| Research background and purpose:Sleep deprivation can cause a wide range of health problems and have negative consequences for life and productivity,and has become a serious social issue at a time of rapid social development and drastic changes in lifestyle.As a result,sleep deprivation research has gradually become a hot topic in the field of medical research.Acute sleep deprivation research trials are highly controllable and easy to perform,and because acute sleep deprivation is likely to occur in military,transport and medical practitioners,such research is highly practical and exploratory.Deep transcranial magnetic stimulation is a relatively safe,non-invasive neuromodulation tool that works on brain nerve cells to improve neuroplasticity through pulsed electric fields generated by magnetic field induction,thereby relieving sleep stress and improving sleep.Our study attempts to investigate the changes in brain function and cognitive behaviour of sleep deprived individuals after deep transcranial magnetic stimulation from two perspectives: cognitive behaviour and functional brain imaging.Materials and Methods:Thirty healthy male subjects with good sleep habits were recruited from Chengdu Medical College and the University of Electronic Science and Technology according to inclusion and exclusion criteria,and the experiment was conducted in a comfortable and well-equipped sleep laboratory and MRI centre.Each subject was supervised and accompanied by medical and nursing staff in shifts over a period of four days,with video surveillance throughout.After waking from normal sleep,the subject undergoes the first MRI image acquisition and mental alertness test to obtain behavioural and functional imaging data of the subject during normal sleep.The acute sleep deprivation experiment is conducted for 36 h starting at 8:00 a.m.on day 2 and continuing until8:00 p.m.on day 3.Subjects are asked to remain awake for 36 h of acute sleep deprivation,without taking any stimulant or depressant drinks or drugs and without leaving the sleep laboratory.On the third day at 8:00 pm subjects underwent a second MRI image acquisition and mental alertness test to obtain behavioral and functional imaging data of the subjects after 36 h of sleep deprivation.Subjects were tested for mental alertness every 2h during the 36 h of acute sleep deprivation,a total of 18 times.On the third day at 10:00 pm subjects received deep transcranial magnetic stimulation for 30 minutes.After the stimulation was completed,the subjects underwent restorative sleep.A minimum of 8 hours of sleep was ensured and the sleep recordings were monitored by a surveillance camera system.On the fourth day,the subject received another deep transcranial magnetic stimulation session for 30 min at 8 am.A third MRI image acquisition and mental alertness test were then performed to obtain behavioural and functional imaging data after the deep transcranial magnetic stimulation.Data were processed using MATLAB 2013-based SPM,Dpabi and pc-pvt-bin-2.0.4,and statistical distraction was performed using Graph Pad Prism and Stata15.Result:1.Behavioural results: Compared to the normal sleep state,the mean reaction time,the fastest 10% reaction time,the number of minor lapses and the number of false starts gradually lengthened or increased during about 20 h of sleep deprivation,while the number of serious lapses remained unchanged.Each indicator then showed a clear tendency to fluctuate in prolongation or increase,with peaks in the 24h-32 h range,but all decreased at 36 h,with the number of severe errors returning to normal.After restorative sleep with deep transcranial magnetic stimulation,the number of minor misses,false starts and severe misses all returned to post-normal sleep levels,while the mean response time and fastest 10% response time did not return to post-normal sleep levels.2.Cerebral blood flow(CBF)results: Significant differences(Voxel-level FWE,p<0.05)were found in the right syrinx,bilateral orbital middle frontal gyrus,right dorsolateral superior frontal gyrus,left lingual gyrus and right precuneus in the three states: post-normal sleep,post-sleep deprivation and deep transcranial magnetic stimulation restorative sleep.A two-by-two comparison of the three states revealed a significant increase in CBF in the bilateral orbito-medial frontal gyrus and a significant decrease in CBF in the right syrinx,right dorsolateral superior frontal gyrus and left lingual gyrus after 36 h of sleep deprivation compared to normal sleep(p<0.01).After restorative sleep with deep transcranial magnetic stimulation,CBF was reduced in the left orbitofrontal gyrus and increased in the right syrinx,right