Curative Effect And FMRI Study Of Low-Frequency Repetitive Transcranial Magnetic Stimulation On Uremia Patients With Insomnia

Objective: To research the curative efficacy of repetitive transcranial magnetic stimulation(rTMS)on uremia patients with insomnia by using clinical assessments and amplitude of low frequency fluctuation(ALFF).To investigate the changes of ALFF of Uremia patients with insomnia by using resting state functional magnetic resonance maging(rs-fMRI).The application of resting state functional magnetic resonance imaging(rs-fMRI)expression and function in uremic patients with insomnia brain spontaneous neural activity observed after treatment of rTMS imaging,and to explore the mechanism of rTMS treatment.Methods: According to the inclusion and exclusion criteria,31 patients with uremia insomnia were selected.Twenty one were included in the rTMS treatment group and 10 were enrolled to the blank control group.Each patient in the rTMS treatment group received rTMS treatment 1 time a day for 15 consecutive days.The Pittsburgh Sleep Quality Index,(PSQI)and Athens Insomnia Scale(AIS)score were assessed before treatment,at the fifth day,tenth day,and fifteenth day respectively for both groups.At the same time,the fMRI images were acquired for each patient in the rTMS group.Except for the rTMS treatment,all of the other treatment methods were same as the rTMS group for the blank control group.Comparative analysis of PSQI and ASIwere performed between rTMS group and blank control group,and between every two treatment stages.In addition,the ALFF changes were also calculated between before and after rTMS treatment for the rTMS group.Results:(1)Before treatment,there was no significant differencebetween rTMS group andblank control group on gender,age,period of hemodialysis,period of insomnia,PSQI score and AIS score(P>0.05).(2)With the increasing number of rTMS treatment,in the rTMSgroup the total score of PSQI and score of each component(subjective sleep quality,sleep latency,sleep duration,sleep efficiency,sleep disorders,daytime dysfunction)and AIS score decreased,sleep efficiency increased,PSQIand AIS total score graduallyreaching the standardincreased.(3)In the rTMS group,after treatment for 5 day and 10 days the clinical sleep score each index compared with beforetreatment,the results showedthat sleep latency period total score compared with before treatment,there was no statistically significant difference(P > 0.05);the rest of the grading index,the difference was statistically significant(P < 0.05).In the rTMS group,the treatment of 15 days before sleep score index and its treatment,compared results suggest: the score index difference had statistical significance(P< 0.05).In the rTMS group,5 days after the index compared with control group,the clinical sleep scoring results suggest that sleep disorders total score difference has no statistical significance(P> 0.05),the grading index difference was statistically significant(P< 0.05).In the rTMS group,after treatment for 10 days,15 days the index compared with control group,the clinical sleep scoring results suggest that the score index difference has statistical significance(P< 0.05).(4)In the rTMS group,after treatment for 5 days,10 days,15 days of PSQI and AIS total score pairwise comparison.Results indicate that aftertreatment 5 days compared with 10 days,the difference was statistically significant(P < 0.05);after treatment for 5 days compared with the 15 days,the difference was statistically significant(P < 0.05);after treatment for10 days compared with the 15 days,there was no statistically significant difference(P> 0.05).(5)In rTMS group,after15 days of rTMS treatment,the ALFF were significantly increased in the bilateral frontal lobe,bilateral amygdala,left hippocampus,and left anterior cingulate gyrus;the ALFF value significantly decreased in the bilateral insula(P<0.05).Conclusion: Low frequency rTMS is effective in the treatment of uremic patients with insomnia,and more conducive to the improvement of sleep structure.The application of rs-fMRI technology can directly observe the effect of rTMS stimulation on neural activity in patients with insomnia,which provides a scientific and objective imaging basis for elucidating the mechanism rTMS to improve sleep quality.