EEG spectral analysis in insomnia disorder: A systematic review and meta-analysis

Insomnia disorder (ID) has become the second-most common mental disorder. Despite burgeoning evidence for increased high-frequency electroencephalography (EEG) activity and cortical hyperarousal in ID, the detailed spectral features of this disorder during wakefulness and different sleep stages remain unclear. Therefore, we adopted a meta-analytic approach to systematically assess existing evidence on EEG spectral features in ID. Hedges's g was calculated by 148 effect sizes from 24 studies involving 977 participants. Our results demonstrate that, throughout wakefulness and sleep, patients with ID exhibited increased beta band power, although such increases sometimes extended into neighboring frequency bands. Patients with ID also exhibited increased theta and gamma power during wakefulness, as well as increased alpha and sigma power during rapid eye movement (REM) sleep. In addition, ID was associated with decreased delta power and increased theta, alpha, and sigma power during NREM sleep. The EEG measures of absolute and relative power have similar sensitivity in detecting spectral features of ID during wakefulness and REM sleep; however, relative power appeared to be a more sensitive biomarker during NREM sleep. Our study is the first statistics-based review to quantify EEG power spectra across stages of sleep and wakefulness in patients with ID.