Effect of combined treatment with transcranial direct current stimulation and repetitive transcranial magnetic stimulation compared to monotherapy for the treatment of chronic insomnia: a randomised, double-blind, parallel-group, controlled trial

• Published in: BMC medicine 2024-11, Vol.22 (1), p.538-16, Article 538
• Main Authors: Zhou, Qi, Liu, Zhiwang, Yu, Chang, Wang, Qiao, Zhuang, Wenhao, Tang, Yafang, Zheng, Tianming, Yu, Haihang, Zhou, Dongsheng
• Format: Article
• Language: English
• Subjects: Adult; Adverse events; Aged; Anxiety; Brain research; Brain stimulation; Care and treatment; Chronic illnesses; Chronic insomnia; Clinical trial; Clinical trials; Combined Modality Therapy - methods; Combined therapy; Combined treatment; Direct current; Double-Blind Method; Drug withdrawal; Effectiveness; Electrical stimulation of the brain; Electrodes; ESB; Evaluation; Female; Health problems; Humans; Insomnia; Magnetic fields; Male; Mental depression; Mental disorders; Methods; Middle Aged; Patient outcomes; Patients; Repetitive transcranial magnetic stimulation; Sleep; Sleep disorders; Sleep Initiation and Maintenance Disorders - therapy; Stability augmentation; Therapy; Transcranial direct current stimulation; Transcranial Direct Current Stimulation - methods; Transcranial magnetic stimulation; Transcranial Magnetic Stimulation - methods; Treatment Outcome
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-024-03751-y

Chronic insomnia increases the risk of various health problems and mental illness. Existing research suggests promise for both transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in treating chronic insomnia individually. However, the combined effects of tDCS and rTMS on this condition remain unclear. This study aimed to verify the efficacy and safety of tDCS combined with rTMS for the treatment of adult patients with chronic insomnia. This was a randomised double-blind parallel-group controlled study. Overall, 157 participants with chronic insomnia were randomly assigned to one of three neurotherapy regimens: tDCS + rTMS, sham tDCS + rTMS, or tDCS + sham rTMS. All groups received 20 treatment sessions over 4 consecutive weeks. The primary outcome was the change in patients' sleep as assessed by the Pittsburgh Sleep Quality Index (PSQI) at 2 weeks, 4 weeks, and 3 months of follow-up. The secondary outcome was the assessment of different dimensions of depression and anxiety in patients through the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), as well as the occurrence of adverse events. Throughout the intervention and after the 3-month follow-up, the tDCS + rTMS group had significantly reduced total PSQI scores compared with the other two groups [tDCS + rTMS, 9.21 vs. sham tDCS + rTMS, 10.03; difference - 1.10; 95% confidence interval (CI), - 1.82 to - 0.38; p = 0.003; tDCS + rTMS, 9.21 vs. tDCS + sham rTMS, 10.76; difference - 2.14; 95% CI, - 2.90 to - 1.38; p