| Insomnia,defined as a persistent difficulty with sleep initiation,duration,consolidation,or quality that occurs despite adequate opportunity and circumstances for sleep,and results in some form of daytime impairment,is the most common sleep disorder.Insomnia is an independent disease,or a symptom of another disorder.According to the course of disease,insomnia is divided into short-term insomnia disorder lasting less than three months,chronic insomnia disorder lasting more than three months,and other insomnia disorders.The prevalence of insomnia disorder appears to be in the range of 6%to 48%,based on different diagnostic schedules that present diagnostic criteria for insomnia.At present,the clinical diagnosis of insomnia is mainly based on difficulty initiating sleep,maintaining sleep,fatigue,and evaluation results of relevant scales.There is still lack of objective and sensitive diagnostic tool,which will affect the scientific research and clinical workers on the comprehensive understanding of insomnia.Therefore,understanding characteristics and regularity of chronic insomnia from different views is a very necessary scientific research work.The four diagnosic information of Traditional Chinese medicine(TCM)are obtained by a comprehensive examination including inspection,auscultation and olfaction,inquiry as well as pulse-taking ang palpation.Among the four diagnostic methods,pulse-taking is the most representative embodiment of TCM characteristics,and is the most frequently method to diagnose disease.Pulse graph parameters obtained by the pulse instrument is an indicator of the objectiveization of the information of Chinese medicine,the most widely used and correct diagnostic test method in the objective study of Chinese medicine,and also an important part of the study of Chinese medicine diagnosis and modernization rsearch.Polysomnography(PSG)is an objective method for assessing sleep,recognized as an applicable technique for sleep research.Sleep structure stage according to PSG is the basis of sleep medicine research,which can objectively reflect the integrity of sleep,distinguish between sleep perception error and insomnia,judge wakefulness or sleep,and assess the severity of insomnia as a key parameter.Infrared thermal imaging technology analysis quantificationally different parts of the body surface temperature,and distinguish the cold and heat,yin and yang of the disease to a certain extent,then provide a technical method for the visualization and quantitative study of TCM syndromes.Objective:To obtain the characteristics and regularity of chronic insomnia from subjective symptoms,pulse graph parameters,PSG sleep structure and surface temperature,and analyze the correlation between characteristic parameters in contrast to normal population,which in order to provide data support for more objective,standardized diagnosis and evaluation of chronic insomnia in the future.Methods:The subjective symptoms obtained by the four information questionnaire of TCM,the objective characteristics and regularity of chronic insomnia obtained by the Chinese medicine pulse information collection and analysis system,PSG,infrared imaging technology.Results:The characteristics and regularity of chronic insomnia obtained by different methods,and the results showed that:1.Demographic characteristics of insomnics and normal populationDemographic characteristics of controls:The age of normal population appears to be in the range of 37.53±13.05 years,men accounted for 46.67%(28/60),women accounted for 53.33%(32/60),unmarried accounted for 45%(27/60),married accounted for 55%(33/60),the Han nationality accounted for 91.67%(55/60),mental work mainly accounted for 83.33%(50/60),manual labor accounted for 16.67%(10/60),university degree or above accounted for 76.67%(46/60),and 23.33%(14/60)for high school education and below.Demographic characteristics of insomniacs:The age of insomniacs appears to be in the range of 41.85±11.27 years,men accounted for 43.33%(26/60),women accounted for 56.67%(34/60),unmarried accounted for 28.33%(17/60),married accounted for 71.67%(43/60),the Han nationality accounted for 96.67%(58/60),mental work mainly accounted for 73.33%(44/60),manual labor accounted for 26.66%(16/60),university degree or above accounted for 76.67%(46/60),and 23.33%(14/60)for high school education and below.2.Analysis of symptoms of TCM in two groups of population(1)Card side test:71 symptoms of the two groups of people by ?2 test,the minimum expected count is greater,P<0.05,indicating that insomniacs and normal population symptoms are statistically different.(2)Frequency statistics:There were more than 30 insomnia related and systemic symptoms in the two groups of people,including difficulty initiating sleep,difficulty maintaining sleep,waking up earlier than desired,dreams,fatigue or malaise,attention,concentration,or memory impairment,snoring,toilet visits at night,reduced motivation,energy or initiative,daytime sleepiness,irritability,palpitations,afraid heat,dizziness,trichomadesis,dry eyes,thirst,odor in the mouth,heavy body,distraught,low back pain.(3)Factor analysis:The factor load matrix is obtained by factor analysis,and the maximum variance orthogonal rotation is carried out on this basis,and the total variance is explained after iterative.According to the criteria of the characteristic root greater than 1,21 male factors were extracted from 71 symptoms,and the cumulative variance contribution rate reached 75%,that is,75%of the original information was extracted from 21 male factors.Select the absolute load coefficient of each male factor and the symptom sindication information of 0.3 to analyze the symptom elements and the disease locations.Symptom elements including qi deficiency,blood deficiency,food hysteria,yin deficiency,qi hysteresis,blood unsmooth,fire,impotence,yang deficiency,dampness.Disease locations including heart,spleen,kidney,liver,gallbladder,stomach.