低频经颅磁刺激联合认知行为疗法对帕金森病合并睡眠障碍患者的疗效观察

柳敏芬; 蓝丽康; 吕锦; 梁燕飞; 徐如月; 吴泓蔚

doi:10.16766/j.cnki.issn.1674-4152.004205

低频经颅磁刺激联合认知行为疗法对帕金森病合并睡眠障碍患者的疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.004205

温州医科大学附属第六医院丽水市人民医院神经内科，浙江丽水 323000

基金项目:

浙江省医药卫生科技计划项目 2022KY1443

详细信息

通讯作者:
吴泓蔚，E-mail：whwenjoy@163.com

中图分类号: R742.5 R493
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出版历程
- 收稿日期: 2025-03-12

Efficacy of low frequency transcranial magnetic stimulation combined with cognitive behavioral therapy in patients with Parkinson's disease complicated with sleep disorders

Department of Neurology, Lishui People ' s Hospital, Wenzhou Medical College Affiliated Sixth Hospital, Lishui, Zhejiang 323000, China

摘要

摘要: 目的探讨低频经颅磁刺激(LF-TMS)联合认知行为疗法(CBT)治疗帕金森病(PD)合并睡眠障碍患者的临床效果，为改善PD患者睡眠质量提供指导方案。方法选取2021年10月—2023年10月丽水市人民医院收治的PD合并睡眠障碍患者92例，采用随机数表法分为观察组和对照组，各46例，2组均给予LF-TMS治疗，观察组在LF-TMS治疗基础上行CBT干预。采用匹兹堡睡眠质量指数(PSQI)量表、帕金森睡眠量表(PDSS)、心肺耦合(CPC)-测评系统评估干预前、4周时的睡眠状况，并比较2组干预后3个月的临床疗效。结果 2组干预后4周时的PSQI、ESS量表评分均明显低于同组干预前(P＜0.001)，PDSS评分均明显高于干预前(P＜0.001)；观察组干预后4周时的PSQI量表评分指标均明显低于同期对照组(P＜0.05)；观察组临床总有效率明显高于对照组[44例(95.65%) vs. 36例(78.26%)，χ²=6.133, P=0.013]；干预前，2组CPC指标比较差异无统计学意义(P＞0.05)；干预后，观察组上述指标均明显优于对照组(P＜0.01)。结论 LF-TMS联合CBT应用于PD合并睡眠障碍患者治疗效果显著，能明显改善PD患者睡眠障碍，提高睡眠质量。
- 帕金森病 /
- 低频经颅磁刺激 /
- 认知行为疗法 /
- 睡眠障碍
Abstract: Objective To explore the clinical effect of low-frequency transcranial magnetic stimulation (LF-TMS) combined with cognitive behavioral therapy (CBT) in the treatment of patients with Parkinson ' s disease (PD) complicated with insomnia disorder, and to provide guidance for improving the sleep quality of PD patients. Methods A total of 92 patients with PD complicated with sleep disorders admitted to Lishui People ' s hospital from October 2021 to October 2023 were selected and randomly divided into an observation group and a control group, with 46 cases in each group, by the random number table method. Both groups were treated with LF-TMS, and the observation group received CBT intervention on the basis of LF-TMS treatment. The Pittsburgh sleep quality index (PSQI) scale, Parkinson ' s disease sleep scale (PDSS), and cardiopulmonary coupling (CPC)- assessment system were used to evaluate the sleep status before the intervention and at 4 weeks, and the clinical efficacy of the two groups 3 months after the intervention was compared. Results The PSQI scale score indicators of the two groups at 4 weeks after the intervention were significantly lower than the corresponding indicators of the same group before the intervention (P < 0.01), and the PDSS scores were significantly higher than the indicators before the intervention (P < 0.01). The PSQI scale score indicators of the observation group at 4 weeks after the intervention were significantly lower than those of the control group at the same period (P < 0.05). The total clinical effective rate of the observation group was significantly higher than that of the control group [44 cases (95.65%) vs. 36 cases (78.26%), χ²=6.133, P=0.013]. Before the intervention, there was no statistically significant difference in the CPC index between the two groups (P>0.05). After the intervention, the above indicators in the observation group were significantly better than those in the control group (P < 0.01). Conclusion The utilization of LF-TMS in conjunction with CBT in the treatment of PD patients with sleep disorders has significant clinical effect, which can significantly improve the sleep disorders of PD patients and improve the sleep quality.
- Parkinson ' s disease /
- Low frequency transcranial magnetic stimulation /
- Cognitive behavioral therapy /
- Sleep disorder
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表 1 2组PD合并睡眠障碍患者临床资料比较

Table 1. Comparison of clinical data in PD patients with sleep disorder between two groups

组别	例数	性别[例(%)]		年龄(x ±s，岁)	PD病程(x ±s，岁)	失眠病程(x ±s，岁)	霍亚分期[例(%)]
组别	例数	男性	女性	年龄(x ±s，岁)	PD病程(x ±s，岁)	失眠病程(x ±s，岁)	1期	2~3期
观察组	46	25(54.35)	21(45.65)	68.59±2.85	6.76±1.52	4.27±1.84	17(36.96)	29(63.04)
对照组	46	22(47.83)	24(52.17)	69.25±2.93	6.29±1.28	4.21±1.93	20(43.48)	26(56.52)
统计量		0.391^a		1.095^b	1.604^b	0.153^b	0.407^a
P值		0.532		0.276	0.112	0.879	0.524
注：^a为χ²值，^b为t值。

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表 2 CPC监测睡眠质量总评参考值

Table 2. CPC reference for overall sleep quality

指标	参考值
睡眠总时间(TST)	8 h
睡眠效率(TST/TIB)	≥90%
熟睡时间	3.3~5.2 h
浅睡时间	≤2.9 h
REM睡眠时间	≤1 h
觉醒时间	≤1 h
睡眠呼吸睡眠指数(AHI)	< 5次/h

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表 3 2组PD合并睡眠障碍患者PSQI评分比较(x ±s，分)

Table 3. Comparison of PSQI scores in PD patients with sleep disorders between two groups(x ±s, points)

组别	例数	干预前	干预后4周
观察组	46	13.53±1.49	6.18±1.76^b
对照组	46	13.65±1.51	9.58±1.78^b
统计量		0.647^a	9.859^c
P值		0.695	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.01。

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表 4 2组PD合并睡眠障碍患者PDSS评分比较(x ±s，分)

Table 4. Comparison of PDSS scores of PD patients with sleep disorders between two groups(x ±s, points)

组别	例数	干预前	干预后4周
观察组	46	79.68±7.79	108.68±9.82^b
对照组	46	78.97±8.68	98.58±9.86^b
统计量		0.229^a	4.923^c
P值		0.819	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.01。

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表 5 2组PD合并睡眠障碍患者CPC睡眠监测指标比较(x ±s)

Table 5. Comparison of changes of CPC sleep monitoring indexes in PD patients with sleep disorders between two groups(x ±s)

组别	例数	睡眠总时间(h)			睡眠效率(%)		浅睡时间(h)			REM睡眠时间(min)
组别	例数	干预前	干预后4周		干预前	干预后4周	干预前	干预后4周		干预前	干预后4周
观察组	46	5.25±0.57	7.63±0.65^b		63.85±2.78	85.66±3.82^b	3.92±0.78	2.31±0.68^b		81.58±2.78	55.82±2.69^b
对照组	46	5.22±0.68	6.28±0.75^b		63.62±2.69	71.95±3.86^b	3.82±0.55	2.91±0.42^b		81.82±2.55	72.63±2.72^b
统计量		0.413^a	9.226^c		0.403^a	17.122^c	0.447^a	9.008^c		-0.431	-40.942
P值		0.681	＜0.001		0.688	＜0.001	0.657	＜0.001		0.667	< 0.001

组别	例数	熟睡时间(h)				觉醒时间(h)			睡眠呼吸睡眠指数(次/h)
组别	例数	干预前		干预后4周		干预前	干预后4周		干预前		干预后4周
观察组	46	2.23±0.57		3.69±0.25^b		2.52±0.23	1.56±0.26^b		7.63±0.82		83.89±0.68^b
对照组	46	2.27±0.21		3.28±0.17^b		2.61±0.31	1.98±0.18^b		44.87±5.75		72.83±6.92^b
统计量		0.711^a		7.415^c		1.338^a	5.092^c		-1.378^a		6.986^c
P值		0.479		＜0.001		0.184	＜0.001		0.172		< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.01。

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表 6 2组PD合并睡眠障碍患者临床总有效率比较[例(%)]

Table 6. Comparison of the total clinical effective rate between the two groups of patients with PD and sleep disorders[cases (%)]

组别	例数	显效	有效	无效	总有效
观察组	46	21(45.65)	23(50.00)	2(4.35)	44(95.65)
对照组	46	14(30.43)	22(47.83)	10(21.74)	36(78.26)
注：2组总有效率比较，χ²=6.133，P=0.013。

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