveda gives importance to the natural sleep for the maintenance of health. It is always better that Nidranasha (primary insomnia) should be initially managed without the use of any pharmacological compound.

ObjectiveDaytime cognitive impairment is an essential symptom of primary insomnia (PI). However, the underlying neural substrate remains largely unknown. Many studies have shown that the right anterior insula (rAI) as a key node of salience network (SN) plays a critical role in switching between the executive control network (ECN) and the default mode network (DMN) for better performance of cognitively demanding tasks. Aberrant effective connectivity (directional functional connectivity) of rAI with ECN or DMN may be one reason for daytime cognitive impairment in PI patients. Up to now, no effective connectivity study has been conducted on patients with PI during resting state. Our aim is to investigate the effective connectivity between the rAI and the other voxels in the whole brain in PI.Materials and methodsFifty drug-naive patients with PI and forty age- and sex-matched healthy controls were scanned using resting-state functional MRI. Seed-based Granger causality analysis was used to examine effective connectivity between the rAI, including ventral and dorsal part, and the whole brain. The effective connectivity was compared between the two groups and was correlated with clinical characteristics.ResultsCompared with controls, patients showed decreased effective connectivity from the rAI to the bilateral precuneus, the left postcentral gyrus (extending to bilateral precuneus) and the bilateral cerebellum posterior lobe, and decreased effective connectivity from the bilateral orbitofrontal cortex (OFC) to the rAI (single voxel P

Accumulating evidence from neuroimaging studies suggests that primary insomnia (PI) affects interregional neural coordination of multiple interacting functional brain networks. However, a complete understanding of the whole-brain network organization from a system-level perspective in PI is still lacking. To this end, we investigated in topological organization changes in brain functional networks in PI. 36 PI patients and 38 age-, sex-, and education-matched healthy controls were recruited. All participants underwent a series of neuropsychological assessments and resting-state functional magnetic resonance imaging scans. Individual whole-brain functional network were constructed and analyzed using graph theory-based network approaches. There were no significant differences with respect to age, sex, or education between groups (P > 0.05). Graph-based analyses revealed that participants with PI had a significantly higher total number of edges (P = 0.022), global efficiency (P = 0.014), and normalized global efficiency (P = 0.002), and a significantly lower normalized local efficiency (P = 0.042) compared with controls. Locally, several prefrontal and parietal regions, the superior temporal gyrus, and the thalamus exhibited higher nodal efficiency in participants with PI (P

Xiao Nie,1,* Yi Shao,2,* Si-yu Liu,3 Hai-jun Li,1 Ai-lan Wan,4 Si Nie,1 De-chang Peng,1 Xi-jian Dai1,5 1Department of Radiology, The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, People’s Republic of China; 2Department of Ophthalmology,The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, People’s Republic of China; 3Medical College of Nanchang University, Nangchang, Jiangxi, People’s Republic of China; 4Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, People’s Republic of China; 5Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People’s Republic of China *These authors contributed equally to this work Objective: The aim of this study is to explore the resting-state functional connectivity (FC) differences between the paired default mode network (DMN) subregions in patients with primary insomnia (PIs).Methods: Forty-two PIs and forty-two age- and sex-matched good sleepers (GSs) were recruited. All subjects underwent the resting-state functional magnetic resonance imaging scans. The seed-based region-to-region FC method was used to evaluate the abnormal connectivity within the DMN subregions between the PIs and the GSs. Pearson correlation analysis was used to investigate the relationships between the abnormal FC strength within the paired DMN subregions and the clinical features in PIs.Results: Compared with the GSs, the PIs showed higher Pittsburgh Sleep Quality Index score, Hamilton Anxiety Rating Scale score, Hamilton Depression Rating Scale score, Self-Rating Depression Scale score, Self Rating Anxiety Scale score, Self-Rating Scale of Sleep score, and Profile of Mood States score (P

Primary insomnia is a chronic disorder and characterized by inadequate sleep or poor sleep quality. The prevalence of insomnia is relatively high and daytime fatigue, mood disruption and cognitive impairments associated with insomnia negatively affect productivity and quality of life of patients. However, the neurobiological understanding of primary insomnia is still insufficient. Meanwhile, many neuroimaging studies have performed to investigate the structural or functional derangement in brains of patients with primary insomnia. There is no doubt that neuroimaging techniques can be useful in identifying the cerebral mechanisms of insomnia pathogenesis, and the neural correlates of insomnia symptoms. The current review focuses on structural neuroimaging findings in patients with primary insomnia.

