HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Brain Behav. 2023 Nov;13(11):e3252. doi: 10.1002/brb3.3252. Epub 2023 Sep 12.
Chronic pain associates with various sleep problems. Patients with complex regional pain syndrome (CRPS) often report impaired sleep, but objective measurements of sleep in CRPS patients are scarce. Neuromodulation with repetitive transcranial magnetic stimulation (rTMS) can alleviate pain and improve sleep. Secondary somatosensory cortex (S2) is a possible rTMS target for the treatment of chronic pain, but the effect of S2-targeted rTMS on sleep is unknown.
This randomized, sham-controlled trial assessed the effect of S2-targeted rTMS on sleep in patients with CRPS. Patients (n = 31) received either S2-targeted rTMS (10 Hz) or sham stimulation for 3 weeks. The effect of treatment on sleep was assessed with validated questionnaires, with a sleep and pain diary, and with a consumer-grade sleep tracker, the Oura ring. In addition to an ordinary univariate analysis of the results, we conducted multivariate testing of the Oura data using linear discriminant analysis (LDA).
S2-targeted rTMS decreased sleep restlessness that significantly differed between the rTMS and sham stimulation patient groups (p = .028). In the multivariate analysis of the Oura data, LDA classification accuracy to separate the rTMS and sham groups exceeded 95% confidence level in four out of the seven tested models. In the subjective evaluation of sleep, the effect of rTMS and sham did not differ.
S2-targeted rTMS influenced sleep in patients with CRPS. Improved sleep may enhance CRPS symptom alleviation and be of clinical importance. A univariate analysis could separate the rTMS and sham treatments. The multivariate analysis revealed that including multiple sleep-related parameters can be beneficial when analyzing rTMS effects on sleep. As sleep is related both to pain and quality of life, and sleep rTMS can be directly affected by rTMS, objective monitoring of sleep in various future rTMS trials could be fruitful.
慢性疼痛与各种睡眠问题有关。患有复杂性区域疼痛综合征 (CRPS) 的患者常报告睡眠受损，但对 CRPS 患者睡眠的客观测量却很少。重复经颅磁刺激 (rTMS) 神经调节可以缓解疼痛和改善睡眠。次级体感皮层 (S2) 可能是治疗慢性疼痛的 rTMS 靶点，但 S2 靶向 rTMS 对睡眠的影响尚不清楚。
这项随机、假对照试验评估了 S2 靶向 rTMS 对 CRPS 患者睡眠的影响。患者（n=31）接受 S2 靶向 rTMS（10 Hz）或假刺激治疗 3 周。使用经过验证的问卷、睡眠和疼痛日记以及消费级睡眠追踪器 Oura 戒指评估治疗对睡眠的影响。除了对结果进行常规单变量分析外，我们还使用线性判别分析 (LDA) 对 Oura 数据进行了多变量测试。
S2 靶向 rTMS 减少了睡眠不安，rTMS 和假刺激患者组之间的差异具有统计学意义（p=0.028）。在 Oura 数据的多变量分析中，LDA 分类准确率在四个测试模型中的四个模型中超过了 95%的置信水平，可将 rTMS 和假刺激组分开。在对睡眠的主观评价中，rTMS 和假刺激的效果没有差异。
S2 靶向 rTMS 影响 CRPS 患者的睡眠。改善睡眠可能会增强 CRPS 症状缓解，并具有临床重要意义。单变量分析可以将 rTMS 和假刺激治疗区分开来。多变量分析表明，当分析 rTMS 对睡眠的影响时，包括多个与睡眠相关的参数可能会有所帮助。由于睡眠与疼痛和生活质量有关，并且睡眠 rTMS 可以直接受到 rTMS 的影响，因此在未来的各种 rTMS 试验中对睡眠进行客观监测可能会有所收获。
