Share this content in WeChat
Advances in fMRI-based research to explore the central mechanisms of acupuncture in the treatment of insomnia with mood disorders
WANG Yixiang  SUN Zhao  LI Hao  WANG Jing  KANG Xiaona  RAN Binyan  WU Qiong  HUANG Luyu  CHEN Yize  SHEN Wei 

Cite this article as: WANG Y X, SUN Z, LI H, et al. Advances in fMRI-based research to explore the central mechanisms of acupuncture in the treatment of insomnia with mood disorders[J]. Chin J Magn Reson Imaging, 2023, 14(3): 144-148. DOI:10.12015/issn.1674-8034.2023.03.026.

[Abstract] Insomnia with mood disorder is a physical and mental disorder characterized by a range of physical and mental discomforts such as sleep disturbances, nervousness and fear, palpitations and irritability.It has seriously affected people's physical and mental health and quality of life.Acupuncture has the advantage of being safe, non-toxic and cost-effective in the management of insomnia with mood disorders, but its central mechanism is not yet clear. In recent years, advances in functional magnetic resonance imaging (fMRI) have helped to objectively assess the efficacy of acupuncture in the treatment of insomnia with mood disorders.It has also provided an opportunity to explore the central mechanisms of acupuncture in the treatment of insomnia with mood disorders.In this paper, we review the relevant domestic and international literature in recent years to explore the central response characteristics of acupuncture on brain structure and brain function in patients with insomnia with mood disorders.To better understand the current state of neuroimaging research on the therapeutic mechanisms of acupuncture for insomnia with mood disorders, and to provide reference and input for future research.
[Keywords] acupuncture;insomnia with mood disorders;central mechanism;functional brain imaging;magnetic resonance imaging;functional magnetic resonance imaging

WANG Yixiang1   SUN Zhao1   LI Hao2   WANG Jing3   KANG Xiaona1   RAN Binyan1   WU Qiong1   HUANG Luyu1   CHEN Yize1   SHEN Wei1, 4*  

1 School of Traditional Chinese Medicine, Hainan Medical College, Haikou 571199, China

2 Department of Ophthalmology, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou 570203, China

3 Department of Tuina, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou 570203, China

4 Department of Acupuncture, the First Affiliated Hospital of Hainan Medical College, Haikou 570100, China

Corresponding author: Shen W, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS National Natural Science Foundation of China (No. 81860880, 82260966); High-level Talent Project of Hainan Provincial Natural Science Foundation (No. 821RC567); Scientific Research Project of Hainan Provincial Health Department (No. 22A200035); Hainan Medical College Postgraduate Innovation Project (No. HYYS2021A15).
Received  2022-10-28
Accepted  2023-03-02
DOI: 10.12015/issn.1674-8034.2023.03.026
Cite this article as: WANG Y X, SUN Z, LI H, et al. Advances in fMRI-based research to explore the central mechanisms of acupuncture in the treatment of insomnia with mood disorders[J]. Chin J Magn Reson Imaging, 2023, 14(3): 144-148. DOI:10.12015/issn.1674-8034.2023.03.026.

