中国实用神经疾病杂志2026，Vol.29Issue(10)：1239-1244,6.DOI:10.12083/SYSJ.251863
rTMS靶向右侧前额叶背外侧区联合dCBT-I对失眠障碍共病焦虑患者睡眠质量及过度觉醒状态的干预作用
Effects of rTMS targeting the right dorsolateral prefrontal cortex combined with dCBT-I on sleep quality and hyperarousal state in patients with insomnia disorder comorbid with anxiety
摘要
Abstract
Objective To analyze the interventional effects of repetitive transcranial magnetic stimulation(rTMS)targeting the right dorsolateral prefrontal cortex combined with digital cognitive behavioral therapy for insomnia(dCBT-I)on sleep quality and hyperarousal state in patients with insomnia disorder comorbid with anxiety.Methods A total of 65 patients with insomnia disorder comorbid with anxiety,who were admitted to the General Hospital of Pingmei Medical Group between January 2022 and January 2025,were selected as study subjects.Using a random number table,they were assigned to control group(n=35)and experimental group(n=30).The control group received conventional treatment,while the experimental group underwent rTMS targeting the right dorsolateral prefrontal cortex combined with dCBT-I.Assessments were conducted before the intervention,at 2 weeks and 6 weeks post-intervention.The scores of Pittsburgh sleep quality index(PSQI),insomnia severity index(ISI),Hamilton anxiety scale(HAMA),hyperarousal scale(HAS),as well as serum cortisol and brain-derived neurotrophic factor(BDNF)levels between the two groups were compared.Results At 2 weeks post-intervention,the experimental group showed significantly lower PSQI,ISI,HAMA,and HAS scores compared to the control group(P<0.05),and this advantage persisted at 6 weeks post-intervention(P<0.05).The experimental group also demonstrated significantly greater reductions in serum cortisol levels and increases in BDNF levels at both 2 and 6 weeks post-intervention compared to the control group(P<0.05).Clinically,the total effective rate was 100%in the experimental group,which was significantly higher than 80%in the control group(P<0.05).Conclusion The combination of rTMS targeting the right DLPFC and dCBT-I can rapidly and significantly improve sleep quality,alleviate anxiety,and reduce hyperarousal in patients with insomnia disorder comorbid with anxiety.This combined intervention demonstrates superior efficacy compared to dCBT-I alone and is associated with beneficial neurobiological changes,making it an effective comprehensive treatment approach.关键词
失眠障碍/焦虑/共病/重复经颅磁刺激/数字认知行为疗法/睡眠质量/过度觉醒状态Key words
Insomnia disorder/Anxiety/Comorbidity/Repetitive transcranial magnetic stimulation/Digital cognitive behavioral therapy for insomnia/Sleep quality/Hyperarousal state分类
医药卫生引用本文复制引用
康宪政,孟森,胡淑丽..rTMS靶向右侧前额叶背外侧区联合dCBT-I对失眠障碍共病焦虑患者睡眠质量及过度觉醒状态的干预作用[J].中国实用神经疾病杂志,2026,29(10):1239-1244,6.基金项目
河南省医学科技攻关计划联合共建项目(编号:LHGJ20250823) （编号:LHGJ20250823）
