Abstract
Primary insomnia (PI) is among the most prevalent sleep-related disorders and has a far-reaching impact on daytime functioning. Repetitive transcranial magnetic stimulation (rTMS) has drawn attention because of its effectiveness and safety. The purpose of the current study was to detect changes in the topological organization of whole-brain functional networks and to determine their associations with the clinical treatment effects of rTMS. Resting-state functional magnetic resonance imaging (rsfMRI) data from 32 patients with PI were collected and compared with findings from 32 age- and gender-matched healthy controls (HCs). The patients were treated with Stanford accelerated intelligent neuromodulation therapy, which is a recently validated neuroscience-informed accelerated intermittent theta-burst stimulation protocol. Graph theoretical analysis was used to construct functional connectivity matrices and to extract the attribute features of small-world networks in insomnia. Scores on the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and the associations between these clinical characteristics and functional metrics, were the primary outcomes. At baseline, the patients with PI showed inefficient small-world property and aberrant functional segregation and functional integration compared with the HCs. These properties showed renormalization after individualized rTMS treatment. Furthermore, low functional connectivity between the right insula and left medial frontal gyrus correlated with improvement in ISI scores. We highlight functional network dysfunctions in PI patients and provide evidence into the pathophysiological mechanisms involved and the possible mode of action of rTMS.
Highlights
Primary insomnia (PI) is an important public health problem worldwide, with nearly one-third of the general population experiencing insomnia symptoms during their lifetime (Xue et al, 2022)
There was no significant difference in age, gender, and year of education between PI patients and healthy controls (HCs)
At baseline, the patients with PI showed impaired and inefficient small-world properties and aberrant functional segregation and functional integration compared with the HCs
Summary
Primary insomnia (PI) is an important public health problem worldwide, with nearly one-third of the general population experiencing insomnia symptoms during their lifetime (Xue et al, 2022). Lack of sleep can lead to various health problems such as cardiovascular disease (Palagini et al, 2013), obesity (Hargens et al, 2013), diabetes, immune system dysfunction, and cognitive and affective disorders. Cognitive behavioral therapy (CBT) and medication are the most commonly used treatments for PI, they both have some shortcomings. CBT requires a long treatment duration, has a high cost, and shows limited efficacy (Okajima et al, 2017), whereas drugs may bring about adverse effects such as memory disorder, delirium, and daytime sleepiness (Hrehová and Mezian, 2021). There is an urgent need for new therapies for insomnia that have minimal side effects and can be used over a long term
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