Blue velvet arena test to detect spatial memory in patients with chronic insomnia disorder: a clinical study / 中华神经科杂志

Objective:To investigate the feasibility of blue velvet arena test (BVAT) in evaluating spatial memory function in patients with chronic insomnia disorder (CID).Methods:From June 1, 2021 to May 31, 2022, 62 CID outpatients or inpatients were enrolled continuously in the Department of Sleep Disorders, the Affiliated Chaohu Hospital of Anhui Medical University, and 56 good sleepers in the same period were enrolled to serve as controls. Pittsburgh Sleep Quality Index (PSQI) was used to assess their sleep quality. Montreal Cognitive Assessment Scale (MoCA), nine box maze test (NBMT), and BVAT were used to assess general cognition and memories.Results:Compared to the controls, the CID patients had increased PSQI score [15.0 (12.8, 16.0) vs 0 (0, 1.0); Z=-9.47, P<0.001], and decreased MoCA score [24.5 (21.5, 27.0) vs 27.0 (26.0, 28.0); Z=-4.18, P<0.001]; increased numbers of errors in the spatial working [1.0 (0.8, 2.0) vs 1.0 (0, 1.0); Z=-2.24, P<0.05], object working [1.5 (0.8, 3.0) vs 0 (0, 1.0); Z=-4.36, P<0.001] and object recognition [0 (0, 0) vs 0 (0, 0); Z=-2.10, P<0.05] memories in NBMT; and increased average erroring distance in BVAT [23.0 (16.4, 27.2) cm vs 18.7 (16.6, 20.7) cm; Z=-3.30, P<0.01]. Partial correlation analysis showed that in the CID patients, the average erroring distance in BVAT was positively correlated with erroneous numbers in spatial working memory in NBMT ( r=0.54, P<0.001). Principal components analysis showed that the average erroring distance of BVAT (load=0.844) and the errors of spatial working memory in NBMT (load=0.801) were jointly attributed to the first factor. Receiver operating characteristic curve analysis showed that the sensitivity of BVAT was higher than that of NBMT (0.575 vs 0.250, P<0.05) for spatial memory detection in total sample. Conclusion:The BVAT has a higher reliability in the functional assessment of spatial memory in CID patients.

Clinical effect and electroencephalographic oscillation changes of the repetitive transcranial magnetic stimulation and eszopiclone treatment of chronic insomnia disorder / 中华行为医学与脑科学杂志

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.

Effect of acupuncture and estazolam on episodic memory and sleep structure in patients with chronic insomnia disorder: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the effect on chronic insomnia disorder (CID) and influences on episodic memory and sleep structure between acupuncture and estazolam tablets.@*METHODS@#A total of 140 CID patients were randomized into a meridian-point group (46 cases, 1 case dropped off), a non-meridian-and-non-acupoint group (47 cases, 2 cases dropped off) and a medication group (47 cases, 2 cases dropped off). In the meridian-point group, Baihui (GV 20), Shenmen (HT 7), Sanyinjiao (SP 6), Zhaohai (KI 6) and Shenmai (BL 62) were selected and the routine acupuncture was applied. In the non-meridian-and-non-acupoint group, the needling technique was same as the meridian-point group. Acupuncture was given once daily for 4 weeks in the above two groups. In the medication group, estazolam tablets were administered orally, taken 1 to 2 mg per night, consecutively for 4 weeks. Before and after treatment, the changes in the following indexes were observed in each group, i.e. the score of insomnia severity index (ISI), the score of auditory verbal memory test (AVMT) and the relevant indexes of sleep structure [total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE) and the percentage of non rapid eye movement phase 1, 2 and 3 (N1, N2 and N3) and rapid eye movement time (REM) in TST].@*RESULTS@#After treatment, ISI scores were reduced in the meridian-point group and the medication group (<0.01), the score in the meridian-point group was lower than the medication group and the non-meridian-and-non- acupoint group respectively (<0.01) and that in the medication group was lower than the non-meridian-and-non-acupoint group (<0.01). After treatment, the score of each of immediate recall, short-term delayed recall, long-term delayed recall and delayed recognition of AVMT was increased in the meridian-point group and the medication group respectively (<0.01, <0.05) and the score of each item of AVMT in the meridian-point group was higher than the medication group and the non-meridian-and-non-acupoint group respectively (<0.01, <0.05). The scores of immediate memory and delayed recognition in the medication group were higher than the non-meridian-and-non-acupoint group respectively (<0.01). After treatment, SOL, WASO and N1% were all reduced (<0.01) and TST, SE, N3% and REM% were all increased (<0.01, <0.05) in the meridian-point group and the medication group, N2% in the meridian-point group was reduced (<0.01). After treatment, N1% and N2% in the meridian-point group were lower than the medication group (<0.01) and N3% and REM% were higher than the medication group (<0.01). After treatment, TST, SE and N3% in the meridian-point group and the medication group were all higher than the non-meridian-and-non-acupoint group respectively (<0.01, <0.05) and SOL, WASO and N1% were lower than the non-meridian-and-non-acupoint group respectively (<0.01). REM% in the meridian-point group was also higher than the non-meridion-and-non-acupoint group (<0.01), and N2% in the meridian-point group was also lower than the non-meridian-and-non-acupoint group (<0.01).@*CONCLUSION@#Compared with estazolam, acupuncture much better improves sleep quality and episodic memory in patients with chronic insomnia disorder, which is possibly related to the regulation of sleep structure of patients in treatment with acupuncture.

Effect of Taiji Quan on Sleep Quality of Patients with Chronic Insomnia Disorder / 中国康复理论与实践

Objective:To explore the effect of Taiji Quan on the sleep quality of patients with chronic insomnia disorder (CID) and its mechanism. Methods:From January, 2015 to December, 2017, 31 patients with CID were enrolled in the sleep disorder clinic. Before and 24 weeks after Taiji Quan exercise, the Pittsburgh Sleep Quality Index (PSQI) was used to assess their sleep quality, the serum levels of tumor necrosis factor (TNF)-α, TNF-β, soluble tumor necrosis factor receptor (sTNF-R)1 and sTNF-R2 were detected with protein chip, and the correlation between the total score of PSQI and the serum levels of TNF-α, TNF-β, sTNF-R1 and sTNF-R2 were analyzed after exercise. Results:After Taiji Quan exercise, the scores of PSQI factors (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction) and the total score of PSQI decreased (t > 4.080, P < 0.05). The serum levels of TNF-α and TNF-β decreased (t > 13.580, P < 0.01), however, the serum levels of sTNF-R1 and sTNF-R2 significantly increased (t > 160.189, P < 0.001). The serum levels of TNF-α and TNF-β were positively correlated with the total score of PSQI (r > 0.638, P < 0.001), while the serum levels of sTNF-R1 and sTNF-R2 were negatively correlated with the total score of PSQI (r > 0.532, P<0.001). Conclusion:Taiji Quan exercise could help to improve the sleep quality of patients with CID. The mechanism may be related to the decrease of the serum levels of TNF-α and TNF-β, and the increase of the serum levels of sTNF-R1 and sTNF-R2.