Evidence mapPaperPMID 42055949Full record

Trial reportBMJ mental health2026

Functional near-infrared spectroscopy assessment of the effects of transcranial direct current stimulation combined with transcranial magnetic stimulation on dynamic functional networks in patients with chronic insomnia: randomised, double-blind, parallel-group, controlled clinical trial.

Qi Zhou, Zhiwang Liu, Chang Li, Qiao Wang, Tianming Zheng, Dong-Sheng Zhou, Haihang Yu, Chang Yu

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in BMJ mental health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Qi Zhou *Department of Psychiatry, Zhejiang Key Laboratory of Drug Addiction & Brain Health, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China.ORCID 0000-0002-7616-0313
Zhiwang Liu *Department of Psychiatry, Zhejiang Key Laboratory of Drug Addiction & Brain Health, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China.
Chang Li *Department of Psychiatry, Zhejiang Key Laboratory of Drug Addiction & Brain Health, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China.
Qiao WangDepartment of Psychiatry, Zhejiang Key Laboratory of Drug Addiction & Brain Health, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China.
Tianming ZhengDepartment of Psychiatry, Zhejiang Key Laboratory of Drug Addiction & Brain Health, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China.
Dong-Sheng ZhouDepartment of Psychiatry, Zhejiang Key Laboratory of Drug Addiction & Brain Health, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China.
Haihang YuDepartment of Psychiatry, Zhejiang Key Laboratory of Drug Addiction & Brain Health, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China 272450699@qq.com yuhaihang0414@sina.com.ORCID 0009-0002-9326-4242
Chang YuDepartment of Psychiatry, Zhejiang Key Laboratory of Drug Addiction & Brain Health, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China 272450699@qq.com yuhaihang0414@sina.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEvidence suggests that transcranial direct current stimulation (tDCS) combined with repetitive transcranial magnetic stimulation (rTMS) is more effective than either modality alone. However, the underlying neural mechanisms remain unclear.

objectiveTo explore the effects of combined tDCS-rTMS on cortical functional networks and neural regulation processes in chronic insomnia.

methodsIn this randomised, double-blind, sham-controlled trial, 111 adults with chronic insomnia were allocated to real tDCS+real rTMS or sham tDCS+real rTMS. Participants received 20 weekday sessions over 4 weeks. Of these, 106 completed treatment and 103 provided functional near-infrared spectroscopy (fNIRS) data meeting predefined quality criteria. fNIRS measured oxygenated haemoglobin (Oxy-Hb) responses in prefrontal and temporal regions during a verbal fluency task (VFT) before and after treatment. The primary outcome was haemodynamic activation; secondary outcomes were functional connectivity and sleep quality.

findingsSleep quality improved in both groups, with significantly greater reduction in Pittsburgh Sleep Quality Index (PSQI) scores in the real tDCS+real rTMS group (p<0.05). No between-group differences were observed in VFT performance. However, the combined stimulation group showed significantly increased Oxy-Hb responses across multiple fronto-temporal channels, particularly in bilateral temporal regions, and greater enhancement in mean functional connectivity (p<0.05). Both interventions were well tolerated, with no serious adverse events.

conclusionsThis study provides neuroimaging evidence that combined tDCS and rTMS may improve chronic insomnia by enhancing activation of fronto-temporal cortices and strengthening inter-regional functional connectivity. These findings offer objective support for the clinical efficacy of the combined stimulation protocol, link neurophysiological changes to treatment optimisation and suggest potential advantages of this approach for neuromodulation-based therapeutic strategies. CLINICAL IMPLICATIONS: These findings suggest that tDCS combined with rTMS may represent a feasible and well tolerated non-pharmacological strategy for chronic insomnia, with potential advantages over rTMS alone at both clinical and neurophysiological levels. TRIAL REGISTRATION NUMBER: This study was registered as a clinical trial with the China Clinical Trial Registration Centre (ChiCTR2100052681).

Indexed as

Sleep Initiation and Maintenance DisordersTranscranial Direct Current StimulationTranscranial Magnetic StimulationAdultCombined Modality TherapyDouble-Blind MethodFemaleHumansMaleMiddle AgedSleep QualitySpectroscopy, Near-InfraredTreatment Outcomechronic insomniacombined therapyfunctional near-infrared spectroscopyrepetitive transcranial magnetic stimulationtranscranial direct current stimulation

Identifiers

PMID42055949
PMCPMC13141000

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.