Summary: Among veterans with traumatic brain injury (TBI), poor sleep was linked to larger MRI-visible perivascular spaces and an increase in persistent post-concussive symptoms.
Source: Oregon Health and Sciences University
Sound, restorative sleep appears vital to recovery after traumatic brain injury, according to a new study of military veterans.
Published in the Journal of Neurotrauma, the study used an advanced MRI analysis developed at Oregon Health & Science University to evaluate perivascular spaces (PVS) — small fluid-filled channels that surround blood vessels in the brain. Enlargement of these spaces is associated with aging and with increased risk for cognitive decline, including dementia.
In this veteran cohort, individuals who reported poor sleep showed greater enlargement of perivascular spaces and experienced more severe post-concussive symptoms than those who slept well.
“These findings have important implications for both active-duty service members and veterans, as well as for civilians,” said Juan Piantino, M.D., MCR, assistant professor of pediatrics (neurology) at OHSU and lead author of the study. “The results suggest that sleep supports the brain’s clearance mechanisms after traumatic injury — and without good sleep, waste removal may be less effective.”
Piantino, a physician-scientist at OHSU’s Papé Family Pediatric Research Institute, studies how sleep quality affects recovery after traumatic brain injury.
The study benefited from an automated MRI technique created by co-authors Daniel Schwartz and Erin Boespflug, Ph.D., under the guidance of Lisa Silbert, M.D., M.C.R., professor of neurology at OHSU. This approach measures the number, location, and diameter of perivascular channels, providing a precise assessment of PVS burden as an indicator of glymphatic system function — the brain-wide pathway believed to clear metabolic waste during sleep.
“Using this method, we could accurately quantify PVS structures across the white matter,” Piantino said.
Co-author Jeffrey Iliff, Ph.D., professor of psychiatry and behavioral sciences and of neurology at the University of Washington and a researcher at the VA Puget Sound Health Care System, has conducted extensive research into the glymphatic system’s role in neurodegenerative diseases such as Alzheimer’s. His work supports the concept that sleep enhances clearance of metabolic proteins that otherwise accumulate in the brain.
The analysis used data from 56 Iraq and Afghanistan veterans enrolled between 2011 and 2019 through the VA Puget Sound Mental Illness Research, Education and Clinical Center, led by co-authors Elaine Peskind, M.D., and Murray Raskind, M.D.
Piantino explained the hypothesis with a simple analogy: “When the brain is healthy, waste is managed efficiently. After a concussion, the brain produces more metabolic byproducts that must be removed, but the clearance pathways can become overwhelmed or impaired.”
The study’s findings suggest that the MRI-based method developed by Silbert’s team could also be useful for evaluating risk in older adults. “In the long term, this technique may help identify individuals at higher risk for cognitive decline, including dementia,” Piantino said.
This research adds to a growing body of evidence positioning sleep as a central factor in brain health. Improving sleep is a modifiable behavior that can be addressed through practical measures such as maintaining consistent sleep schedules, minimizing screen time before bed, and optimizing sleep environment — all areas of interest for OHSU researchers, including Miranda Lim, M.D., Ph.D., associate professor of neurology, medicine, and behavioral neuroscience and a mentor to Piantino.
“This study places sleep squarely at the center of recovery after traumatic brain injury,” Piantino said.
Funding: The research was supported by the National Heart, Lung, and Blood Institute of the NIH (award K23HL150217-01); the U.S. Department of Veterans Affairs Rehabilitation Research and Development Service Merit Review grant B77421; and NIH award P30AG008017-18.
About this sleep and TBI research news
Source: Oregon Health and Sciences University
Contact: Erik Robinson – Oregon Health and Sciences University
Image: The image is in the public domain
Original Research: Closed access. “Link between mild traumatic brain injury, poor sleep, and MRI-visible perivascular spaces in Veterans” by Juan Piantino et al., Journal of Neurotrauma
Abstract
Link between mild traumatic brain injury, poor sleep, and MRI-visible perivascular spaces in Veterans
Impaired clearance of perivascular waste from the brain may contribute to long-term problems following mild traumatic brain injury (mTBI). This study examined whether mTBI in U.S. military veterans is associated with an increased burden of MRI-visible perivascular spaces (PVS), and whether sleep quality modifies that relationship. The analysis also explored correlations between PVS burden and the severity of persistent post-concussive symptoms.
Fifty-six Iraq/Afghanistan veterans underwent 3T MRI as part of a prospective cohort study of military blast-related mTBI. White matter PVS burden — measured as both the number and the volume of visible PVS — was calculated with an established automated segmentation algorithm. Multivariate regression models assessed the association between military mTBIs and PVS burden while adjusting for age, blood pressure, number of non-military impact mTBIs, and blast exposures.
Results showed a statistically significant positive relationship between the number of mTBIs sustained during military service and both PVS count and PVS volume (p = 0.04). A significant interaction was observed between mTBI and poor sleep on PVS volume (p = 0.04), indicating that sleep quality influences the impact of mTBI on PVS burden. PVS number and volume also correlated with greater severity of persistent post-concussive symptoms (p = 0.03), with further analysis revealing a moderate correlation between PVS measures and balance problems (p < 0.001).
In this cohort of Iraq and Afghanistan veterans, mTBI was associated with increased PVS burden. Poor sleep amplified that association, and higher PVS burden — a potential marker of impaired waste clearance — was linked to more severe persistent post-concussive symptoms.