Analysis Of The Efficacy Of Low-frequency Repetitive Transcranial Magnetic Stimulation In The Treatment Of Chronic Insomnia

Objectives 1.To analyse and compare the clinical efficacy of low frequency(1Hz)repetitive transcranial magnetic stimulation(r TMS)combined with zolpidem tartrate and zolpidem tartrate alone in the treatment of chronic insomnia patients,and to provide new treatment ideas for chronic insomnia patients who have poor results with conventional medication.2.To investigate the effects of low frequency(1Hz)r TMS combined with zolpidem tartrate treatment on serum ACTH,TSH,FT3 and FT4 levels in patients with chronic insomnia,and to provide some theoretical reference for the mechanism of action of r TMS in the treatment of chronic insomnia..Methods 1.Based on the inclusion and exclusion criteria,50 patients with chronic insomnia who met the diagnostic criteria were selected for the Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI),Self-Rating Scales for Anxiety(SAS)and Depression(SDS),as well as serum levels of adrenocorticotropic hormone(ACTH),thyroid stimulating hormone(TSH),free triiodothyronine(FT3)and free thyroxine(FT4)levels were measured.Patients were randomly divided into control group(zolpidem tartrate treatment)and r TMS group(zolpidem tartrate combined with r TMS),25 cases each.2.Patients in the control group were given continuous oral zolpidem tartrate tablets 5mg/night for 2 weeks.Patients in the r TMS group were given low frequency(1Hz)r TMS treatment with an intensity of 80%resting motor threshold(RMT)in the right dorsolateral prefrontal lobe(DLPFC)based on the control group drug regimen,with a total number of 1500 pulses of stimulation and a total duration of approximately 30 min per session,once daily for 1 course of treatment(10 sessions in total)over 2 weeks.3.The changes of each scale score and serum ACTH,TSH,FT3 and FT4 levels before and after treatment were compared between the two groups;at the same time,the correlation between the difference in PSQI scores and the difference in SAS and SDS scores as well as the difference in serum ACTH,TSH,FT3 and FT4 between the two groups before and after treatment was analysed.Results1.The final 45 patients completed the study and the difference in baseline information between the two groups was not statistically significant.2.Comparison of the scores on each scale between the two groups: After 2 weeks of treatment,the PSQI,ISI,SAS and SDS scores of patients in both groups were significantly lower than those before treatment,and the difference was statistically significant(P < 0.05).The r TMS group’s scores on the above scales were lower than those of the control group when compared between groups..3.Comparison of ACTH levels between the two groups: After 2 weeks of treatment,there was no statistically significant difference in ACTH levels in the control group when compared within the group(P > 0.05),ACTH levels in the r TMS group were significantly lower than before treatment,and the difference was statistically significant(P < 0.05),and ACTH levels in the r TMS group were lower than those in the control group when compared between the groups,and the difference was statistically significant(P < 0.05).4.Comparison of TSH,FT3 and FT4 levels between the two groups: after 2 weeks of treatment,there was no statistically significant difference in TSH levels between the control group compared within the group(P > 0.05),the TSH levels in the r TMS group decreased compared with those before treatment,and the difference was statistically significant(P <0.05),there was no statistically significant difference in FT3 and FT4 levels between the two groups compared within the group(P > 0.05),and there was no statistically significant difference between the control group compared between the groups There was no statistically significant difference in TSH,FT3,FT4 and r TMS group between the groups(P > 0.05).5.Spearman’s correlation analysis showed that in the control group,there was a statistically significant correlation between the difference in PSQI scores before and after treatment and the difference in SAS and SDS scores before and after treatment(P < 0.05),with a positive correlation(r = 0.658,0.638).In the r TMS group,the correlation between the difference in PSQI scores before and after treatment and the difference in SAS,SDS scores and ACTH levels before and after treatment was statistically significant(P < 0.05)and positively correlated(r = 0.562,0.603,0.308),while no significant correlation was found between the remaining indicators and the difference in PSQI scores.Conclusions1.Low-frequency r TMS combined with zolpidem tartrate treatment is superior to drug treatment alone in improving sleep quality in patients with chronic insomnia,and r TMS can significantly improve anxiety and depression in patients with chronic insomnia..2.Low-frequency r TMS reduces serum ACTH levels in patients with chronic insomnia,and its improvement in sleep quality may be associated with lower ACTH levels.