{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T06:25:27Z","timestamp":1787034327345,"version":"build-2736575974"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic insomnia is increasingly recognized as a disorder of persistent hyperarousal, and current single-modality treatments often provide limited or unsustained benefits. This study aimed to explore the feasibility, safety, and preliminary signal of benefit of a multimodal sleep intervention combining stellate ganglion block (SGB), cognitive behavioral therapy for insomnia (CBT-I), and anesthetic-assisted sleep induction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective exploratory pilot study, 30 patients with refractory chronic insomnia who showed inadequate response to conventional therapies were enrolled. The intervention consisted of SGB, CBT-I, and propofol- and dexmedetomidine-assisted sleep induction. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at baseline and at 7\u202fdays, 1\u202fmonth, 3\u202fmonths, and 6\u202fmonths after treatment. Objective sleep parameters were evaluated using a wearable sleep monitoring device. Repeated measures were analyzed using generalized estimating equations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PSQI total and component scores were significantly reduced at all follow-up time points compared with baseline (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). The mean reduction in PSQI total score was approximately 8 points. Notably, the proportions of deep sleep and REM sleep increased significantly despite minimal changes in total sleep time (both\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). No serious adverse events were observed during the study period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This multimodal sleep intervention showed preliminary signals of improvements in subjective sleep quality and selected objective sleep architecture parameters, suggesting feasibility and tolerability in patients with refractory chronic insomnia and appeared to be generally well tolerated. Given the exploratory single-arm design and limited sample size, randomized controlled studies are required to further evaluate efficacy, durability, and the relative contribution of individual treatment components.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.chictr.org.cn<\/jats:ext-link>\n                      , ChiCTR2400085256.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1877949","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:37:53Z","timestamp":1787031473000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A multimodal sleep intervention improves sleep quality and architecture in chronic insomnia: a prospective exploratory study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yingjie","family":"Che","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Shihezi People\u2019s Hospital","place":["Shihezi, Xinjiang Uygur Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranwei","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Shihezi People\u2019s Hospital","place":["Shihezi, Xinjiang Uygur Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Shihezi People\u2019s Hospital","place":["Shihezi, Xinjiang Uygur Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiulin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Shihezi People\u2019s Hospital","place":["Shihezi, Xinjiang Uygur Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1016\/s0140-6736(22)00879-0","article-title":"Insomnia","volume":"400","author":"Perlis","year":"2022","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.sleep.2004.10.006","article-title":"How do individuals sleep around the world? Results from a single-day survey in ten countries","volume":"6","author":"Soldatos","year":"2005","journal-title":"Sleep Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e1055","DOI":"10.1016\/s2468-2667(25)00250-6","article-title":"Sleep health in China: status, challenges, and promotion strategies","volume":"10","author":"Liu","year":"2025","journal-title":"Lancet Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/s11065-010-9154-6","article-title":"Sleep and Sleep Disorders in Older Adults","volume":"21","author":"Crowley","year":"2011","journal-title":"Neuropsychol Rev"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"363","DOI":"10.3969\/j.issn.1672-6731.2013.05.002","article-title":"Interpretation of the guidelines for the diagnosis and treatment of adult insomnia in China","volume":"13","author":"Zhang","year":"2013","journal-title":"Chin J Contemp Neurol Neurosurg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"307","DOI":"10.5664\/jcsm.6470","article-title":"Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of sleep medicine clinical practice guideline","volume":"13","author":"Sateia","year":"2017","journal-title":"J Clin Sleep Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"487","DOI":"10.5664\/jcsm.27286","article-title":"Clinical guideline for the evaluation and Management of Chronic