| 【Abstract】 Background Currently, patients with insomnia disorder are mainly treated with medication, which has the disadvantages of adverse drug reactions. Compared with medication treatment, repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioral therapy (CBT-I) have the advantages of small side effects and good tolerance in the treatment of chronic insomnia disorder (CID). Objective To explore the clinical efficacy of rTMS and CBT-I in treating patients with chronic insomnia disorder, providing more references and choices for CID patients. Methods 46 CID patients who visited the outpatient/community clinics of the Inner Mongolia Autonomous Region Mental Health Center from September 21, 2020, to December 16, 2021, and 16 age and gender-matched healthy controls. Diagnoses were based on the American International Classification of Sleep Disorders Third Edition (ICSD-3). The CID patients were randomly divided into rTMS group and CBT-I group according to random number table method, and received 6 weeks of rTMS or CBT-I treatment respectively. Before and after intervention, both groups received polysomnography (PSG), the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); all participants completed resting-state functional magnetic resonance imaging (rs-fMRI) scans for low-frequency amplitude analysis. At the same time, the brain regions with different low-frequency amplitude analysis in CID patients and healthy controls were taken as regions of interest (ROI) for functional connectivity analysis. Results: After a 6-week intervention in the two groups of CID patients, there were statistically significant main effects of time on PSQI (F=41.160, P<0.05), ISI (F=69.615, P<0.05), and the RBANS assessment for immediate recall (F=47.923, P<0.05), language function (F=12.09, P<0.05), and delayed memory (F=28.193, P<0.05). The CBT-I group showed a significant increase in sleep efficiency compared to pre-treatment (t=?2.785, P<0.05). The total sleep time and sleep efficiency's time main effects were statistically significant post-intervention (F=3.035, P<0.05; F=3.574, P<0.05), with a significant group main effect in sleep efficiency (F=2.162, P<0.05). Results of functional connectivity during resting states indicated that the rTMS group showed more excellent functional connectivity of the orbital part of the superior frontal gyrus with the left caudate nucleus (t=4.991, P<0.05), the medial and adjacent cingulate gyrus on the right (t=4.471, P<0.05), and the right postcentral gyrus (t=4.922, P<0.05). The functional connectivity with the left middle frontal gyrus was significantly increased in the orbital part of the superior frontal gyrus in the CBT-I group (t=6.586, P<0.05). Conclusion The primary mechanism of rTMS treatment for improving sleep is to promote neural regeneration or reconstruction by regulating the release of various neurotransmitters. On the contrary, the CBT-I intervention mostly takes the improvement of sleep quality as its core and changes the cognitive patterns and behavioral habits of patients. Both treatments have been effective, to some extent, in increasing the quality of sleep and cognitive functions. |