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• Clinical Article •
Association of MRI indexes of brain glymphatic function with sleep status in insomnia patients disorders and the effects of repetitive transcranial magnetic stimulation treatment on them
ZHANG Zhengnan  CHENG Shihan  WANG Huixiao  ZHOU Jinli  ZHU Yifei  GENG Zuojun  YANG Haiqing 

Cite this article as: ZHANG Z N, CHENG S H, WANG H X, et al. Association of MRI indexes of brain glymphatic function with sleep status in insomnia patients disorders and the effects of repetitive transcranial magnetic stimulation treatment on them[J]. Chin J Magn Reson Imaging, 2025, 16(5): 88-95. DOI:10.12015/issn.1674-8034.2025.05.014.


[Abstract] Objective To investigate the relationship between brain glymphatic function and sleep status in insomnia disorder (ID) patients, and to investigate whether repetitive transcranial magnetic stimulation (rTMS) can improve sleep status and brain glymphoid function in patients with ID.Materials and Methods Patients were divided into a real rTMS treatment group (n = 28), a sham rTMS treatment group (n = 9), and a healthy control group matched for age and gender (n = 20). All subjects underwent neuropsychological and sleep scale assessments, polysomnography (PSG), and MRI. Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) was used to evaluate glymphatic function. Continuous variables were compared among three groups using one-way ANOVA or Kruskal-Wallis test, with post-hoc analysis conducted using Tukey or Dunn's multiple comparison test. Categorical variables were analyzed using the χ2 test. The intraclass correlation coefficient was used to assess the consistency of DTI-ALPS index measurements among different observers. Univariate and multivariate linear regression analyses were used to evaluate the correlations between DTI-ALPS and clinical data, sleep assessment scales, and PSG indicators. Paired sample t-tests were used to assess changes in sleep status and DTI-ALPS indices before and after treatment in the real/sham rTMS groups.Results The DTI-ALPS index was lower in all ID patients than in healthy controls before rTMS treatment (F = 13.08, P < 0.001). N2 sleep duration (β = 0.01, 95% CI: 0.01 to 0.01, P = 0.034; β = 0.01, 95% CI: 0.01 to 0.01, P = 0.034) and arousal index (β = -0.01, 95% CI: -0.02 to -0.01, P < 0.001; β = -0.01, 95% CI: -0.01 to -0.01, P = 0.002) were independently associated with the DTI-ALPS index in both the minimally adjusted model Ⅰ and the strictly adjusted model Ⅱ in all ID patients. After rTMS, the sleep questionnaire results, total sleep time, N2 sleep time, arousal index, and DTI-ALPS index in the true stimulation group compared to the sham stimulation group reflected that rTMS treatment improved sleep status as well as brain glymphatic function in ID patients.Conclusions N2 sleep time and arousal index were independently correlated with brain glymphatic function, and rTMS treatment could improve brain glymphatic function and sleep status of insomnia patients.
[Keywords] insomnia disorder；diffusion-tensor imaging；magnetic resonance imaging；brain glymphatic function；repetitive transcranial magnetic stimulation

ZHANG Zhengnan1   CHENG Shihan1   WANG Huixiao1   ZHOU Jinli1   ZHU Yifei2   GENG Zuojun1   YANG Haiqing1*  

1 Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China

2 Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China

Corresponding author: YANG H Q, E-mail: hbyhq@sina.com

Conflicts of interest   None.

Received  2024-12-14
Accepted  2025-05-10
DOI: 10.12015/issn.1674-8034.2025.05.014
Cite this article as: ZHANG Z N, CHENG S H, WANG H X, et al. Association of MRI indexes of brain glymphatic function with sleep status in insomnia patients disorders and the effects of repetitive transcranial magnetic stimulation treatment on them[J]. Chin J Magn Reson Imaging, 2025, 16(5): 88-95. DOI:10.12015/issn.1674-8034.2025.05.014.

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