Background: Insomnia is the second most commonly presenting symptom, after pain, in clinics. Insomnia prevalence in India is 28.1 %., Objective: This study explores the effect of Mamsyadi Kwatha in the management of primary insomnia., Materials and Methods: Fifty patients attending KLE Ayurveda hospital meeting the diagnostic criteria of primary insomnia (DSM IV TR) were enrolled. Patients were randomly divided into two groups: group MK and TK. Intervention in group MK was 24 ml of Mamsyadi Kwatha twice a day and in group TK was 24 ml of Tagaradi Kwatha twice a day for 30 days. Assessment was done through primary outcome measures like Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), insomnia severity index (ISI). Secondary outcome measures were sleep diary recordings of past 15 days and depression anxiety and stress scale (DASS). Follow ups were at base line, 15th and 30th day of interventions. Laboratory assessments of liver function test, haemoglobin, and serum creatinine levels were carried at base line and 30th day of intervention., Results: Effect on primary and secondary outcomes showed that both the drugs were comparable. = Within group comparison of both the drugs showed that they produced significant improvement in PSQI, ESS, ISI, sleep diary variables, and DASS. However, Mamsyadi kwath has additional benefit of early recovery in total sleep. Both the drugs showed good safety profile evaluated through serum creatinine and liver function tests., Conclusion: The effects of Mamsyadi Kwatha is comparable to Tagaradi Kwatha. Both drugs produced significant improvement in clinical assessments of insomnia, anxiety, depression, and stress., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective/background: It has been shown that actigraphy may have a discriminant function (DS) for the diagnosis of narcolepsy type 1 patients (NT1), based on a combination of nighttime and daytime parameters. Here, we aimed to test those findings using another actigraph model with a different clinical sample as control (ie, primary insomniacs, PI), carrying out a secondary analysis of previously collected data.Patients/methods: The study sample consisted of 13 NT1 (nine females; mean age 39.38 ± 11.48), 13 PI (nine females; mean age 38.69 ± 10.72) and 13 Healthy Controls (HC) (nine females; mean age 38 ± 10.77). Participants wore the Actiwatch AW64 (Cambridge Neurotechnology Ltd, Cambridge, UK) around the non-dominant wrist for seven consecutive days.Results: Significant differences between groups were observed with a higher number of episodes of wakefulness (wake bouts, WB) in PI than HC, a higher fragmentation index (FI) in NT1 than HC and PI, a higher duration of the longest nap (LNAP) in NT1 than HC and PI and higher DS in PI and NT1 than HC. A new DS (NDS), with LNAP and FI as independent variables, was proposed; which was higher in NT1 than HC and PI.Conclusions: The present study confirms that actigraphy discriminates NT1 from HC. However, considering PI, a new discriminant function NDS which takes into account LNAP and FI is better for this actigraph model. [ABSTRACT FROM AUTHOR]

