Sex Differences in Insomnia and Circadian Rhythm Disorders: A Systematic Review

Chronic sleep restriction during juvenility alters hedonic and anxiety-like behaviours in a sex-dependent fashion in adolescent Wistar rats

Chronic reduction of sleep time in children and adolescents has been related to increased incidence of anxiety and depression. In rats, protocols of protracted sleep deprivation or chronic sleep restriction (CSR) are considered a stressor. In previous studies we showed that post-weaning CSR in male rats induces anxiety-like behaviour and changes in neurotransmission in emotion-related brain areas. In the present study we examined whether the effects of this adversity are sex-dependent. Twenty-two litters, containing four males and four females were distributed into control (CTL) and CSR groups. CSR began on postnatal day (PND) 21 and lasted for 21 days; each day the animals were placed onto small platforms immersed in water for 18 h and were allowed to sleep freely in their home-cages for the remaining 6 h. Throughout the CSR, all animals underwent the sucrose splash test once/week to assess their self-care and hedonic behaviours. Body weight was measured on PNDs 21 and 42. At the end of CSR period, the adolescents were allowed to sleep freely for 2 days, after which, behavioural tests began. Within each litter, one male and one female (pair) were not tested and provided blood and brain for determination of basal corticosterone (CORT) levels and hippocampal BDNF. One pair was tested in the sucrose preference test (SPT), one pair on the elevated plus maze (EPM) and one pair in the forced swim test (FST). CORT was measured after all conditions. CSR impaired self-care behaviour and body weight gain in males and females and increased relative adrenal weight only in males. There were no changes in sucrose intake in the SPT; CSR females displayed less immobility in the FST and CSR males displayed more anxiety-like behaviour in the EPM. CORT levels were similar between CTL and CSR males, whilst lower in CSR females than CTL ones in all experimental conditions. No changes in BDNF levels were detected in the dorsal hippocampus of CSR rats. The results indicate that CSR impaired self-care behaviour in both sexes, but only males displayed anxiety-like behaviour, whilst sleep recovery in females appeared to normalise their behaviour.

The abnormalities of brain function in females with primary insomnia: a resting-state functional magnetic resonance imaging study

Background

The neuropathologic mechanism of primary insomnia (PI) of females remains unclear. This study aims to investigate the features of amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) in females with PI using functional magnetic resonance imaging (fMRI), and then explore the abnormalities of functional connectivity (FC).

Materials and methods

A total of 39 female PI patients and 31 female healthy controls (HC) were enrolled in the study. The sleep condition was assessed using the Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI), and their depressive symptom was evaluated using the Hamilton Depression Scale (HAMD-24). The rs-fMRI was once conducted for every subject. ReHo, ALFF, and ROI-based FC were used to analyze the changes of brain function.

Results

ALFF values were increased in the Cerebelum_4_5_L, as well as decreased ALFF in the bilateral Frontal_Sup_Medial (SFGmed), Angular_L (ANG.L), Parietal_Inf_R (IPL.R), SupraMarginal_R (SMG.R), and Postcentral_R (PoCG.R). ReHo values were increased in the Temporal_Pole_Mid_R (TPOsup.R), as well as decreased ReHo in the Insula_R (INS.R), Frontal_Inf_Oper_R (ORBinf.R), Putamen_R (PUT.R), Rolandic_Oper_R (ROL.R), bilateral Cingulum_Post (PCG), bilateral Frontal_Sup_Medial (SFGmed), bilateral anterior cingulate and paracingulate gyri (ACG), and the bilateral precuneus (PCUN). Across the entire brain, there was a decline in the FC between Angular_R and Frontal_Sup_Medial_L.

Conclusion

Alterations in brain regions of female patients with PI involved multiple functional networks, including the default mode network, the salience network, the central executive network, and the limbic network. Reduced coordination between functional networks may be an important mechanism for insomnia and may lead to reduced cognitive function and decision-making ability.

The yin and yang of two opponent processes of sleep-wake regulation: Sex-associated differences in the spectral EEG markers of the drives for sleep and wake

Although objectively measured characteristics of sleep efficiency and quality were found to be better in women than men, women more frequently than men suffer from poor or insufficient or non-restorative sleep. We explored this apparent paradox by testing the sex-associated differences in electroencephalographic (EEG) indicators of two opponent processes of sleep-wake regulation, the drives for sleep and wake. We tried to provide empirical support for the hypothesis that a stronger women's sleep drive can explain better objective characteristics of sleep quality in women than men, while a stronger women's wake drive can be an explanation of a higher frequency of sleep-related complaints in women than men. To our knowledge, this was the first attempt to examine the associations of sex with scores on the 1st and 2nd principal components of the EEG spectrum that can serve as objective spectral EEG markers of the opponent drives for sleep and wake, respectively. The particular prediction was that, in women compared to men, not only the 1st principal component score but also the 2nd principal component score could be higher (i.e. both drives could be stronger). In a sample of 80 university students (40 females), the EEG signals were recorded during 160 afternoon napping attempts (50 min or longer). The difference between male and female students in sleep latencies did not reach a statistically significant level. In accordance with our prediction, both principal component scores were found to be higher in female than in male students irrespective of sleep stage. It is likely that the influence of the wake drive is entirely overlooked in the polysomnographic studies due to the predominant contribution of the indicators of the sleep drive to the conventional objective characteristics of sleep quality. Therefore, a stronger women's sleep drive can be an explanation of women's better sleep quality in the results of polysomnographic studies. On the other hand, if a stronger women's wake drive can influence the perception of their sleep quality, this can explain their more frequent sleep-related complaints.