ABSTRACT
Objective:To observe the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with eszopiclone in the treatment of chronic insomnia disorder and its influence on brain electrical activity.Methods:Ninety patients with chronic insomnia were randomly divided into rTMS group, drug group and combination group, with 30 cases each group. The rTMS group was treated with bilateral dorsolateral prefrontal lobe (left 5 Hz 400 pulse, right 1 Hz 1 200 pulse), the drug group was treated with eszopiclone (3mg/d) and the combination group was treated with rTMS + eszopiclone. Continuous treatment for 2 weeks, Pittsburgh sleep quality index (PSQI), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and changes in brain electricity activity (α, β, θ, δ) and sleep parameters were evaluated before treatment, after treatment and during follow-up. The SPSS generalized linear model statistical method was used to analyze the changes of each evaluation index.Results:Compared with before treatment, the PSQI score of the combination group decreased (7.2±1.7 vs 13.2±2.9), and the improvement was better than that of the rTMS group (9.2±2.5 vs 12.1±2.8) and the drug group (7.5±2.8 vs 11.4±2.9) ( P<0.05). Multiple comparisons results showed that combination group > drug group > rTMS group; and combination group > rTMS group > drug group during follow-up. After treatment and during follow-up, the HAMA and HAMD scores of the rTMS group and the combination group decreased. There was no statistical difference in the improvement rate between the two groups, but they were all higher than the drug group ( P<0.05). After treatment and during follow-up, the β power of the rTMS group and the combination group decreased, and the α power increased, but there was no statistical difference in the δ and θ power. The β, δ and θ power in the drug group increased ( P<0.05), but the α power had no statistical difference. Multiple comparisons results showed that the power of β, δ and θ bands in the rTMS group and the combination group were lower than the drug group, α power was higher than that in the drug group ( P<0.05). Compared with before treatment During follow-up, the sleep latency of the combination group and rTMS group was shorten, and the total sleep time, sleep efficiency, deep sleep (N3) and rapid eye movement (REM) increased( P<0.05), but there was no statistical difference in the changes of sleep parameters in the drug group. Conclusions:rTMS combined with Eszopiclone can significantly improve the sleep quality of patients with chronic insomnia, which is better than that of rTMS and Eszopiclone alone, and it can reduce cortical excitability by regulating brain electrical activity. It can be an ideal treatment for patients with chronic insomnia disorder.