Previous neuroimaging studies have reported brain morphological alterations and the occurrence of mental disorders in primary insomnia (PI) patients. However, studies of the effect of disrupted sleep on brain structure have showed inconsistent results. In this study, DARTEL-VBM was used to evaluate the changes in gray matter volume from 60 PI patients and 53 controls. Voxel-wise statistics was performed in two ways. One is a more liberal statistical analysis using an uncorrected P < 0. 001 with 25 voxels, and the other one is a more conservative approach using a threshold of P < 0.05, corrected for multiple comparisons using the Gaussian random field (GRF) method. Partial correlation was used to analyze the relationship between abnormal volume and clinical features. PI patients had reduced gray matter volume primarily in the right middle cingulate cortex with correction (P < 0.05). Correlation analysis showed gray matter changes in the left middle cingulate cortex were negatively associated with self-ratings for anxiety and depression. This study showed that gray matter deficits in cingulate cortex in patients with insomnia, and the decreased gray matter volume may be associated with the difficulties in emotional management due to insomnia. Functional roles of the affected regions in emotion and regulation of sleep might provide supplementary evidence and guide further research that may facilitate understanding the mechanisms underlying insomnia. [ABSTRACT FROM AUTHOR]

Purpose: Primary insomnia (PI) is the second most common mental disorder. However, the topologic alterations in structural brain connectome in patients with PI remain largely unknown. Methods: A total of 44 PI patients and 46 age-, gender-, and education level matched healthy control (HC) participants were recruited in this study. Diffusion tensor imaging (DTI) and resting state MRI were used to construct structural connectome for each participant, and the network parameters were employed by non-parametric permutations to evaluate the significant differences between the two groups. Relationships between abnormal network metrics and clinical characteristics, including the disease duration, the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS), were investigated with Spearman's correlation analysis in PI patients. Results: PI patients demonstrated small-world architecture with lower global (P = 0.005) and local (P = 0.035) efficiencies compared with the HC group. The unique hub nodal properties in PI patients were mainly in the right limbic cortico-basal-ganglia circuit. Five disrupted subnetworks in PI patients were observed in the limbic cortico-basal-ganglia circuit and left default-mode networks (DMN) (P < 0.05, NBS corrected). Moreover, most unique hub nodal properties in the right limbic cortico-basal-ganglia circuit were significantly correlated with disease duration, and clinical characteristics (SAS, SDS, ISI scores) in PI processing. Conclusion: These findings suggested the abnormal anatomical network architecture may be closely linked to clinical characteristics in PI. The study provided novel insights into the neural substrates underlying symptoms and neurophysiologic mechanisms of PI. [ABSTRACT FROM AUTHOR]

Background: Resting-state functional magnetic resonance imaging (fMRI) studies have uncovered the disruptions of functional brain networks in primary insomnia (PI) patients. However, the etiology and pathogenesis underlying this disorder remains ambiguous, and the insomnia related symptoms are influenced by a complex network organization in the brain. The purpose of this study was to explore the abnormal intrinsic functional hubs in PI patients using a voxel-wise degree centrality (DC) analysis and seed-based functional connectivity (FC) approach. Methods: A total of 26 PI patients and 28 healthy controls were enrolled, and they underwent resting-state fMRI. Degree centrality was measured across the whole brain, and group differences in DC were compared. The peak points, which significantly altered DC between the two groups, were defined as the seed regions and were further used to calculate FC of the whole brain. Later, correlation analyses were performed between the changes in brain function and clinical features. Results: Primary insomnia patients showed DC values lower than healthy controls in the left inferior frontal gyrus (IFG) and middle temporal gyrus (MTG) and showed a higher DC value in the right precuneus. The seed-based analyses demonstrated decreased FC between the left MTG and the left posterior cingulate cortex (PCC), and decreased FC was observed between the right precuneus and the right lateral occipital cortex. Reduced DC in the left IFG and decreased FC in the left PCC were positively correlated with the Pittsburgh sleep quality index and the insomnia severity index. Conclusions: This study revealed that PI patients exhibited abnormal intrinsic functional hubs in the left IFG, MTG, and the right precuneus, as well as abnormal seed-based FC in these hubs. These results contribute to better understanding of how brain function influences the symptoms of PI. [ABSTRACT FROM AUTHOR]

