虚拟现实技术治疗对慢性失眠患者睡眠质量、睡眠结构及神经心理特征的影响

Effect of virtual reality on sleep quality, sleep structure and neuropsychological characteristics of patients with chronic insomnia

目的探讨虚拟现实(VR)技术治疗对慢性失眠患者睡眠质量、睡眠结构及神经心理特征的影响。方法选择自2021年10月至2022年4月就诊于天津医科大学总医院神经内科门诊的51例慢性失眠患者为研究对象,依据患者意愿分为VR联合药物治疗组(n=26)与单纯药物治疗组(n=25)。单纯药物治疗组患者采用非苯二氮卓类药物联合褪黑素受体激动剂、五羟色胺再摄取抑制剂治疗。VR联合药物治疗组患者在上述药物治疗的基础上添加每周5 d、每天30 min的VR技术治疗。治疗前、治疗6周后应用Epworth嗜睡量表(ESS)、匹茨堡睡眠质量指数(PSQI)、失眠严重程度指数(ISI)评估患者的主观睡眠质量,应用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评估焦虑抑郁情绪,应用简易精神状态检查量表(MMSE)、听觉词语学习测试(AVLT)、数字广度测试(DST)、连线测试(TMT)、Stroop色词测试A/B/C、线方向判断(JLO)、数字符号转换测试(SDMT)评估总体及单项认知功能,采用基于心肺耦合技术的便携式睡眠监测仪(PSM)-100A评估睡眠结构。比较2组患者治疗前、后及VR联合药物治疗组患者自身治疗前后主观睡眠质量、神经心理特征和睡眠结构的差异。结果(1)治疗6周后,与单纯药物治疗组相比,VR联合药物治疗组患者的PSQI、ISI及HAMD、HAMA评分明显降低,AVLT-即刻回忆总分及AVLT-短时延迟回忆评分、长时延迟回忆评分、再认评分明显升高,TMT-A、TMT-B用时明显缩短,DST-倒背评分、SDMT评分明显升高,高频耦合带(HF)睡眠比例明显升高,低频耦合带(LF)睡眠比例、LF/HF值明显降低,差异均有统计学意义(P<0.05)。(2)与治疗前相比,治疗6周后VR联合药物治疗组患者的PSQI、ISI及HAMD、HAMA评分明显降低,AVLT-即刻回忆总分及AVLT-短时延迟回忆评分、长时延迟回忆评分、再认评分明显升高,TMT-A、TMT-B用时明显缩短,DST-顺背、倒背评分明显升高,JLO、Stroop色词测试A/B/C和SDMT评分明显升高,HF睡眠比例明显升高,LF睡眠比例、LF/HF值明显降低,觉醒次数减少,差异均有统计学意义(P<0.05)。结论VR技术联合药物治疗较单纯药物治疗可更有效地改善慢性失眠患者的主观睡眠质量和睡眠结构、减轻抑郁焦虑情绪、改善记忆力和注意力。

Objective To explore the effect of virtual reality(VR)on sleep quality,sleep structure and neuropsychological characteristics of patients with chronic insomnia.MethodsFifty one patients with chronic insomnia enrolled from Department of Neurology,General Hospital of Tianjin Medical University from October 2021 to April 2022 were chosen;according to their wills,they were divided into VR combined drug treatment group(n=26)and drug treatment group(n=25).Patients in drug treatment group accepted non-benzodiazepine combined with melatonin receptor agonist and serotonin reuptake inhibitor;in patients of VR combined drug treatment group,VR was added 30 min/d for 5 d/week on basis of above drug therapy.Subjective sleep quality was assessed by Epworth Sleepiness Scale(ESS),Pittsburgh Sleep Quality Index(PSQI),and Insomnia Severity Scale(ISI).Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)were used to assess anxiety and depression.Mini-Mental State Examination(MMSE),Auditory Verbal Learning Test(AVLT),Digital Span Test(DST),Trail Making Test(TMT),Stroop Color Word Test A/B/C,Judgment of Line Orientation Test(JLO),and Symbol Digit Modalities Test(SDMT)were used to assess the overall and individual cognitive functions.Portable sleep monitor(PSM)-100A based on cardiopulmonary coupling technology was used to evaluate the sleep structure.Differences of subjective sleep quality,sleep structure,and neuropsychological characteristics were compared between the 2 groups before and after treatment and in VR combined drug treatment group before and after treatment.Results(1)After 6 weeks of treatment,compared with the drug treatment group,the VR combined with drug treatment group had significantly decreased scores of PSQI,ISI,HAMD and HAMA,increased total scores of AVLT immediate memory,scores of AVLT short delay recall,long delay recall and recognition,higher SDMT scores,increased correct times of DST reciting in reverse order,shorter time in TMT-A and TMT-B,higher proportion of high frequency coupled sleep(HF,stable sleep),lower proportion of low frequency coupled sleep(LF,unstable sleep),and decreased LF/HF(P<0.05).(2)The VR combined with drug treatment group after VR treatment had significantly decreased PSQI,ISI,HAMD and HAMA scores,higher total scores of AVLT immediate memory,higher scores of AVLT short delay recall,long delay recall and recognition,shorter time in TMT-A and TMT-B,increased correct times of DST reciting in order and reciting in reverse order,and higher scores of JLO,Stroop Color Word Test A/B/C and SDMT,higher proportion of HF sleep,lower LF sleep,decreased LF/HF,and decreased arousal frequency compared with that before VR treatment(P<0.05).ConclusionVR combined with drug treatment can effectively improve the subjective sleep quality and sleep structure,reduce depression and anxiety,and improve memory and attention of patients with chronic insomnia.