重复经颅磁刺激在大学生高水平女排运动员赛前焦虑及睡眠管理中的疗效探索

Exploration of Therapeutic Effect of Repetitive Transcranial Magnetic Stimulation on Pre-competitive Anxiety and Sleep Management among High-level Female Volleyball Players

目的:调查重复经颅磁刺激(rTMS)是否可以有效改善大学生高水平女排队员赛前焦虑及睡眠障碍。方法:21例被试随机分入实验组(n=11)接受rTMS干预,对照组(n=10)接受安慰剂rTMS干预。干预从赛前2周开始,3次/周,隔天1次,至赛前1天结束。所有被试于夏训期间(某一常规训练日)、赛前2周及赛前1天,予以竞赛状态焦虑量表(CSAI-2)测评并观察脑源性神经营养因子(BDNF)和血清神经元特异性烯醇化酶(NSE),以及血清神经递质包括5-羟色胺(5-HT)、去甲肾上腺素(NE)和多巴胺(DA)表达水平的变化,考虑到焦虑与睡眠的潜在联系,所有被试还接受Actigraphy监测[主要监测睡眠效率(SE)、总睡眠时间(TST)和睡眠觉醒水平(SA)]结果:(1)与夏训期间相比,两组被试在赛前2周,认知、身体状态焦虑评分均显著升高(P<0.05)但状态自信心变化不明显(P>0.05);SE、TST参数均显著下降(P<0.05),但SA变化不明显(P>0.05);三种神经递质(5-HT、NE和DA)表达水平均显著上升(P<0.05),BDNF表达水平均明显下降(P<0.05),但NSE表达水平波动不明显(P>0.05)。(2)经2周干预,实验组认知、躯体状态焦虑评分均有所下降(P<0.05),对照组认知状态焦虑评分下降不明显(P>0.05),躯体状态焦虑评分继续上升。(3)经2周干预,实验组SE、TST参数均明显回升(P<0.05),对照组SE参数继续下降,TST参数虽有小幅回升但与干预前相比并不明显(P>0.05)。(4)经2周干预,实验组BDNF表达水平明显回升(P<0.05),但对照组BDNF表达水平的下降趋势仍在继续。治疗组5-HT、NE表达水平明显回落(P<0.05),DA表达水平不但没有下降,反而呈继续上升趋势,而对照组5-HT、DA表达水平继续呈上升趋势,NE表达水平比干预前稍有回落但并不明显(P>0.05)。结论:赛前连续的rTMS干预可以在一定程度上缓解大学生高水平女排队员赛前焦虑情绪,并改善因这种负性情绪导致的睡眠效率低下和总睡眠时间减少。并且,rTMS的这种有益效益可能与其对BDNF表达水平的促进和(或)对5-HT、NE等神经递质表达水平的抑制有关。尚未有足够证据证明rTMS可以提高女排运动员的赛前状态自信心。

Objective: to investigate if repetitive transcranial magnetic stimulation (rTMS) could effectively mitigate pre-competitive anxiety and sleep disturbance among college high-level female volleyball players. Methods: 21 participants were enrolled and randomized into either experimental group (n=11) receiving rTMS therapy or control group (n=10) receiving sham-rTMS therapy. rTMS/Sham-rTMS was provided between 2 weeks before the competition and 1 day before the competition, once every other day, 3 times a week for total 2 weeks. The Competitive State Anxiety Inventory-2 (CSAI-2), expression levels of serum brain-derived neurotrophic factor (BDNF) and neuron-specific enolase (NSE), and serum neurotransmitters including 5-hydroxytryptamine (5-HT), Norepinephrine (NE) and dopamine (DA) were assessed at summer-training period (a general training day), pre-competitive 2 weeks and 1 day respectively. Considering the potential correlation between anxiety and sleep, all participants were monitored by Actigraphy [the main monitoring indicators were sleep efficiency (SE), total sleep time (TST) and sleep awakenings (SA)]Results:Compared with the summer-training period, both somatic and cognitive state anxiety were significantly increased ( P <0.05) while state self-confidence were decreased ( P <0.05) in both two groups;SE and TST parameters were significantly decreased ( P <0.05), but changes of SA were not drastic ( P > 0.05 ) in both two groups. The expression levels of neurotransmitters (5-HT, NE and DA) increased significantly ( P < 0.05 ) whereas BDNF decreased significantly ( P <0.05) in both two groups, however, no dramatic change was observed in the expression level of NSE ( P >0.05).(2) After 2-week, both somatic and cognitive state anxiety scores of the experimental group decreased ( P <0.05), while in the control group, the cognitive state anxiety score did not decrease significantly ( P >0.05), and the somatic state anxiety score continued to rise and significantly higher than that of the baseline ( P <0.05).(3) After 2-week intervention, both SE and TST parameters in the experimental group increased significantly ( P <0.05). However, the SE parameter of the control group continued to decline while the TST parameter increased slightly though it was still not significant compared with that of the pre-intervention ( P >0.05).(4) After 2-week intervention , the expression level of BDNF in the experimental group was significantly higher than that before 2 weeks ( P <0.05), but the decreasing trend of BDNF expression in the control group continued. The expression levels of 5-HT and NE in the experimental group were significantly lower than those before the intervention ( P <0.05), but the expression level of DA did not decrease, but continued to rise. The expression levels of 5-HT and DA in the control group continued to increase, and were significantly higher than the baseline levels ( P <0.05) while the expression level of NE was slightly lower than that before intervention without statistical difference ( P >0.05). Condusion:per-competitive and consecutive rTMS can mitigate pre-competition anxiety and elevate the lower SE and TST caused by this negative emotion among college high-level female volleyball players through promoting the expression of BDNF and (or) inhibiting the expression of neurotransmitters including 5-HT and NE. However, there is insufficient evidence to support that rTMS is helpful in increasing the pre-competition self-confidence among female volleyball players.