Share this content in WeChat
Application progress of functional magnetic resonance imaging in the treatment of sleep disorder with traditional Chinese and western medicine
WU Lunxin  WANG Oucheng  LIU Yong 

Cite this article as: WU L X, WANG O C, LIU Y. Application progress of functional magnetic resonance imaging in the treatment of sleep disorder with traditional Chinese and western medicine[J]. Chin J Magn Reson Imaging, 2023, 14(6): 108-112. DOI:10.12015/issn.1674-8034.2023.06.019.

[Abstract] Sleep disorder (SD) is a condition characterized by difficulties in falling asleep or maintaining sleep due to various causes, and is one of the most prevalent diseases in the world, causing a serious burden to both individuals and society. The current SD treatment methods are diverse and have clear effects, and elucidating the central mechanisms of various therapies in both traditional Chinese medicine (TCM) and western medicine (WM) for SD is of great significance for the SD treatment strategy development and patient management. Functional magnetic resonance imaging (fMRI), which can indirectly reflect the activity of neurons in the brain, is an important tool for the study of SD. Considering that the central mechanisms of various therapies in TCM and WM for SD are not the same, the author reviews the latest progress of fMRI applications in the central mechanisms of TCM and WM different therapies to improve sleep for SD. The shortcomings of current research are discussed and future research directions are prospected, aiming to provide references for further exploration of deeper neural mechanisms in the therapy of SD.
[Keywords] sleep disorder;insomnia;magnetic resonance imaging;functional magnetic resonance imaging;traditional Chinese and western medicine treatment

WU Lunxin1   WANG Oucheng2   LIU Yong2*  

1 Southwest Medical University, Luzhou 646000, China

2 Department of MRI, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China

Corresponding author: Liu Y, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Sichuan Provincial Administration of Traditional Chinese Medicine's 2021 Special Scientific Research for Traditional Chinese Medicine (No. 424).
Received  2022-04-07
Accepted  2023-05-06
DOI: 10.12015/issn.1674-8034.2023.06.019
Cite this article as: WU L X, WANG O C, LIU Y. Application progress of functional magnetic resonance imaging in the treatment of sleep disorder with traditional Chinese and western medicine[J]. Chin J Magn Reson Imaging, 2023, 14(6): 108-112. DOI:10.12015/issn.1674-8034.2023.06.019.

