Tiaoshen acupuncture for primary insomnia: a pilot randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effects of Tiaoshen (regulating the spirit) acupuncture on cognitive function and sleep quality in patients with primary insomnia (PI).@*METHODS@#Sixty patients with PI were randomly divided into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 2 cases dropped off, 1 case was excluded). The patients in the observation group were treated with acupuncture at Baihui (GV 20), Shenting (GV 24), Sishencong (EX-HN 1), and bilateral Benshen (GB 13), Shenmen (HT 7), Neiguan (PC 6), Sanyinjiao (SP 6). The patients in the control group were treated with shallow needling at non-effective points. Each treatment was provided for 30 min, once every other day, 3 treatments per week for 4 weeks. The Montreal cognitive assessment (MoCA), digit span test (DST), trail making test (TMT)-A, Pittsburgh sleep quality index (PSQI), and fatigue scale-14 (FS-14) were used to assess cognitive function and sleep quality before and after treatment, as well as in follow-up of 4-week after treatment completion. Correlation analysis was conducted between the differences in PSQI scores and differences in MoCA scores before and after treatment in the observation group.@*RESULTS@#Compared with before treatment, the total score, visuospatial and executive function score and delayed memory score of MoCA as well as DST backward score were increased (P<0.01), while TMT-A time, PSQI and FS-14 scores were significantly reduced (P<0.01) after treatment and in follow-up in the observation group. Compared with before treatment, the PSQI score in the control group was reduced (P<0.01, P<0.05). After treatment and in follow-up, the observation group had significantly higher total score, visuospatial and executive function score, delayed memory score of MoCA, and DST backward score compared to the control group (P<0.05, P<0.01). In the observation group, the TMT-A time was significantly shorter than that in the control group (P<0.05, P<0.01), and the PSQI and FS-14 scores were significantly lower than those in the control group (P<0.01). In the observation group, there was a negative correlation between the difference in PSQI scores (post-treatment minus pre-treatment) and the difference in MoCA scores (post-treatment minus pre-treatment) (r=-0.481, P<0.01). A similar negative correlation was found between the difference in PSQI scores (follow-up minus pre-treatment) and the difference in MoCA scores (follow-up minus pre-treatment) (r=-0.282, P<0.05).@*CONCLUSION@#Tiaoshen acupuncture could improve cognitive function, enhance sleep quality, and alleviate daytime fatigue in patients with PI. The improvement in cognitive function in patients with PI is correlated with the improvement in sleep quality.

Characteristics and Mechanism of Brain Default Mode Network Dysfunction in Primary Insomnia / 中山大学学报(医学科学版)

Primary insomnia is one of the common sleep disorders. It is a type of insomnia with unknown causes， which is often accompanied by a variety of daytime dysfunction and sleep-wake disorders. Neuroimaging and neuroelectrophysiology studies suggest that there may be default mode network dysfunction in patients with primary insomnia， which is closely related to daytime dysfunction and sleep-wake disorder. This article summarizes the characteristics of default mode network dysfunction of primary insomnia and introduces related research in neural structural imaging， functional imaging and neuroelectrophysiology， as well as the role and the mechanism of default mode network impairment leading to daytime dysfunction and sleep-wake disorder of primary insomnia.

Research progress in the treatment of primary insomnia with electroacupuncture / 国际中医中药杂志

Electroacupuncture treatment of primary insomnia is widely used and with confirmed efficacy. The factors influencing the therapeutic effect of electroacupuncture include waveform selection, treatment frequency, stimulation intensity, stimulation time and acupoint selection. The mechanism of electroacupuncture in treating this disease mainly includes regulating the levels of excitatory neurotransmitters, γ-aminobutyric acid, melatonin and interleukin cytokines.

