耳穴刺激经迷走神经对失眠伴抑郁患者多导睡眠图特征的影响

Effects of auricular point stimulation via the vagus nerve on polysomnographic features in patients with insomnia and depression

目的:观察耳穴刺激经迷走神经(taVNS)对失眠伴抑郁患者客观睡眠结构及各睡眠阶段脑电功率谱的影响。方法:纳入21例失眠伴抑郁患者,采用治疗前后自身对照的原则,评估经taVNS治疗4周前后匹兹堡睡眠质量指数(PSQI)、汉密尔顿抑郁量表(HAMD-17)评分及多导睡眠监测(PSG),分析睡眠连续性指标:总睡眠时间(TST)、睡眠潜伏期(SL)、睡眠效率(SE)、入睡后的觉醒(WASO);睡眠结构:非快速眼动睡眠1、2、3期(NREM 1、NREM 2、NREM 3)和快速眼动睡眠期(REM)百分比,并分析其脑电功率谱变化。结果:与治疗前比较,taVNS治疗4周后失眠伴抑郁患者PSQI、HAMD-17评分显著降低;SE和NREM 3显著升高、SL显著缩短;NREM 1的delta1功率谱显著降低、NREM 3的delta2功率谱显著升高,以上差异均有统计学意义(P<0.05,P<0.01)。结论:taVNS可有效改善失眠伴抑郁患者的临床症状、调整睡眠连续性、睡眠结构及增加NREM 3的delta2功率谱,降低皮层过度觉醒状态。

Objective: To observe the effects of transcutaneous auricular vagus nerve stimulation(taVNS) on objective sleep structure and EEG power spectrum of insomnia and depression. Methods: A total of 21 patients with insomnia and depression were included, and the principle of body control before and after treatment was adopted. Pittsburgh sleep Quality Index(PSQI),Hamilton Depression Scale(HAMD-17) score and polysomnography monitoring(PSG) were evaluated before and after taVNS treatment for 4 weeks. Sleep continuity indicators were analyzed: total sleep time(TST), sleep latency(SL), sleep efficiency(SE) and wake after falling asleep(WASO);Sleep structure: percentage of nonrapid eye movement sleep(NREM) 1, NREM 2, NREM 3 and rapid eye movement sleep(REM), and change of EEG power spectrum were analyzed. Results: After taVNS treatment for 4 weeks,PSQI and HAMD-17 scores of insomnia patients with depression were significantly lower than before treatment. SE and NREM 3were significantly increased and SL was significantly shortened. NREM 1 delta1 power spectrum decreased significantly, NREM 3delta2 power spectrum increased significantly. The above differences were statistically significant(P<0.05, P<0.01). Conclusion:taVNS can effectively improve the clinical symptoms, adjust the sleep continuity and sleep structure, increase the NREM 3 delta2power spectrum, and reduce the hyperarousal state of the cortex in patients with insomnia and depression.