| Objective:To evaluate the sleep microstructure by cardiopulmonary coupling technology and neuropsychology in patients with circadian rhythm sleep-wake disorders with depression and anxiety.To investigate the effects of repetitive transcranial magnetic stimulation on subjective and objective sleep quality and sleep stability,depression and anxiety,and cognitive function in patients with circadian rhythm sleep-wake disorders with depression and anxiety.Method:From October 2018 to March 2019,a total of 80 patients who met the diagnostic criteria of circadian rhythm sleep-wake disorders in ICSD-3 and were associated with mild to moderate depression and anxiety were collected from the department of neurology and sleep disorders clinic in the general hospital of tianjin medical university and the airport hospital.36 CRSWDs patients who met the inclusion criteria and agreed to participate in this study were selected.According to the patient complaints,sleep diary and morningness-eveningness questionnaire(MEQ),they were classified into three types: delayed sleep-wake phase disorder(DSWPD)(MEQ≤41)、advanced sleep-wake phase disorder(ASWPD)(MEQ≥59)and shift work sleep disorder.The patients were randomly divided into two groups:the repeated transcranial magnetic stimulation(TMS)combined with drug therapy group(n=18)and the single drug therapy group(n=18).And basic information were collected.Patients in both groups were treated with melatonin receptor agonist(Agomelatin table 25mg/d)combined with SSRI drugs(Escitalopram oxalate tablets 10mg/d)and non-benzodiazepine drugs(Zopiclone capsules 7.5mg/d or zolpidem tartrate tablets 5mg/d).The rTMS combined drug therapy group was treated with rTMS stimulation for 6 weeks(4 weeks continuous treatment +2 weeks maintenance treatment),stimulus intensity by 100% resting motor threshold(RMT),stimulating frequency of 1 hz,stimulate the position is located in the patients with the left dorsolateral prefrontal cortex(DLPFC).The following evaluations were performed on patients in the two groups before treatment,after 6 weeks of treatment,and 6 weeks after treatment:Pittsburgh Sleep Quality Index(PSQI),Epworth Sleepiness Scale(ESS)and Insomnia Severity Index(ISI)were used to evaluate and observe the improvement of subjective sleep quality in patients.Sleep microstructure was used to evaluate by cardiopulmonary coupling technique and observe the improvement of objective sleep quality and sleep stability in patients.Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were used to evaluate and observe the improvement of depression and anxiety in patients.Montreal Cognitive Assessment Scale(MoCA)was used to evaluate and observe the improvement of cognitive function in patients.To investigate the effects of repetitive transcranial magnetic stimulation on subjective and objective sleep quality and sleep stability,depression and anxiety,and cognitive function in patients with circadian rhythm sleep-wake disorders with depression and anxiety.Result:1.Before treatment,there were no significant differences in PSQI,ESS and ISI scores,the proportion of HFC,LFC and VLFC,HFC/LFC,HAMD and HAMA scale scores,the total score of MoCA scale and scores in each category between the rTMS combined drug therapy group and the single drug therapy group(p> 0.05).2.In the rTMS combined with drug therapy group,PSQI and ISI scores were significantly reduced after 6 weeks of treatment compared with that before treatment,and the difference was statistically significant(p < 0.05).3.In the rTMS combined with drug therapy group,the proportion of HFC and HFC/LFC after 6 weeks of treatment was significantly higher than that before treatment,while the proportion of LFC was lower than that before treatment,and the difference was statistically significant(p< 0.05).4.In the rTMS combined with drug therapy group,the HAMD and HAMA scale scores were lower after 6 weeks of treatment than before treatment,and the difference was statistically significant(p < 0.05).5.In the rTMS combined with drug therapy group,the total score of MoCA scale and attention score were significantly higher after 6 weeks of treatment than before treatment,with statistically significant differences(p < 0.05).6.After 6 weeks of treatment,PSQI,ISI and ESS scores,HFC,LFC,VLFC ratio and HFC/LFC,HAMD and HAMA scale scores,MoCA total scores and score for each item were not significantly different from those before treatment(p > 0.05).7.Compared with the single drug therapy group,the proportion of HFC and HFC/LFC in the rTMS combined drug therapy group were increased after 6 weeks of treatment and the proportion of LFC was decreased,and the difference was statistically significant(p < 0.05).8.Compared with the single drug therapy group,the HAMD and HAMA scale scores in the rTMS combined drug therapy group were decreased after 6 weeks of treatment,and the difference was statistically significant(p < 0.05).Conclusion:1.rTMS treatment can effectively increase stable sleep,reduce unstable sleep,and increase the proportion of stable sleep/unstable sleep,improve the sleep quality of CRSWDs patients.2.rTMS treatment can alleviate depression and anxiety in patients with CRSWDs.3.rTMS combined with drug treatment can improve the cognitive function of CRSWDs patients,especially in the aspect of attention. |
PDF Full Text Request