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. 2022 Mar 29;42(9):1676–1692. doi: 10.1177/0271678X221090747

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© The Author(s) 2022

This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Figure 4. — Increased CSF tracer enrichment in iNPH patients with poor sleep quality. For patient cohort #2 with the dementia subtype iNPH, CSF tracer enrichment in brain tissue is presented as percentage increase of normalized T1 MRI signal units from baseline until 24 hours, and indicated at the color scale. Tracer in CSF spaces has been subtracted. (a) The average increase in cerebral normalized T1 signal units from baseline until 24 hours for the iNPH cohort with good sleep quality is presented as sagittal (left), axial (middle), and coronal (right) MRI scans, with percentage change shown at the color scale (n = 12; Good sleepers). (b) The average percentage increase in normalized T1 signal units from baseline until 24 hours is shown for the cohort with poor sleep quality (n = 12; Poor sleepers). (c) The difference in percentage increase in normalized T1 signal units between the Poor sleepers and the Good sleepers is shown. The color maps demonstrate stronger tracer enrichment in Poor sleepers with red color indicating the highest tracer levels, which is interpreted as glymphatic enhancement. Blue color and negative values are indicative of accelerated clearance of tracer. (d) Trend plots of percentage change in normalized T1 signal units within cerebral cortex of iNPH subjects demonstrating significant differences between the Poor sleepers (red line) and Good sleepers (blue line) at 4-7 and 24 hours. (e) Trend plots of percentage change in normalized T1 signal units within white matter of cerebral cortex demonstrating significant differences between the Poor sleepers (red line) and Good sleepers (blue line) at 24 hours.*P < 0.05, **P < 0.01, ***P < 0.001. Trend plots show mean with error bars (95% confidence intervals) from linear mixed models.