Two secondary analyses of previously collected data were carried out to detect the best screening strategy for primary insomnia (Study 1) and narcolepsy type 1 (Study 2) between two different approaches: (A) step-by-step (i.e. first step: subjective assessment through mini sleep questionnaire - MSQ; second step: objective assessment through actigraphic assessment only for those positive at the first step) and (B) single step (i.e. simultaneous subjective and objective assessment). Forty-six healthy controls (HC) and 46 primary insomnia patients (PI) were analyzed in Study 1; 40 HC and 40 narcolepsy type-1 patients (NT1) were analyzed in Study 2. All participants originally wore the Micro Motionlogger Watch actigraph (Ambulatory Monitoring, Inc., Ardlsey, NY) around the non-dominant wrist for seven consecutive days, and upon completing the actigraphic assessment filled in the MSQ. In Study 1, the single-step approach correctly identified 93.48% of PI, while only 50% of PI were correctly identified by the step-by-step approach. In Study 2, 100% of NT1 was correctly classified through the single-step approach, while 72.5% according to the step-by-step approach. The result of both studies highlights the higher appropriateness of single step (i.e. bi-dimensional assessment) compared to step-by-step approach to screen primary insomnia and narcolepsy type-1 patients. [ABSTRACT FROM AUTHOR]

We aimed to identify the sleep electroencephalography (EEG) spectral power correlates of the subjective-objective discrepancy (SOD) of sleep onset latency (SOL) in major depressive disorder (MDD), primary insomnia (PI), and normal sleeping control (NSC) groups. We examined relative power values in standard frequency bands of the EEG spectra during the first Non-Rapid Eye Movement (NREM) sleep period as correlates of SOD of SOL between sleep diary and polysomnography in MDD ( n  = 36), PI ( n  = 19), and NSC ( n  = 23) groups. We also compared the relative spectral power of sleep EEG among MDD ( n  = 40), PI ( n  = 19), and NSC ( n  = 23) groups. SOD of SOL in MDD patients was positively correlated with relative sigma ( r  = 0.622, p corrected < 0.001), beta power ( r  = 0.559, p corrected = 0.002), and alpha power ( r  = 0.469, p corrected = 0.024) in the first NREM sleep period. There was no significant difference of sleep EEG power spectra among the three groups. SOD was positively correlated with high frequency EEG in MDD. High frequency EEG power is thought to be associated with hyperarousal and memory consolidation, and future larger-scale studies may further elucidate the neurophysiological mechanisms underlying SOD of sleep onset duration. [ABSTRACT FROM AUTHOR]

Introduction: Insomnia is the most commonly reported sleep problem, which profoundly affects the person's quality of life. In Ayurveda various non-pharmacological methods related with dietary modifications, physical and psychological factors are well described for the effective management of Nidranasha (primary insomnia) and to improve the quality of life. Aim: To explore the non-pharmacological strategies for the effective management of Nidranasha (primary insomnia) from the perspective of Ayurveda. Comparison with Pharmacologic Treatments: Various pharmacological compounds are effectively used for the symptomatic treatment of insomnia such as hypnotics, antidepressants, neuroleptics etc., however, their safety, dependency and adverse effect remains a matter of concern among physicians, when used for the long-term. Ayurvedic approaches can be a better choice in this situation. Materials and Methods: For this, Ayurevda classics have been thoroughly studied, PubMed was searched using key words, Anidra, Nidranasha and non-pharmacological treatment for insomnia from Ayurveda, the free full text article published during 2000 to 2017 were reviewed. The information was also taken from the modern medical science article from the same year and from the official web page of Centers for Disease Control and Prevention. Results: A total of 5 free full text articles from Ayurveda and 40 from modern medicine were found in the PubMed search. Information from the classical Ayurveda texts and published articles both were utilized in this review. Conclusion: Ayurveda gives importance to the natural sleep for the maintenance of health. It is always better that Nidranasha (primary insomnia) should be initially managed without the use of any pharmacological compound. [ABSTRACT FROM AUTHOR]

