Gender-related difference in altered fractional amplitude of low-frequency fluctuations after electroacupuncture on primary insomnia patients: A resting-state fMRI study

Xiao-Hua Shi, Yu-Kai Wang, Tie Li, Hong-Yu Liu, Xin-Tong Wang, Zhi-Hong Wang, Jing Mang, Zhong-Xin Xu, Xiao-Hua Shi, Yu-Kai Wang, Tie Li, Hong-Yu Liu, Xin-Tong Wang, Zhi-Hong Wang, Jing Mang, Zhong-Xin Xu

Abstract

Background: Primary insomnia (PI) is defined as a sleep disorder with no definite cause or inducement. Electroacupuncture, a treatment of inserting needles into specific points on the body surface and applying electrical stimulation, has been proved effective in treating PI with minimal adverse effects. However, the influence of gender difference on the clinical treatment efficacy of electroacupuncture for PI patients remains unclear. Therefore, we designed a clinical trial to compare the clinical treatment efficacy of electroacupuncture for PI patients with different genders. The research on the mechanism of electroacupuncture suggested it could modulate the sleep and wakefulness by activating or deactivating brain regions via a needling/tactile somatosensory specific stimulus. Therefore, we also designed a resting-state functional magnetic resonance imaging (rs-fMRI) study to detect the spontaneous brain activity of PI patients before and after the electroacupuncture treatment.

Method: Thirty PI patients were recruited to accept 5-week electroacupuncture treatment on HT-7. Athens Insomnia Scale (AIS) and Pittsburgh sleep quality index (PSQI) questionnaires were used to evaluate the clinical treatment efficacy. Rs-fMRI was employed to observe the spontaneous brain activity in the resting state at the baseline and after 5 weeks of electroacupuncture treatment, which was measured by the fractional amplitude of low-frequency fluctuations (fALFF).

Result: The AIS and PSQI scores were significantly decreased both in the female PI group and the male PI group after treatment. The decreased PSQI of female patients was significantly more than that of male patients (p < .05). The gender-related difference in the cerebral response to electroacupuncture was mainly in posterior cingulate and supramarginal gyrus.

Conclusion: There is a gender-related difference in the clinical treatment efficacy of electroacupuncture for PI patients, and female patients may benefit more from electroacupuncture. Gender-related differences in the cerebral response to electroacupuncture may be one of the factors affecting clinical treatment efficacy.

Trial registration: ClinicalTrials.gov NCT02448602.

Keywords: amplitude of low-frequency fluctuations; electroacupuncture; functional magnetic resonance imaging; primary insomnia.

Conflict of interest statement

The authors declare no competing financial interests.

© 2020 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
The location of acupoint HT‐7
FIGURE 2
FIGURE 2
The altered fALFF regions of MPIs after 5 weeks electroacupuncture. (an uncorrected voxel‐wise p  <  .001 and cluster‐level FWE correction p <  .05, cluster size > 30). R: right brain. a: right postcentral gyrus, b: left postcentral gyrus, c: left superior frontal gyrus, d: left superior parietal lobule, e: left middle frontal gyrus, f: right precuneus, g: right parahippocampal gyrus, h: left middle temporal gyrus
FIGURE 3
FIGURE 3
The altered fALFF regions of FPIs after 5 weeks electroacupuncture. (an uncorrected voxel‐wise p  <  .001 and cluster‐level FWE correction p <  .05, cluster size > 30). R: right brain. a: left inferior frontal gyrus, b: left supramarginal gyrus, c: left superior temporal gyrus, d: left posterior cingulate, e: left middle temporal gyrus
FIGURE 4
FIGURE 4
The differences of altered fALFF regions between MPIs and FPIs. (an uncorrected voxel‐wise p  <  .005 and cluster‐level FWE correction p <  .05, cluster size > 30). R: right brain. a: left postcentral gyrus, b: left supramarginal gyrus, c: left posterior cingulate

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