| 宋昕桦,刘欣,王宏江,娄敏杰,张一可,高子唅,梅俊华,陈国华.基于多导睡眠监测探讨低频重复经颅磁刺激联合右佐匹克隆对慢性失眠障碍患者过度觉醒的影响[J].中国康复,2026,41(8):478-484 |
| 基于多导睡眠监测探讨低频重复经颅磁刺激联合右佐匹克隆对慢性失眠障碍患者过度觉醒的影响 |
| Effects of low frequency repetitive transcranial magnetic stimulation combined with eszopiclone on hyperarousal in patients with chronic insomnia disorder: a polysomnography-based study |
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| DOI：10.3870/zgkf.2026.08.006 |
| 中文关键词: 低频重复经颅磁刺激 慢性失眠障碍 过度觉醒 多导睡眠监测 |
| 英文关键词: low-frequency repetitive transcranial magnetic stimulation chronic insomnia disorder hyperarousal polysomnography |
| 基金项目:湖北省中医药管理局中医药科研项目（ZY2025L039）；广东省中医药局科研项目项目（20241053） |
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| 中文摘要: |
| 目的：过度觉醒是慢性失眠障碍（CID）的核心病理机制假说之一，本研究结合入睡前觉醒量表（PSAS）及多导睡眠监测（PSG）客观觉醒相关指标，探讨低频重复经颅磁刺激（rTMS）联合右佐匹克隆对CID失眠症状及过度觉醒表型的影响。方法：将CID患者随机分为对照组（右佐匹克隆1.5 mg/晚，n=44）与观察组（右佐匹克隆+右侧背外侧前额叶DLPFC低频rTMS，1Hz，30min/次，5次/周，n=42），干预4周，并于治疗前、第4周及第12周随访，评估匹兹堡睡眠质量指数（PSQI）、失眠严重程度指数（ISI）、入睡前觉醒量表（PSAS）及多导睡眠监测（PSG）相关觉醒指标。结果：治疗后第4周和随访第12周，2组PSQI、ISI及PSAS总分及其躯体觉醒和认知觉醒的分量表评分均较治疗前显著降低（P<0.01），观察组降低更显著（P<0.01）。治疗4周后2组入睡后觉醒时间（WASO）、觉醒次数、微觉醒指数、总自发性觉醒指数及快速眼动睡眠（REM）期自发性觉醒指数均较治疗前降低（P<0.05，0.01），观察组降低更显著（P<0.01）。结论：低频rTMS联合药物干预不仅改善CID患者主观失眠症状，同时改善其过度觉醒症状，为CID过度觉醒表型的联合治疗提供了客观证据支持。 |
| 英文摘要: |
| Objective: Hyperarousal is one of the core pathophysiological hypotheses of chronic insomnia disorder (CID). This study combined the pre-sleep arousal scale (PSAS) and objective arousal-related indicators derived from polysomnography (PSG) to investigate the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with eszopiclone on insomnia symptoms and the hyperarousal phenotype in patients with CID. Methods: Patients with CID were randomly assigned to a control group receiving eszopiclone (1.5 mg) nightly (n=44) or an observation group receiving eszopiclone plus low-frequency rTMS over the right dorsolateral prefrontal cortex (DLPFC, 1 Hz, 30 min/session, 5 sessions/week, n=42). The intervention lasted 4 weeks. The Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), PSAS, and PSG-derived arousal-related indicators were assessed at baseline, after 4 weeks of treatment, and at the 12-week follow-up. Results: At week 4 after treatment and at the 12-week follow-up, PSQI, ISI, and PSAS total scores, as well as the somatic and cognitive arousal subscale scores of the PSAS, significantly decreased from baseline in both groups (P<0.001), with greater improvements observed in the observation group, as indicated by significant group × time interactions (P<0.01). Objective PSG indicators showed that, after 4 weeks of treatment, wake after sleep onset (WASO), number of awakenings, microarousal index, total spontaneous arousal index, and rapid eye movement (REM) sleep spontane-ous arousal index were significantly reduced after treatment in both groups (P<0.05, 0.01). Interaction analyses further indicated greater improvements in the observation group (P<0.01). Conclusion: Low-frequency rTMS combined with pharmacological treatment not only improves subjective insomnia symptoms in patients with CID but also alleviates hyperarousal symptoms, providing objective evidence for a combined ther-apeutic strategy targeting the hyperarousal phenotype of CID. |
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