Yunjee Hwang,1 Kyung Hwa Lee,2,3 Nambeom Kim,4 Jooyoung Lee,5 Ha Young Lee,2 Jeong Eun Jeon,2 Yu Jin Lee,2 Seog Ju Kim5 1Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea; 2Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea; 3Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; 4Department of Biomedical Engineering Research Center, Gachon University, Incheon, Republic of Korea; 5Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of KoreaCorrespondence: Yu Jin Lee, Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea, Email ewpsyche@snu.ac.kr Seog Ju Kim, Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea, Email ksj7126@skku.eduPurpose: Sounds play important roles in promoting and disrupting sleep. How our brain processes sleep-related sounds and individual differences in processing sleep-related sounds must be determined to understand the role of sound in sleep. We investigated neural responses to sleep-related sounds and their associations with cognitive appraisals of sleep.Participants and Methods: Forty-four healthy adults heard sleep-related and neutral sounds during functional magnetic resonance imaging using a 3T scanner. They also completed the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) questionnaire, which was used to assess cognitive appraisals of sleep. We conducted a voxel-wise whole-brain analysis to compare brain activation in response to sleep-related and neutral sounds. We also examined the association between the DBAS score and brain activity in response to sleep-related sounds (vs neutral sounds) using region of interest (ROI) and whole-brain correlation analyses. The ROIs included the anterior cingulate cortex (ACC), anterior insula (AI), and amygdala.Results: The whole-brain analysis revealed increased activation in the temporal regions and decreased activation in the ACC in response to sleep-related sounds compared to neutral sounds. The ROI and whole-brain correlation analyses showed that higher DBAS scores, indicating a negative appraisal of sleep, were significantly correlated with increased activation of the ACC, right medial prefrontal cortex, and brainstem in response to sleep-related sounds.Conclusion: These results indicate that the temporal cortex and ACC, which are implicated in affective sound processing, may play important roles in the processing of sleep-related sounds. The positive association between the neural responses to sleep-related sounds and DBAS scores suggest that negative and dysfunctional appraisals of sleep may be an important factor in individual differences in the processing of sleep-related sounds.Keywords: anterior cingulate cortex, appraisal, functional magnetic resonance imaging, sleep-related sounds