RIEMANN D. Sleep, insomnia and anxiety-Bidirectional mechanisms and chances for intervention[J/OL]. Sleep Med Rev, 2022, 61: 101584 [2023-02-23]. DOI: 10.1016/j.smrv.2021.101584.
PALMER C A, ALFANO C A. Anxiety modifies the emotional effects of sleep loss[J/OL]. Curr Opin Psychol, 2020, 34: 100-104 [2023-02-23]. DOI: 10.1016/j.copsyc.2019.12.001.
MIKLOWITZ D J, WEINTRAUB M J, SINGH M K, et al. Mood Instability in Youth at High Risk for Bipolar Disorder[J]. J Am Acad Child Adolesc Psychiatry, 2022, 61(10): 1285-1295. DOI: 10.1016/j.jaac.2022.03.009.
BENBIR G, DEMIR A U, AKSU M, et al. Prevalence of insomnia and its clinical correlates in a general population in Turkey[J]. Psychiatry Clin Neurosci, 2015, 69(9): 543-552. DOI: 10.1111/pcn.12252.
OHAYON M M, ROTH T. Place of chronic insomnia in the course of depressive and anxiety disorders[J]. J Psychiatr Res, 2003, 37(1): 9-15. DOI: 10.1016/s0022-3956(02)00052-3.
GARDANI M, BRADFORD D R R, RUSSELL K, et al. A systematic review and meta-analysis of poor sleep, insomnia symptoms and stress in undergraduate students[J/OL]. Sleep Med Rev, 2022, 61: 101565 [2023-02-23]. DOI: 10.1016/j.smrv.2021.101565.
NGUYEN V V, ZAINAL N H, NEWMAN M G. Why Sleep is Key: Poor Sleep Quality is a Mechanism for the Bidirectional Relationship between Major Depressive Disorder and Generalized Anxiety Disorder Across 18 Years[J/OL]. J Anxiety Disord, 2022, 90: 102601 [2023-02-23]. DOI: 10.1016/j.janxdis.2022.102601.
COX R C, OLATUNJI B O. Sleep in the anxiety-related disorders: A meta-analysis of subjective and objective research[J/OL]. Sleep Med Rev, 2020, 51: 101282 [2023-02-23]. DOI: 10.1016/j.smrv.2020.101282.
HERTENSTEIN E, FEIGE B, GMEINER T, et al. Insomnia as a predictor of mental disorders: A systematic review and meta-analysis[J]. Sleep Med Rev, 2019, 43: 96-105. DOI: 10.1016/j.smrv.2018.10.006.
CHELLAPPA S L, AESCHBACH D. Sleep and anxiety: From mechanisms to interventions[J/OL]. Sleep Med Rev, 2022, 61: 101583 [2023-02-23]. DOI: 10.1016/j.smrv.2021.101583.
WANG T, YAN J, LI S, et al. Increased insular connectivity with emotional regions in primary insomnia patients: a resting-state fMRI study[J]. Eur Radiol, 2017, 27(9): 3703-3709. DOI: 10.1007/s00330-016-4680-0.
JIANG T, ZHANG Q, YUAN F, et al. Efficacy of acupuncture and its influence on the emotional network in adult insomnia patients: protocol for a randomized controlled clinical trial[J/OL]. Trials, 2022, 23(1): 11 [2023-02-23]. DOI: 10.1186/s13063-021-05913-2.
WASSING R, LAKBILA-KAMAL O, RAMAUTAR J R, et al. Restless REM Sleep Impedes Overnight Amygdala Adaptation[J]. Curr Biol, 2019, 29(14): 2351-2358. DOI: 10.1016/j.cub.2019.06.034.
YU S, SHEN Z, LAI R, et al. The Orbitofrontal Cortex Gray Matter Is Associated With the Interaction Between Insomnia and Depression[J/OL]. Front Psychiatry, 2018, 9: 651 [2023-02-23]. DOI: 10.3389/fpsyt.2018.00651.
CHEN L, SHAO Z, LEI W, et al. Abnormal hippocampal substructure volume in insomnia disorder[J]. Brain Imaging Behav, 2022, 16(2): 672-679. DOI: 10.1007/s11682-021-00540-6.
SUN J J, LIU X M, SHEN C Y, et al. Reduced prefrontal activation during verbal fluency task in chronic insomnia disorder: a multichannel near-infrared spectroscopy study[J]. Neuropsychiatr Dis Treat, 2017, 13: 1723-1731. DOI: 10.2147/NDT.S136774.