Modulation of transcutaneous auricular vagus nerve stimulation on default mode network in patients with primary insomnia / 中国针灸

OBJECTIVE@#To explore the modulation of transcutaneous auricular vagus nerve stimulation (taVNS) on default mode network (DMN) in patients with primary insomnia (PI).@*METHODS@#A total of 22 PI patients (one patient dropped off and two patients were excluded) were included and treated with taVNS. The bilateral auricular points of Xin (CO15) and Shen (CO10) were selected and treated with disperse-dense wave at frequency of 4 Hz/20 Hz, the intensity was based on the patient's tolerance. taVNS was given once in the morning and once in the evening for 30 minutes each time. The treatment lasted for at least 5 days a week for 4 weeks. At the same time, 16 healthy subjects matched with gender and age were recruited. The Pittsburgh sleep quality index (PSQI) score was evaluated before and after treatment in PI patients. The resting-state functional magnetic resonance imaging (rs-fMRI) data of PI patients before and after treatment and healthy subjects at baseline period were collected to observe the effect of taVNS on the functional connection (FC) between posterior cingulate cortex (PCC) and whole brain.@*RESULTS@#After treatment, the total score of PSQI in PI patients was lower than that before treatment (P<0.01). Compared with healthy subjects, the FC of the left PCC was increased either with the left orbital superior frontal gyrus or with left middle frontal gyrus (P<0.001), and the FC between right PCC and left middle frontal gyrus was increased in PI patients before treatment (P<0.001). Compared before treatment, the FC between left PCC and left middle frontal gyrus was decreased (P<0.05), and the FC of the right PCC was decreased either with the right medial prefrontal cortex or with the left middle frontal gyrus in PI patients after treatment (P<0.001, P<0.01).@*CONCLUSION@#taVNS can modulate the FC between anterior and posterior DMN, and between DMN and cognitive control network of PI patients, which may be one of the brain effect mechanisms of taVNS in the treatment of PI patients.

Effect of transcutaneous auricular vagus nerve stimulation on nocturnal autonomic nervous function in primary insomnia patients / 中国针灸

OBJECTIVE@#To observe the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on the sleep quality and nocturnal heart rate variability (HRV) in patients with primary insomnia.@*METHODS@#Twenty-one patients with primary insomnia were included. Using SDZ-ⅡB electric acupuncture apparatus, Xin (CO15) and Shen (CO10) were stimulated with disperse-dense wave, 4 Hz/ 20 Hz in frequency, (0.2±30%) ms of pulse width and tolerable intensity. Electric stimulation was given once every morning and evening of a day, 30 min each time, for 4 weeks totally. Before and after treatment, the score of Pittsburgh sleep quality index (PSQI), objective sleep structure (total sleep time [TST], sleep latency [SL], wake after sleep onset [WASO], sleep efficiency [SE], the percentages of non-rapid eye movement period 1, 2, 3, and the percentage of rapid eye movement period to TST [N1%, N2%, N3%, REM%] ) and nocturnal HRV (high frequency [HF], low frequency [LF], the ratio of LF to HF [LF/HF], standard deviation for the normal RR intervals [SDNN], squared root of the mean sum of squares of differences between adjacent intervals RR [RMSSD], the percentage of adjacent RR intervals with differences larger than 50 ms in the entire recording [PNN50%], the mean of sinus RR intervals [NNMean] ) were compared in the patients separately.@*RESULTS@#After treatment, the score of each item and the total score of PSQI and SL were all reduced as compared with those before treatment (P<0.01, P<0.001); SE, N3%, LF, HF, LF/HF, SDNN, NNMean and RMSSD were all increased compared with those before treatment (P<0.001, P<0.01).@*CONCLUSION@#The taVNS improves the sleep quality and objective sleep structure in patients with primary insomnia, which is probably related to the regulation of autonomic nervous functions.

