经皮耳穴-迷走神经电刺激对原发性失眠患者夜间自主神经功能的影响

Effect of transcutaneous auricular vagus nerve stimulation on nocturnal autonomic nervous function in primary insomnia patients

目的:观察经皮耳穴-迷走神经电刺激(taVNS)对原发性失眠(PI)患者睡眠质量及夜间心率变异性(HRV)的影响。方法:纳入PI患者21例,于耳穴心、肾区,采用SDZ-ⅡB型电子针疗仪进行刺激,予疏密波,频率4 Hz/20 Hz,脉冲宽度(0.2±30%)ms,强度以患者能耐受为度。早晚各1次,每次30 min,共治疗4周。比较患者治疗前后匹兹堡睡眠质量指数量表(PSQI)评分、客观睡眠结构[总睡眠时间(TST)、睡眠潜伏期(SL)、入睡后清醒时间(WASO)、睡眠效率(SE),非快速眼动1、2、3期和快速眼动期(REM)时间占TST的百分比(N1%、N2%、N3%、REM%)]及夜间心率变异性[高频(HF)、低频(LF)、低频/高频(LF/HF)比值、正常心动周期的标准差(SDNN)、相邻心动周期差值的均方平方根(RMSSD)、相邻RR间期差值超过50 ms的心搏数占总心搏数的百分比(PNN50%)、窦性RR间期的平均值(NNMean)]。结果:治疗后,患者PSQI各项评分及总分、SL较治疗前降低(P<0.01,P<0.001),SE、N3%、LF、HF、LF/HF、SDNN、NNMean、RMSSD较治疗前升高(P<0.001,P<0.01)。结论:taVNS可改善PI患者的睡眠质量及客观睡眠结构,可能与调节患者自主神经功能有关。

Objective To observe the effect of transcutaneous auricular vagus nerve stimulation(taVNS)on the sleep quality and nocturnal heart rate variability(HRV)in patients with primary insomnia.Methods Twenty-one patients with primary insomnia were included.Using SDZ-ⅡB electric acupuncture apparatus,Xin(CO15)and Shen(CO10)were stimulated with disperse-dense wave,4 Hz/20 Hz in frequency,(0.2±30%)ms of pulse width and tolerable intensity.Electric stimulation was given once every morning and evening of a day,30 min each time,for 4 weeks totally.Before and after treatment,the score of Pittsburgh sleep quality index(PSQI),objective sleep structure(total sleep time[TST],sleep latency[SL],wake after sleep onset[WASO],sleep efficiency[SE],the percentages of non-rapid eye movement period 1,2,3,and the percentage of rapid eye movement period to TST[N1%,N2%,N3%,REM%])and nocturnal HRV(high frequency[HF],low frequency[LF],the ratio of LF to HF[LF/HF],standard deviation for the normal RR intervals[SDNN],squared root of the mean sum of squares of differences between adjacent intervals RR[RMSSD],the percentage of adjacent RR intervals with differences larger than 50 ms in the entire recording[PNN50%],the mean of sinus RR intervals[NNMean])were compared in the patients separately.Results After treatment,the score of each item and the total score of PSQI and SL were all reduced as compared with those before treatment(P<0.01,P<0.001);SE,N3%,LF,HF,LF/HF,SDNN,NNMean and RMSSD were all increased compared with those before treatment(P<0.001,P<0.01).Conclusion The taVNS improves the sleep quality and objective sleep structure in patients with primary insomnia,which is probably related to the regulation of autonomic nervous functions.