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Repetitive transcranial magnetic stimulation (rTMS) for post-stroke sleep disorders: a systematic review of randomized controlled trials

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Abstract

Objective

Survivors of stroke often experience post-stroke sleep disorders (PSSDs), but pharmacotherapy risks adverse side effects. Transcranial magnetic stimulation (TMS) is potentially a nonpharmacotherapeutic option. This meta-analysis investigated the effects of rTMS to treat PSSD.

Methods

Databases were searched for randomized controlled trials (RCTs) of rTMS to treat PSSD, conducted in accordance with the PRISMA 2020 guidelines. Risk-of-bias assessments were performed using the Cochrane risk-of-bias tool. A meta-analysis of the following indexes was performed using RevMan 5.4 software: Pittsburgh sleep quality index; effective rate of sleep improvement; Hamilton Anxiety Rating Scale (for mood); and National Institute of Health Stroke Scale (NIHSS, stroke severity). Mean differences (MDs) and confidence intervals (CIs) were calculated.

Results

The meta-analysis included 17 RCTs, with 1411 patients overall. The indexes indicated that rTMS could improve the sleep quality, mood, and stroke severity of patients with PSSD: Pittsburgh sleep quality index (12 studies; MD =  − 2.51, 95% CI [− 3.24, − 1.79], P < 0.00001); effective rate of sleep improvement (7 studies; MD = 4.03, 95% CI [2.43, 6.68], P < 0.0001); Hamilton Anxiety Rating Scale (2 studies; MD =  − 4.05, 95% CI [− 4.77, − 3.32], P < 0.00001); and NIHSS (2 studies; MD = –2.71, 95% CI [− 3.36, − 2.06], P < 0.00001).

Conclusion

The results suggest that rTMS may have positive effects on the sleep quality, mood, and stroke severity of patients with PSSD.

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References

  1. Owolabi MO, Thrift AG, Martins S et al (2021) The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys. Int J Stroke 16(8):889–901

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sall J, Eapen BC, Tran JE et al (2019) The management of stroke rehabilitation: a synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med 171(12):916–924

  3. Lindsay MP et al (2019) World Stroke Organization (WSO): global stroke fact sheet. Int J Stroke 14(8):806–817

    Article  PubMed  Google Scholar 

  4. Global, regional, and national burden of stroke (2019) 1990–2016: a systematic analysis for the Global Burden of Disease Study. Lancet Neurol 18(5):439–458

  5. Pérez-Carbonell L, Bashir S (2020) Narrative review of sleep and stroke. J Thorac Dis 12(Suppl2):S176–S190

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mountain A et al (2020) Canadian Stroke Best Practice Recommendations: rehabilitation, recovery, and community participation following stroke. Part two: transitions and community participation following stroke. Int J Stroke 15(7):789–806

  7. Zhang Q, Liu Y, Liang Y et al (2021) Exercise intervention for sleep disorders after stroke: a protocol for systematic review and meta-analysis. Medicine 100(17):e25730

  8. Pavlova K, Latreille MV (2019) Sleep disorders. Am J Med 132(3):292–299

    Article  Google Scholar 

  9. Bassetti C, Randerath W, Vignatelli L et al (2020) EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur Respir J 55(4):1901104

  10. Iddagoda MT, Inderjeeth CA, Chan K et al (2020) Post-stroke sleep disturbances and rehabilitation outcomes: a prospective cohort study. Intern Med J 50(2):208–213

    Article  PubMed  Google Scholar 

  11. Wondergem R, Pisters MF, Wouters EJ et al (2017) The course of activities in daily living: who is at risk for decline after first ever stroke? Cerebrovasc Dis 43:1–8

    Article  PubMed  Google Scholar 

  12. Yu S, Arima H, Bertmar C et al (2016) Depression but not anxiety predicts recurrent cerebrovascular events. Acta Neurol Scand 134:29–34

    Article  CAS  PubMed  Google Scholar 

  13. Yuan J, Wang H, Chen J et al (2020) Effect of low frequency repetitive magnetic stimulation at Shenmen (HT7) on sleep quality in patients with chronic insomnia. Medicine(Baltimore) 99(30):e21292

  14. Auger RR, Burgess HJ, Emens JS et al (2015) Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for, et al (2015) an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 11(10):1199–236

  15. Jiang B, He D, Guo Z et al (2019) Efficacy and placebo response of repetitive transcranial magnetic stimulation for primary insomnia. Sleep Med 63:9–13

    Article  PubMed  Google Scholar 

  16. Herrero BA, De Beaumont L, Lavigne GJ (2018) Transcranial magnetic stimulation: potential use in obstructive sleep apnea and sleep bruxism. Sleep Med Clin 13(4):571–582