Placebo effect in primary insomnia: a meta-analysis / 上海交通大学学报（医学版）

Objective : To investigate the clinical efficacy and degree of impact of placebo in the patients with primary insomnia. Methods ¡¤ Databases including PubMed, Cochrane, and Embase were searched. The Consolidated Standards of Reporting Trials (CONSORT) was used as a reference standard for enrollment and evaluation. The objective and subjective sleep assessment indicators were collected before and after pla-cebo treatment. Meta-analysis was performed using RevMan 5.3 and Comprehensive Meta-Analysis V2 softwares. Results ¡¤ A total of 17 arti-cles (18 studies) were included in the systematic review, and the total sample size was 1 980. These indicators were analyzed by age subgroups (adults and elderly adults). The objective indicators showed that the number of awaking was only statistically different in elderly adults group (P=0.043), while the latency period of sleep, wakefulness time after sleep onset and total sleep time were statistically different in both groups (P<0.05). The absolute value of total effect range was 0.153-0.414. Subjective indicators showed that the subjective total sleep time, subjective wakefulness time after sleep onset, and subjective number of awaking were statistically different in both groups (P<0.05), while subjective la-tency period of sleep was only statistically different in adults group (P=0.000). The absolute value of total effect range was 0.289-0.474. Con-clusion ¡¤ Placebo in the patients with primary insomnia can improve objective and subjective sleep assessment indicators, but the effect is small.

Acupuncture at acupoints along the meridians for primary insomnia: a multi-center randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical effect differences among different acupoint selection methods for primary insomnia.@*METHODS@#A total of 333 patients with primary insomnia were recruited from 3 study centers and randomly divided into a group A (111 cases, 7 cases dropped off), a group B (111 cases, 5 cases dropped off) and a group C (111 cases, 2 cases dropped off). The patients in the group A were treated with acupuncture at Shenmen (HT 7) and Baihui (GV 20), the patients in the group B were treated with acupuncture at Sanyinjiao (SP 6) and Baihui (GV 20), and the patients in the group C were treated with acupuncture at non-acupoint and Baihui (GV 20). All the treatment was given once a day, 30 min each time; 5 treatments were taken as a course and 5 courses of treatment were given. The Pittsburgh sleep quality index (PSQI) and Athens insomnia scale (AIS) scores were evaluated before and after treatment as well as 4 weeks after treatment. The encephalofluctuograph technology (ET) was observed before and after treatment.@*RESULTS@#Compared before treatment, the PSQI scores after treatment and at follow-up were significantly decreased in three groups (0.05).@*CONCLUSION@#The acupuncture at acupoints along the meridians could improve the sleep quality in patients with primary insomnia, and the therapeutic effect of acupoint along the meridians is better than that of non-acupoint.

A clinical trial of treatment of primary insomnia of patients with qi-stagnation constitution by shallow acupuncture combined with ear-acupoint pellet-pressing / 针刺研究

