| 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 |
| EN KeyWords: low-frequency repetitive transcranial magnetic stimulation chronic insomnia disorder hyperarousal polysomnography |
| Fund Project: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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| EN Abstract: |
| 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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