    Article  Google Scholar 

  17. Lanza G (2020) Repetitive TMS for sleep disorders: are we ready? Sleep Med 71:111–112

  18. Higgins JPT, Green S (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0

  19. Tammasse J, Akbar M et al (2021) The influence of repetitive transcranial magnetic stimulation toward improvement of post ischemic stroke patient’s quality of sleep. Med Clín Práct 4(S1):100203

  20. Qian Y, Ma F, Wang J (2021) Clinical effect and impact on polysomnography parameters of Bailemian capsule combined with repetitive transcranial magnetic stimulation on insomnia secondary to ischemic stroke. Chin J Clin Rational Drug Use 14(15):28–30+34

  21. Lingshu W, Zhang Yu, Shuang L et al (2021) A randomized controlled study on acupuncture combined with low frequency repetitive transcranial magnetic stimulation in the treatment of insomnia after stroke. Mod J Integr Tradit Chin West Med 30(06):616–620

    Google Scholar 

  22. Qiaojuan Z, Shirui G, Huiling X (2021) Effect of repetitive transcranial magnetic stimulation combined with diazepam on patients with post-stroke insomnia. Med J Chin People’s Health 33(18):22–24

    Google Scholar 

  23. Ding l, Xiao B, Chen X et al (2020) Effects of repetitive transcranial magnetic stimulation on sleep structure and brain-derived neurotrophic factors in patients with post-stroke sleep disorders. J Pract Med Tech 27(02):153–156

    Google Scholar 

  24. Hua Q, Xia W, Guo F et al (2020) Clinical study of repetitive transcranial magnetic stimulation combined with dexzopiclone tablets in treatment of sleep disorder in cerebral infarction patients. Neural Inj Funct Reconstr 15(05):267–270+295

  25. Wei S, Xue Y, Ling L et al (2019) Efficacy of TMS combined with music electro -acupuncture in treating post-stroke sleep disorders: a clinical observation by polysomnography. J Clin Acupunct Moxibustion 35(04):7–12

    Google Scholar 

  26. Li C (2019) Clinical effect of transcranial magnetic stimulation combined with clonazepam on patients with post-stroke sleep disorders. Pract Clin Med 20(11):14–15+65

  27. Sheng W, Lyu L, Yang X et al (2019) Effect of transcranial magnetic stimulation combined with ear pressure on patients with post-stroke sleep disorders. Med Diet Health (3):77, 79

  28. Chang X (2018) The clinical study of transcranial magnetic stimulation for the therapeutic effect of sleep disorder. Jinan University

  29. Zhu M (2018) Clinical study of infra-low frequency transcranial magnetic stimulation in the treatment of insomnia after ischemic stroke. Nanjing Medical University

  30. Lili D, Lihong Ma, Jianling W et al (2018) Clinical observation on five elements music and low-frequency repetitive transcranial magnetic stimulation for post-stroke sleep disorders. Chin J Integr Med Cardio-Cerebrovasc Dis 16(11):1494–1496

    Google Scholar 

  31. Xu D, Tian J, Chen C et al (2021) Effect of low-frequency repetitive transcranial magnetic stimulation on insomnia after stroke. Chin J Neuroimmunol Neurol 28(01):58–60+66

  32. Peng C, Zhikang C, Mingfen Li et al (2018) Clinical study of repeated transcranial magnetic stimulation on insomnia after stroke. J Hubei Univ Med 37(03):262–264

    Google Scholar 

  33. Zhengmei L (2017) Clinical study on transcranial magnetic stimulation in treatment of insomnia after stroke. Shenzhen J Integr Tradit Chin West Med 27(06):11–13

    Google Scholar 

  34. Hailong L, Wang C, Gu J (2016) Curative observation of transcranial magnetic stimulation in insomnia in patients after stroke. Chin J Neuromed 15(04):403–405

    Google Scholar 

  35. Chunmei W, Luo H, Gu J (2016) Effect of transcranial magnetic stimulation on insomnia after stroke. Mod Med J China 18(05):51–52

    Google Scholar 

  36. Jean-Pascal L, Nathalie A-O, Andrea A et al (2014) Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 125:2150–2206

    Article  Google Scholar 

  37. Bassetti CLA (2019) Sleep and stroke: a bidirectional relationship with clinical implications. Sleep Med Rev 45:127–128

    Article  PubMed  Google Scholar 

  38. Gottlieb E et al (2019) The bidirectional impact of sleep and circadian rhythm dysfunction in human ischaemic stroke: a systematic review. Sleep Med Rev 45:54–69

    Article  PubMed  Google Scholar 

  39. Park D-I, Choi-Kwon S (2018) Poststroke sleep disorders: an executive summary. J Neurosci Nurs 50(50):314–317

    Article  PubMed  Google Scholar 

  40. Falck RS et al (2019) Sleep and cognitive function in chronic stroke: a comparative cross-sectional study. Sleep 42(5):zsz040