OBJECTIVE: To investigate the clinical effect of shallow acupuncture combined with ear-acupoint pellet-pressing in the treatment of primary insomnia in patients with qi-stagnation constitution. METHODS: A total of 60 primary insomnia outpatients with qi-stagnation constitution were randomly divided into treatment group and control group, with 30 patients in each group. The patients in the control group were given oral Alprazolam tablets once a day, and those in the treatment group given shallow acupuncture of Yintang (EX-HN3), Shangen (inferior to EX-HN3), Anmian (EX-HN16) and bilateral Xingjian (LR2) and bilateral Taichong (LR3), once a day, and combined with pellet-pressing of ear acupoints "Shenmen""Sympathy""Subcortex""Heart" and "Liver" once every other day. Each course of treatment was 10 consecutive days, and both groups were treated for three courses. The sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI), the emotional status assessed using Self-rating Depression Scale (SDS), and the qi-stagnation state evaluated according to "the Criteria for Classification and Judgement of Constitution of Traditional Chinese Medicine (2009)". The therapeutic effect was evaluated according to "the Criteria for Diagnosis and Evaluation of Therapeutic Effect of Diseases of Traditional Chinese Medicine"．. RESULTS: Of the two 30 cases in the control and treatment groups, 2 (6.7%) and 6 (20.0%) were cured, 6 (20.0%) and 14 (46.7%) experienced marked improvement in their symptoms, 21 (70.0%) and 6 (20.0%) were effective, and 1 (3.3%) and 4 (13.3%) ineffective, with the effective rate being 86.7% and 96.7%, respectively. No significant difference was found between the two groups in the short-term effect (P>0.05). One month's follow-up showed that, of the two 30 cases in the control and treatment groups, 2 (6.7%) and 5 (16.7%) were cured, 4(13.3%) and 14 (46.6%) experienced marked improvement, 10 (33.3%) and 6 (20.0%) were effective, and 14(46.7%) and 5(16.7%) ineffective, with the effective rate being 53.3% and 83.3%, respectively. The long-term therapeutic effect of the treatment group was significantly superior to that of the control group (P<0.05). After the treatment, both PSQI and SDS scores in the two groups, and qi-stagnation score in the treatment group showed a significant reduction in comparison with their own pretreatment (P<0.05), and one-month's follow-up (not the short-term outcome) displayed that the PSQI, SDS and qi-stagnation scores of the treatment group were significantly lower than those of the control group (P<0.05)．. CONCLUSION: Shallow acupuncture combined with ear-acupoint pellet-pressing can significantly improve sleep quality, depression symptoms, and pathological constitution in primary insomnia patients with qi-stagnation constitution, possessing a stable long-term clinical effect.

Effect of "Yinqi Guiyuan" needling on primary insomnia / 针刺研究

OBJECTIVE: To observe the clinical effect of "Yinqi Guiyuan" needling in the treatment of primary insomnia. METHODS: A total of 79 primary insomnia outpatients were randomly divided into treatment group (n=40) and control group (n=39). The patients in the control group were given oral Estazolam tablets once a day, for successive 4 weeks. For patients of the treatment group, Zhongwan (CV12), Xiawan (CV10), Qihai (CV6), Guanyuan (CV4), Baihui (GV20), etc., were punctured with filiform needles for 30 min. The treatment was conducted three times per week for 4 successive weeks. The sleep quality (sleeping quality, falling asleep time, sleep duration, sleep efficiency, sleep disorders, hypnotic and daytime dysfunction, 0 to 21 points) was evaluated by using Pittsburgh Sleep Quality Index (PSQI). The severity of insomnia (self-perception, sleep satisfaction, daytime function damage, sensibility change, and concern for sleep problems, 0 to 28 points) was assessed using insomnia severity index (ISI) score. The therapeutic effect was evaluated according to the PSQI score reduction rate = (pre-treatment PSQI score-post-treatment PSQI score)/pre-treatment PSQI score ×100%. RESULTS: After treatment, the total score of PSQI, ISI and the score of each item were all significantly reduced in the two groups relevant to their own pre-treatment (P0.05). CONCLUSION: "Yinqi Guiyuan" needling and Estazolam are comparable in treatment primary insomnia, and the former is superior to the latter in avoiding hypnotic drug use and in improving daytime function.

Instant adjustive effect of auricular electroacupuncture on brain default model network of patients with primary insomnia / 针刺研究