Objective: Daytime cognitive impairment is an essential symptom of primary insomnia (PI). However, the underlying neural substrate remains largely unknown. Many studies have shown that the right anterior insula (rAI) as a key node of salience network (SN) plays a critical role in switching between the executive control network (ECN) and the default mode network (DMN) for better performance of cognitively demanding tasks. Aberrant effective connectivity (directional functional connectivity) of rAI with ECN or DMN may be one reason for daytime cognitive impairment in PI patients. Up to now, no effective connectivity study has been conducted on patients with PI during resting state. Our aim is to investigate the effective connectivity between the rAI and the other voxels in the whole brain in PI. Materials and methods: Fifty drug-naive patients with PI and forty age- and sexmatched healthy controls were scanned using resting-state functional MRI. Seed-based Granger causality analysis was used to examine effective connectivity between the rAI, including ventral and dorsal part, and the whole brain. The effective connectivity was compared between the two groups and was correlated with clinical characteristics. Results: Compared with controls, patients showed decreased effective connectivity from the rAI to the bilateral precuneus, the left postcentral gyrus (extending to bilateral precuneus) and the bilateral cerebellum posterior lobe, and decreased effective connectivity from the bilateral orbitofrontal cortex (OFC) to the rAI (single voxel P < 0.001, AlphaSim corrected with P < 0.01). In addition, effective connectivity from the ventral rAI to the left postcentral gyrus and from the left OFC to the ventral rAI were significantly negatively correlated with Insomnia Severity Index scores (r = -0.28/P = 0.046 and r = -0.29/P = 0.038, respectively). Conclusion: The present study is the first to reveal aberrant effective connectivity between the SN hub (rAI) and the posterior DMN hub (precuneus) as well as decisionmaking region (OFC) and sensori-motor region in PI. These findings suggest an aberrant salience processing system of the rAI in PI patients. [ABSTRACT FROM AUTHOR]

Accumulating evidence from neuroimaging studies suggests that primary insomnia (PI) affects interregional neural coordination of multiple interacting functional brain networks. However, a complete understanding of the whole-brain network organization from a system-level perspective in PI is still lacking. To this end, we investigated in topological organization changes in brain functional networks in PI. 36 PI patients and 38 age-, sex-, and education-matched healthy controls were recruited. All participants underwent a series of neuropsychological assessments and resting-state functional magnetic resonance imaging scans. Individual whole-brain functional network were constructed and analyzed using graph theory-based network approaches. There were no significant differences with respect to age, sex, or education between groups (P > 0.05). Graphbased analyses revealed that participants with PI had a significantly higher total number of edges (P = 0.022), global efficiency (P = 0.014), and normalized global efficiency (P = 0.002), and a significantly lower normalized local efficiency (P = 0.042) compared with controls. Locally, several prefrontal and parietal regions, the superior temporal gyrus, and the thalamus exhibited higher nodal efficiency in participants with PI (P < 0.05, false discovery rate corrected). In addition, most of these regions showed increased functional connectivity in PI patients (P < 0.05, corrected). Finally, altered network efficiency was correlated with neuropsychological variables of the Epworth Sleepiness Scale and Insomnia Severity Index in patients with PI. PI is associated with abnormal organization of large-scale functional brain networks, which may account for memory and emotional dysfunction in people with PI. These findings provide novel implications for neural substrates associated with PI. [ABSTRACT FROM AUTHOR]

Insomnia is a common sleep-related symptom which occurs in many populations, however, the neural mechanism underlying insomnia is not yet known. The hyperarousal model explains the neural mechanism of insomnia to some extent, and the frontal cortex dysfunction has been known to be related to primary insomnia. In this review, we discuss studies that applied resting state and/or task-related functional magnetic resonance imaging to demonstrate the deficits/dysfunctions of functional activation and network in primary insomnia. Empirical evidence of the hyperarousal model and proposed relation between the frontal cortex and other brain regions in primary insomnia are examined. Reviewing these studies could provide critical insights regarding the pathophysiology, brain network and cerebral activation in insomnia and the development of novel methodologies for the diagnosis and treatment of insomnia. [ABSTRACT FROM AUTHOR]

