Clinical Efficacy And Resting-state Functional Magnetic Resonance Study Of Zolpidem Tartrate In The Treatment Of Patients With Chronic Insomnia Disorder

Objective To observe the clinical efficacy of Chronic Insomnia disorder(CID)after treatment with Zolpidem tartrate.Based on resting-state functional magnetic resonance imaging(rs-FMRI),functional connectivity(FC)was used to explore the changes of functional connectivity between brain regions in patients with chronic insomnia disorder,healthy controls and patients before and after treatment with Zolpidem tartrate,and to explore the correlation between the clinical efficacy of zolpidem tartrate and the changes of functional connectivity in brain regions before and after treatment.To explore the neuroimaging mechanism of Zolpidem tartrate in the treatment of chronic insomnia disorder,so as to provide theoretical guidance for optimizing clinical treatment.To observe the clinical efficacy of Zolpidem tartrate before treatment in patients with chronic insomnia(CID).Based on resting state functional magnetic resonance imaging(rs-f MRI),functional connection analysis(FC)was used to explore the changes of brain functional connections between patients with chronic insomnia and healthy controls and patients before and after Zolpidem tartrate treatment.To explore the correlation between the clinical efficacy of Zolpidem tartrate and the changes of functional connections in the brain before and after treatment,and then to explore the neuroimaging mechanism of Zolpidem tartrate in the treatment of chronic insomnia,so as to provide theoretical guidance for optimizing clinical treatment.Methods A total of 23 patients with first-episode unmedicated chronic insomnia disorder who met the diagnostic criteria of International Classifcation of Sleep Disorders Third Edition and 16 matched healthy controls were included in this study.This study counted all participants for general demographic information.The Pittsburgh sleep quality index(PSQI),Insomnia severity index(ISI),Hamilton depression scale(HAMD)and Hamilton anxiety scale(HAMA)were assessed for CID patients before and after treatment and for HC subjects at baseline.Polysomnography(PSG)and rs-f MRI data were collected throughout the night;patients with CID were all treated with zolpidem tartrate 5～10 mg alone for 6 weeks.SPSS25.0 software was used for statistical analysis of clinical scales and demographic data,and the reductive ratio of above scales after treatment in CID patients was calculated.In this study,the DPARSF5.2 software based on Matlab(R2018b)platform,SPM12 software was used to pre-process the MRI data.This study analysed the interrelationships between the right anterior cingulate gyrus,the right insula and whole brain regions using a functional connectivity.Gaussian Random Field(GRF)method was used for correction,and voxel(P<0.005)and cluster(P<0.05)were set as statistically significant.Correlations between post-treatment clinical effects and FC in patients in the CID group were analysed using Spearman’s correlation.Results Comparison between CID group and healthy controls group at baseline :(1)PSQI,ISI,HAMA and HAMD scores in CID group were significantly higher than those in healthy controls group,and the differences were statistically significant(P<0.05);(2)Polysomnography showed that the proportion of N3 sleep in the CID group was significantly lower than that in healthy controls group,and the difference was statistically significant(P<0.05);(3)The functional connections between right anterior cingulate gyrus and left thalamus and left lingual gyrus were decreased in CID group compared with HC group(P<0.05).Functional connections between the right insula and the left anterior central gyrus and the right medial superior frontal gyrus were increased(P<0.05).Comparison before and after treatment in CID group :(1)PSQI,ISI and HAMA scores in CID patients after zolpidem tartrate treatment were lower than those before treatment(P<0.05);(2)The functional connections between the right insula and the right middle frontal gyrus were increased(P<0.05),the functional connections between the right anterior cingulate gyrus and the left anterior cingulate gyrus were increased(P<0.05),and the functional connections between the right anterior cingulate gyrus and the right angular gyrus and the right middle frontal gyrus were decreased;The decrease of functional connectivity between right anterior cingulate gyrus and right angular gyrus was negatively correlated with the decrease of ISI score(r=-0.56,P<0.05);The growth rate of sleep proportion in N1 stage was negatively correlated with the decrease of functional connection between right anterior cingulate gyrus and right angular gyrus(r=-0.56,P<0.05).Conclusions(1)In CID patients,there were abnormal functional connections between the right insula and the left anterior central gyrus,the right medial superior frontal gyrus,the right anterior cingulate gyrus and the left thalamus,the left interlingual gyrus and other brain regions.(2)Zolpidem tartrate can improve insomnia symptoms in patients with CID,and the mechanism may be related to changes in functional connections between right anterior cingulate gyrus and left anterior cingulate gyrus,right angular gyrus,right middle frontal gyrus,and right insula and right middle frontal gyrus.