Neuroimaging of NREM sleep in primary insomnia: a Tc-99-HMPAO single photon emission computed tomography study

Sleep. 2002 May 1;25(3):325-35.


Study objectives: The objectives of this study were to: 1) demonstrate the feasibility of combining polysomnography and SPECT neuroimaging to study NREM sleep in primary insomnia and 2) evaluate possible functional CNS abnormalities associated with insomnia.

Design: Patients with insomnia and good sleeper controls were studied polysomnographically for three nights with a whole brain SPECT Scan of NREM sleep on Night 3. Groups were screened for medical/psychiatric history, substance use, and matched on age, body mass index, and education.

Setting: Sleep Research Laboratory and Nuclear Medicine Center

Participants: Nine females, 5 patients with chronic psychophysiologic insomnia and 4 healthy good sleepers (mean age 36 years, SD 12, range 27-55).

Interventions: N/A.

Measurements and results: Tomographs of regional cerebral blood flow during the 1st NREM sleep cycle were successfully obtained. Contrary to our expectations, patients with insomnia showed a consistent pattern of hypoperfusion across all 8 pre-selected regions of interest, with particular deactivation in the basal ganglia (p=.006). The frontal medial, occipital, and parietal cortices also showed significant decreases in blood flow compared to good sleepers (p<.05). Subjects with insomnia had decreased activity in the basal ganglia relative to the frontal lateral cortex, frontal medial cortex, thalamus, occipital and parietal cortices (p<.05).

Conclusions: This study demonstrated the feasibility of combining neuroimaging and polysomnography to study cerebral activity in chronic insomnia. These preliminary results suggest that primary insomnia may be associated with abnormal central nervous system activity during NREM sleep that is particularly linked to basal ganglia dysfunction.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Basal Ganglia / blood supply
  • Basal Ganglia / physiopathology
  • Brain / blood supply*
  • Brain / metabolism
  • Brain / physiopathology
  • Cerebrovascular Circulation / physiology
  • Female
  • Humans
  • Male
  • Polysomnography
  • Radiopharmaceuticals / pharmacokinetics
  • Severity of Illness Index
  • Sleep Initiation and Maintenance Disorders / diagnosis*
  • Sleep Initiation and Maintenance Disorders / physiopathology
  • Sleep, REM / physiology*
  • Technetium Tc 99m Exametazime* / pharmacokinetics
  • Tomography, Emission-Computed, Single-Photon*
  • Wakefulness / physiology


  • Radiopharmaceuticals
  • Technetium Tc 99m Exametazime