OBJECTIVE: To investigate the immediate brain effect of auricular electroacupuncture (EA) in the treatment of primary insomnia (PI). METHODS: In this study, 15 subjects with PI who were diagnosed according to Pitsburgh Sleep Quality Index (PSQI), and other 15 age- and gender-matched subjects without insomnia were recruited in the present study. The PI patients received EA (4 Hz/20 Hz, a tolerable electrical current strength) of auricular concha for 30 min, and their resting state functional magnetic resonance imaging (fMRI) data before and after treatment were collected. The healthy subjects received no any treatment and their resting state fMRI data were collected. The diffe-rence of default mode network functional connectivity between the patients and healthy subjects, and changes of the patient's brain functional connectivity after EA treatment were estimated by using seed-point-based analysis (SPBA). RESULTS: Analysis by taking the posterior cingulate gyrus as the seed-point showed that compared with the healthy participants before treatment, the patient's brain functional connectivity between the posterior cingulate gyrus and the right insula, or the inferior frontal gyrus of the right opercularis region, or the right rolandic operculum was increased. After 30 minutes' EA treatment, the functional connectivity between the posterior cingulate gyrus and the precuneus, the left angular gyrus, the left frontal superior gyrus, the left frontal middle cortex, the right temporalis inferior gyrus, the right temporalis middle gyrus or the left medial orbitofrontal cortex was decreased, while the functional connectivity between the posterior cingulate gyrus and the right lingual gyrus, or the cortex surrounding the right calcarine fissure was increased. CONCLUSION: EA of auricular concha has an instant effect in modulating the brain default mode network in PI patients, which may be its brain mechanism underlying improvement of PI.

Observation of Addition and Subtraction Therapy of Liuwei Dihuangwan Combined with Huanglian Ejiaotang to Primary Insomnia in Elderly Liver and Kidney Yin Deficiency Syndrome / 中国实验方剂学杂志

Objective:To observe the clinical efficacy of addition and subtraction therapy of Liuwei Dihuangwan combined with Huanglian Ejiaotang to primary insomnia in the elderly (liver and kidney Yin deficiency syndrome), and to investigate its regulation effect on neurotransmitter. Method:Randomly 136 patients were divided into control group (68 cases) and observation group (68 cases) by number table. Patients in control group got Estazolam tablets by oral administration before going to bed, 1-2 mg/time, 1 time/day. Patients in observation group got addition and subtraction therapy of Liuwei Dihuangwan combined with Huanglian Ejiao tang, 1 dose/day. Both groups of patients received sleep guidance and cognitive behavior guidance, with treatment course of 8 weeks. During the observation period, physical therapy and acupuncture could not been used. Before and after treatment, pittsburgh sleep quality index (PSQI), whole night polysomnography, sleep latency (SL), awakening times (AT), sleep efficiency (SE), rapid eye movement (REM), latency (RL), total actual sleep time (TST) and proportion of N1, N2, N3 and REM in the whole sleep stage were recorded. Scores of self-rating depression scale (SDS), self-rating anxiety scale (SAS), kidney Yin deficiency syndrome score and treatment emergent symptom scale (TESS) were graded, and levels of 5-hydroxytryptamine (5-HT), 5-hydroxyindole acetic acid(5-HIAA), gamma-aminobutyric acid (GABA), norepinephrine (NE) and dopamine (DA) were detected. Result:In rank sum test, clinical efficacy in observation group was better than that in control group (Z=2.115, PPPPPPPPχ2=9.945, PConclusion:Addition and subtraction therapy of Liuwei Dihuangwan combined with Huanglian Ejiaotang can improve sleep quality, prolong sleep time, alleviate depression, anxiety, and can also regulate neurotransmitters to improve sleep effect. The efficacy of PSQI is better than that of Estazolam tablets.

Sleep Disorders Documented by Night Polysomnography in Patients with Chronic Insomnia Disorder

BACKGROUND: To investigate the sleep disorders related to chronic insomnia and compare the characteristics of each group. METHODS: We registered 191 patients (female 56.0%, age 61.7 years) who have complained about symptoms of insomnia for more than three months and assessed sleep disorders related chronic insomnia by analyzing their polysomnography (PSG) parameters, demographics, and questionnaires (Insomnia Severity Index, Beck Depression Inventory, Pittsburg Sleep Quality Index, and Epworth Sleepiness Scale, and World Health Organization Quality of Life Assessment Instrument abbreviated version). RESULTS: Patients were categorized into groups of primary insomnia (PI, 51.8%, n=99), comorbid insomnia with obstructive sleep apnea (CIO, 38.7%, n=74), and comorbid insomnia with periodic limb movement disorder (CIP, 9.4%, n=18). CIO was older and more obese than PI and CIP. The proportion of males was the highest in CIO. Arousal index of PSG was higher in CIO and CIP than in PI. Other parameters and the results of questionnaires were not different among groups. CONCLUSIONS: About a half of patients with chronic insomnia symptoms (48.2%) had considerable sleep disorders associated with insomnia. Our study suggests that the PSG as well as history taking and demographics are necessary to clarify the relevant conditions of chronic insomnia disorder for appropriate treatment.

