The Study of Mechanism of Chronic Insomnia Disorder Using Acupuncture Based on Changes of Brain GABA and fMRI

Study Overview
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Brief Summary
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Insomnia disorder is one of the major neuropsychiatric diseases which received more attention in recent years. Disturbances in the amino acid neurotransmitter, gama-amino butyric acid (GABA) and hyperarousal of cortex are hypothesized to contribute to the neurobiology of insomnia. Both animal experiment and clinical observation have demonstrated that acupuncture can generate treatment effect on insomnia symptom. However, the underlying mechanism remains unclear. The principal objective of this project is to use magnetic resonance spectroscopy (MRS) as well as acupuncture to provide the first in vivo characterization of cortical GABA levels between pro- and post-acupuncture treatment in individuals with chronic insomnia disorder (CID), and use resting state functional magnetic resonance imaging (fMRI) to determine whether CID patients have altered brain connectivity and network parameter changes. The investigators are also exploring the correlation between cortical GABA levels, fMRI parameter changes and abnormalities in sleep parameters and neuropsychology test in CID patients.

Detailed Description
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Three groups of subjects (CID accepted true acupuncture, CID accepted sham acupuncture and healthy) will participate in the study. All subjects will undergo a laboratory blood test, physical and neurological examination, polysomnography (PSG) and an extensive battery of neuropsychological assessments. All subjects meeting eligibility criteria for the study will complete a baseline MRS and fMRI to evaluate differences in multi-modality brain GABA and fMRI parameters between the patients and healthy. After randomized acupuncture treatment, investigators will compare brain metabolic and functional parameters to elucidate the neural mechanism of acupuncture therapy on insomnia, provide theoretical evidence from the perspective of neurotransmitters and brain network.

Official Title
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The Study of Brain GABA and Brain Functional Modulatory Mechanism of Chronic Insomnia Disorder Using Acupuncture at Combined Magical-door Acupoints

Conditions
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Insomnia Disorder

Intervention / Treatment
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* Procedure: ture acupuncture
* Procedure: sham acupuncture


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of chronic insomnia disorder (CID) met the criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Subject has history of chronic insomnia (difficulty with sleep induction, awakenings during the night, early morning awakening) of at least 3 months Must be able to cooperate with cognitive testing and MRI scan Exclusion Criteria: Known pre-existing sleep disorder other than chronic insomnia disorder Circadian rhythm sleep disorder determined by sleep-wake cycles of sleep (such as work time at day and night alternation) Severe general medical disorders of cardiovascular, endocrine, renal, or hepatic systems Clinical diagnosis of AD or Parkinson's neurodegenerative diseases Moderate or severe psychological illness Clinical history of stroke or other severe cerebrovascular disease Clinical history of malignancies disease Active treatment with antipsychotic medications, benzodiazepines or other hypnotic agents (i.e. Trazodone, Mirtazapine, Zolpidem, Zaleplon) Alcohol or drug abuse

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Insomnia-ture acupuncture<br>True acupuncture at the Magical-door, Si-shen-cong, Shen-ting, Local-cave acupoints will be administered on CID patients Intervention: Procedure: true acupuncture | Procedure: ture acupuncture<br>* ture acupuncture at the Magical-door, Si-shen-cong, Shen-ting, Local-cave acupoints, three times per week and last for 6 weeks<br>|
| Sham Comparator: Insomnia-sham acupuncture<br>Sham acupuncture at the Magical-door, Si-shen-cong, Shen-ting, Local-cave acupoints will be administered on CID patients Intervention: Procedure: true acupuncture | Procedure: sham acupuncture<br>* Sham acupuncture at the Magical-door, Si-shen-cong, Shen-ting, Local-cave acupoints, three times per week and last for 6 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change from baseline brain GABA level at 24 days | GABA levels in the prefrontal gyrus, occipital gyrus | at the 2 day before acupuncture treatment and the 24th day after acupuncture treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| brain functional connectivity | functional connectivity between the medial prefrontal cortex and other brain regions | at the 24th day after acupuncture treatment | 
| Wake time after sleep onset (WASO) | WASO is the total time of awake occurring between sleep onset and final wake up | at the 24th day after acupuncture treatment |