Objective: This study investigated alterations of resting-state networks (RSNs) in primary insomnia patients as well as relationships between these changes and clinical features.Methods: Fifty-nine primary insomnia patients and 53 healthy control subjects underwent a resting-state fMRI scan (rs-fMRI). Ten RSNs were identified using independent component analysis of rs-fMRI data. To assess significant differences between the two groups, voxel-wise analysis of ten RSNs was conducted using dual regression with FSL randomised non-parametric permutation testing and a threshold-free cluster enhanced technique to control for multiple comparisons. Relationships between abnormal functional connectivity and clinical variables were then investigated with Pearson's correlation analysis.Results: Primary insomnia patients showed decreased connectivity in regions of the right frontoparietal network (FPN), including the superior parietal lobule and superior frontal gyrus. Moreover, decreased connectivity in the right middle temporal gyrus and right lateral occipital cortex with the FPN showed significant positive correlations with disease duration and self-rated anxiety, respectively.Conclusions: Our study suggests that primary insomnia patients are characterised by abnormal organisation of the right FPN, and dysfunction of the FPN is correlated with disease duration and anxiety. The results enhance our understanding of neural substrates underlying symptoms of primary insomnia from the viewpoint of resting-state networks.Key Points: • Primary insomnia patients showed altered functional connectivity in the right FPN. • Middle temporal gyrus FC with FPN was significantly correlated with disease duration. • Lateral occipital cortex FC with FPN was significantly correlated with SAS scores. [ABSTRACT FROM AUTHOR]

Background Primary insomnia is one of the most common issues for adults. However, whether to use music intervention as a non-pharmacological method of treatment, as well as which treatment should be preferred, is still a matter of controversy. Therefore, we aimed to compare and rank music interventions and no-music controls for primary insomnia patients. Methods A network meta-analysis was used to identify evidence from relevant clinical trials. We searched PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure Library for publications up to May 2017, pertaining to music intervention for primary insomnia patients. The prespecified primary outcome was sleep quality (scored by the PSQI and overall), and the secondary outcomes were sleep onset latency and sleep efficiency. We did pairwise meta-analyses using the random-effects model, later completing the random-effects network meta-analyses. The study was registered with PROSPERO, number CRD42017064750. Results We deemed 20 trials to be eligible, involving 1339 patients and 12 intervention arms. For PSQI scores, all intervention arms were statistically more effective than the usual care, with patients ranking listening to music as the best means of intervention (SMD: −0.61, 95%CrI: −1.01 to −0.20). For overall sleep quality, only music-associated relaxation was statistically more effective than the patients’ usual care (−0.28, −0.48 to −0.08). In terms of sleep onset latency, music-associated relaxation and listening to music had significant advantages (−0.26, −0.64 to −0.09, and −0.28, −0.53 to −0.02); listening to music and music with exercise displayed a tendency to improve sleep efficiency. Conclusions When considering the efficacy, music intervention seemed to offer clear advantages for adults with primary insomnia. Listening to music and music-associated relaxation are probably the best options to consider in the application of music intervention. [ABSTRACT FROM AUTHOR]

Insomnia is an important public health problem because it has a significant negative impact on individuals’ physical, psychological, and social performance, and quality of life. It may arise directly from a sleep-wake regulatory dysfunction and/or indirectly result from comorbid psychiatric or medical conditions. It is also known that insomnia as a symptom has a negative impact on clinical structure, response to therapeutic intervention, and prognosis of co-morbid pathology. However, it has generally been viewed and treated as a symptom rather than disease. It is not always clear which insomnia cases are primary and which are secondary. But the distinction between insomnia as a disease (primary) and as a symptom (secondary) is essential for better conceptualization of the condition for etiopathogenesis, and it is also important for choosing the most appropriate and effective therapy. For these reasons, a systematic evaluation of insomnia cases is needed.