Abstract:

Objective　To explore the effects of low-frequency transcranial magnetic stimulation combined with cognitive behavioral nursing on sleep structure and emotional regulation in patients with insomnia after stroke. Methods　A prospective study was conducted to select 122 stroke patients admitted to Henan Provincial People 's Hospital from June 2023 to October 2024 as the study subjects, and were divided into two groups by random number table method, 61 cases in each group. In the control group, 36 males and 25 females, aged (67.48±10.12) years, with a course of (2.13±0.32) months, were treated with low-frequency transcranial magnetic stimulation. There were 34 males and 27 females in the observation group, aged (67.53±10.13) years old, and the course of disease was (2.07±0.31) months. On the basis of the control group, insomnia cognitive behavioral nursing was combined. Both groups were intervened continuously for 6 weeks. The sleep structure [sleep efficiency (SE), sleep latency (SL), rapid eye movement sleep latency (RL), rapid eye movement sleep time (RT), 1 stage sleep (S1), 2 stage sleep (S2), 3,4 stage sleep (S3, S4), rapid eye movement sleep (R)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], psychological emotion [Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS)], neurological impairment [National Institutes of Health Stroke Scale (NIHSS)], cognitive impairment [Mini-Mental State Examination (MMSE)] and quality of life [36-Item Short Form Health Survey,Short Form 36 (SF-36)] were compared between the two groups before and after intervention. Statistical methods using t test. Results　After intervention, the levels of SE, RT, S3, S4, and R and the scores of MMSE and SF-36 in the observation group were higher than those in the control group [(88.16±13.22)% vs. (72.92±10.94)%, (68.29±10.24) min vs. (52.54±7.88) min, (26.46±3.97)% vs. (21.38±3.21)%, (19.46±2.92)% vs. (16.39±2.46)%, 26.97±4.05 vs. 22.22±3.3, and 88.49±13.27 vs. 74.35±11.15], and the SL, RL, S1, S2 levels and sleep time, sleep quality, sleep time, sleep disorders, sleep efficiency, hypnotic drugs, daytime function, SAS, SDS, NIHSS scores were lower [(11.64±1.75) min vs. (31.35±4.70) min, (118.41±17.76) min vs. (131.36±19.70) min, (12.35±1.85)% vs. (14.44±2.17)%, (41.68±6.25)% vs. (46.47±6.97)%, 0.77±0.12 vs. 0.92±0.14, 1.21±0.18 vs. 1.67±0.25, 0.76±0.11 vs. 1.25±0.19, 0.61±0.09 vs. 0.77±0.12, 0.62±0.09 vs. 0.79±0.12, 0.68±0.10 vs. 0.85±0.13, 1.04±0.16 vs. 1.36±0.20, 44.60±6.69 vs. 51.35±7.70, 43.15±6.47 vs. 50.47±7.57, and 3.88±0.58 vs. 7.74±1.16], with statistical differences (all P<0.05).Conclusions　The application of low-frequency transcranial magnetic stimulation combined with cognitive behavioral intervention for insomnia in stroke patients with insomnia is conducive to improving the sleep structure and quality of patients and alleviating their negative emotions. It can also promote the recovery of neurological function and enhance their quality of life.

Key words:

Cerebral apoplexy, Insomnia, Low-frequency transcranial magnetic stimulation, Cognitive behavioral intervention, Sleep structure

摘要：

目的　探讨脑卒中后失眠患者应用低频经颅磁刺激联合认知行为护理对其睡眠结构及情绪调节的影响。方法　采用前瞻性研究，选取2023年6月至2024年10月河南省人民医院收治的脑卒中患者122例作为研究对象，以随机数字表法分为两组，各61例。对照组男36例、女25例，年龄（67.48±10.12）岁，病程（2.13±0.32）个月，行低频经颅磁刺激治疗；观察组男34例、女27例，年龄（67.53±10.13）岁，病程（2.07±0.31）个月，在对照组基础上联合失眠认知行为护理。两组均连续干预6周。对比两组患者干预前后睡眠结构［睡眠效率（SE）、睡眠潜伏期（SL）、快速动眼睡眠潜伏期（RL）、快速动眼睡眠时间（RT）、1期睡眠（S1）、2期睡眠（S2）、3期睡眠+4期睡眠（S3+S4）、快速动眼睡眠（R）］、睡眠质量［匹兹堡睡眠质量指数（PSQI）］、心理情绪［焦虑自评量表（SAS）、抑郁自评量表（SDS）］、神经功能损伤情况［美国国立卫生研究院卒中量表（NIHSS）］、认知功能缺损程度［简易智力状态检查量表（MMSE）］及生活质量水平［生活质量量表（SF-36）］。统计学方法采用t检验。结果　干预后，观察组SE、S3+S4、R水平及MMSE、SF-36评分均高于对照组［（88.16±13.22）%比（72.92±10.94）%、（26.46±3.97）%比（21.38±3.21）%、（19.46±2.92）%比（16.39±2.46）%、（26.97±4.05）分比（22.22±3.33）分、（88.49±13.27）分比（74.35±11.15）］分，RT长于对照组［（68.29±10.24）min比（52.54±7.88）min］，SL、RL均短于对照组［（11.64±1.75）min比（31.35±4.70）min、（118.41±17.76）min比（131.36±19.70）min］，S1、S2水平及入睡时间、睡眠质量、睡眠时间、睡眠障碍、睡眠效率、催眠药物、日间功能、SAS、SDS、NIHSS评分均低于对照组［（12.35±1.85）%比（14.44±2.17）%、（41.68±6.25）%比（46.47±6.97）%、（0.77±0.12）分比（0.92±0.14）分、（1.21±0.18）分比（1.67±0.25）分、（0.76±0.11）分比（1.25±0.19）分、（0.61±0.09）分比（0.77±0.12）分、（0.62±0.09）分比（0.79±0.12）分、（0.68±0.10）分比（0.85±0.13）分、（1.04±0.16）分比（1.36±0.20）分、（44.60±6.69）分比（51.35±7.70）分、（43.15±6.47）分比（50.47±7.57）分、（3.88±0.58）分比（7.74±1.16）分］，差异均有统计学意义（均P<0.05）。结论　将低频经颅磁刺激联合失眠认知行为干预应用于脑卒中失眠患者中，有利于促进患者睡眠结构、睡眠质量改善和不良情绪的缓解，还可促进患者神经功能恢复，提高其生活质量水平。

关键词:

脑卒中, 失眠, 低频经颅磁刺激, 认知行为干预, 睡眠结构