| Research Background:Plateau insomnia is a common manifestation of acute and chronic plateau diseases,which can easily lead to anxiety or depression,cognitive impairment,as well as hypertension,heart disease,endocrine disorders,and many other diseases,seriously affecting the physical and mental health of plateau residents.At present,medication is still the main treatment for insomnia on the plateau,but it has side effects and potential dependence,and long-term use will increase the risk of developing neurological diseases.Although psychotherapy has long-term efficacy for insomnia,it has problems of high price,long periodicity,and low patient compliance.In recent years,physiotherapy has received increasing attention from scholars at home and abroad,among which transcutaneous auricular vagus nerve stimulation(taVNS)has been proven to improve insomnia symptoms as a safe,low-cost,non-invasive method,but its specific efficacy on plateau insomnia in high altitude is not clear.Based on this,this study intends to use clinical symptom scale assessment,polysomnography,and serum cytokine assay to explore the intervention effect of the taVNS technique on insomnia at plateau,and provide a scientific basis for clinical treatment of plateau insomnia.Research content Study 1: Symptomatic features of highland insomnia and potential blood biological markers.Study 2: The effect of taVNS on the intervention of plateau insomnia.Research method Study 1: A sample of 100 young males from the plains was selected for the study,clinical scale and serum test data were collected before and after subjects entered the plateau,and basic information about the subjects was collected using the demographic data questionnaire.The subjects’ sleep status was assessed using the Pittsburgh sleep quality index(PSQI)and Insomnia Severity Index Scale(ISI),their anxiety and depression levels were assessed using the Beck Depression Inventory(BDI)and Generalized Anxiety Disorder-7(GAD-7),the levels of cytokines in the serum of the subjects were measured using an enzyme-linked immunosorbent assay,and the indices of the subjects before and after entering the plateau were tested for differences.Study 2: Using a single-blind,randomized grouping method,105 young male insomnia subjects in the plateau were recruited and divided into a physical intervention group,psychological intervention group,and sham stimulation group,with taVNS intervention in the physical group,CBTI intervention in the psychological group and sham taVNS intervention in the sham stimulation group.The PSQI score and polysomnographic monitoring results were used as the primary evaluation indexes,and the GAD-7,ISI,and Psychological stress self-evaluation(PSET)scores were used as secondary evaluation indexes,and the cytokine levels in the serum of the subjects were measured using enzymelinked immunosorbent assay to compare and observe before and after 4 weeks of treatment.The changes of clinical symptom scale scores,polysomnographic indicators,and serum cytokines in each group were compared before and after 4 weeks of treatment,and intergroup and intra-group comparisons were made to assess the efficacy of taVNS on insomnia in a plateau.Study Results Study 1:1.Results of the Clinical Symptom Scale showed that:(1)after entering the plateau,subjects had significantly higher PSQI(p<0.001)and ISI(p<0.001)scores were significantly higher after entering the plateau compared to the plain area,indicating that the subjects’ sleep quality decreased;(2)after entering the plateau,the subjects’ scores on BDI(p<0.001)and GAD-7(p<0.001)were significantly higher compared to the plain area,indicating that the subjects’ anxiety and depression levels increased significantly;(3)those who experienced insomnia in the subject group had significantly higher sleep quality on the PSQI scale items(p<0.01),time to fall asleep(p<0.05),sleep duration(p<0.01),sleep efficiency(p<0.01),sleep disturbance(p<0.05),and daytime score(p<0.001)scores of each item in the subject group who developed insomnia were significantly higher than those before entering the plateau,suggesting that the occurrence of plateau insomnia was closely related to the changes of each of the above components.2.The serum test results showed that after entering the plateau,the subjects’ serum scores of IL-1β(p<0.001),IL-6(p<0.001)and norepinephrine(p<0.001)levels were significantly higher than those in the plains,suggesting that the occurrence of insomnia is closely related to changes in the levels of neurotransmitters and inflammatory factors.Study 2.1.The results of the clinical symptom scales showed that:(1)for the comparison at baseline:the three groups of subjects in the general demographic information,PSQI,the ISI,and GAD-7 clinical scales,the differences were not statistically significant,indicating that the three groups were comparable on each clinical scale;(2)in the comparison of the post-test,the subjects in the taVNS and CBTI groups had lower PSQI,ISI,and GAD-7 scores than the sham-stimulated group(p<0.05),which indicated that the subjects in the taVNS and CBTI groups had significantly better sleep status and anxiety after the intervention.