{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:19:09Z","timestamp":1790813949464,"version":"4.1.0"},"reference-count":52,"publisher":"SAGE Publications","issue":"17","license":[{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>\n                    Impaired clearance of perivascular waste in the brain may play a critical role in morbidity after mild traumatic brain injury (mTBI). We aimed to determine the effect of mTBI on the burden of magnetic resonance imaging (MRI)-visible perivascular spaces (PVSs) in a cohort of U.S. military veterans and whether sleep modulates this effect. We also investigated the correlation between PVS burden and severity of persistent post-concussive symptoms. Fifty-six Iraq\/Afghanistan veterans received 3 Tesla MRI as part of a prospective cohort study on military blast mTBI. White matter PVS burden (i.e., number and volume) was calculated using an established automated segmentation algorithm. Multi-variate regression was used to establish the association between mTBIs sustained in the military and PVS burden. Covariates included age, blood pressure, number of impact mTBIs outside the military, and blast exposures. Correlation coefficients were calculated between PVS burden and severity of persistent post-concussive symptoms. There was a significant positive relationship between the number of mTBIs sustained in the military and both PVS number and volume (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.04). A significant interaction was found between mTBI and poor sleep on PVS volume (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.04). A correlation was found between PVS number and volume, as well as severity of postconcussive symptoms (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.03). Further analysis revealed a moderate correlation between PVS number and volume, as well as balance problems (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.001). In Iraq\/Afghanistan veterans, mTBI is associated with an increase in PVS burden. Further, an interaction exists between mTBI and poor sleep on PVS burden. Increased PVS burden, which may indicate waste clearance dysfunction, is associated with persistent post-concussive symptom severity.\n                  <\/jats:p>","DOI":"10.1089\/neu.2020.7447","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T06:14:36Z","timestamp":1613628876000},"page":"2391-2399","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":77,"title":["Link between Mild Traumatic Brain Injury, Poor Sleep, and Magnetic Resonance Imaging: Visible Perivascular Spaces in Veterans"],"prefix":"10.1177","volume":"38","author":[{"given":"Juan","family":"Piantino","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Child Neurology, Doernbecher Children's Hospital, Department of Emergency Medicine, Oregon Health &amp; Science University, Portland, Oregon, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel L.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Layton Aging and Alzheimer's Disease Center, Neurology, Department of Emergency Medicine, Oregon Health &amp; Science University, Portland, Oregon, USA."},{"name":"Advanced Imaging Research Center, Department of Emergency Medicine, Oregon Health &amp; Science University, Portland, Oregon, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Luther","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Child Neurology, Doernbecher Children's Hospital, Department of Emergency Medicine, Oregon Health &amp; Science University, Portland, Oregon, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Newgard","sequence":"additional","affiliation":[{"name":"Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health &amp; Science University, Portland, Oregon, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Silbert","sequence":"additional","affiliation":[{"name":"Layton Aging and Alzheimer's Disease Center, Neurology, Department of Emergency Medicine, Oregon Health &amp; Science University, Portland, Oregon, USA."},{"name":"Portland Veterans Affairs Medical Center, Neurology, Portland, Oregon, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murray","family":"Raskind","sequence":"additional","affiliation":[{"name":"Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA."},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Pagulayan","sequence":"additional","affiliation":[{"name":"Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA."},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Kleinhans","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Iliff","sequence":"additional","affiliation":[{"name":"Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA."},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA."},{"name":"Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Peskind","sequence":"additional","affiliation":[{"name":"Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA."},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa072972"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.3171\/JNS\/2008\/108\/5\/0950"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617709991287"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2012.04.006"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(96)90196-3"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001199-200605000-00001"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0b013e3181a0b281"},{"key":"e_1_3_4_9_2","first-page":"403","article-title":"Sleep, sleep disorders, and mild traumatic brain injury","volume":"13","author":"Wickwire E.M.","year":"2016","unstructured":"Wickwire E.M., , Williams S.G., , Roth T., , Capaldi V.F., , Jaffe M., , Moline M., , Motamedi G.K., , Morgan G.W., , Mysliwiec V., , Germain A., , Pazdan R.M., , Ferziger R., , Balkin T.J., , MacDonald M.E., , Macek T.A., , Yochelson M.R., , Scharf S.M., , and Lettieri C.J. 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