低频重复经颅磁刺激和失眠认知行为疗法治疗儿童失眠症的临床效果和安全性对比

Clinical effect and safety of low-frequency repetitive transcranial magnetic stimulation versus cognitive behavioral therapy for insomnia for treating children with insomnia:a comparative study

目的比较低频重复经颅磁刺激(rTMS)和失眠认知行为疗法(CBT-I)治疗儿童失眠症的临床效果和安全性。方法将68例失眠症患儿随机分为研究组1(n=17)、研究组2(n=18)、研究组3(n=17)和对照组(n=16)。给予研究组1、研究组2、研究组3低频rTMS治疗8周(刺激数目分别为1000次、1200次、1400次),给予对照组CBT-I治疗8周。于治疗前及治疗第8周末,对4组患儿进行多导睡眠监测,并采用匹兹堡睡眠质量指数(PSQI)及儿童睡眠习惯问卷(CSHQ)评估其睡眠质量总体情况和睡眠习惯。记录4组患儿在治疗过程中不良反应的发生情况。结果(1)治疗第8周末,4组患儿的实际睡眠总时间、睡眠潜伏期、觉醒时间、觉醒次数、睡眠效率及快速眼动睡眠潜伏期均较治疗前改善(均P<0.05);研究组3患儿的实际睡眠总时间较研究组1及对照组增加,觉醒次数和快速眼动睡眠潜伏期均较其他3组减少或缩短(均P<0.05)。(2)治疗第8周末,4组患儿的非快速眼动睡眠1期、快速眼动睡眠期均较治疗前改善,研究组2和研究组3患儿的非快速眼动睡眠3期均较治疗前改善(均P<0.05);研究组3患儿的非快速眼动睡眠1期较对照组缩短,非快速眼动睡眠3期较其他3组延长,快速眼动睡眠期较研究组1及对照组延长(均P<0.05)。(3)治疗第8周末,4组患儿的PSQI总分和CSHQ总分均较治疗前降低,且3个研究组患儿的PSQI总分及研究组3患儿的CSHQ总分均较对照组降低(均P<0.05)。(4)4组患儿不良反应发生率差异无统计学意义(P>0.05)。结论低频rTMS可以缩短失眠症患儿的入睡时间,减少其觉醒次数,改善其睡眠质量和睡眠习惯,效果优于CBT-I,且不良反应少,患儿接受度高,值得临床应用推广。

Objective To compare the clinical effect and safety of low-frequency repetitive transcranial magnetic stimulation(rTMS)with cognitive behavioral therapy for insomnia(CBT-I)for treating children with insomnia.Methods A total of 68 children with insomnia were randomly assigned to research group 1(n=17),research group 2(n=18),research group 3(n=17),or control group(n=16).The research groups 1,2,and 3 received a 8-week treatment of low-frequency rTMS(the number of stimulation was 1000 times,1200 times,and 1400 times,respectively),whereas the control group was treated with CBT-I for 8 weeks.Before treatment and at the end of 8-week treatment,polysomnography was performed on children of the four groups,and the total conditions of sleep quality and sleep habits were evaluated by using Pittsburgh Sleep Quality Index(PSQI)and Children′s Sleep Habits Questionnaire(CSHQ).The occurrence of adverse reactions during treatment of children in the four groups was recorded.Results(1)At the end of 8-week treatment,the actual total time of sleep,sleep latency,awakening time,awakening frequency,sleep efficiency,rapid eye movement sleep latency were improved in children of the four groups as compared with before treatment(all P<0.05).The research group 3 exhibited an increased actual total time of sleep as compared with the research group 1 and the control group,whereas decreased awakening frequency and shorter rapid eye movement sleep latency as compared with the remaining 3 groups(all P<0.05).(2)At the end of 8-week treatment,the non-rapid eye movement in sleep stage 1 and rapid eye movement in sleep stage in children of the four groups were improved as compared with before treatment,and the research groups 2 and 3 interpreted an improved non-rapid eye movement in sleep stage 3 as compared with before treatment(all P<0.05).The research group 3 yielded a shorter non-rapid eye movement in sleep stage 1 as compared with the control group,whereas a prolonged non-rapid eye movement in sleep stage 3 as compared with the remaining 3 groups,and a prolonged rapid eye movement in sleep stage as compared with the research group 1 and the control group(all P<0.05).(3)At the end of 8-week treatment,the total scores of PSQI and CSHQ in children of the four groups were decreased as compared with before treatment,and the 3 research groups depicted a decreased PSQI total score,and the research group 3 exhibited a decreased CSHQ total score as compared with the control group(all P<0.05).(4)No statistically significant difference in the incidence rate of adverse reactions in children was found between the four groups(P>0.05).Conclusion Low-frequency rTMS can shorten the time of falling asleep in children with insomnia,reduce their awakening frequency,ameliorate their sleep quality and sleep habits,and its effect is superior to CBT-I,with few adverse reactions,as well as it is acceptable in children,and it is worthy of clinical application and promotion.