rTMS靶向右侧前额叶背外侧区联合dCBT-I对失眠障碍共病焦虑患者睡眠质量及过度觉醒状态的干预作用OA
Effects of rTMS targeting the right dorsolateral prefrontal cortex combined with dCBT-I on sleep quality and hyperarousal state in patients with insomnia disorder comorbid with anxiety
目的 分析重复经颅磁刺激(rTMS)靶向右侧背外侧前额叶皮质联合数字认知行为疗法(dCBT-I)对失眠障碍共病焦虑患者的睡眠质量及过度觉醒状态的干预效果.方法 从 2022-01-2025-01平煤神马医疗集团总医院治疗的失眠障碍患者中选取65例共病焦虑的患者为研究对象,采用随机数字表法分为对照组(n=35)和试验组(n=30),其中对照组接受常规治疗,试验组行rTMS靶向右侧前额叶背外侧区联合dCBT-I治疗,比较2组患者干预前、干预2周、干预6周后的匹兹堡睡眠质量指数(PSQI)、失眠严重指数(ISI)、汉密尔顿焦虑量表(HAMA)与过度觉醒量表(HAS)评分及血清皮质醇、脑源性神经营养因子(BDNF)水平.结果 干预2周后,试验组PSQI、ISI、HAMA及HAS评分均显著低于对照组(P<0.05),且这种优势持续至干预6周后(P<0.05).试验组在干预2周和6周后血清皮质醇水平显著降低,BDNF水平显著升高,且改善幅度均优于对照组(P<0.05).试验组总有效率100%,显著高于对照组的80%(P<0.05).结论 rTMS靶向右侧背外侧前额叶皮质联合dCBT-I能在短期内显著改善失眠障碍共病焦虑患者的睡眠质量,缓解焦虑情绪,降低过度觉醒状态,其疗效优于单一dCBT-I治疗,并伴随有益的神经生化改变,是一种有效的综合干预方案.
Objective To analyze the interventional effects of repetitive transcranial magnetic stimulation(rTMS)targeting the right dorsolateral prefrontal cortex combined with digital cognitive behavioral therapy for insomnia(dCBT-I)on sleep quality and hyperarousal state in patients with insomnia disorder comorbid with anxiety.Methods A total of 65 patients with insomnia disorder comorbid with anxiety,who were admitted to the General Hospital of Pingmei Medical Group between January 2022 and January 2025,were selected as study subjects.Using a random number table,they were assigned to control group(n=35)and experimental group(n=30).The control group received conventional treatment,while the experimental group underwent rTMS targeting the right dorsolateral prefrontal cortex combined with dCBT-I.Assessments were conducted before the intervention,at 2 weeks and 6 weeks post-intervention.The scores of Pittsburgh sleep quality index(PSQI),insomnia severity index(ISI),Hamilton anxiety scale(HAMA),hyperarousal scale(HAS),as well as serum cortisol and brain-derived neurotrophic factor(BDNF)levels between the two groups were compared.Results At 2 weeks post-intervention,the experimental group showed significantly lower PSQI,ISI,HAMA,and HAS scores compared to the control group(P<0.05),and this advantage persisted at 6 weeks post-intervention(P<0.05).The experimental group also demonstrated significantly greater reductions in serum cortisol levels and increases in BDNF levels at both 2 and 6 weeks post-intervention compared to the control group(P<0.05).Clinically,the total effective rate was 100%in the experimental group,which was significantly higher than 80%in the control group(P<0.05).Conclusion The combination of rTMS targeting the right DLPFC and dCBT-I can rapidly and significantly improve sleep quality,alleviate anxiety,and reduce hyperarousal in patients with insomnia disorder comorbid with anxiety.This combined intervention demonstrates superior efficacy compared to dCBT-I alone and is associated with beneficial neurobiological changes,making it an effective comprehensive treatment approach.
康宪政;孟森;胡淑丽
平煤神马医疗集团总医院,河南 平顶山 467000平煤神马医疗集团总医院,河南 平顶山 467000平煤神马医疗集团总医院,河南 平顶山 467000
医药卫生
失眠障碍焦虑共病重复经颅磁刺激数字认知行为疗法睡眠质量过度觉醒状态
Insomnia disorderAnxietyComorbidityRepetitive transcranial magnetic stimulationDigital cognitive behavioral therapy for insomniaSleep qualityHyperarousal state
《中国实用神经疾病杂志》 2026 (10)
1239-1244,6
河南省医学科技攻关计划联合共建项目(编号:LHGJ20250823)
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