White Matter Alterations in Heart-kidney Imbalance Insomnia and Jiao-tai-wan Treatment: A Diffusion-tensor Imaging Study

Abstract Background: Previous studies have reported changes in white matter (WM) microstructures in patients with insomnia. However, few neuroimaging studies have focused specifically on WM tracts in insomnia patients after having received treatment. In this prospective study, diffusion-tensor imaging was used in two samples of heart-kidney imbalance insomnia patients (HKIIPs) who were treated with Jiao-Tai-Wan (JTW) or a placebo to assess the changes in WM tracts.Methods: Tract-based spatial statistical analyses were first applied to compare the changes in mean diffusivity (MD) and fractional anisotropy (FA) of WM between 75 HKIIPs and 41 healthy control participants. In subsequent randomized, double-blind, placebo-controlled trials, comparisons of MD and FA were also performed in 24 HKIIPs (8 males; 16 females; 42.5 ± 10.4 years) with JTW and 26 HKIIPs (11 males; 15 females; 39.7 ± 9.4 years) with a placebo, with age and sex as covariates.Results: HKIIPs showed lower MD and FA values of several WM tracts than healthy control participants, such as the bilateral anterior limb of internal capsule, bilateral superior longitudinal fasciculus and bilateral posterior corona radiata. Specifically, FA values in left corticospinal tract (CST) were increased in HKIIPs. After being treated with JTW, HKIIPs showed a trend towards reduced FA values in the left CST.Conclusions: These results suggest that JTW may reverse WM alterations caused by heart-kidney imbalance insomnia.Trial registration: Chinese Clinical Trial Registry, ChiCTR1800019239; registered on 1 November 2018-retrospectively registered, http://www.chictr.org.cn/listbycreater.aspx, more than a month after the start of the experiment. The delay was due to lack of experience regarding trail, registration with a data sharing website.