重复经颅磁刺激对脑卒中后睡眠障碍患者睡眠质量的系统评价与Meta分析

Effects of repetitive transcranial magnetic stimulation on sleep quality in patients with sleep disorder after stroke:systematic review and meta-analysis

目的评价重复经颅磁刺激(rTMS)对脑卒中后睡眠障碍(PSSD)患者睡眠质量的改善作用。方法检索国内外共9个医学数据库的有关rTMS干预PSSD患者的临床随机对照研究。经过文献去重、独立筛选、风险评估等一系列严谨操作后,将纳入文献数据录入RevMan5.4软件展开Meta分析。结果本研究共纳入符合标准的文献12篇。Meta分析结果显示:rTMS干预后PSSD患者的匹兹堡睡眠指数量表(PSQI)评分[MD=-2.60,95%CI(-3.03,-2.17),P<0.00001];多导睡眠图(PSG)各参数评分中SL[MD=-9.69,95%CI(-16.87,-2.50),P<0.01]、SE[MD=8.90,95%CI(5.41,12.39),P<0.01]、AT[MD=-1.15,95%CI(-2.26,-0.04),P=0.04]、AWT[MD=-10.95,95%CI(-13.30,-8.61),P<0.01]、REM[MD=4.54,95%CI(2.24,6.85),P<0.01];血清脑源性神经营养因子(BDNF)评分[MD=5.29,95%CI(2.47,8.11),P=0.0002];临床疗效率评分[OR=4.46,95%CI(2.75,7.23),P<0.00001],与对照组比较差异均有统计学意义(均P<0.05)。结论rTMS改善PSSD患者睡眠质量临床疗效明确,值得临床推广。

Objective To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS)on sleep quality in patients with post-stroke sleep disorder(PSSD).Methods The clinical randomized controlled trials involving PSSD patients who received rTMS were retrieved from nine medical databases.After excluding duplicated references,screening for independent references and risk evaluation,the remaining references were input into RevMan5.4 software for meta-analysis.Results Twelve eligible literatures were included in the final analysis.Meta-analysis results revealed that after rTMS intervention,there were significant differences in the following terms between the treatment and control groups(all P<0.05):Pittsburgh sleep quality index score[MD=-2.60,95%CI(-3.03,-2.17),P<0.00001];sleep latency[MD=-9.69,95%CI(-16.87,-2.50),P<0.01],sleep efficiency[MD=8.90,95%CI(5.41,12.39),P<0.01],number of awakenings[MD=-1.15,95%CI(-2.26,-0.04),P=0.04],awakening duration[MD=-10.95,95%CI(-13.30,-8.61),P<0.01],and rapid eye movement[MD=4.54,95%CI(2.24,6.85),P<0.01]in polysomnography;brain-derived neurotrophic factor score[MD=5.29,95%CI(2.47,8.11),P=0.0002];clinical curative rate[OR=4.46,95%CI(2.75,7.23),P<0.00001].Conclusion rTMS can improve the sleep quality in patients with PSSD,which is worthy of clinical promotion.