HAN F, TANG X D, ZHANG B. Chinese guideline for insomnia disorder diagnosis and its treatment[J]. Natl Med J China, 2017, 97(24): 1844-1856. DOI: 10.3760/cma.j.issn.0376-2491.2017.24.002.
SILVA-COSTA A, GRIEP R H, ROTENBERG L. Associations of a short sleep duration, insufficient sleep, and insomnia with self-rated health among nurses[J/OL]. PLoS One, 2015, 10(5): e0126844 [2023-02-13]. DOI: 10.1371/journal.pone.0126844.
CHATTU V K, MANZAR M D, KUMARY S, et al. The global problem of insufficient sleep and its serious public health implications[J/OL]. Healthcare, 2018 : 1 [2023-02-13]. DOI: 10.3390/healthcare7010001.
CAO X L, WANG S B, ZHONG B L, et al. The prevalence of insomnia in the general population in China: A meta-analysis[J/OL]. Plos One, 2017, 12(2): e0170772 [2023-02-13]. DOI: 10.1371/journal.pone.0170772.
SPIELMAN A J, CARUSO L S, GLOVINSKY P B. A behavioral perspective on insomnia treatment[J]. Psychiatr Clin North Am, 1987, 10(4): 541-553. DOI: 10.1016/S0193-953X(18)30532-X.
WANG Z J, LIU J F. The molecular basis of insomnia: implication for therapeutic approaches[J]. Drug Dev Res, 2016, 77(8): 427-436. DOI: 10.1002/ddr.21338.
LI C, DONG M, YIN Y, et al. Abnormal whole-brain functional connectivity in patients with primary insomnia[J]. Neuropsychiatr Dis Treat, 2017, 13(13): 427-435. DOI: 10.2147/NDT.S128811.
AYABE N, OKAJIMA I, NAKAJIMA S, et al. Effectiveness of cognitive behavioral therapy for pharmacotherapy-resistant chronic insomnia: a multi-center randomized controlled trial in Japan[J]. Sleep Med, 2018, 50: 105-112. DOI: 10.1016/j.sleep.2018.05.038.
CHOW P I, INGERSOLL K S, THORNDIKE F P, et al. Cognitive mechanisms of sleep outcomes in a randomized clinical trial of internet-based cognitive behavioral therapy for insomnia[J]. Sleep Med, 2018, 47: 77-85. DOI: 10.1016/j.sleep.2017.11.1140.
TRAUER J M, QIAN M Y, DOYLE J S, et al. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis[J]. Ann Intern Med, 2015, 163(3): 191-204. DOI: 10.7326/M14-2841.
LEE J Y, FARRELL B, HOLBROOK A M. Deprescribing benzodiazepine receptor agonists taken for insomnia: a review and key messages from practice guidelines[J]. Pol Arch Intern Med, 2019, 129(1): 43-49. DOI: 10.20452/pamw.4391.
SYS J, VAN CLEYNENBREUGEL S, DESCHODT M, et al. Efficacy and safety of non-benzodiazepine and non-Z-drug hypnotic medication for insomnia in older people: a systematic literature review[J]. Eur J Clin Pharmacol, 2020, 76(3): 363-381. DOI: 10.1007/s00228-019-02812-z.
China academy of Chinese Medical Sciences. TCM clinical guidelines of insomnia research group(WHO/SPO)[J]. World Journal of Sleep Medicine, 2016, 3(1): 8-25.
SINGH A, ZHAO K. Treatment of insomnia with traditional Chinese herbal medicine[J]. Int Rev Neurobiol, 2017, 135: 97-115. DOI: 10.1016/bs.irn.2017.02.006.
LIU C, XI H, WU W, et al. Placebo effect of acupuncture on insomnia: a systematic review and meta-analysis[J]. Ann Palliat Med, 2020, 9(1): 19-29. DOI: 10.21037/apm.2019.11.15.
ZHANG M, ZHAO J, LI X, et al. Effectiveness and safety of acupuncture for insomnia: Protocol for a systematic review[J/OL]. Medicine, 2019, 98(45): e17842 [2023-02-13]. DOI: 10.1097/MD.0000000000017842.
ZHOU J. Clinical observation on the management of insomnia with single-finger pushing manipulation plus medication[J]. Journal of Acupuncture Tuina Science, 2010, 8(1): 38-41. DOI: 10.1007/s11726-010-0038-3.
FENG G, HAN M, LI X, et al. Clinical effectiveness of Tui Na for insomnia compared with estazolam: A systematic review and meta-analysis of randomized controlled trials[J/OL]. Complement Ther Med, 2019, 47: 102186 [2023-02-13]. DOI: 10.1016/j.ctim.2019.08.020.
LIU Q, GUAN S, CHEN Y F, et al. Research progress on treatment of intractable insomnia with traditional Chinese and Western medicine[J]. Journal of Basic Chinese Medicine, 2021, 27(10): 1670-1674. DOI: 10.19945/j.cnki.issn.1006-3250.2021.10.036.
SHA Z W, XU J. Progress of treatment of insomnia with traditional Chinese and Western medicine[J]. Military Medicine Journal of Southeast China, 2016, 18(2): 182-184. DOI: 10.3969/j.issn.1672-271X.2016.02.024.
CHEN H X, DOU Z Q, LIU S R, et al. Efficacy and safety of Guipi Decoction combined with conventional Western medicine in the treatment of insomnia with deficiency of heart and spleen: a meta-analysis[J]. Asian Toxicology Research, 2022, 4(1): 3. DOI: 10.53388/2022020203.
ESPIE C A, BROOMFIELD N M, MACMAHON K M A, et al. The attention-intention-effort pathway in the development of psychophysiologic insomnia: a theoretical review[J]. Sleep Med Rev, 2006, 10(4): 215-245. DOI: 10.1016/j.smrv.2006.03.002.
HARVEY A G. A cognitive model of insomnia[J]. Behav Res Ther, 2002, 40(8): 869-893. DOI: 10.1016/s0005-7967(01)00061-4.
BAGLIONI C, SPIEGELHALDER K, REGEN W, et al. Insomnia disorder is associated with increased amygdala reactivity to insomnia-related stimuli[J]. Sleep, 2014, 37(12): 1907-1917. DOI: 10.5665/sleep.4240.
KIM S J, LEE Y J, KIM N, et al. Exploration of changes in the brain response to sleep-related pictures after cognitive–behavioral therapy for psychophysiological insomnia[J]. Sci Rep, 2017, 7(1): 1-10. DOI: 10.1038/s41598-017-13065-0.
