Efficacy Of Drug Therapy Combined With Psychological Intervention On Insomnia After Stroke And Its Effect On IL-6 And TNF-? Levels In The Elderly

Background and purposeStroke,as a common neurological disease,is one of the most important diseases that endanger human life and health in the world today.Stroke not only causes physical dysfunction,but also induces emotional disorders such as depression and anxiety,which has various effects on the sleep pattern of patients,leading to frequent disturbances of sleep-wake cycles and insomnia.About 20-50%of elderly patients with stroke experience insomnia,and the specific mechanism has not been fully clarified.Clinical studies have found that cytokines can be involved in the regulation of sleep behavior.Interleukin 6(IL-6)?tumor necrosis factor ?(TNF-?)regulate the secretion of various neurotransmitters in the brain through inflammatory pathways.The levels of IL-6 and TNF-? in patients with insomnia increased.After the sleep condition improved,the levels of IL-6 and TNF-? in peripheral blood gradually decreased.The treatment methods for insomnia include drug therapy and non-drug therapy.Psychotherapy for insomnia,as an emerging treatment method developed in recent years,has been widely recognized in clinical practice for its safety and efficacy,and has become the first choice recommended by the international sleep association for the treatment of insomnia.Studies have confirmed that the combination of right zopicrone and gamma aminobutyric acid(GABA)complex as a sleep promoting drug has a significant effect on improving sleep quality,with a short half-life of drug metabolism and little addiction,and is one of the most commonly used oral drugs for the treatment of insomnia after stroke.At present,the clinical treatment of insomnia after stroke mainly consists of monotherapy(namely,hypnotic drugs/psychotherapy).Both of them have their own characteristics in the treatment of insomnia alone:drug therapy has a quick effect and side effects,while psychological therapy has a slow effect and poor compliance.However,there are few reports on the combined program of sleep promoting drugs and psychological intervention in the treatment of insomnia after stroke in the elderly.This study was performed on elderly patients with insomnia after stroke with drug therapy,psychological intervention,and drug therapy combined with psychological intervention.Compared with the control group,we observed the improvement of patients' sleep status and the effects on the levels of IL-6 and TNF-?in plasma in order to explore a more effective treatment for insomnia after stroke.MethodA total of 180 patients diagnosed with insomnia after stroke in the outpatient and ward of department of neurology,department of geriatrics and department of rehabilitation of our hospital from March 2018 to May 2019 were collected as the study subjects and randomly divided into four groups.Among them,45 patients in the control group received routine supportive treatment with drugs(including improving circulation,scavenging free radicals,nourishing nerves,anti-platelet aggregation,controlling blood pressure,blood lipid and blood glucose,etc.).The observation group was divided into 3 groups,with 45 patients in each group.On the basis of conventional supportive treatment,group A received dzopiclone orally(3mg each time,once per night).Group B:psychological treatment;Group C(combined treatment group):right zopiclone was given orally(3mg each time,1 time per night)and psychotherapy.Continue for 4 weeks for 1 course of treatment.The indicators of polysomnography(PSG)before treatment,2 weeks after treatment and 4 weeks after treatment were evaluated in the observation group and the control group:Sleep latency(SL),total sleep time(TST),arousal times(AT),Pittsburgh sleep quality index(PSQI)score and plasma levels of IL-6 and TNF-? were used to observe the efficacy of drug therapy combined with psychological intervention on insomnia after stroke in the elderly and the influence of IL-6 and TNF-? levels.SPSS25.0 software package was used for statistical processing of the data.Result1.Monitoring indicators of polysomnography(SL,TST,AT):within 2 weeks of treatment and 4 weeks after treatment,the intra-group comparison showed that the SL and AT of patients in each group were reduced compared with before treatment,and decreased after 4 weeks of treatment It was more obvious,and the differences were statistically significant(P<0.01);TST in each group increased compared with that before treatment,and the increase was more significant after 4 weeks of treatment,and the differences were statistically significant(P<0.01).After 2 weeks of treatment and 4 weeks of treatment,there was no significant difference in SL and AT betweenthe groups(P>0.05).The TST in the observation group was higher than that in the control group,and the TST in group C was significantly higher than that of A,There were statistically significant differences between the two groups(P<0.05).There was no significant difference in the TST between groups A and B(P>0.05).2.Pittsburgh Sleep Quality Index(PSQI):After 2 weeks of treatment and 4 weeks of treatment,the intra-group comparison showed that the PSQI scores of patients in each group were lower than before treatment,and the decline was more significant after 4 weeks of treatment.The difference was statistically significant(P<0.01).After 2 weeks and 4 weeks of treatment,the comparison between the groups showed that the PSQI of the observation group was lower than that of the control group,and the PSQI score of group C was significantly lower than that of the A and B groups,and the differences were statistically significant(P<0.05).There was no significant difference in PSQI score between group B and group B(P>0.05).3.Levels of IL-6 and TNF-?:After 2 weeks and 4 weeks of treatment,the intra-group comparison showed that the levels of IL-6 and TNF-? in patients in each group were lower than before treatment,and the decline was more significant after 4 weeks of treatment.Significantly,the difference was statistically significant(P<0.01).After 2 weeks of treatment and 4 weeks of treatment,the levels of IL-6 and TNF-? in the observation group were lower than those in the control group.The levels of IL-6 and TNF-? in the group C were significantly lower than those in the A and B groups,and the differences were statistically significant.Significance(P<0.0001).There was no significant difference in the levels of IL-6 and TNF-? between group A and group B(P>0.05).ConclusionDrug therapy combined with psychological intervention has a significant effect on the treatment of insomnia after stroke,which can effectively improve the symptoms of insomnia and reduce the levels of IL-6 and TNF-? in patients.