音乐治疗基础上联合经颅直流电刺激对失眠效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.10.010

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (10): 1193-1202.doi: 10.3969/j.issn.1006-9771.2024.10.010

音乐治疗基础上联合经颅直流电刺激对失眠效果的随机对照试验

蔡丝妍, 范颖洁, 田慧芳, 夏春亚, 张娟, 苏敏()

苏州大学附属第四医院（苏州市独墅湖医院）康复医学科/苏州大学康复研究所，江苏苏州市215124

收稿日期:2024-09-20 出版日期:2024-10-25 发布日期:2024-11-08
通讯作者: 苏敏(1978-)，女，汉族，山西大同市人，博士，教授，主要研究方向：神经康复、肌骨康复、盆底康复。E-mail： sumin@suda.edu.cn
作者简介:蔡丝妍(2001-)，女，汉族，福建安溪县人，硕士研究生，主要研究方向：神经康复、盆底康复。
基金资助:
国家重点研发计划项目(2022YFC2009700);国家重点研发计划项目(2022YFC2009706);苏州大学横向课题(H201173);苏州大学横向课题(H220099);江苏省自然科学基金面上项目(BK20211088)

Effect of transcranial direct current stimulation based on music therapy on insomnia: a randomized controlled trial

CAI Siyan, FAN Yingjie, TIAN Huifang, XIA Chunya, ZHANG Juan, SU Min()

Department of Rehabilitation Medicine, the Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital)/Institute of Rehabilitation, Soochow University, Suzhou, Jiangsu 215124, China

Received:2024-09-20 Published:2024-10-25 Online:2024-11-08
Contact: SU Min, E-mail： sumin@suda.edu.cn
Supported by:
National Key R & D Program(2022YFC2009700);National Key R & D Program(2022YFC2009706);Soochow University Lateral Projects(H201173);Soochow University Lateral Projects(H220099);Jiangsu Natural Science Foundation (General)(BK20211088)

摘要/Abstract

摘要：

目的探讨经颅直流电刺激(tDCS)联合音乐治疗对失眠患者的疗效。

方法 2023年7月至2024年4月，苏州大学附属第四医院失眠患者70例，随机分为对照组(n = 35)和观察组(n = 35)。两组均予音乐治疗，观察组予tDCS，对照组予假tDCS，共4周。治疗前后，采用匹兹堡睡眠质量指数量表(PSQI)总分和亚分、17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、中文版压力知觉量表(CPSS)进行评定，测量静息态脑电相对功率，采用经颅多普勒测量脑各支动脉平均血流速度(Vm)。

结果对照组脱落5例，观察组脱落4例。治疗后，观察组PSQI总分和亚分、HAMD-17、HAMA和CPSS评分均明显下降(|t| > 3.503, P < 0.01)，除睡眠时间、睡眠效率和CPSS评分外，其他指标均优于对照组(|t| > 2.304, P < 0.05)；观察组δ、θ频段相对功率增加，α、β和γ频段相对功率显著降低(|t| > 6.468, P < 0.001)，且均优于对照组(|t| > 2.395, P < 0.05)；观察组各支动脉Vm均显著提高(|t| > 4.624, P < 0.001)，且均优于对照组(|t| > 2.147, P < 0.05)。

结论在音乐治疗基础上联合tDCS有助于进一步改善失眠患者的睡眠质量和脑电活动，提高脑血流速度，减少不良情绪。

关键词: 失眠, 经颅直流电刺激, 音乐治疗, 抑郁, 焦虑, 脑电图, 经颅多普勒, 随机对照试验

Abstract:

Objective To explore the effect of transcranial direct current stimulation (tDCS) based on music therapy on insomnia.

Methods From July, 2023 to April, 2024, 70 patients with insomnia in the Fourth Affiliated Hospital of Soochow University were randomly divided into control group (n = 35) and observation group (n = 35). Both groups accepted music therapy; moreover, the observation group accepted tDCS, and the control group accepted sham tDCS, for four weeks. They were assessed with Pittsburgh Sleep Quality Index (PSQI) total score and sub-score, Hamilton Depression Scale 17-item (HAMD-17), Hamilton Anxiety Scale (HAMA), Chinese version of Stress Perception Scale (CPSS); and the relative power of resting-state electroencephalography (EEG) and mean blood flow velocity (Vm) of each cerebral artery with transcranial Doppler were measured before and after treatment.

Results Five cases dropped down in the control group, and four in the observation group. PSQI total score and sub-score, HAMD-17 score, HAMA score and CPSS score (|t| > 3.503, P < 0.01) in the observation group decreased after treatment, and were less in the observation group than in the control group (|t| > 2.304, P < 0.05), except sleep duration, sleep efficiency and CPSS scores. The relative power of δ and θ increased in the observation group, and decreased in α, β and γ (|t| > 6.468, P < 0.001), and were better in the observation group than in the control group (|t| > 2.395, P < 0.05). The Vm of each artery increased in the observation group (|t| > 4.624, P < 0.001), and were more in the observation group than in the control group (|t| > 2.147, P < 0.05).