KIM N, KANG S G, LEE Y J, et al. Decreased regional brain activity in response to sleep‐related sounds after cognitive behavioral therapy for psychophysiological insomnia[J]. Psychiatry Clin Neurosci, 2019, 73(5): 254-261. DOI: 10.1111/pcn.12822.
ALTENA E, VAN DER WERF Y D, SANZ-ARIGITA E J, et al. Prefrontal hypoactivation and recovery in insomnia[J]. Sleep, 2008, 31(9): 1271-1276. DOI: 10.5665/sleep/31.9.1271.
HWANG J Y, KIM N, KIM S, et al. Stroop task-related brain activity in patients with insomnia: changes after cognitive-behavioral therapy for insomnia[J]. Behav Sleep Med, 2019, 17(5): 621-633. DOI: 10.1080/15402002.2018.1435546.
CANARIO E, CHEN D, BISWAL B. A review of resting-state fMRI and its use to examine psychiatric disorders[J]. Psychoradiology, 2021, 1(1): 42-53. DOI: 10.1093/psyrad/kkab003.
MARQUES D R, GOMES A A, CLEMENTE V, et al. The Effect of Tailored Cognitive-Behavioral Therapy for Insomnia on Brain's Resting-State Networks[J]. Sleep and Vigilance, 2020, 4(1): 29-33. DOI: 10.1007/s41782-020-00086-5.
LEE Y J G, KIM S, KIM N, et al. Changes in subcortical resting-state functional connectivity in patients with psychophysiological insomnia after cognitive–behavioral therapy[J]. Neuroimage Clin, 2018, 17: 115-123. DOI: 10.1016/j.nicl.2017.10.013.
LEE Y G, KIM S, KIM N, et al. The effect of cognitive-behavioral therapyon intrinsic functional connectivity in patients with psychophysiological insomnia: A resting state fMRI study[J/OL]. Sleep, 2017, 40(Suppl_1): A110-A110 [2023-02-13]. DOI: 10.1093/sleepj/zsx050.296.
FENG F, YU S, WANG Z, et al. Non-pharmacological and pharmacological interventions relieve insomnia symptoms by modulating a shared network: a controlled longitudinal study[J/OL]. Neuroimage Clin, 2019, 22: 101745 [2023-02-13]. DOI: 10.1016/j.nicl.2019.101745.
VARGAS I, PERLIS M L. Insomnia and depression: clinical associations and possible mechanistic links[J]. Curr Opin Psychol, 2020, 34: 95-99. DOI: 10.1016/j.copsyc.2019.11.004.
MI W F, TABARAK S, WANG L, et al. Effects of agomelatine and mirtazapine on sleep disturbances in major depressive disorder: evidence from polysomnographic and resting-state functional connectivity analyses[J/OL]. Sleep, 2020, 43(11): zsaa092 [2023-02-13]. DOI: 10.1093/sleep/zsaa092.
ZHAO S Y, SU Z F. Research progress of proton magnetic resonance spectroscopy in primary insomnia[J]. Chin J Magn Reson Imaging, 2022, 13(1): 157-160. DOI: 10.12015/issn.1674-8034.2022.01.037.
FRANSSON P. Spontaneous low‐frequency BOLD signal fluctuations: An fMRI investigation of the resting‐state default mode of brain function hypothesis[J]. Hum Brain Mapp, 2005, 26(1): 15-29. DOI: 10.1002/hbm.20113.
HUANG H J, WANG Y. Evaluation of the effect of acupuncture on brain function in patients with primary insomnia based on whole-brain Rs-fMRI[J]. Chinese Journal of Integrative Medicine on Cardio-/Cerebrovascuiar Disease, 2019, 17(19): 3040-3043. DOI: 10.12102/j.issn.1672-1349.2019.19.044.
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]. BMC Complement Med Ther, 2020, 20(1): 1-13. DOI: 10.1186/s12906-020-02969-6.
ZHAO B, LI L, ZHANG J L, et al. Instant adjustIve effect of auricular electroacupuncture on brain default model network of patients with primary insomnia[J]. Acupuncture Research, 2019, 44(12): 884-887. DOI: 10.13702/j.1000-0607.190562.
ZHAO B, BI Y Z, ZHANG L, et al. Central mechanism study of transcutaneous auricular vagus nerve stimulation based on ReHo in the treatment of primary insomnia[J]. China Journal of TCM and pharmacy, 2020, 35(05): 2585-2588.
XU X Y, WANG S, LU R, et al. Alteration of whole-brain networks degree centrality in patients with primary insomnia after acupuncture therapy: A voxel-based Resting-state fMRI research[J]. Journal of Sun Yat-sen University, 2017, 38(2): 296-300. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2017.0048.
ZHANG H S. Study on effects of fMRI and BGP in DSH-PI with abdominal massage based on brain-bowel interaction[D]. Changchun: Changchun University of Chinese Medicine, 2020. DOI: 10.26980/d.cnki.gcczc.2020.000004.
YIN X L. Mechanism study of insomnia (heart and spleen deficiency syndrome) intervened by Xingnao Kaiqiao Tuina therapy based on BOLD[D]. Jinan: Shandong University of Traditional Chinese Medicine, 2020. DOI: 10.27282/d.cnki.gsdzu.2020.000037.
NI Y C, XIE S Y, ZHANG B, et al. Efficacy of the Zhenzao capsule on senile primary insomnia based on Rs-fMRI[J]. Clinical Journal of Chinese Medicine, 2020, 12(28): 14-16. DOI: 10.3969/j.issn.1674-7860.2020.28.004.
LI W W, LIU C C, WANG R Q, et al. Efficacy of integrated traditional Chinese medicine and Western medicine in the treatment of poststroke insomnia: A protocol for systematic review and meta-analysis of randomized controlled trials[J/OL]. Medicine, 2021, 100(40) [2023-02-13]. DOI: 10.1097/MD.0000000000027396.

PREV Research progress of brain function magnetic resonance imaging in patients with pain-depression comorbidity
NEXT Research progress on the application of 4D-ASL in cerebrovascular disease

Tel & Fax: +8610-67113815    E-mail: