Pilot Neuroimaging Evidence of Altered Resting Functional Connectivity of the Brain Associated with Poor Sleep After Acquired Brain Injury

Background/Objectives: This study aimed to characterize objective sleep measures in subacute acquired brain injury (ABI) and examine if disturbed sleep is associated with poor recovery outcomes. Another objective was to compare the functional connectivity of the brain between ABI poor sleepers and ABI normal sleepers as measured by resting state functional magnetic resonance imaging (rs-fMRI). Methods: This was a pilot, prospective, observational study of ABI subjects compared with age and gender-matched healthy controls. A total of 27 ABI subjects (consisting of ischemic or haemorrhagic stroke, or traumatic injury) were recruited from the outpatient clinics of a tertiary hospital with a neurological centre, and 49 healthy controls were recruited by word-of-mouth referrals. Study procedure involved subjective and objective sleep measures, self-report psychological measures, cognitive tests, and structural and functional MRI of the brain. Results: The frequency of poor-quality sleep was 66.67% in the ABI group and not significantly different from 67.35% in the control group when compared by chi-squared test (p = 0.68). ABI subjects with poor sleep had worse performance on a test of sustained attention (Colour Trails Test 1) than healthy controls with poor sleep when compared by Student’s t-test (mean 55.95 s, SD ± 18.48 vs. mean 40.04 s, SD ± 14.31, p = 0.01). Anxious ABI subjects have poorer sleep efficiency and greater time spent awake after sleep onset (WASO). ABI-poor sleepers show significantly greater functional connectivity within a frontoparietal network and bilateral cerebellum. Conclusions: Sleep problems after ABI are associated with poorer cognitive and psychological outcomes. ABI-poor sleepers exhibit altered functional connectivity within regions that contribute to motor planning, attention, and self-referential processes, suggesting that disrupted sleep after ABI may impair the integration of sensorimotor and cognitive control systems, and therefore, impair recovery.