Nardone Raffaele, Sebastianelli Luca, Versace Viviana, Brigo Francesco, Golaszewski Stefan, Pucks-Faes Elke, Saltuari Leopold, Trinka Eugen
Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy.
Sleep Med. 2020 Jul;71:113-121. doi: 10.1016/j.sleep.2020.01.028. Epub 2020 Feb 19.
In this review, we aimed at identifying the studies that have employed repetitive transcranial magnetic stimulation (rTMS) in patients with sleep disorders. Low-frequency (LF) rTMS stimulating the right dorsolateral prefrontal cortex (DLPFC) or the posterior parietal cortex (PPC) was found to be effective to reduce cortical hyperexcitability and improve the sleep quality in subjects with chronic primary insomnia (PI). Both high-frequency (HF) and LF rTMS applied over the primary motor cortex or the supplementary motor cortex seem to have transient beneficial effects in patients with restless legs syndrome (RLS). Stimulation of upper airway muscles during sleep by isolated TMS and by rTMS twitch can improve airflow dynamics in obstructive sleep apnea syndrome (OSAS) patients without arousal. A single case report study indicates that HF rTMS over the left DLPFC might represent an alternative choice for symptom control in narcoleptic patients with cataplexy, and a pilot study also raises the possibility of therapeutic benefits from rTMS in patients with sleep bruxism. rTMS may also exert intrinsic effects on hypersomnia in depressed adolescents. In conclusion, rTMS may contribute to the development of new non-pharmacological therapeutic options for several sleep disorders. rTMS might be useful as therapeutical tool in particular in patients with PI, RLS, OSAS and narcolepsy, while its effect in other sleep disorders (ie, parasomnias) has not yet been explored. rTMS integrated with clinical, sleep-related, and neuroimaging data may represent an effective tool in modulating cortical excitability and inducing short-term synaptic plasticity. Further studies with larger patient samples, repeated sessions, an optimized rTMS setup, and clinical follow-up warranted to verify the initial findings, and to expand clinical and research interest towards neuromodulation in the different sleep disorders.
在本综述中，我们旨在确定那些在睡眠障碍患者中应用重复经颅磁刺激（rTMS）的研究。发现低频（LF）rTMS刺激右侧背外侧前额叶皮质（DLPFC）或顶叶后皮质（PPC）可有效降低慢性原发性失眠（PI）患者的皮质兴奋性过高，并改善其睡眠质量。在原发性运动皮质或辅助运动皮质上施加高频（HF）和LF rTMS似乎对不安腿综合征（RLS）患者有短暂的有益影响。通过孤立的TMS和rTMS抽搐刺激睡眠期间的上呼吸道肌肉，可以改善阻塞性睡眠呼吸暂停综合征（OSAS）患者的气流动力学而不引起觉醒。一项单病例报告研究表明，对患有猝倒症的发作性睡病患者，左侧DLPFC上的HF rTMS可能是症状控制的一种替代选择，并且一项初步研究也提出了rTMS对磨牙症患者有治疗益处的可能性。rTMS也可能对抑郁青少年的发作性睡病有内在影响。总之，rTMS可能有助于为几种睡眠障碍开发新的非药物治疗选择。rTMS可能作为一种治疗工具有用，特别是对PI、RLS、OSAS和发作性睡病患者，而其在其他睡眠障碍（即异态睡眠）中的作用尚未探索。rTMS与临床、睡眠相关和神经影像学数据相结合可能是调节皮质兴奋性和诱导短期突触可塑性的有效工具。需要进一步开展更大样本量患者、重复疗程、优化rTMS设置以及临床随访的研究，以验证初步发现，并扩大对不同睡眠障碍中神经调节的临床和研究兴趣。