Clinical curative effect research status and analysis of acupuncture treatment for primary insomnia / 中国针灸

<p><b>OBJECTIVE</b>To grasp the clinical efficacy of acupuncture in the treatment of primary insomnia (PI), and analyze its future research directions.</p><p><b>METHODS</b>A total of 41 prospective randomized controlled trials (RCTs) were conducted in which the clinical efficacy of acupuncture for treatment of PI was compared with sedative and hypnotic drugs in recent six years by searching databases of CNKI, database, PubMed, and BioMed Central (BMC), the aspects of diagnostic criteria, efficacy standards, observation time, control drugs, characteristics of acupoint selection and regularity were used to review and analyse.</p><p><b>RESULTS</b>Acupuncture treatment for PI was mainly based on acupoints in the head, combined with selecting the points according to the different syndrome, showing short-term efficacy and safety advantages, but it was not well-established in many aspects such as diagnostic criteria, efficacy evaluation, observation time, and control drugs.</p><p><b>CONCLUSION</b>Current evidence shows that acupuncture treatment is effective, but it is necessary to add more stringent RCTs, and introduce objective monitoring indicators to strengthen the evidence and enhance the overall level of research.</p>

The Roles of Frontal Cortex in Primary Insomnia : Findings from Functional Magnetic Resonance Imaging Studies

Insomnia is a common sleep-related symptom which occurs in many populations, however, the neural mechanism underlying insomnia is not yet known. The hyperarousal model explains the neural mechanism of insomnia to some extent, and the frontal cortex dysfunction has been known to be related to primary insomnia. In this review, we discuss studies that applied resting state and/or task-related functional magnetic resonance imaging to demonstrate the deficits/dysfunctions of functional activation and network in primary insomnia. Empirical evidence of the hyperarousal model and proposed relation between the frontal cortex and other brain regions in primary insomnia are examined. Reviewing these studies could provide critical insights regarding the pathophysiology, brain network and cerebral activation in insomnia and the development of novel methodologies for the diagnosis and treatment of insomnia.

Professor GU Xizhen's Experience in Treating Primary Insomnia / 浙江中医药大学学报

[Objective]To discuss the clinical experience of treating primary insomnia with Professor GU Xizhen, the famous Chinese doctor in Jiangsu Province. [Methods]To study the understanding of the etiology and pathogenesis of primary insomnia by Professor GU Xizhen, summarize the experience of treating primary insomnia based on the use of the key suppressing Yang and basing on the syndrome differentiation.[Results]Professor GU Xizhen thinks that the movement of the Ying and Wei is the most important physiological mechanism for the formation of sleep, and that Yang does not enter the Yin is the basis of the pathologic theory, the deficiency of Qi and blood and the dysfunction of the viscera are the pathogenic factors. Based on the urgent cure of the symptoms, delayed treatment of the fundamental principles, put forward the treatment when suppressing Yang into Yin first, on the basis of the emphasis on tonifying Qi and blood, Yin and Yang, clearing heat, removing the wet, regulating Qi activity etc, matching specific time of the drug. It can relieve both primary and secondary symptoms and get good results.[Conclusion]The treatment of primary insomnia by the Professor GU Xizhen is very effective. It deserves further study and promotion in clinical practice. One medical case is attached to prove the above conclusion.

