经颅直流电刺激对卒中后失眠的疗效

doi:10.3969/j.issn.1006-9771.2022.12.012

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (12): 1466-1472.doi: 10.3969/j.issn.1006-9771.2022.12.012

经颅直流电刺激对卒中后失眠的疗效

顾彬^1,²,黄富表^1,²,李泓钰³,宋鲁平^1,⁴()

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院，北京市 100068
3.宁夏医科大学总医院，宁夏银川市 750003
4.深圳大学总医院，广东深圳市 518071

收稿日期:2022-08-11 修回日期:2022-11-08 出版日期:2022-12-25 发布日期:2023-01-10
通讯作者: 宋鲁平 E-mail:songluping882002@aliyun.com
作者简介:顾彬(1986-)，男，汉族，山东滨州市人，硕士研究生，主管技师，主要研究方向：神经康复、认知神经科学、康复治疗。|宋鲁平(1964-)，女，汉族，主任医师，教授，博士研究生导师，主要研究方向：神经康复、认知神经科学。
基金资助:
中国康复研究中心项目(2019ZX-Q2)

Effect of transcranial direct current stimulation on post-stroke insomnia

GU Bin^1,²,HUANG Fubiao^1,²,LI Hongyu³,SONG Luping^1,⁴()

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Ningxia Medical University General Hospital, Yinchuan, Ningxia 750003, China
4. Shenzhen University General Hospital, Shenzhen, Guangzhou 518071, China

Received:2022-08-11 Revised:2022-11-08 Published:2022-12-25 Online:2023-01-10
Contact: SONG Luping E-mail:songluping882002@aliyun.com
Supported by:
China Rehabilitation Research Center Project(2019ZX-Q2)

摘要/Abstract

摘要：

目的观察经颅直流电刺激(tDCS)对卒中后失眠(PSI)患者睡眠及情绪的影响。

方法 2020年1月至2021年5月，北京博爱医院神经康复中心PSI患者44例随机分为对照组(n = 22)和试验组(n = 22)。在常规治疗基础上，试验组采用tDCS治疗，对照组采用假刺激治疗，共4周。治疗前后采用匹兹堡睡眠质量指数量表(PSQI)、基于心肺耦合技术的睡眠监测系统评估患者睡眠质量；采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评估患者情绪。

结果两组各脱落2例。治疗后，两组PSQI、HAMA、HAMD评分均显著低于治疗前(t > 8.575, P < 0.001)，试验组PSQI、HAMA评分明显优于对照组(t > 2.811, P < 0.01)，两组间HAMD评分无显著性差异(t = 1.756, P > 0.05)；两组睡眠质量指数、睡眠总时间、睡眠潜伏期、睡眠效率、觉醒转换次数均显著优于治疗前(|t| > 4.721, P < 0.001)，试验组快速眼动期时间优于治疗前(t = -2.851, P = 0.010)；试验组睡眠质量指数、睡眠总时间、睡眠效率、觉醒转换次数均优于对照组(|t| > 2.190, P < 0.05)，但睡眠潜伏期、快速眼动期时间改善不明显(|t| < 1.073, P > 0.05)。

结论 tDCS可以改善PSI患者睡眠质量和焦虑情绪，对睡眠结构影响不大。

关键词: 卒中后失眠, 经颅直流电刺激, 焦虑, 抑郁, 康复

Abstract:

Objective To observe the effects of transcranial direct current stimulation (tDCS) on insomnia, anxiety and depression in patients with post-sroke insomnia (PSI).

Methods From January, 2020 to May, 2021, 44 patients with PSI from Beijing Bo'ai Hospital were randomly divided into control group (n = 22) and experimental group (n = 22). On the basis of conventional treatment, the experimental group accepted tDCS, and the control group accepted sham stimulation for four weeks. Pittsburgh Sleep Quality Index (PSQI) and sleep monitoring system based on cardiopulmonary coupling technology were used to evaluate the sleep quality of the patients before and after treatment. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate mood.

