rTMS for rapid relief of sleep disorders induced by influenza virus infection: a clinical retrospective study.

To explore the effect of repetitive transcranial magnetic stimulation (rTMS) on influenza-induced sleep disorders, verify its adjuvant value, and reveal the "influenza-immune inflammation-abnormal brain function-sleep disorder" pathway, a retrospective cohort study enrolled 55 adults (18-40 years, no comorbidities) with acute influenza (2023-2025, First Affiliated Hospital of Air Force Medical University). They were divided into positive control group (PC, n = 20, conventional treatment) and rTMS group (n = 16, conventional + rTMS: 10 Hz, 1x/day, 20-30 mins, 3000 pulses, 100% motor threshold, 3 days; split into pre-treatment [BT-rTMS] and post-treatment [AT-rTMS] subgroups). Twenty healthy people served as negative controls group (NC). Assessments included polysomnography (PSG), Sleep Disorder-Visual Analog Scale (SD-VAS), functional near-infrared spectroscopy (fNIRS) for frontal oxygenated hemoglobin, and ELISA for 9 blood indicators. Two-sample Mendelian randomization (TSMR), ROC models, and t-tests (P < 0.05) were used. TSMR showed influenza correlated with insomnia (IVW:P = 0.047, 95% OR = 1.001-1.134) and 27 brain structural changes (frontal most affected, n = 10). Serum IgM (IVW:P = 0.048, 95% OR = 1.001-1.193) and neutrophils (IVW:P = 0.003, 95% OR = 1.018-1.089) mediated sleep disorders, linking to SD-VAS and frontal gray matter. Left inferior frontal gyrus and right orbital gyrus were key. BT-rTMS had abnormal sleep (duration/efficiency/stages) vs NC, with higher right orbitofrontal cortex (R-OFC) and left ventrolateral prefrontal cortex (L-VLPFC) oxygenated hemoglobin (P < 0.05). AT-rTMS improved sleep vs PC, with lower R-OFC/L-VLPFC oxygenated hemoglobin (P < 0.05). A 7-indicator ROC model had AUC = 0.8571. rTMS improves influenza-related sleep disorders short-term by inhibiting frontal overactivation (R-OFC, L-VLPFC) and regulating immunity (IgM,neutrophils), offering a safe, rapid new approach for acute influenza sleep management.