Conclusion tDCS based on music therapy may further improve sleep quality and EEG activity, increase cerebral blood flow velocity, and reduce adverse emotions in insomnia patients.

Key words: insomnia, transcranial direct current stimulation, music therapy, depression, anxiety, lectroencephalography, transcranial Doppler, randomized controlled trial

中图分类号:

R740

蔡丝妍, 范颖洁, 田慧芳, 夏春亚, 张娟, 苏敏. 音乐治疗基础上联合经颅直流电刺激对失眠效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(10): 1193-1202.

CAI Siyan, FAN Yingjie, TIAN Huifang, XIA Chunya, ZHANG Juan, SU Min. Effect of transcranial direct current stimulation based on music therapy on insomnia: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1193-1202.

图/表 7

表1

表2

两组治疗前后PSQI总分和维度分比较"

变量	组别	n	测试	$x - ± s$	t值	P值
PSQI总分	对照组	30	前测	12.73±2.94	6.814	< 0.001
			后测	10.37±3.32
	观察组	31	前测	13.10±2.61	9.589	< 0.001
			后测	7.90±2.29
	治疗前两组均值差			0.36±0.71	0.511	0.611
	治疗后两组均值差			-2.46±0.73	-3.388	0.001
睡眠质量	对照组	30	前测	2.70±0.47	8.764	< 0.001
			后测	1.77±0.77
	观察组	31	前测	2.58±0.50	13.616	< 0.001
			后测	1.26±0.51
	治疗前两组均值差			-0.12±0.12	-0.962	0.340
	治疗后两组均值差			-0.51±0.17	-3.013	0.004
入睡时间	对照组	30	前测	2.53±0.68	7.954	< 0.001
			后测	1.73±0.83
	观察组	31	前测	2.45±0.57	11.180	< 0.001
			后测	1.16±0.64
	治疗前两组均值差			-0.08±0.16	-0.509	0.612
	治疗后两组均值差			-0.57±0.19	-3.030	0.004
睡眠时间	对照组	30	前测	1.77±0.90	1.649	0.110
			后测	1.57±0.82
	观察组	31	前测	1.87±0.67	3.503	0.001
			后测	1.48±0.51
	治疗前两组均值差			0.10±0.20	0.513	0.610
	治疗后两组均值差			-0.08±0.18	-0.473	0.638
睡眠效率	对照组	30	前测	1.97±0.85	1.682	0.103
			后测	1.83±0.83
	观察组	31	前测	2.26±0.63	5.068	< 0.001
			后测	1.53±0.63
	治疗前两组均值差			0.29±0.19	1.524	0.133
	治疗后两组均值差			-0.32±0.19	-1.684	0.097
睡眠障碍	对照组	30	前测	1.87±0.90	2.693	0.012
			后测	1.67±0.92
	观察组	31	前测	2.06±0.68	6.750	< 0.001
			后测	1.19±0.65
	治疗前两组均值差			0.20±0.21	0.967	0.338
	治疗后两组均值差			-0.47±0.21	-2.304	0.025
日间功能障碍	对照组	30	前测	1.90±0.89	1.000	0.326
			后测	1.80±0.81
	观察组	31	前测	1.87±0.72	4.811	< 0.001
			后测	1.29±0.64
	治疗前两组均值差			-0.03±0.21	-0.141	0.888
	治疗后两组均值差			-0.51±0.19	-2.737	0.008

表2

表3

两组治疗前后HAMD-17评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	30	前测	9.87±4.39	4.568	< 0.001
		后测	7.93±3.59
观察组	31	前测	10.29±4.61	7.375	< 0.001
		后测	5.81±2.26
治疗前两组均值差			0.42±1.15	0.367	0.715
治疗后两组均值差			-2.13±0.77	-2.759	0.008

表3

表4

两组治疗前后HAMA评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	30	前测	9.93±4.31	4.176	< 0.001
		后测	7.97±2.53
观察组	31	前测	10.42±4.41	12.101	< 0.001
		后测	6.19±3.10
治疗前两组均值差			0.49±1.12	0.435	0.665
治疗后两组均值差			-1.77±0.73	-2.443	0.018

表4

表5

两组治疗前后CPSS评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	30	前测	41.97±4.77	3.537	0.001
		后测	39.63±4.15
观察组	31	前测	43.23±5.52	5.609	< 0.001
		后测	37.61±4.84
治疗前两组均值差			1.26±1.32	0.952	0.345
治疗后两组均值差			-2.02±1.16	-1.748	0.086