dorsolateral superior frontal gyrus,left lingual gyrus and right precuneus compared to after 36 h of sleep deprivation(p < 0.01).Compared to after normal sleep,after restorative sleep with deep transcranial magnetic stimulation,CBF was elevated in the right orbital middle frontal gyrus and right precuneus,while CBF was decreased in the right dorsolateral superior frontal gyrus and left lingual gyrus(p < 0.01).3.Fractional low frequency amplitude(f ALFF)results: Significant differences were found in the left perisylvian cortex,right lingual gyrus,bilateral superior temporal gyrus and left middle occipital gyrus(Voxel-level FEW,p<0.05)after normal sleep,after sleep deprivation and during deep transcranial magnetic stimulation restorative sleep.(Voxel-level FWE,p<0.05).A two-by-two comparison of the three states revealed significantly higher f ALFF in the left perisylvian cortex,right lingual gyrus,bilateral superior temporal gyrus and left middle occipital gyrus after 36 h of sleep deprivation compared to normal sleep,with no brain areas with significantly lower f ALFF(p<0.01).After restorative sleep with deep transcranial magnetic stimulation,f ALFF was significantly lower in the left perisylvian cortex,right lingual gyrus and bilateral superior temporal gyrus compared to after 36 h of sleep deprivation,and there were no brain regions with significantly higher f ALFF(p < 0.01).Compared to after normal sleep,after restorative sleep with deep transcranial magnetic stimulation,f ALFF was significantly higher in the left perirhinal cortex,right lingual gyrus,bilateral superior temporal gyrus and left middle occipital gyrus,and there were no brain regions with significantly lower f ALFF(p < 0.01).4.Regional homogeneity(Re Ho)results: significant differences were found in the three states of normal post-sleep,post-sleep deprivation and deep transcranial magnetic stimulation restorative sleep in the bilateral perirhinal fissure cortex,left lingual gyrus,bilateral superior temporal gyrus and right cuneus(Voxel-level FWE p<0.05).A two-by-two comparison of the three states revealed significantly higher Re Ho in the bilateral perirhinal cortex,left lingual gyrus,bilateral superior temporal gyrus and right cuneus after 36 h of sleep deprivation compared to normal sleep,with no brain areas with significantly lower Re Ho(p<0.01).After restorative sleep with deep transcranial magnetic stimulation,the right perisylvian cortex,left lingual gyrus,left superior temporal gyrus and right cuneus had significantly lower Re Ho compared to after 36 h of sleep deprivation,and there were no brain regions with significantly higher Re Ho(p <0.01).Compared to after normal sleep,after restorative sleep with deep transcranial magnetic stimulation,Re Ho was significantly higher in the bilateral perirhinal cortex,left lingual gyrus,bilateral superior temporal gyrus and right cuneus,and there were no brain regions with significantly lower Re Ho(p<0.01).5.Brain imaging-behavioural relationships: we found that changes in CBF in the left orbitofrontal middle gyrus caused changes in the number of serious errors in all three states,and changes in f ALFF in the left lingual gyrus and left superior temporal gyrus caused changes in mean reaction time.6.Analysis of the relationship between ASL and BOLD observables: In the whole acute sleep deprivation experiment with deep transcranial magnetic stimulation,we found that the brain region that showed changes in CBF,f ALFF and Re Ho was the lingual gyrus,and the brain regions that showed changes in both f ALFF and Re Ho were the bilateral perisylvian fissure cortex and the bilateral superior temporal gyrus.In contrast,there were significant differences in the right cingulate gyrus,left orbital middle frontal gyrus,right orbital middle frontal gyrus,right dorsolateral superior frontal gyrus and right precuneus only in the CBF index,left middle occipital gyrus only in the f ALFF index and right cuneus only in the Re Ho index.Conclusion:Acute sleep deprivation for 36 h impairs vigilance and attention,while functional brain areas such as control of emotion,memory,vision,hearing and perception are affected after 36 h of sleep deprivation as shown by brain imaging results.After restorative sleep with deep transcranial magnetic stimulation,cognitive behavioural and functional brain changes were gradually restored,but not to normal post-sleep levels.These results suggest that deep transcranial magnetic stimulation can ameliorate the negative effects of sleep deprivation,but has limited ability to alleviate them and does not immediately restore them to normal levels. |
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