基于多导睡眠监测探讨低频重复经颅磁刺激联合右佐匹克隆对慢性失眠障碍患者过度觉醒的影响OA

Objective:Hyperarousal is one of the core pathophysiological hypotheses of chronic insomnia disorder(CID).This study combined the pre-sleep arousal scale(PSAS)and objective arousal-related indicators derived from polysomnography(PSG)to investigate the effects of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with eszopiclone on insomnia symptoms and the hyperarousal phenotype in patients with CID.Methods:Patients with CID were randomly assigned to a control group receiving eszopiclone(1.5 mg)nightly(n=44)or an observation group receiving eszopiclone plus low-frequency rTMS over the right dorsolateral prefrontal cortex(DLPFC,1 Hz,30 min/session,5 sessions/week,n=42).The intervention lasted 4 weeks.The Pitts-burgh sleep quality index(PSQI),insomnia severity index(ISI),PSAS,and PSG-derived arousal-related indicators were assessed at baseline,after 4 weeks of treatment,and at the 12-week follow-up.Results:At week 4 after treat-ment and at the 12-week follow-up,PSQI,ISI,and PSAS total scores,as well as the somatic and cognitive arousal subscale scores of the PSAS,significantly decreased from baseline in both groups(P<0.001),with greater im-provements observed in the observation group,as indicated by significant group×time interactions(P<0.01).Objective PSG indicators showed that,after 4 weeks of treatment,wake after sleep onset(WASO),number of a-wakenings,microarousal index,total spontaneous arousal index,and rapid eye movement(REM)sleep spontane-ous arousal index were significantly reduced after treat-ment in both groups(P<0.05,0.01).Interaction an-alyses further indicated greater improvements in the ob-servation group(P<0.01).Conclusion:Low-frequen-cy rTMS combined with pharmacological treatment not only improves subjective insomnia symptoms in pa-tients with CID but also alleviates hyperarousal symp-toms,providing objective evidence for a combined ther-apeutic strategy targeting the hyperarousal phenotype of CID.