重复经颅磁刺激治疗慢性失眠障碍的效果及影响因素

Efficacy and influencing factors of repetitive transcranial magnetic stimulation in the treatment of chronic insomnia

背景慢性失眠障碍病程迁延反复,重复经颅磁刺激(rTMS)作为改善睡眠质量的物理治疗方法,关于其疗效与人格特征相关性的证据有限。目的探讨rTMS治疗慢性失眠障碍的效果及其影响因素,为慢性失眠障碍的治疗提供参考。方法选取2022年9月—2023年9月于绵阳市第三人民医院就诊的、符合《精神障碍诊断与统计手册(第5版)》(DSM-5)诊断标准的慢性失眠障碍患者46例。于治疗前进行艾森克人格问卷(EPQ)、汉密尔顿抑郁量表17项版(HAMD-17)和汉密尔顿焦虑量表(HAMA)评定,分别于治疗前、治疗第2周末和治疗结束1周后采用匹兹堡睡眠质量指数量表(PSQI)评定睡眠质量。结果治疗第2周末,患者PSQI总评分及主观睡眠质量、睡眠潜伏期、睡眠持续时间、睡眠效率、睡眠干扰、日间功能障碍因子评分均低于治疗前,差异均有统计学意义(t=4.755~13.361,P均<0.01),24例(54.35%)治疗有效。多元线性回归分析结果显示,内外向人格特征进入了回归方程(B=0.317,P<0.01),可解释29.90%的总变异(R^(2)=0.299)。结论rTMS治疗可能有助于改善慢性失眠障碍患者的睡眠质量,其疗效可能与内外向人格特征存在关联。

Background Chronic insomnia is characterized by a prolonged and recurrent course.The efficacy of repeated transcranial magnetic stimulation(rTMS)as a physical therapy method to improve sleep quality remains inadequately supported by evidence,particularly regarding its relationship with personality traits.Objective To explore the efficacy and influencing factors of rTMS in the treatment of chronic insomnia,and to provide insights into its therapeutic potential.Method A total of 46 patients who met the diagnostic criteria for chronic insomnia according to the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5),and were treated at the Third Hospital of Mianyang from September 2022 to September 2023 were selected.Prior to treatment,participants underwent assessments using the Eysenck Personality Questionnaire(EPQ),Hamilton Depression Scale-17 item(HAMD-17)and Hamilton Anxiety Scale(HAMA).The Pittsburgh Sleep Quality Index(PSQI)was used to assess sleep quality before treatment,at the end of the second week of treatment and one week post-treatment.Results At the end of the second week of treatment,patients exhibited significantly improved total PSQI score and subscale scores related to subjective sleep quality,sleep latency,sleep duration,sleep efficiency,sleep disturbance and daytime dysfunction(t=4.755~13.361,P<0.01),with 24 cases(54.35%)showing effective treatment outcomes.Multiple linear regression analysis showed that introverted and extroverted personality traits contributed significantly to the regression equation(B=0.317,P<0.01),explaining 29.90% of the total variation(R^(2)=0.299).Conclusion rTMS treatment may effectively improve the sleep quality of patients with chronic insomnia,with its therapeutic effect appearing to associated with introverted and extroverted personality traits.