{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T08:36:17Z","timestamp":1768120577801,"version":"3.49.0"},"reference-count":22,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001349","name":"National Medical Research Council of Singapore","doi-asserted-by":"crossref","award":["MOH-001183-0"],"award-info":[{"award-number":["MOH-001183-0"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: This study aimed to characterize objective sleep measures in subacute acquired brain injury (ABI) and examine if disturbed sleep is associated with poor recovery outcomes. Another objective was to compare the functional connectivity of the brain between ABI poor sleepers and ABI normal sleepers as measured by resting state functional magnetic resonance imaging (rs-fMRI). Methods: This was a pilot, prospective, observational study of ABI subjects compared with age and gender-matched healthy controls. A total of 27 ABI subjects (consisting of ischemic or haemorrhagic stroke, or traumatic injury) were recruited from the outpatient clinics of a tertiary hospital with a neurological centre, and 49 healthy controls were recruited by word-of-mouth referrals. Study procedure involved subjective and objective sleep measures, self-report psychological measures, cognitive tests, and structural and functional MRI of the brain. Results: The frequency of poor-quality sleep was 66.67% in the ABI group and not significantly different from 67.35% in the control group when compared by chi-squared test (p = 0.68). ABI subjects with poor sleep had worse performance on a test of sustained attention (Colour Trails Test 1) than healthy controls with poor sleep when compared by Student\u2019s t-test (mean 55.95 s, SD \u00b1 18.48 vs. mean 40.04 s, SD \u00b1 14.31, p = 0.01). Anxious ABI subjects have poorer sleep efficiency and greater time spent awake after sleep onset (WASO). ABI-poor sleepers show significantly greater functional connectivity within a frontoparietal network and bilateral cerebellum. Conclusions: Sleep problems after ABI are associated with poorer cognitive and psychological outcomes. ABI-poor sleepers exhibit altered functional connectivity within regions that contribute to motor planning, attention, and self-referential processes, suggesting that disrupted sleep after ABI may impair the integration of sensorimotor and cognitive control systems, and therefore, impair recovery.<\/jats:p>","DOI":"10.3390\/jcm15020534","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T08:09:06Z","timestamp":1767946146000},"page":"534","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pilot Neuroimaging Evidence of Altered Resting Functional Connectivity of the Brain Associated with Poor Sleep After Acquired Brain Injury"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3553-1525","authenticated-orcid":false,"given":"Lai Gwen","family":"Chan","sequence":"first","affiliation":[{"name":"Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Lin","sequence":"additional","affiliation":[{"name":"Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3863-0994","authenticated-orcid":false,"given":"Chin Leong","family":"Lim","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"},{"name":"College of Health Science, VinUniversity, Hanoi 12426, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ding, C., Wu, Y., Chen, X., Chen, Y., Wu, Z., Lin, Z., Kang, D., Fang, W., and Chen, F. (2022). Global, regional, and national burden and attributable risk factors of neurological disorders: The Global Burden of Disease study 1990\u20132019. Front. Public Health, 10, Available online: https:\/\/www.frontiersin.org\/journals\/public-health\/articles\/10.3389\/fpubh.2022.952161.","DOI":"10.3389\/fpubh.2022.952161"},{"key":"ref_2","first-page":"177","article-title":"Functions of sleep","volume":"70","year":"2021","journal-title":"Physiol. Res."},{"key":"ref_3","first-page":"91","article-title":"The consequences of sleep deprivation on cognitive performance","volume":"28","author":"Khan","year":"2023","journal-title":"Neurosci. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e33777","DOI":"10.1097\/MD.0000000000033777","article-title":"Sleep quality after stroke: A systematic review and meta-analysis","volume":"102","author":"Luo","year":"2023","journal-title":"Medicine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1177\/1545968320962501","article-title":"The impact of sleep disorders on functional recovery and participation following stroke: A systematic review and meta-analysis","volume":"34","author":"Fulk","year":"2020","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.aucc.2020.05.006","article-title":"Sleep and agitation during subacute traumatic brain injury rehabilitation: A scoping review","volume":"34","author":"Poulsen","year":"2021","journal-title":"Aust. Crit. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1080\/09638288.2018.1516819","article-title":"Sleep disturbance and recovery during rehabilitation after traumatic brain injury: A systematic review","volume":"42","author":"Lowe","year":"2020","journal-title":"Disabil. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1750","DOI":"10.1093\/milmed\/usaa142","article-title":"Testosterone and Resting State Connectivity of the Parahippocampal Gyrus in Men with History of Deployment-Related Mild Traumatic Brain Injury","volume":"185","author":"Knutson","year":"2020","journal-title":"Mil. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Wang, H., Huang, Y., Li, M., Yang, H., An, J., Leng, X., Xu, D., and Qiu, S. (2022). Regional brain dysfunction in insomnia after ischemic stroke: A resting-state fMRI study. Front. Neurol., 13, Available online: https:\/\/www.frontiersin.org\/journals\/neurology\/articles\/10.3389\/fneur.2022.1025174.","DOI":"10.3389\/fneur.2022.1025174"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1389-9457(00)00065-4","article-title":"Validation of the Insomnia Severity Index as an outcome measure for insomnia research","volume":"2","author":"Bastien","year":"2001","journal-title":"Sleep Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_15","unstructured":"D\u2019Elia, L.F., Satz, P., Uchiyama, T., and White, T. (1996). Color Trails Test Professional Manual, Psychological Assessment Resources."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Smith, A. (1973). Symbol Digit Modalities Test, Western Psychological Services.","DOI":"10.1037\/t27513-000"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/arclin\/acr039","article-title":"Sensitivity and Test\u2013Retest Reliability of the International Shopping List Test in Assessing Verbal Learning and Memory in Mild Alzheimer\u2019s Disease","volume":"26","author":"Thompson","year":"2011","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"419","DOI":"10.5664\/jcsm.5598","article-title":"Sleep disturbances in traumatic brain injury: A meta-analysis","volume":"12","author":"Grima","year":"2016","journal-title":"J. Clin. Sleep Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1016\/j.ncl.2012.08.008","article-title":"Traumatic Brain Injury and Sleep Disorders","volume":"30","author":"Watson","year":"2012","journal-title":"Neurol. Clin."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1038\/nrn.2017.55","article-title":"The sleep-deprived human brain","volume":"18","author":"Krause","year":"2017","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Yang, Y., Yang, Y., Li, J., Xin, W., Huang, Y., Shao, Y., and Zhang, X. (2019). Alterations in cerebellar functional connectivity are correlated with decreased psychomotor vigilance following total sleep deprivation. Front. Neurosci., 13.","DOI":"10.3389\/fnins.2019.00134"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/B978-0-444-63956-1.00004-7","article-title":"Functional topography of the human cerebellum","volume":"154","author":"Stoodley","year":"2018","journal-title":"Handb. Clin. Neurol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/534\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T05:13:51Z","timestamp":1768108431000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/534"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020534"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020534","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]}}}