Results Two cases dropped out in each group. After treatment, the scores of PSQI, HAMA and HAMD decreased in both groups (t > 8.575, P < 0.001), and the scores of PSQI and HAMA were better in the experimental group than in the control group (t > 2.811, P < 0.01), however, there was no significant difference in the scores of HAMD between two groups (t = 1.756, P > 0.05). After treatment, the sleep quality index, total sleep time, sleep latency, sleep efficiency and wake conversion times improved (|t| > 4.721, P < 0.001), and the rapid eye movement time prolonged in the experimental group (t = -2.851, P = 0.010); the sleep quality index, total sleep time, sleep efficiency and wake conversion times were better in the experimental group than in the control group (t > 2.190, P < 0.05), however, no significant difference was found in the sleep latency and rapid eye movement time between two groups (|t|< 1.073, P > 0.05).

Conclusion tDCS could improve the sleep quality and anxiety in PSI patients, and has little effect on sleep structure.

Key words: post-sroke insomnia, transcranial direct current stimulation, anxiety, depression, rehabilitation

中图分类号:

R743.3

顾彬,黄富表,李泓钰,宋鲁平. 经颅直流电刺激对卒中后失眠的疗效[J]. 《中国康复理论与实践》, 2022, 28(12): 1466-1472.

GU Bin,HUANG Fubiao,LI Hongyu,SONG Luping. Effect of transcranial direct current stimulation on post-stroke insomnia[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1466-1472.

图/表 5

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组别	n	性别(男/女)/n	年龄/岁	病程/月	卒中类型(梗死/出血)/n	病灶侧别(左/右)/n
对照组	20	14/6	58.6±12.58	2.1±1.21	12/8	8/12
试验组	20	14/6	54.2±12.66	2.45±1.43	10/10	7/13
χ²/t值		0.000	0.943	-0.835	0.404	0.107
P值		1.000	0.352	0.409	0.525	0.744

组别	n	治疗前	治疗后	t值	P值
对照组	20	14.65±3.117	11.25±2.511	12.350	< 0.001
试验组	20	14.35±3.200	8.90±2.770	10.903	< 0.001
t值		0.300	2.811
P值		0.766	0.008

组别	n	治疗前	治疗后	t值	P值
对照组	20	18.85±4.452	14.30±2.993	8.828	< 0.001
试验组	20	19.90±5.418	10.85±4.043	9.582	< 0.001
t值		-0.670	3.067
P值		0.507	0.004

组别	n	治疗前	治疗后	t值	P值
对照组	20	21.40±5.355	15.45±3.170	8.575	< 0.001
试验组	20	23.25±6.095	13.40±4.147	9.254	< 0.001
t值		-1.020	1.756
P值		0.314	0.087

睡眠参数	对照组(n = 20)		试验组(n = 20)		t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
睡眠参数	治疗前	治疗后	治疗前	治疗后	t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
睡眠质量指数	35.90±9.744	45.35±8.400	36.60±9.875	51.70±9.879	-6.626	< 0.001	-8.983	< 0.001	-0.226	0.823	-2.190	0.035
睡眠总时间/min	289.15±13.768	351.71±10.643	291.39±14.125	388.47±10.838	-89.527	< 0.001	-132.056	< 0.001	-0.507	0.615	-10.824	< 0.001
睡眠潜伏期/min	69.11±15.346	26.13±10.962	71.57±10.064	26.45±4.802	43.840	< 0.001	38.345	< 0.001	-0.601	0.551	-0.121	0.905
睡眠效率/%	57.64±14.15	67.17±14.87	55.44±11.49	78.00±11.79	-59.320	< 0.001	-336.344	< 0.001	0.541	0.592	-2.553	0.015
觉醒转换次数/次	20.95±6.42	18.65±5.78	19.45±5.95	15.00±3.54	4.721	< 0.001	5.784	< 0.001	0.766	0.448	2.409	0.022
快速眼动期/min	8.43±2.41	8.92±5.23	9.15±1.79	10.48±3.88	-0.783	0.443	-2.851	0.010	1.077	0.288	1.073	0.290

经颅直流电刺激对卒中后失眠的疗效

Effect of transcranial direct current stimulation on post-stroke insomnia

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