低频重复经颅磁刺激部位对老年慢性失眠症患者的影响

目的:探讨不同部位低频重复经颅磁刺激(rTMS)对老年慢性失眠症患者睡眠及日间疲劳的影响。方法:90例患者被随机分为右背外侧前额叶皮质(DLPFC)组、脑干中缝核(RN)组和伪刺激组。右DLPFC组和RN组分别在右侧DLPFC区和RN区给予低频rTMS,伪刺激组将线圈垂直竖起置于顶叶。治疗4周前后,通过睡眠日记获取患者睡眠潜伏期(SOL)、睡后觉醒时间(WASO)、睡后觉醒次数(WNSO)、总睡眠时间(TST)、总卧床时间(TIB)、睡眠效率(SE),并评定匹兹堡睡眠质量指数(PSQI)和多维度疲劳量表(MFI)的分项分及总分,比较治疗前后各项指标和评分的差异。结果:治疗后与治疗前对比,右DLPFC组和RN组SOL、WASO、WNSO、TST、SE及PSQI各项评分与MFI总分和一般疲劳、躯体疲劳、精神疲劳分项得分出现显著降低,差异具有显著性意义(P<0.05),而伪刺激组虽个别患者评分也出现小幅下降,但差异无显著性意义(P>0.05)。多组间比较,右DLPFC组在TST、SE及PSQI的睡眠质量、睡眠时间、睡眠效率、日间功能、总分和MFI的总分、一般疲劳、精神疲劳方面改善最好,差异具有显著性意义(P<0.05)。结论:低频rTMS刺激右DLPFC区较RN区对老年慢性失眠症患者的主观睡眠质量和日间疲劳度改善更优。

The influence of low-frequency repetitive transcranial magnetic stimulation sites on the elderly patients with chronic insomnia

Objective: To investigate the influence of low-frequency repetitive transcranial magnetic stimulation sites on the sleep and daytime fatigue of the elderly patients with chronic insomnia.Method: Ninety patients were selected and divided into 3 groups randomly, which are Right DLPFC(Dorsolateral prefrontal cortex) group, RN(raphe nuclei) group and Sham stimulation group. At the pre-and the post-4 weeks treatment, we assessed the subjective sleep quality and daytime fatigue of the patients by PSQI(Pittsburgh sleep quality index), multidimensional fatigue inventory(MFI) and sleep diary which can be used to obtain sleep onset latency(SOL), wake time after sleep onset(WASO), wake number after sleep onset(WNSO), total sleep time(TST), total time in bed(TIB) and sleep efficiency(SE).Result: There was a significant improvement in SOL, WASO, WNSO, TST, SE and the score of PSQI and MFI in the right DLPFC group and RN group after treatment in statistics, compared with the pre-treatment(P<0.05). But the similar improvement was not found in the Sham stimulation group and the difference was not significant in statistics(P>0.05). Meanwhile, we compared the effects of 3 groups. The right DLPFC group was the best in TST, SE, PSQI, subjective sleep quality, sleep duration, habitual sleep efficiency, daytime dysfunction, MFI, general fatigue, mental fatigue. There was a significant difference among the right DLPFC group, the RN group and the sham group in statistics(P<0.05).Conclusion: It is more efficacious for stimulating the right DLPFC than the RN to improve the subjective sleep quality and alleviate daytime fatigue of the elderly patients with chronic insomnia.