表5

表6

Comparison of the relative power of EEG between two groups pre- and post-treatment 单位：μV2"

频段	组别	n	测试	$x - ± s$	t值	P值
δ	对照组	30	前测	4.77±0.73	-1.588	0.123
			后测	4.87±0.63
	观察组	31	前测	4.69±0.81	-8.132	< 0.001
			后测	5.27±0.67
	治疗前两组均值差			-0.08±0.20	-0.391	0.697
	治疗后两组均值差			0.40±0.17	2.415	0.019
θ	对照组	30	前测	3.33±0.53	-4.185	< 0.001
			后测	3.48±0.47
	观察组	31	前测	3.29±0.59	-8.822	< 0.001
			后测	3.77±0.48
	治疗前两组均值差			-0.04±0.14	-0.312	0.756
	治疗后两组均值差			0.29±0.12	2.395	0.020
α	对照组	30	前测	6.94±0.57	4.137	< 0.001
			后测	6.74±0.67
	观察组	31	前测	6.98±0.61	9.043	< 0.001
			后测	6.31±0.73
	治疗前两组均值差			0.04±0.15	0.291	0.772
	治疗后两组均值差			-0.43±0.18	-2.424	0.018
β	对照组	30	前测	3.59±0.57	0.608	0.548
			后测	3.54±0.58
	观察组	31	前测	3.62±0.46	6.558	< 0.001
			后测	3.15±0.57
	治疗前两组均值差			0.04±0.13	0.268	0.789
	治疗后两组均值差			-0.39±0.15	-2.609	0.011
γ	对照组	30	前测	0.45±0.08	3.125	0.004
			后测	0.41±0.08
	观察组	31	前测	0.44±0.07	6.468	< 0.001
			后测	0.35±0.07
	治疗前两组均值差			-0.01±0.02	-0.476	0.636
	治疗后两组均值差			-0.06±0.02	-3.092	0.003

表6

表7

Comparison of Vm of each artery between two groups pre- and post-treatment 单位：cm/s"

变量	组别	n	测试	$x - ± s$	t值	P值
ICA	对照组	30	前测	30.07±3.01	-5.159	< 0.001
			后测	32.63±3.16
	观察组	31	前测	29.71±3.07	-11.624	< 0.001
			后测	35.42±3.06
	治疗前两组均值差			-0.36±0.78	-0.459	0.648
	治疗后两组均值差			2.79±0.80	3.498	0.001
MCA	对照组	30	前测	59.07±8.35	-2.962	0.006
			后测	62.03±7.42
	观察组	31	前测	59.94±8.14	-5.804	< 0.001
			后测	66.52±7.92
	治疗前两组均值差			0.87±2.11	0.412	0.682
	治疗后两组均值差			4.48±1.97	2.280	0.026
ACA	对照组	30	前测	48.63±6.26	-1.885	0.069
			后测	50.27±5.83
	观察组	31	前测	47.94±6.04	-4.666	< 0.001
			后测	53.39±5.52
	治疗前两组均值差			-0.70±1.85	-0.443	0.659
	治疗后两组均值差			3.12±1.45	2.147	0.036
PCA	对照组	30	前测	36.20±4.82	-0.872	0.390
			后测	37.10±4.64
	观察组	31	前测	35.90±4.69	-4.624	< 0.001
			后测	40.10±5.02
	治疗前两组均值差			-0.30±1.22	-0.244	0.808
	治疗后两组均值差			3.00±1.24	2.420	0.019
VA	对照组	30	前测	29.20±3.85	-4.482	< 0.001
			后测	31.67±3.66
	观察组	31	前测	29.81±3.81	-7.043	< 0.001
			后测	34.06±3.47
	治疗前两组均值差			0.61±0.98	0.619	0.538
	治疗后两组均值差			2.40±0.91	2.625	0.011
BA	对照组	30	前测	36.40±3.70	-4.686	< 0.001
			后测	40.07±4.19
	观察组	31	前测	37.06±3.87	-8.667	< 0.001
			后测	42.65±3.82
	治疗前两组均值差			0.67±0.97	0.685	0.496
	治疗后两组均值差			2.58±1.03	2.513	0.015

表7

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组别	n	性别(男/女)/n	年龄/岁	教育年限/年
对照组	30	17/13	40.87±11.62	12.50±4.19
观察组	31	14/17	42.81±15.94	11.87±5.51
t/χ²值		0.807	0.544	-0.503
P值		0.369	0.588	0.617

音乐治疗基础上联合经颅直流电刺激对失眠效果的随机对照试验

Effect of transcranial direct current stimulation based on music therapy on insomnia: a randomized controlled trial

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