(3)in the comparison of the fourth week of follow-up,the PSQI,ISI,and GAD-7 scores of subjects in the taVNS and CBTI groups were lower than those in the control group(p<0.05),and the subjects in the taVNS group had lower PSQI and ISI scores than those in the CBTI group(p<0.05),which indicated that the subjects in the taVNS and CBTI groups in the fourth week after the intervention had a significantly better.(4)in the comparison of the eighth week of follow-up,the subjects in the taVNS and CBTI groups had lower PSQI,ISI,and GAD-7scores than the control group(p<0.05),and the subjects in the taVNS group had lower PSQI and ISI scores than the CBTI group(p<0.05),and the subjects in the taVNS group had lower PSQI and ISI scores than the CBTI group(p<0.05),which indicated that the subjects in the taVNS and CBTI groups had significantly better sleep status and anxiety than the control group at the eighth week after the intervention,and the taVNS group improved sleep better than the CBTI group.2.Polysomnographic results:(1)compared with baseline,subjects in the taVNS group had significantly higher sleep efficiency after the intervention(p<0.05),and the difference between the taVNS sleep efficiency posttest and the CBTI group and the sham stimulation group were not significant,indicating that subjects in the taVNS group had increased sleep efficiency after the intervention;(2)compared with baseline,subjects in the taVNS group(p<0.001)and the CBTI group(p<0.05)subjects had a significant increase in deep sleep time,and the difference between deep sleep time in the taVNS group after intervention compared to the sham stimulation group was significant(p<0.05),and the difference between deep sleep time in the CBTI group subjects at the posttest stage compared to both the taVNS group and the sham stimulation group was not significant;indicating that subjects in the taVNS group had an increase in deep sleep time after intervention;(3)compared to baseline,the The taVNS group had a significantly shorter sleep latency SOL after the intervention,and the difference between the taVNS sleep latency post-test and the CBTI group and the sham stimulation group was not significant,indicating that the subjects in the taVNS group had a shorter sleep latency after the intervention;(4)the difference between the taVNS group and the CBTI group and the sham stimulation group in total sleep time TST and wakefulness time WASO at the post-test stage were not significant,indicating that The effects of taVNS real and sham stimulation and CBTI intervention on the total sleep time and wake-up time of the three groups of subjects were not statistically significant.3.Changes in cytokines:(1)compared with baseline,IL-6 levels were significantly decreased in the taVNS group after the intervention(p<0.001),and the differences were not significant compared with both the CBTI and sham stimulation groups,indicating that the taVNS intervention reduced the subjects’ inflammation levels;(2)compared with baseline,NE levels were significantly lower in the taVNS group after the intervention(p<0.001),and the differences were significant compared with both the CBTI and sham stimulation groups(p<0.001),compared with the CBTI and sham stimulation groups(p<0.05),indicating that the taVNS intervention reduced the serum levels of norepinephrine in the subjects;(3)compared to baseline,5-HT levels were significantly higher in the taVNS group after the intervention(p<0.001)and significantly different compared to the CBTI group(p<0.05),indicating that the taVNS intervention increased the 5-HT levels in the serum of the subjects.Conclusion1.Insomnia symptoms in young men in the highlands are mainly characterized by decreased sleep quality,prolonged time to sleep,sleep efficiency.The occurrence of insomnia was closely related to the imbalance of neurotransmitter regulation mechanism and immune dysfunction.2.taVNS technique can effectively improve the sleep quality and reduce the anxiety level of young male insomniacs in the plateau.The long-term efficacy of taVNS is better than CBTI in insomnia(the fourth week of follow-up and the eighth week of follow-up);its mechanism for treating insomnia may be through enhancing deep sleep,shortening sleep latency,regulating neurotransmitter levels and immune function. |
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