A Study on Central Mechanism of Tiaoshen Acupuncture Treatment for Early Awakening Insomnia Based on fMRI Low-Frequency Amplitude Ratio Analysis
Objective:To explore the potential central mechanisms of Tiaoshen acupuncture in treating early awakening insomnia based on resting-state functional magnetic resonance imaging(rs-fMRI).Methods:48 patients with early awakening insomnia were randomly assigned to the study group(n=24,1 case dropped off)and the control group(n=24,1 case dropped off,1 case was removed).The study group was treated with Tiaoshen needling Baihui(DU20),Shenting(DU24),Sishencong(EX-HN1),Benshen(GB47),Shenmen(HT7),Neiguan(PC6)and Sanyinjiao(SP6);the control group was treated with needling 1-inch next to non-effective points of Binao(LI14),Shousanli(LI10),Yangchi(TE4),Waiguan(TE5),Fengshi(GB31),Futu(ST32)and Liangqiu(ST34).Both groups were treated 3 times a week for 4 weeks.The Pittsburgh Sleep Quality Index(PSQI)score,PSQI early awakening score,Hamilton Depression Scale(HMAD-17)score and Hamilton Anxiety scale(HAMA)score were compared between before and after the treatment in thetwo groups.rs-fMRI scan was performed before and after the treatment.The change of fractional amplitude of low frequency fluctuations(fALFF)was observed in the two groups,and the correlations between the fALFF value and the scales of PSQI,HAMA and HAMD were analyzed.Results:The PSQI score,PSQI early awakening score,HAMD score,HAMD early awakening score and HAMA score were significantly lower after the treatment than those before the treatment in the study group(P＜0.01),and the scale scores were significantly lower in the study group than those in the control group after the treatment(P＜0.05).The HAMA score was significantly lower after the treatment than that before the treatment in the control group(P＜0.01).The fALFF value was increased in the left dorsolateral superior frontal gyrus(SFGd)and it was decreased in the left cerebellar 4_5 area(CER4_5)after the treatment in the study group compared to those in the control group(GRF correction,P-voxel＜0.01,P-cluster＜0.01,double-tail).The fALFF value of left SFGd was significantly positively correlated with the PSQI score(r=0.386),PSQI early awakening score(r=0.330)and HAMD score(r=0.358)(P＜0.05).The fALFF value of left CER4_5 was significantly negatively correlated with PSQI score(r=0.374)and HAMD score(r=0.483)(P＜0.05).Conclusion:Tiaoshen acupuncture can modulate the intensity of local brain function in patients with early awakening insomnia,so as to effectively improve sleep quality and early awakening symptoms,and relieve anxiety and depression.
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