Study on Difference of Intestinal Flora in Patients with Primary Insomnia with Different TCM Syndromes / 中国中医药信息杂志

Objective To explore structural differences of intestinal flora in primary insomnia patients with different TCM syndromes through the high-throughput 16S rDNA sequencing analysis. Methods Totally 65 patients with primary insomnia were divided into 22 patients with syndrome of liver depression transforming into fire, 17 patients with deficiency of both heart and spleen syndrome, 26 patients with syndrome of hyperactivity of fire due to yin deficiency, with 47 cases of healthy people as the control group. The fecal flora structure of the subjects was analyzed by high-throughput 16S rDNA sequencing. QIIME software and R language stats package were used to analyze the diversity of flora. Results Totally 1226 different operational taxonomic units (OUTs) were obtained, and there were 180 significant differences among the 4 groups (P<0.05), indicating that the samples were rich in microbial colonies. The mapped reads in group of liver depression transforming into fire and hyperactivity of fire due to yin deficiency were more than the group of deficiency of both heart and spleen and the control group (P<0.05). Unweighted UniFrac analysis showed that the difference among groups was remarkably greater than the difference within group, and the grouping was statistically significant (R=0.103, P=0.002). It suggested that the diversity of intestinal flora was highly correlated with different TCM syndromes of insomnia. There were a total of 57 genera found significant differences among the different groups at the genus level (P<0.05), and 115 species at all species level. The dominant flora of the control group were prevotella, megamonas, clostridium Ⅺ (clostridium ⅩⅧ), weissella, and alloprevotella; The dominant flora of liver depression transforming into fire syndrome were phascolarctobacterium, flavonifractor, eggerthella, and bilophila; The dominant flora of deficiency of both heart and spleen syndrome were sphingomonas and methylobacterium; The dominant flora in hyperactivity of fire due to yin deficiency syndrome group were bacteroides, parabacteroides, parasutterella, butyricimonas, odoribacter. Conclusion The patients with primary insomnia have abundant intestinal flora diversity and diverse flora structure, which may affect the occurrence, development and outcome of different TCM syndromes.

Research advances of functional magnetic resonance imaging in patients with primary insomnia / 第二军医大学学报

Primary insomnia (PI), a prevalent sleep disorder, has been associated with cognitive deficits and emotional disorders. Several studies have shown that PI involves a wide range of brain abnormalities. In recent years, functional magnetic resonance imaging techniques combined with different analysis methods are widely applied in the study of PI. It can objectively and indirectly analyze the changes in brain functional activities, help to elucidate the neuropathological mechanisms of PI, and provide reliable objective basis for the early diagnosis of disease. In this paper, we reviewed the application of task state functional magnetic resonance imaging, resting-state functional magnetic resonance imaging and function connectivity in patients with PI.

Regulation action and nerve electrophysiology mechanism of acupuncture on arousal state in patients of primary insomnia / 中国针灸

