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SYSTEMATIC REVIEW article

Front. Neurol.
Sec. Stroke
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1420363
This article is part of the Research Topic Sleep Disorders and Cerebrovascular Diseases View all 4 articles

Efficacy of non-invasive brain stimulation for post-stroke sleep disorders: a systematic review and meta-analysis

Provisionally accepted
Linyu HUANG Linyu HUANG 1Xingling ZHANG Xingling ZHANG 1Jie ZHANG Jie ZHANG 1Long LI Long LI 1Xianyu ZHOU Xianyu ZHOU 1Tingyu YANG Tingyu YANG 1Xuemei An Xuemei An 2,3*
  • 1 College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
  • 2 Nursing Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
  • 3 Deyang Hospital, Hospital of Chengdu University of Traditional Chinese Medicine, Deyang, China

The final, formatted version of the article will be published soon.

    Objective: This study aimed to systematically assess the clinical efficacy of non-invasive brain stimulation (NIBS) for treating post-stroke sleep disorders (PSSD).We conducted thorough literature search across multiple databases, including PubMed, Web of Science, EmBase, Cochrane Library, Scopus, China Biology Medicine(CBM); China National Knowledge Infrastructure(CNKI);Technology Periodical Database(VIP), and Wanfang Database, focusing on RCTs examining NIBS for PSSD. Meta-analyses were performed using RevMan 5.4 and Stata 14.Results: 17 articles were reviewed, including 16 on repetitive Transcranial Magnetic Stimulation (rTMS), one on Theta Burst Stimulation (TBS), and two on transcranial Direct Current Stimulation (tDCS). Meta-analysis results indicated that rTMS within NIBS significantly improved the Pittsburgh Sleep Quality Index (PSQI) score (MD = -2.22, 95% CI [-3.35, -1.09], P < 0.05), the 17-item Hamilton Depression Rating Scale (HAMD-17) score (MD = -2.85, 95% 95% CI [-3.40, -2.30], P < 0.05), and serum brain-derived neurotrophic factor (BDNF) levels (MD = 4.19, 95% CI [2.70, 5.69], P < 0.05), while reducing the incidence of adverse reactions (RR = 0.36, 95% CI [0.23, 0.55], P < 0.05). TBS significantly improved the PSQI score in patients with PSSD (P < 0.05). Conversely, tDCS significantly improved the HAMD-17 score in PSSD patients (MD = -1.52, 95% CI [-3.41, -0.64], P < 0.05). Additionally, rTMS improved sleep parameters, including Stage 2 sleep (S2%) and combined Stage 3 and 4 sleep (S3 + S4%) (P < 0.05), while tDCS improved total sleep time (TST) and sleep efficiency (SE) (P < 0.05).Subgroup analysis results indicated: (1) Both LF-rTMS and HF-rTMS improved PSQI scores (P < 0.05). (2) Both rTMS combined with medication and rTMS alone improved PSQI scores (P < 0.05). Compared to the sham/blank group, the rTMS group showed improvements in SE, sleep latency (SL), S1%, S3 + S4%, and REM sleep (REM%). The rTMS combined with medication group showed improved SL compared to the medication-only group (P < 0.05). Conclusion: NIBS effectively improves sleep quality, structure, depression levels, and BDNF levels in PSSD patients, while also being safe. Further investigations into the potential of NIBS in PSSD treatment may provide valuable insights for clinical applications.

    Keywords: non-invasive brain stimulation, Transcranial Magnetic Stimulation, transcranial direct current stimulation, Stroke, sleep disorder, insomnia, Meta-analysis

    Received: 20 Apr 2024; Accepted: 07 Oct 2024.

    Copyright: © 2024 HUANG, ZHANG, ZHANG, LI, ZHOU, YANG and An. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xuemei An, Nursing Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.