{"title":"太极拳与重复经颅磁刺激相结合治疗老年人睡眠障碍:随机对照试验","authors":"","doi":"10.1016/j.sleep.2024.07.029","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances.</p></div><div><h3>Methods</h3><p>Thirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2).</p></div><div><h3>Results</h3><p>Significant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's <em>d</em> = 1.62, <em>p</em> = 0.003) and T2 (Cohen's <em>d</em> = 1.97, <em>p</em> < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's <em>d</em> = 1.03, <em>p</em> = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (<em>p</em> = 0.015) and total sleep time (<em>p</em> = 0.004), depression (<em>p</em> = 0.003) and stress scores (<em>p</em> = 0.002), and mental function in relation to quality of life (<em>p</em> = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity.</p></div><div><h3>Conclusion</h3><p>The research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. Future studies are needed to unravel the underlying mechanism and optimize the protocol to maximize the therapeutic benefits.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Integration of tai chi and repetitive transcranial magnetic stimulation for sleep disturbances in older adults: A pilot randomized controlled trial\",\"authors\":\"\",\"doi\":\"10.1016/j.sleep.2024.07.029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances.</p></div><div><h3>Methods</h3><p>Thirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2).</p></div><div><h3>Results</h3><p>Significant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's <em>d</em> = 1.62, <em>p</em> = 0.003) and T2 (Cohen's <em>d</em> = 1.97, <em>p</em> < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's <em>d</em> = 1.03, <em>p</em> = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (<em>p</em> = 0.015) and total sleep time (<em>p</em> = 0.004), depression (<em>p</em> = 0.003) and stress scores (<em>p</em> = 0.002), and mental function in relation to quality of life (<em>p</em> = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity.</p></div><div><h3>Conclusion</h3><p>The research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. 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引用次数: 0
摘要
背景:唤醒状态已被证明与睡眠障碍的基本病理生理机制有关。太极拳(TC)和重复经颅磁刺激(rTMS)已被证实可通过干扰不同的唤醒成分来缓解睡眠障碍。我们有理由认为,将太极拳和经颅磁刺激结合起来,可以对睡眠障碍产生协同和更持久的疗效:38名居住在社区的老年人被随机分配到三组中的一组:经颅磁刺激加经颅磁刺激组(12 人)、单独经颅磁刺激组(13 人)和常规治疗组(13 人)。两个干预组每周进行三次干预,为期 4 周。主要结果是失眠的严重程度,次要结果是动觉仪评估的睡眠模式、催眠药物的使用、情绪状态和生活质量。中介结果包括自我报告的躯体唤醒和认知唤醒,以及脑电图(EEG)评估的皮质唤醒。评估分别在基线(T0)、干预后(T1)和 3 个月随访(T2)时进行:结果:在 T1(Cohen's d = 1.62,p = 0.003)和 T2(Cohen's d = 1.97,p 结论:与 TAU 组相比,TC 加经颅磁刺激组的失眠严重程度有明显改善:研究结果有望进一步指导临床实践,利用各种干预措施治疗老年人的睡眠障碍。今后还需要开展研究,以揭示其潜在机制并优化方案,从而最大限度地提高治疗效果。
Integration of tai chi and repetitive transcranial magnetic stimulation for sleep disturbances in older adults: A pilot randomized controlled trial
Background
The arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances.
Methods
Thirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2).
Results
Significant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's d = 1.62, p = 0.003) and T2 (Cohen's d = 1.97, p < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's d = 1.03, p = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (p = 0.015) and total sleep time (p = 0.004), depression (p = 0.003) and stress scores (p = 0.002), and mental function in relation to quality of life (p = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity.
Conclusion
The research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. Future studies are needed to unravel the underlying mechanism and optimize the protocol to maximize the therapeutic benefits.
期刊介绍:
Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without.
A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry.
The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.