Electroencephalographic connectivity predicts clinical response to repetitive transcranial magnetic stimulation in patients with insomnia disorder

Xue Shi; Yi Guo; Lin Zhu; Wei Wu; Brenton Hordacre; Xiaolin Su; Qian Wang; Xiaoxia Chen; Xiaoyong Lan; Ge Dang

doi:10.1016/j.sleep.2021.10.017

Electroencephalographic connectivity predicts clinical response to repetitive transcranial magnetic stimulation in patients with insomnia disorder

Sleep Med. 2021 Dec:88:171-179. doi: 10.1016/j.sleep.2021.10.017. Epub 2021 Oct 25.

Authors

Xue Shi¹, Yi Guo², Lin Zhu¹, Wei Wu³, Brenton Hordacre⁴, Xiaolin Su¹, Qian Wang¹, Xiaoxia Chen¹, Xiaoyong Lan¹, Ge Dang⁵

Affiliations

¹ Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China.
² Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China; Shenzhen Bay Laboratory, Shenzhen, 518020, Guangdong, China.
³ School of Automation Science and Engineering, South China University of Technology, Guangzhou, 510641, China.
⁴ Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Australia.
⁵ Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China. Electronic address: dgq220@163.com.

PMID: 34773788
DOI: 10.1016/j.sleep.2021.10.017

Abstract

Background: Accumulating evidence suggests that low frequency repetitive transcranial magnetic stimulation (rTMS), which generally decreases cortical excitability and remodels plastic connectivity, improves sleep quality in patients with insomnia disorder. However, the effects of rTMS vary substantially across individuals and treatment is sometimes unsatisfactory, calling for biomarkers for predicting clinical outcomes.

Objective: This study aimed to investigate whether functional connectivity of the target network in electroencephalography is associated with the clinical response to low frequency rTMS in patients with insomnia disorder.

Methods: Twenty-five patients with insomnia disorder were subjected to 10 sessions of treatment with 1 Hz rTMS over the right dorsolateral prefrontal cortex. Resting-state electroencephalography was collected before rTMS. Pittsburgh Sleep Quality Index, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Mini-Mental State Exam were performed before and after rTMS treatment, with a follow-up after one month. Electroencephalographic connectivity was measured by the power envelope connectivity at the source level. Partial least squares regression identified models of connectivity that maximally accounted for the rTMS response.

Results: Scores of Pittsburgh Sleep Quality Index, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale were decreased after rTMS and one-month later. Baseline weaker connectivity of a network in the beta and alpha bands between a brain region approximating the stimulated right dorsolateral prefrontal cortex and areas located in the frontal, insular, and limbic cortices was associated with a greater change in Pittsburgh Sleep Quality Index and Hamilton Depression Rating Scale following rTMS.

Conclusions: Low frequency rTMS could improve sleep quality and depressive moods in patients with insomnia disorder. Moreover, electroencephalographic functional connectivity would potentially be a robust biomarker for predicting the therapeutic effects.

Keywords: Electroencephalography; Functional connectivity; Insomnia disorder; Power envelope connectivity; Repetitive transcranial magnetic stimulation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Dorsolateral Prefrontal Cortex
Electroencephalography
Humans
Prefrontal Cortex
Sleep Initiation and Maintenance Disorders* / therapy
Sleep Quality
Transcranial Magnetic Stimulation*
Treatment Outcome