Cross-sectional and longitudinal association of sleep patterns and aneurysmal vulnerability biomarkers on high-resolution magnetic resonance vessel wall imaging

Background Aneurysm wall enhancement (AWE) on vessel wall imaging (VWI) scans is a robust biomarker for aneurysmal vulnerability. This study aimed to explore the association of different sleep patterns with AWE and other vulnerability features. Methods Patients with unruptured intracranial aneurysms were prospectively recruited. Sleep characteristics were collected through a standard questionnaire. Poor sleep quality was defined using the Pittsburgh Sleep Quality Index (PSQI)>5. Cross-sectional multistate predictive models were used to identify various sleep patterns related to aneurysmal vulnerability. In longitudinal observation, core covariates were adjusted with each sleep characteristic to verify cross-sectional results. Results A total of 344 aneurysms were enrolled for cross-sectional analyses, while 74 cases (21.5%) that did not receive preventive treatment participated in longitudinal follow-up. In cross-sectional analysis, U-shaped relationships were evident between AWE and nocturnal sleep duration and siesta habit. Improper nocturnal sleep duration, inappropriate siesta habits, insomnia, and snoring were significantly associated with multiple VWI markers of aneurysmal vulnerability (all P<0.05). Notably, all vulnerability indicators were related to poor sleep quality. In longitudinal analysis, short nocturnal sleep duration, snoring, and poor sleep quality were independently associated with aneurysmal progression (all P<0.05). Conclusions Unhealthy sleep patterns were significantly associated with multiple features related to aneurysmal vulnerability. Interventional studies are needed to evaluate the role of improving sleep burden and individual sleep symptoms as potential targets for reducing the risk of aneurysm rupture.