  41. Lefaucheur JP (2019) Transcranial magnetic stimulation. Handb Clin Neurol 160:559–580

    Article  PubMed  Google Scholar 

  42. Deuschle M, Schredl M, Wisch C et al (2018) Serum brain-derived neurotrophic factor (BDNF) in sleep-disordered patients: relation to sleep stage N3 and rapid eye movement (REM) sleep across diagnostic entities. J Sleep Res 27(1):73–77

    Article  PubMed  Google Scholar 

  43. Luo J, Zheng H, Zhang L et al (2017) High-frequency repetitive transcranial magnetic stimulation (rTMS) improves functional recovery by enhancing neurogenesis and activating BDNF/TrkB signaling in ischemic rats. Int J Mol Sci 18:455

  44. Shao D, Zhao ZN, Zhang YQ et al (2021) Efficacy of repetitive transcranial magnetic stimulation for post-stroke depression: a systematic review and meta-analysis of randomized clinical trials. Braz J Med Biol Res 54(3):e10010

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Byun E, Kohen R, Becker KJ et al (2020) Stroke impact symptoms are associated with sleep-related impairment. Heart Lung 49:117–122

    Article  PubMed  Google Scholar 

  46. Cao B, Passos IC, Mwangi B et al (2017) Hippocampal subfield volumes in mood disorders. Mol Psychiatry 22:1352–1358

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Piotr G, Monika T (2018) Neurodevelopmental theory of depression. Prog Neuropsychopharmacol Biol Psychiatry 80:267–272

    Article  Google Scholar 

  48. Herrmann MJ, Katzorke A, Busch YM et al (2017) Medial prefrontal cortex stimulation accelerates therapy response of exposure therapy in acrophobia. Brain Stimul 10:291–297

    Article  PubMed  Google Scholar 

  49. Guoxiang F, Ying W (2018) Effects of rTMS on hippocampal endocannabinoids and depressive-like behaviors in adolescent rats. Neurochem Res 43:1756–1765

    Article  Google Scholar 

  50. Katzan IL, Thompson NR, Walia HK et al (2020) Sleep disturbance predicts future health status after stroke. J Clin Sleep Med 16:1863–1870

    Article  PubMed  PubMed Central  Google Scholar 

  51. Raven F, Van der Zee EA, Meerlo P et al (2018) The role of sleep in regulating structural plasticity and synaptic strength: implications for memory and cognitive function. Sleep Med Rev 39:3–11

    Article  PubMed  Google Scholar 

  52. Konjarski M, Murray G, Lee VV et al (2018) Reciprocal relationships between daily sleep and mood: A systematic review of naturalistic prospective studies. Sleep Med Rev 42:47–58

    Article  PubMed  Google Scholar 

  53. Jean-Pascal L, André A, Chris B et al (2020) Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Clin Neurophysiol 131:474–528

    Article  Google Scholar 

  54. Philipp R, Matthias H, Stephan B et al (2019) Modulating functional connectivity between medial frontopolar cortex and amygdala by inhibitory and excitatory transcranial magnetic stimulation. Hum Brain Mapp 40:4301–4315

    Article  Google Scholar 

  55. Burke MJ, Fried PJ, Pascual-Leone A (2019) Transcranial magnetic stimulation: neurophysiological and clinical applications. Handb Clin Neurol 163:73–92

    Article  PubMed  Google Scholar 

Download references

Funding

The authors disclose the receipt of the following financial support for the research, authorship, and/or publication of this article: Supported by Natural Science Foundation of Fujian Province, China (Grant No. 2021J01946).

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Authors and Affiliations

  1. Nursing College, Fujian University of Traditional Chinese Medicine, No. 1 Qiu Yang Road, Shangjie, Minhou, Fujian, 350122, Fuzhou, People’s Republic of China

    Jiaying Guo, Xin Chen, Zecai Lyu, Huoqin Xiu, Shaohong Lin & Fang Liu

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  1. Jiaying Guo
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  2. Xin Chen
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  4. Huoqin Xiu
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Contributions

Conceived the idea: Jiaying Guo and Fang Liu; collected data: Jiaying Guo, Fang Liu, and Xin Chen; analyzed and interpreted data: Jiaying Guo, Fang Liu, Shaohong Lin, and Xin Chen; wrote the first draft: Jiaying Guo, Fang Liu, and Zecai Lyu; key revisions to important contents of the manuscript: Jiaying Guo, Fang Liu and Huoqin Xiu; conducted meta-analyses: Jiaying Guo, Fang Liu, and Zecai Lyu; and study supervision: Jiaying Guo and Fang Liu, who contributed equally to this study.

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Correspondence to Fang Liu.

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Guo, J., Chen, X., Lyu, Z. et al. Repetitive transcranial magnetic stimulation (rTMS) for post-stroke sleep disorders: a systematic review of randomized controlled trials. Neurol Sci 43, 6783–6794 (2022). https://doi.org/10.1007/s10072-022-06349-5

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