<p><b>OBJECTIVE</b>To compare the difference between acupuncture and estazolam on arousal state in patients of primary insomnia, and to explore its nerve electrophysiology mechanism.</p><p><b>METHODS</b>Sixty-four patients of primary insomnia were randomized into an acupuncture group (32 cases) and a medication group (32 cases). After 3 patients were excluded, 31 cases in the acupuncture group and 30 cases in the medication group were included. Patients in the acupuncture group were treated with acupuncture at Sishencong (EX-HN 1), Anmian (Extra), Shenmen (HT 7), Sanyinjiao (SP 6), Zhaohai (KI 6), Shenmai (BL 62) as main acupoints, combined with supporting acupoints, once a day, five times per week, continuously for 4 weeks. Patients in the medication group were treated with oral administration of estazolam, once a day, continuously for 4 weeks. The Pittsburgh sleep quality index (PSQI) and mean sleep latency (MSL) of multiple sleep latency test (MSLT) were compared before and after treatment in the two groups; the polysomnography (PSG) was applied to monitor the indices regarding sleep structure.</p><p><b>RESULTS</b>Compared before treatment, PSQI score was reduced after treatment in the two groups (both<0.01), which was more significant in the acupuncture group (<0.05). Compared before treatment, sleep onset latency (SOL), number of awakenings (NWAK) and wake after sleep onset (WASO) were reduced, while total sleep time (TST) and sleep efficiency (SE) were significantly increased in the two groups after treatment (all<0.01). Compared before treatment, the percentage of non-rapid eye movement period 1/2/3 (N1, N2, N3) and the percentage of rapid eye movement period (REM) to TST were not significantly changed after treatment in the medication group (all>0.05). Compared before treatment, the percentage of N1, N2 to TST was reduced, while the percentage of N3 and REM to TST was increased after treatment in the acupuncture group (<0.01). The SOL, NWAK, WASO, TST, SE were not statistically changed after treatment in each group (all>0.05). Compared with the medication group, the percentage of N1 and N2 was reduced while that of N3 and REM was increased after treatment in the acupuncture group (all<0.01). After treatment, MSL of MSLT were obviously decreased in the two groups (both<0.01), which were more significant in the acupuncture group (<0.05).</p><p><b>CONCLUSIONS</b>Acupuncture can more effectively improve sleep quality of primary insomnia than estazolam, and is more beneficial for regulation of hyperarousal state.</p>

Transcutaneous vagus nerve stimulation for primary insomnia and affective disorder:a report of 35 cases / 中国针灸

<p><b>OBJECTIVE</b>To observe and evaluate the clinical efficacy of transcutaneous vagus nerve stimulation (taVNS) at auricular concha for primary insomnia (PI) and affective disorder.</p><p><b>METHODS</b>A total of 35 patients who met the diagnosis standard of PI in(5th edition) were included. The self-developed auricular vagus nerve stimulator (TENS-200A) was applied at auricular concha, 30 min per treatment, twice a day, 5 days a week for consecutive 4 weeks. The follow-up visit was conducted at the end of 6th week. The Pittsburg sleep quality index scale (PSQI), 17-items Hamilton depression scale (17HAMD) and Hamilton anxiety scale (HAMA) were applied for evaluation. The PSQI, HAMA and 17HAMD were observed before and after treatment; the safety was also observed.</p><p><b>RESULTS</b>Compared before treatment, the PSQI was significantly decreased to (13.20±3.61) at the end of 2nd week (<0.05); compared before treatment, the 17HAMD and HAMA were significantly decreased at the end of 4th week and 6th week (all<0.05). No adverse reaction was observed.</p><p><b>CONCLUSIONS</b>The taVNS could not only relieve PI symptoms, but also improve the depressive and anxiety symptoms, in addition, it may have positive long-term efficacy and safety.</p>

Change of Whole Brain Degree in Primary Insomnia / 中山大学学报(医学科学版)

[Objective] Based on the resting state functional magnetic resonance imaging to investigate the abnormal features of the functional connectivity of resting brain neural network in the patients with primary insomnia,by using voxel-wise whole-brain finctional networks analysis of degree centrality (DC) for imaging evidence of neural mechanisms underlying primary insomnia.[Methods] The resting state fMRI were performed in 59 PI patients and 47 age,education,and sex-matched normal healthy subjects.Analysis of DC map changes between the two patient groups and the control group were performed by two sample t test.(threshold at P ＜ 0.05).[Results] Compared with the control group,the patients with PI showed significantly reduced DC value in bilateral medial frontal gyrus (MFG),bilateral anterior cingulate gyrus (ACG),and right insula;and increased DC value in right middle temporal gyrus (MTG),and left cuneus,(CUN),P ＜ 0.05.[Conclusion]Changes of DC value occurred in some region of brain in the P[patient groups when compared with the control group.It was indicated that DC,as a novel resting-state fMRI parameter in the voxel-wise whole-brain functional networks,might be an appealing alternative approach for further study on pathologic and neuropsychological states of PI.