Repetitive Transcranial Magnetic Stimulation on Primary Insomnia Electrophysiology Detected by Polysomnography: A Systematic Review and Meta-Analysis.

Source: International Journal of Clinical and Experimental Medicine. 14(8) (pp 2153-2163), 2021. Article Number: IJCEM0128843.

Date of Publication: 2021.

Authors: Zheng Y.; Fan Y.; Liang N.; Lu J.

This systematic review was performed to examine the efficacy of repetitive transcranial magnetic stimulation (rTMS) on the electrophysiology results of patients with primary insomnia based on prior polysomnography research.

Method(s): We performed a comprehensive literature search for randomized clinical trials evaluating the efficacy of rTMS by polysomnography addressing primary insomnia, and performed meta-analyses according to Cochrane guidelines.

Result(s): We found that rTMS significantly improved the sleep architecture of primary insomnia patients. The pooled effect size of latency to onset of persistent sleep (LPS) was-6.90 (95% confidence interval (CI):-11.66, 2.15), of wakefulness after persistent sleep onset (WASO)-30.48 (95% CI:-43.13,-17.82), of number of awakenings (NA)-1.23 (95% CI:-1.84,-0.61), of non-rapid eye movement sleep-1 (NREM-1)-1.40 (95% CI:-2.43,-0.37), of total sleep time (TST) 35.19 (95% CI: 19.83, 50.55), of sleep efficiency (SE) 7.74% (95% CI: 3.87%, 11.70%), of NREM-3 2.49 (95% CI: 1.53, 3.45), and of rapid eye movement (REM) 1.33 (95% CI: 0.75, 1.91). In contrast, there was no significant effect on NREM-2-0.47 (95% CI:-1.30, 0.36).

Conclusion(s): The rTMS may be an effective technique to improve sleep architecture in the treatment of primary insomnia. However, the typical effect was uncertain due to heterogeneity. It may be valuable for further research to explore a more acceptable methodology, such as adequate blinding and allocation of concealment so as to provide more objective evidence.