(4)Syndrome differentiation and disease discrimination:According to Insomnia TCM Clinical Practice Guide(WHO/WPO),insomnia is divided into 9 types of syndromes differentiation,insomnics with deficiency of heart and spleen and intermingled deficiency and excess is the majority.3.Decision analysis of pulse graph parameters of two groupsBased on the decision analysis of pulse graph parameters of two groups,it is concluded that the correct differentiation rate of the two groups is about 78%,which indicates that the pulse graph of the insomnics and controla could be classified by their parameters,and the specificity and accuracy of the distinction are higher.A total of 27 parameters were involved in the classification of the two-handed,representing about 14%(27/193).The left cun contributed the most(25%),right guan accounting for 24%.The percentage of the selected parameters of the left cun and right guan amounted to 49%.4.Analysis of PSG sleep structure in two groupsThe parameters of PSG sleep structure in insomnics and controls were tested by T test,and the results showed that there were statistical differences between the two groups in the total sleep time(TST)and rapid eye movement(R).The mean value of TST and R in normal group was greater than that in insomnia group,that is,total sleep time and rapid eye movement of insomnics decreased compared with controls.5.Analysis of thermal image parameters of two groupsThe average head temperature and chest temperature of insomnics and normal population were higher than those in other parts.Insomnics with virtual temperature,gastric epigastric temperature,governor temperature,left hand temperature,right-hand temperature are higher than controls,mean difference(normal group temperature mean and insomnia group temperature mean difference)are>0.2?.There was no significant difference in thermal image parameters between the two groups.As the temperature difference increases,the P value decreases.6.Analysis of feature parametersThe sleep structure parameters were analyzed by Pearson correlation,the results showed that,wake after sleep onset was significantly negatively correlated with total sleep time(TST)and sleep efficiency(SE).TST is positively correlated with non-rapid eye movement 2(N2),rapid eye movement(R),and SE.N2,R period and SE showed significant positive correlation.Non-rapid eye movement 1(N1)was positively correlated with the number of sobriety.The thermal image parameters were analyzed by Pearson correlation,the results showed that,there was a significant positive correlation between the average head temperature,torso temperature,upper energizer temperature,middle energizer temperature,lower energizer temperature,conception vessel temperature,chest temperature,abdominal temperature,left rib temperature and right rib temperature.There was no significant correlation between virtual temperature,stomach temperature and torso temperature and abdominal temperature.The correlation between the insomnia-related symptoms was analyzed by Spearman,and it was found that,difficulty initiating sleep is highly positively related to difficulty maintaining sleep,difficulty maintaining sleep is highly positively related to waking up earlier than desired and easy to wake up with difficulty falling asleep again.There is no statistical difference among insomnia-related symptoms and TST,R period and thermal image parameters used by Spearman correlation.There is no statistical difference between the thermal image parameters and the PSG sleep structure parameters used by typical correlation analysis.Conclusions:1.The pulse graph parameters provide data support for the insomnia theory of the Chinese medicine.The pulse graph parameters can distinguish the insomnics from the normal population,and the left cun and right guan have a great contribution to the classification of insomnia pulse graph,which confirms the connotation of "the loss of mind causing insomnia","the upset of stomach causing insomnia",and the effectiveness of clinical differentiation from the heart and spleen,which provides a reference basis for understanding and evaluating insomnia from the perspective of TCM pulse.2.The statistical results of symptoms are consistent with the pathogenesis and location of insomnia,and distribution results of TCM syndromes.The public factor of the symptoms of insomnia was extracted,and the absolute value of the load coefficient in the public factor was analyzed mostly in the heart,spleen,which consistent with pathogenesis of insomnia,and the deficiency of heart and spleen.3.The pulse graph parameters,the analysis results of the four-diagnosis questionnaire and the traditional Chinese medicine theory are consistent.The objective pulse graph parameters obtained by the modern pulse instrument,the symptoms obtained by four diagnostic information questionnaire of TCM,and pathogenesis of insomnia recorded in the traditional literatures,all point to the heart and spleen.Indicating that the objective pulse graph parameters and subjective symptoms and the pathogenesis insomnia theory are consistent.It also illustrates the possibility of modernizing Chinese medicine.4.Infrared thermal imaging technology is an effective technical means of insomnia research.Insomnics and normal population infrared images are different,which provides a certain technical reference for visualization and quantification of insomnia.In summary,this study provides a certain basis for the evaluation of insomnia in the information of Chinese medicine,PSG and infrared thermal imaging technology,enriches the relevant technical methods of insomnia research,and provides new ideas for pulse diagnosis,objectification,visualization research and application of infrared thermal imaging technology.It also provides a new perspective for the objectification of diagnosis and syndrome differentiation in TCM. |
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