Prediction of treatment efficacy in the suanzaoren decoction and estazolam for chronic insomnia disorder, along with brain function and cognitive changes before and after treatment, and potential gene expression profiles.

OBJECTIVE: This study compared the brain function changes in chronic insomnia disorder (CID) before and after treatment by suanzaoren decoction (SZRD) and estazolam, to reveal their effects in cognition improvement, and to explore the potential genetic basis underpinning the ReHo changes in CID.

METHODS: We recruited 54 healthy controls (HCs) and 82 patients diagnosed with CID. All patients conducted clinical evaluation and fMRI scanning at baseline and after SZRD or estazolam treatment for six weeks. We used the mixed-effects model analysis to assess the pharmacological treatment response. Machine learning and transcriptome-neuroimaging spatial correlation analysis based on ReHo were presented to forecast therapeutic response and gene profiles.

RESULTS: Compared to HCs, CID patients exhibited altered ReHo values in the right inferior parietal gyrus, left posterior cingulate cortex, left superior parietal gyrus, and left precuneus. Both the SZRD and estazolam groups demonstrated improvement in sleep duration and efficiency. Compared to the baseline, the SZRD group presented decreased ReHo value in the left supramarginal gyrus, increased ReHo value in the right middle occipital gyrus (MOG) and increased CoHe-ReHo value in the left MOG. The estazolam group showed no changes. The machine learning model fit the samples well, with predicted changes in PSQI and ISI scores positively correlated with actual changes. Additionally, genes associated with the imaging results were identified.

CONCLUSIONS: SZRD can improve CID symptoms and present advantages to cognitive function. Abnormal ReHo changes may serve as imaging markers for CID and predict drug efficacy and gene expression profiles related to CID.