Clinical Study Of Trazodone Hydrochloride Combined With Repetitive Transcranial Magnetic Stimulation In Patients With Post-Stroke Depression Accompanied By Sleep Disoeders

Objective : To investigate the clinical effect of trazodone hydrochloride combined with repeated transcranial magnetic stimulation on sleep disorders in patients with post-stroke depression.Methods:1.A total of 180 patients admitted to the third Department of Neurology of the First Affiliated Hospital of Hebei North University from January 2021 to October 2022 were selected as the research objects.All the enrolled patients met the diagnostic criteria of the clinical diagnosis and treatment guidelines for poststroke depression and suffered from sleep disorders.Meanwhile,them willing to participate in this study.Patients were randomly divided into basic treatment group,trazodone hydrochloride group,r TMS group and trazodone hydrochloride +r TMS group,with 45 patients in each group.2.General data of sex,age,hypertension,hyperlipidemia,diabetes,smoking and drinking were recorded for statistical analysis.3.All enrolled people were given basic stroke treatment recommended by the guidelines,including anti-platelet aggregation,lipid regulation and plaque stabilization,circulation improvement,and intervention,psychological treatment,and intervention for common chronic diseases such as hypertension and diabetes.4.Trazodone hydrochloride group was given trazodone hydrochloride 50 mg once a day,gradually increased to 50 mg,three times a day;Patients in r TMS group were treated with r TMS for 14 days;Trazodone hydrochloride r TMS group was given 50 mg trazodone hydrochloride,once a day,gradually increased to 50 mg,three times a day combined with repeated transcranial magnetic stimulation for 14 days.Pittsburgh Sleep Quality Prime Scale(PSQI),Hamilton Depression Scale(HAMD),Self-rating Depression Scale(SDS),Epworth Sleepiness Scale(ESS),Fatigue Severity Scale(FSS),NIHSS score and polysomnosis monitoring were evaluated before and after intervention,and statistical analysis was performed.Results:1.basic data: there were no significant differences in age,gender,hypertension,hyperlipidemia,diabetes,smoking and drinking among the four groups,which were comparable.2.Analysis of results of sleep related indexes:(1)after 2 weeks of treatment,PSQI score,TST,S3+S4 accounted for TST,REM accounted for TST,and minimum oxygen saturation of the four groups increased compared with before treatment,except that REM accounted for TST in trazodone hydrochloride group had no statistical difference(P > 0.05),the rest had statistical differences(P <0.05).Two indexes of SL and S1 decreased in the four groups compared with before treatment,and there were statistical differences(P < 0.05).Pair-based comparison between groups showed no statistical difference in the above indexes between trazodone hydrochloride group and r TMS group(P > 0.05),and trazodone hydrochloride r TMS group improved more significantly than the basic treatment group,trazodone hydrochloride group and r TMS group,with statistical difference(P < 0.05).(2)After 2weeks of treatment,the longest apnea time of the basic treatment group,trazodone hydrochloride group,r TMS group and Trazodone hydrochloride r TMS group decreased compared with that before treatment,and there was no statistical difference between the basic treatment group and trazodone hydrochloride group(P > 0.05),but there was statistical difference between the other two groups(P < 0.05).(3)The proportion of S2 in TST in trazodone hydrochloride group was lower than that before treatment,while that in other groups was higher than that before treatment,with statistical differences(P < 0.05).3.Analysis of depression related indicators: HAMD scores and SDS scores of the four groups were decreased compared with those before treatment,with statistical difference(P < 0.05),trazodone hydrochloride group and r TMS group had no statistical significance(P >0.05),Trazodone hydrochloride r TMS group was more significantly decreased than the basic treatment group,Trazodone hydrochloride group and r TMS group,the difference was statistically significant(P < 0.05).4.Analysis of FSS score,ESS score and prognostic NIHSS score: FSS score,ESS score and NIHSS score of the four groups were decreased after treatment compared with before treatment,with statistical differences(P <0.05).There was no statistical difference between trazodone hydrochloride group and r TMS group(P > 0.05),and the decrease of trazodone hydrochloride r TMS group was more obvious than that of basic treatment group,Trazodone hydrochloride group and r TMS group,the difference was statistically significant(P < 0.05).5.Spearman correlation analysis indicated that depression and sleep were positively correlated with the prognosis of PSD patients(NIHSS score),so clinical attention should be paid to the treatment of depression and sleep in such patients,considering that the lighter the depression and better the sleep in PSD patients,the better to improve the prognosis of PSD patients(NIHSS score).Conclusions: 1.It is considered that low-medium dose trazodone hydrochloride and r TMS can improve sleep in patients with post-stroke depression.But the merits of either are unclear.2.For PSD patients with sleep disorders,trazodone hydrochloride combined with repetitive transcranial magnetic stimulation can improve patients’ sleep and depression,and reduce daytime sleepiness and fatigue,and combined treatment is better than single treatment.3.Spearman correlation analysis indicated that depression and sleep were positively correlated with the prognosis of PSD patients(NIHSS score),so clinical attention should be paid to the treatment of depression and sleep in such patients.Considering that the less depressive and better sleep in PSD patients,the better to improve the prognosis of PSD patients(NIHSS score).