| Objective Based on functional magnetic resonance imaging(f MRI),the resting brain functional connectivity method was used to explore the differences of brain functional activities between patients with chronic insomnia disorder(CID)and healthy control(HC).Through the use of cognitive behavioral therapy(cbt-i)in the treatment of chronic insomnia,to explore the clinical efficacy of cbt-i in the treatment of chronic insomnia and the improvement of cognitive function.At the same time,the method of functional connection in functional magnetic resonance imaging(f MRI)technology was used to study the changes of brain functional activities in patients with chronic insomnia before and after cbt-i treatment and its correlation with clinical data,so as To explore the mechanism of cbt-i therapy in the treatment of chronic insomnia.Methods A total of 27 patients with chronic insomnia and 15 matched healthy controls were included in this study.CID patients received cbt-i treatment for 6 weeks.General demographic data were collected to assess the Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA)and Pittsburgh sleep quality index(PSQI),insomnia severity index(ISI)and polysomnography(PSG).Repeatable battery for the assessment of neuropsychological status(RBANS)was used to evaluate the cognitive function of the two groups and CID patients before and after treatment.The clinical data were statistically analyzed by SPSS software.The general data between the two groups were compared by two independent sample t-test,rank sum test and chi square test.Before and after treatment,the patients in the group were tested by paired sample t-test α= 0.05.The f MRI data of the patients with chronic insomnia before and after treatment and the healthy control group were collected.Dparsf5.1 and spm12 were used to connect the whole brain with the region of interest(ROI)of the left insula,bilateral thalamus,right superior parietal gyrus and left middle frontal gyrus.The changes of the brain regions of the patients with chronic insomnia before and after treatment were compared between HC group,CID group and cbt-i group.Results Compared with the healthy control group,the scores of PSQI,ISI,HAMA and HAMD in patients with chronic insomnia were higher(P < 0.05).At the same time,PSG monitoring found that the total sleep time(TST)and sleep efficiency(SE)were lower than those in the control group(P < 0.05).The immediate recall,attention and delayed memory in recognition evaluation were lower than those in the control group(P < 0.05).At the same time,f MRI study found that compared with healthy controls,the FC of left middle frontal gyrus and right precuneus in patients with chronic insomnia increased,the FC of right thalamus and left posterior central gyrus and right anterior central gyrus increased,and the FC of parietal gyrus and left cerebellum decreased.After cbt-i treatment,the scores of PSQI,ISI,HAMD and HAMA in patients with chronic insomnia were lower than those before treatment(P < 0.05).PSG monitoring found that the total sleep time and sleep efficiency were higher than those before treatment(P <0.05),and the immediate recall,language function and delayed memory in cognitive evaluation were higher than those before treatment(P < 0.05).The growth rate of TST in sleep monitoring was negatively correlated with the increase of FC between left thalamus and right angular gyrus(r =-0.794,P < 0.001).The growth rate of SE was negatively correlated with the increase of FC between left thalamus and right angular gyrus(r =-0.832,P < 0.001).After cbt-i treatment,the FC intensity between the left insula and the left precuneus and the right angular gyrus decreased,the FC intensity between the left thalamus and the left precuneus and the right angular gyrus increased,and the FC intensity between the right superior parietal gyrus and the left cerebellum also increased.Conclusions After cbt-i treatment,the clinical symptoms of insomnia patients were improved from sleep to cognitive function.The FC intensity between the left insula and the left precuneus lobe and the right angular gyrus decreased,the FC intensity between the left thalamus and the left precuneus lobe and the right angular gyrus increased,and the FC intensity between the right superior parietal gyrus and the left cerebellum also increased.These changes are the mechanism of cbt-i in the effective treatment of chronic insomnia. |
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