| Liu Yani,Sui Xiaojie,Bai Yinxia,Lyu Dongsheng,Yao Ping,Efficacy of rTMS and CBT-I on patients with chronic insomnia disorder： a randomized controlled study[J].SICHUAN MENTAL HEALTH,2024,37(3):212-218 |
| Efficacy of rTMS and CBT-I on patients with chronic insomnia disorder： a randomized controlled study |
DOI：10.11886/scjsws20240105001 |
| English keywords:Chronic insomnia disorder Repetitive transcranial magnetic stimulation Cognitive behavioral therapy for insomnia Clinical efficacy Functional connectivity |
| Fund projects:内蒙古自治区科技计划项目（项目名称：内蒙古自治区失眠障碍流行病学的调查及干预研究措施，项目编号：201802142） |
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| Background To date， pharmacologic therapy is considered the standard first-line treatment for insomnia disorder， but there are still some concerns over the adverse reactions. Repetitive transcranial magnetic stimulation （rTMS） and cognitive behavioral therapy for insomnia （CBT-I） as an alternative to pharmacologic therapy have the advantages of fewer side effects and better patient tolerance in the treatment of chronic insomnia disorder.Objective To explore the clinical efficacy of rTMS and CBT-I on chronic insomnia disorder， so as to provide a novel therapeutic option for the treatment of chronic insomnia disorder.Methods A total of 50 patients with chronic insomnia disorder attending the outpatient clinic of Inner Mongolia Autonomous Region Mental Health Center or community hospital from September 21， 2020 to December 16， 2021 and fulfilling the International Classification of Sleep Disorders， third edition （ICSD-3） diagnostic criteria were enrolled. Additionally， 16 age- and sex-matched healthy controls recruited from the community were set as control group. Patients were randomly divided into rTMS group and CBT-I group， 25 cases in each group， and received rTMS or CBT-I intervention for 6 weeks respectively. At enrollment and completion of intervention， patients were subjected to Polysomnography （PSG）， Pittsburgh Sleep Quality Index （PSQI）， Insomnia Severity Index （ISI） and Repeatable Battery for the Assessment of Neuropsychological Status （RBANS）. All participants underwent resting-state functional magnetic resonance imaging （rs-fMRI） scans， and amplitude of low-frequency fluctuation （ALFF） was calculated. The brain regions with statistically different ALFF values between patient group and control group were chosen as regions of interest （ROIs）， and whole-brain seed-based functional connectivity analyses were conducted.Results After a 6-week intervention in the two groups， the main effect of time was significant for PSQI （F=41.160， P<0.05）， ISI （F=69.615， P<0.05） and RBANS immediate memory （F=47.923， P<0.05）， language （F=12.090， P<0.05） and delayed memory indices （F=28.193， P<0.05）. A significant main effect of time for total sleep time （F=8.995， P<0.05）， a significant main effect of time for sleep efficiency （F=12.414， P<0.05）， a significant main effect of group for sleep efficiency （F=4.342， P<0.05） and a significant main effect of time for N1% （F=7.806， P<0.05） were observed. Sleep efficacy in CBT-I group improved significantly from pre- to post-test （t=-2.785， P<0.05）. Patients in rTMS group showed increased functional connectivity between the orbital superior frontal gyrus and other regions including left lentiform nucleus putamen （t=4.991， P<0.05）， right median cingulate and paracingulate gyri （t=4.471， P<0.05） and right postcentral gyrus （t=4.922， P<0.05）， and increased functional connectivity between the orbital superior frontal gyrus and left middle frontal gyrus was found in CBT-I group （t=6.586， P<0.05）.Conclusion rTMS and CBT-I may help alleviate insomnia and improve cognitive function of patients with chronic insomnia disorder. [Funded by Science and Technology Planning Projects in Inner Mongolia Autonomous Region （number， 201802142）］ |
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