Neuroimaging biomarkers in sleep disruptions: current evidence from a radiology perspective

Sleep disruption has emerged as an important contributor to cognitive, neurovascular, and metabolic dysfunction, yet its acute cerebral correlates remain incompletely characterized. This review synthesizes current evidence on structural, diffusion, functional, metabolic, and optical neuroimaging biomarkers associated with acute sleep deprivation from a radiology perspective. Structural magnetic resonance imaging studies show rapid but often reversible changes in gray matter morphology and perivascular spaces, whereas white matter signal abnormalities predominantly reflect underlying chronic vascular vulnerability. Diffusion-based approaches, including diffusion tensor and diffusion kurtosis imaging, and diffusion tensor image analysis along the perivascular space, reveal alterations in white matter microstructure and glymphatic transport that may reflect impaired waste clearance and increased vulnerability to sleep debt. Functional magnetic resonance imaging demonstrates disruptions in the default mode, thalamic, and frontoparietal networks, alongside impaired task-related activation and reduced attentional performance due to acute sleep deprivation. Positron emission tomography and magnetic resonance spectroscopy provide complementary metabolic and neurochemical evidence of reduced glucose utilization, incomplete recovery after deprivation, and sleep-related shifts in cerebral metabolites. Functional near-infrared spectroscopy further highlights deficits in prefrontal neurovascular coupling during acute sleep deprivation. Taken together, these modalities indicate that even short-term sleep disruption produces measurable and potentially clinically relevant changes in the brain. Determining whether these transient neuroimaging shifts predict long-term neurological consequences requires prospective, longitudinal studies with standardized acquisition and analysis pipelines to accelerate the clinical translation of quantitative sleep debt biomarkers.