Zhang Shuai, He Jia-Kai, Zhao Ya-Nan, Wang Yu, Zhao Bin, Chen Yu, Fang Ji-Liang, Rong Pei-Jing
Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
Southern Medical University.
Zhongguo Zhen Jiu. 2022 Apr 12;42(4):363-8. doi: 10.13703/j.0255-2930.20210302-0003.
To explore the modulation of transcutaneous auricular vagus nerve stimulation (taVNS) on default mode network (DMN) in patients with primary insomnia (PI).
A total of 22 PI patients (one patient dropped off and two patients were excluded) were included and treated with taVNS. The bilateral auricular points of Xin (CO) and Shen (CO) were selected and treated with disperse-dense wave at frequency of 4 Hz/20 Hz, the intensity was based on the patient's tolerance. taVNS was given once in the morning and once in the evening for 30 minutes each time. The treatment lasted for at least 5 days a week for 4 weeks. At the same time, 16 healthy subjects matched with gender and age were recruited. The Pittsburgh sleep quality index (PSQI) score was evaluated before and after treatment in PI patients. The resting-state functional magnetic resonance imaging (rs-fMRI) data of PI patients before and after treatment and healthy subjects at baseline period were collected to observe the effect of taVNS on the functional connection (FC) between posterior cingulate cortex (PCC) and whole brain.
After treatment, the total score of PSQI in PI patients was lower than that before treatment (<0.01). Compared with healthy subjects, the FC of the left PCC was increased either with the left orbital superior frontal gyrus or with left middle frontal gyrus (<0.001), and the FC between right PCC and left middle frontal gyrus was increased in PI patients before treatment (<0.001). Compared before treatment, the FC between left PCC and left middle frontal gyrus was decreased (<0.05), and the FC of the right PCC was decreased either with the right medial prefrontal cortex or with the left middle frontal gyrus in PI patients after treatment (<0.001, <0.01).
taVNS can modulate the FC between anterior and posterior DMN, and between DMN and cognitive control network of PI patients, which may be one of the brain effect mechanisms of taVNS in the treatment of PI patients.
探讨经皮耳迷走神经刺激（taVNS）对原发性失眠（PI）患者默认模式网络（DMN）的调节作用。
共纳入22例PI患者（1例脱落，2例排除）并接受taVNS治疗。选取双侧耳穴心（CO）、神（CO），采用疏密波，频率为4Hz/20Hz，强度以患者耐受为准。taVNS每天早晚各给予1次，每次30分钟。治疗每周至少进行5天，共4周。同时招募16名年龄、性别匹配的健康受试者。对PI患者治疗前后进行匹兹堡睡眠质量指数（PSQI）评分。收集PI患者治疗前后及健康受试者基线期的静息态功能磁共振成像（rs-fMRI）数据，观察taVNS对后扣带回皮质（PCC）与全脑功能连接（FC）的影响。
治疗后，PI患者PSQI总分低于治疗前（<0.01）。与健康受试者相比，PI患者治疗前左侧PCC与左侧眶额上回或左侧额中回的FC增加（<0.001），右侧PCC与左侧额中回的FC增加（<0.001）。与治疗前相比，PI患者治疗后左侧PCC与左侧额中回的FC降低（<0.05），右侧PCC与右侧内侧前额叶皮质或左侧额中回的FC降低（<0.001，<0.01）。
taVNS可调节PI患者DMN前后部之间以及DMN与认知控制网络之间的FC，这可能是taVNS治疗PI患者的脑效应机制之一。
