耳穴刺激经迷走神经对失眠伴抑郁患者多导睡眠图特征的影响  

Effects of auricular point stimulation via the vagus nerve on polysomnographic features in patients with insomnia and depression

作　　者：赵亚楠 王瑜 张金铃[1] 李素霞[2] 何家恺 张帅 焦玥[1] 翟伟航 荣培晶[1] ZHAO Ya-nan;WANG Yu;ZHANG Jin-ling;LI Su-xia;HE Jia-kai;ZHANG Shuai;JIAO Yue;ZHAI Wei-hang;RONG Pei-jing(Institute of Acupuncture and Moxibustion,China Academy of Chinese Medical Sciences,Beijing 100700,China;Chinese Institute of Drug Dependence,Peking University,Beijing 100191,China)

机构地区：[1]中国中医科学院针灸研究所所,北京100700 [2]北京大学中国药物依赖性研究所,北京100191

出　　处：《中华中医药杂志》2022年第10期6168-6172,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.81473780);中国中医科学院科技创新工程项目(No.CI2021A03305)。

摘　　要：目的:观察耳穴刺激经迷走神经(taVNS)对失眠伴抑郁患者客观睡眠结构及各睡眠阶段脑电功率谱的影响。方法:纳入21例失眠伴抑郁患者,采用治疗前后自身对照的原则,评估经taVNS治疗4周前后匹兹堡睡眠质量指数(PSQI)、汉密尔顿抑郁量表(HAMD-17)评分及多导睡眠监测(PSG),分析睡眠连续性指标:总睡眠时间(TST)、睡眠潜伏期(SL)、睡眠效率(SE)、入睡后的觉醒(WASO);睡眠结构:非快速眼动睡眠1、2、3期(NREM 1、NREM 2、NREM 3)和快速眼动睡眠期(REM)百分比,并分析其脑电功率谱变化。结果:与治疗前比较,taVNS治疗4周后失眠伴抑郁患者PSQI、HAMD-17评分显著降低;SE和NREM 3显著升高、SL显著缩短;NREM 1的delta1功率谱显著降低、NREM 3的delta2功率谱显著升高,以上差异均有统计学意义(P<0.05,P<0.01)。结论:taVNS可有效改善失眠伴抑郁患者的临床症状、调整睡眠连续性、睡眠结构及增加NREM 3的delta2功率谱,降低皮层过度觉醒状态。Objective: To observe the effects of transcutaneous auricular vagus nerve stimulation(taVNS) on objective sleep structure and EEG power spectrum of insomnia and depression. Methods: A total of 21 patients with insomnia and depression were included, and the principle of body control before and after treatment was adopted. Pittsburgh sleep Quality Index(PSQI),Hamilton Depression Scale(HAMD-17) score and polysomnography monitoring(PSG) were evaluated before and after taVNS treatment for 4 weeks. Sleep continuity indicators were analyzed: total sleep time(TST), sleep latency(SL), sleep efficiency(SE) and wake after falling asleep(WASO);Sleep structure: percentage of nonrapid eye movement sleep(NREM) 1, NREM 2, NREM 3 and rapid eye movement sleep(REM), and change of EEG power spectrum were analyzed. Results: After taVNS treatment for 4 weeks,PSQI and HAMD-17 scores of insomnia patients with depression were significantly lower than before treatment. SE and NREM 3were significantly increased and SL was significantly shortened. NREM 1 delta1 power spectrum decreased significantly, NREM 3delta2 power spectrum increased significantly. The above differences were statistically significant(P<0.05, P<0.01). Conclusion:taVNS can effectively improve the clinical symptoms, adjust the sleep continuity and sleep structure, increase the NREM 3 delta2power spectrum, and reduce the hyperarousal state of the cortex in patients with insomnia and depression.

关 键 词：失眠伴抑郁 耳穴刺激经迷走神经 多导睡眠监测 睡眠结构 睡眠连续性 脑电功率谱 

分 类 号：R246.6[医药卫生—针灸推拿学]