STOFFERS D, ALTENA E, VAN DER WERF Y D, et al. The caudate: a key node in the neuronal network imbalance of insomnia[J]. Brain, 2014, 137(Pt 2): 610-620. DOI: 10.1093/brain/awt329.
GUADAGNI V, BURLES F, FERRARA M, et al. Sleep quality and its association with the insular cortex in emotional empathy[J]. Eur J Neurosci, 2018, 48(6): 2288-2300. DOI: 10.1111/ejn.14124.
KAY D B, KARIM H T, HASLER B P, et al. Impact of acute sleep restriction on cerebral glucose metabolism during recovery non-rapid eye movement sleep among individuals with primary insomnia and good sleeper controls[J]. Sleep Med, 2019, 55: 81-91. DOI: 10.1016/j.sleep.2018.12.007.
URRILA A S, HAKKARAINEN A, CASTANEDA A, et al. Frontal Cortex Myo-Inositol Is Associated with Sleep and Depression in Adolescents: A Proton Magnetic Resonance Spectroscopy Study[J]. Neuropsychobiology, 2017, 75(1): 21-31. DOI: 10.1159/000478861.
LI G, ZHANG X, ZHANG J, et al. Magnetic resonance study on the brain structure and resting-state brain functional connectivity in primary insomnia patients[J/OL]. Medicine (Baltimore), 2018, 97(34): e11944 [2023-02-23]. DOI: 10.1097/MD.0000000000011944.
ULLMANN E, PERRY S W, LICINIO J, et al. From Allostatic Load to Allostatic State-An Endogenous Sympathetic Strategy to Deal With Chronic Anxiety and Stress?[J/OL]. Front Behav Neurosci, 2019, 13: 47 [2023-02-23]. DOI: 10.3389/fnbeh.2019.00047.
GRAY J P, MÜLLER V I, EICKHOFF S B, et al. Multimodal Abnormalities of Brain Structure and Function in Major Depressive Disorder: A Meta-Analysis of Neuroimaging Studies[J]. Am J Psychiatry, 2020, 177(5): 422-434. DOI: 10.1176/appi.ajp.2019.19050560.
PARASTOU K M, MOHAMAD N, FARIBA K, et al. Vulnerability of Left Amygdala to Total Sleep Deprivation and Reversed Circadian Rhythm in Molecular Level: Glut1 as a Metabolic Biomarker[J/OL]. Galen Med J, 2019, 8: e970 [2023-02-23]. DOI: 10.31661/gmj.v8i0.970.
PARK S, KANG I, EDDEN R A E, et al. Shorter sleep duration is associated with lower GABA levels in the anterior cingulate cortex[J]. Sleep Med, 2020, 71: 1-7. DOI: 10.1016/j.sleep.2020.02.018.
LEERSSEN J, BLANKEN T F, POZZI E, et al. Brain structural correlates of insomnia severity in 1053 individuals with major depressive disorder: results from the ENIGMA MDD Working Group[J/OL]. Transl Psychiatry, 2020, 10(1): 425 [2023-02-23]. DOI: 10.1038/s41398-020-01109-5.
WU H, ZHENG Y, ZHAN Q, et al. Covariation between spontaneous neural activity in the insula and affective temperaments is related to sleep disturbance in individuals with major depressive disorder[J]. Psychol Med, 2021, 51(5): 731-740. DOI: 10.1017/S0033291719003647.
CHEN M C, CHANG C, GLOVER G H, et al. Increased insula coactivation with salience networks in insomnia[J]. Biol Psychol, 2014, 97: 1-8. DOI: 10.1016/j.biopsycho.2013.12.016.
ZHANG Y, DAI C, SHAO Y, et al. Decreased Functional Connectivity in the Reward Network and Its Relationship With Negative Emotional Experience After Total Sleep Deprivation[J/OL]. Front Neurol, 2021, 12: 641810 [2023-02-23]. DOI: 10.3389/fneur.2021.641810.
LI Z, LIU J, CHEN B, et al. Improved Regional Homogeneity in Chronic Insomnia Disorder After Amygdala-Based Real-Time fMRI Neurofeedback Training[J/OL]. Front Psychiatry, 2022, 13: 863056 [2023-02-23]. DOI: 10.3389/fpsyt.2022.863056.
WANG T, LI S, JIANG G, et al. Regional homogeneity changes in patients with primary insomnia[J]. Eur Radiol, 2016, 26(5): 1292-1300. DOI: 10.1007/s00330-015-3960-4.
MALHI G S, DAS P, OUTHRED T, et al. Role of self-focussed reappraisal of negative emotion in emergence of emotional symptoms in adolescent girls[J]. Br J Psychiatry, 2020, 217(1): 383-389. DOI: 10.1192/bjp.2019.255.
REGEN W, KYLE S D, NISSEN C, et al. Objective sleep disturbances are associated with greater waking resting-state connectivity between the retrosplenial cortex/ hippocampus and various nodes of the default mode network[J]. J Psychiatry Neurosci, 2016, 41(5): 295-303. DOI: 10.1503/jpn.140290.
RAICHLE M E, MACLEOD A M, SNYDER A Z, et al. A default mode of brain function[J]. Proc Natl Acad Sci USA, 2001, 98(2): 676-682. DOI: 10.1073/pnas.98.2.676.
LAIRD A R, EICKHOFF S B, LI K, et al. Investigating the functional heterogeneity of the default mode network using coordinate-based meta-analytic modeling[J]. J Neurosci, 2009, 29(46): 14496-14505. DOI: 10.1523/JNEUROSCI.4004-09.2009.
KOLESAR T A, BILEVICIUS E, WILSON A D, et al. Systematic review and meta-analyses of neural structural and functional differences in generalized anxiety disorder and healthy controls using magnetic resonance imaging[J/OL]. Neuroimage Clin, 2019, 24: 102016 [2023-02-23]. DOI: 10.1016/j.nicl.2019.102016.
MENON V, GALLARDO G, PINSK M A, et al. Microstructural organization of human insula is linked to its macrofunctional circuitry and predicts cognitive control[J/OL]. Elife, 2020, 9: e53470 [2023-02-23]. DOI: 10.7554/eLife.53470.
TSAI P J, KEELEY R J, CARMACK S A, et al. Converging Structural and Functional Evidence for a Rat Salience Network[J]. Biol Psychiatry, 2020, 88(11): 867-878. DOI: 10.1016/j.biopsych.2020.06.023.
HAIRSTON I S, TALBOT L S, EIDELMAN P, et al. Sensory gating in primary insomnia[J]. Eur J Neurosci, 2010, 31(11): 2112-2121. DOI: 10.1111/j.1460-9568.2010.07237.x.
WASSING R, SCHALKWIJK F, LAKBILA-KAMAL O, et al. Haunted by the past: old emotions remain salient in insomnia disorder[J]. Brain, 2019, 142(6): 1783-1796. DOI: 10.1093/brain/awz089.
LI S, TIAN J, LI M, et al. Altered resting state connectivity in right side frontoparietal network in primary insomnia patients[J]. Eur Radiol, 2018, 28(2): 664-672. DOI: 10.1007/s00330-017-5012-8.
GONG L, SHI M, WANG J, et al. The Abnormal Functional Connectivity in the Locus Coeruleus-Norepinephrine System Associated With Anxiety Symptom in Chronic Insomnia Disorder[J/OL]. Front Neurosci, 2021, 15: 678465 [2023-02-24]. DOI: 10.3389/fnins.2021.678465.
GAO L, ZHANG M, GONG H, et al. Differential activation patterns of FMRI in sleep-deprived brain: restoring effects of acupuncture[J/OL]. Evid Based Complement Alternat Med, 2014, 2014: 465760 [2023-02-24]. DOI: 10.1155/2014/465760.
NING Y, ZHENG S, FENG S, et al. The altered intrinsic functional connectivity after acupuncture at shenmen (HT7) in acute sleep deprivation[J/OL]. Front Neurol, 2022, 13: 947379 [2023-02-24]. DOI: 10.3389/fneur.2022.947379.
CHEN H, LIU K, ZHANG B, et al. More optimal but less regulated dorsal and ventral visual networks in patients with major depressive disorder[J]. J Psychiatr Res, 2019, 110: 172-178. DOI: 10.1016/j.jpsychires.2019.01.005.
MAO Y, XIAO H, DING C, et al. The role of attention in the relationship between early life stress and depression[J/OL]. Sci Rep, 2020, 10(1): 6154 [2023-02-24]. DOI: 10.1038/s41598-020-63351-7.
NING Y, ZHENG S, FENG S, et al. Altered Functional Connectivity and Topological Organization of Brain Networks Correlate to Cognitive Impairments After Sleep Deprivation[J]. Nat Sci Sleep, 2022, 14: 1285-1297. DOI: 10.2147/NSS.S366224.
YANG C H, CHOI S H, KIM J S, et al. The Effects of Acupuncture Stimulation for Brain Activation and Alcohol Abstinence Self-Efficacy: Functional MRI Study[J/OL]. Evid Based Complement Alternat Med, 2017, 2017: 2850124 [2023-02-24]. DOI: 10.1155/2017/2850124.
LI Z J, SUN Z R, SUN C Y, et al. Exploring the specificity of the acupuncture effect of Shen Men and Daling[J]. Chin Acupunct & Moxibustion, 2012, 32(4): 325-328. DOI: 10.13703/j.0255-2930.2012.04.014.
XU X Y, WANG S, LU R, et al. Voxel-based resting-state fMRI observation of whole-brain degree centrality changes in primary insomnia patients after acupuncture treatment[J]. J Zhongshan Univ Med Sci, 2017, 38(2): 296-300. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2017.0048.
ZHENG Y, WANG Y, LAN Y, et al. Imaging of brain function based on the analysis of functional connectivity-imaging analysis of brain function by fMRI after acupuncture at LR3 in healthy individuals[J]. AJTCAM, 2016, 13(6): 90-100. DOI: 10.21010/ajtcam.v13i6.14.
CHEN J, XIAO B Y, QIU X Y, et al. Effect of acupuncture at the Tai Chong point and its different matching points on fMRI brain functional imaging in healthy subjects[J]. J Trad Chin Med, 2019, 60(23): 2017-2022. DOI: 10.13288/j.11-2166/r.2019.23.010.
YANKOUSKAYA A, DENHOLM-SMITH T, YI D, et al. Neural Connectivity Underlying Reward and Emotion-Related Processing: Evidence From a Large-Scale Network Analysis[J/OL]. Front Syst Neurosci, 2022, 16: 833625 [2023-02-24]. DOI: 10.3389/fnsys.2022.833625.
WU X, ZHANG W, QIN Y, et al. Effect of acupuncture and its influence on cerebral activity in perimenopausal insomniacs: study protocol for a randomized controlled trial[J/OL]. Trials, 2017, 18(1): 377 [2023-02-24]. DOI: 10.1186/s13063-017-2072-7.
WANG Y K, LI T, HA L J, et al. Effectiveness and cerebral responses of multi-points acupuncture for primary insomnia: a preliminary randomized clinical trial and fMRI study[J/OL]. BMC Complement Med Ther, 2020, 20(1): 254 [2023-02-24]. DOI: 10.1186/s12906-020-02969-6.
ZHAO T, XU H, ZHAO T, et al. Effect of Jiannao Anshen acupuncture on insomnia: a functional magnetic resonance imaging study[J]. Chin Acupunct & Moxibustion, 2021, 41(7): 767-773. DOI: 10.13703/j.0255-2930.20200325-0006.
LI X L, LIU S P, CAO D N, et al. Research progress on the specificity and brain network of acupuncture at Zhigou acupoint based on brain fMRI technology[J]. Chin J Magn Reson Imaging, 2021, 12(5): 110-113. DOI: 10.12015/issn.1674-8034.2021.05.027.
JI X, IVERS H, BEAULIEU-BONNEAU S, et al. Complementary and alternative treatments for insomnia/insomnia-depression-anxiety symptom cluster: Meta-analysis of English and Chinese literature[J/OL]. Sleep Med Rev, 2021, 58: 101445 [2023-02-24]. DOI: 10.1016/j.smrv.2021.101445.

PREV MRI findings of anal canal gastrointestinal stromal tumors with local growth to perineal region: One case report
NEXT MRI research progress in attention deficit hyperactivity disorder

Tel & Fax: +8610-67113815    E-mail: