Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada.
Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada.
Sleep Med Rev. 2021 Feb;55:101381. doi: 10.1016/j.smrv.2020.101381. Epub 2020 Sep 14.
Sleep disturbances (e.g., difficulty to initiate or maintain sleep) and poor sleep quality are major health concerns that accompany several neurological and neuropsychiatric clinical conditions where different brain circuitries are affected (e.g., chronic pain, Parkinson's disease or depression), having a great impact in the individual's well-being, quality of life, and the socioeconomic system. Sleep disturbances in absence of breathing or neurological disorders are mainly treated with medications (e.g., benzodiazepines, hypnotics, etc.) and cognitive behavioral therapy, which are associated with side-effects and adherence issues, respectively. Moreover, these therapies do not seem to work effectively for some individuals. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are non-invasive stimulation techniques used to treat several conditions and symptoms. Results from this systematic review indicate that rTMS and tDCS are safe and have potential to improve insomnia symptoms and sleep disturbances across different types of neurological and neuropsychiatric diseases. However, uncontrolled and quasi experimental studies with high risk of bias were included. Thus, although these results can help developing the field, caution in interpreting them is advised. Additional research efforts are needed to reduce bias, improve quality, and characterize optimal brain stimulation parameters to promote their efficacy on sleep related outcomes.
睡眠障碍（例如，难以入睡或维持睡眠）和睡眠质量差是伴随几种神经和神经精神临床病症的主要健康问题，这些病症会影响不同的大脑回路（例如，慢性疼痛、帕金森病或抑郁症），对个人的幸福感、生活质量和社会经济系统产生重大影响。没有呼吸或神经障碍的睡眠障碍主要通过药物治疗（例如，苯二氮䓬类、催眠药等）和认知行为疗法进行治疗，这两种方法分别存在副作用和依从性问题。此外，这些疗法似乎对某些人效果不佳。重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）是用于治疗多种疾病和症状的非侵入性刺激技术。本系统评价的结果表明，rTMS 和 tDCS 既安全又有潜力改善不同类型的神经和神经精神疾病的失眠症状和睡眠障碍。然而，研究纳入了一些存在高度偏倚风险的未控制和准实验研究。因此，尽管这些结果有助于该领域的发展，但在解释时应谨慎。需要进一步的研究努力来降低偏倚、提高质量，并确定最佳的脑刺激参数，以提高其在睡眠相关结果方面的疗效。