Insomnia in adults","volume":"4","author":"Schutte-Rodin","year":"2008","journal-title":"J Clin Sleep Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"125","DOI":"10.7326\/M15-2175","article-title":"Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians","volume":"165","author":"Qaseem","year":"2016","journal-title":"Ann Intern Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1093\/sleep\/29.11.1415","article-title":"Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of sleep medicine report","volume":"29","author":"Morgenthaler","year":"2006","journal-title":"Sleep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1016\/j.sleep.2014.02.004","article-title":"Speed and trajectory of changes of insomnia symptoms during acute treatment with cognitive\u2013behavioral therapy, singly and combined with medication","volume":"15","author":"Morin","year":"2014","journal-title":"Sleep Med"},{"key":"ref11","first-page":"202","article-title":"A randomized controlled study of intensive cognitive behavioral therapy for insomnia in patients with chronic insomnia disorder complicated with anxiety\/depression","volume":"58","author":"Luo","year":"2025","journal-title":"Chin J Psychiatry"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"294","DOI":"10.12089\/jca.2023.03.014","article-title":"The role of anesthesiologists in sleep medicine","volume":"39","author":"Wang","year":"2023","journal-title":"J Clin Anesthesiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1186\/s12871-026-03763-6","article-title":"Superior autonomic regulation with ropivacaine over lidocaine in stellate ganglion block for chronic insomnia: a randomized controlled trial","volume":"26","author":"Wang","year":"2026","journal-title":"BMC Anesthesiol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1186\/s12871-023-02301-y","article-title":"Effects of ultrasound-guided stellate ganglion block on postoperative sore throat and postoperative sleep disturbance after lumbar spine surgery: a randomized controlled trial","volume":"23","author":"Luo","year":"2023","journal-title":"BMC Anesthesiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"293","DOI":"10.3760\/cma.j.cn101658-20220302-00049","article-title":"Chinese experts' consensus on stellate ganglion block therapy (2022 edition)","volume":"18","author":"Yan","year":"2022","journal-title":"Chin J Painol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1097\/ana.0000000000000907","article-title":"Safety, efficacy, and clinical outcomes of dexmedetomidine for sedation in traumatic brain injury: a scoping review","volume":"36","author":"Hatfield","year":"2023","journal-title":"J Neurosurg Anesthesiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3760\/j.issn.1673-4777.2019.01.023","article-title":"Effects of dexmedetomidine-assisted general anesthesia on analgesic effect and postoperative cognitive and immune functions in elderly patients with lower extremity fractures","volume":"14","author":"Li","year":"2019","journal-title":"China Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"109","DOI":"10.11969\/j.issn.1673-548X.2018.08.025","article-title":"Cerebral protective effect of dexmedetomidine in elderly patients undergoing cardiopulmonary bypass coronary artery bypass grafting","volume":"47","author":"Zhao","year":"2018","journal-title":"J Med Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"211","DOI":"10.3969\/j.issn.1674-7593.2019.04.007","article-title":"Effect of dexmedetomidine on the safety of anesthesia in elderly patients with femoral neck fracture","volume":"40","author":"Jiang","year":"2019","journal-title":"Int J Geriatrics"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1186\/s12871-026-03812-0","article-title":"Bionic sleep therapy for refractory insomnia: a case report and literature review","volume":"26","author":"Xiao","year":"2026","journal-title":"BMC Anesthesiol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1034\/j.1399-6576.1999.430206.x","article-title":"Neuroprotective properties of propofol and midazolam, but not pentobarbital, on neuronal damage induced by forebrain ischemia, based on the GABAA receptors","volume":"43","author":"Ito","year":"1999","journal-title":"Acta Anaesthesiol Scand"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1017\/s0265021507000749","article-title":"Effects of propofol and halothane on long-term potentiation in the rat hippocampus after transient cerebral ischaemia","volume":"24","author":"Kakehata","year":"2007","journal-title":"Eur J Anaesthesiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/01.anes.0000299830.13203.60","article-title":"Propofol restores brain microvascular function impaired by high glucose via the decrease in oxidative stress","volume":"108","author":"Nakahata","year":"2008","journal-title":"Anesthesiology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/s12013-010-9135-7","article-title":"Propofol-induced sleep: efficacy and safety in patients with refractory chronic primary insomnia","volume":"60","author":"Xu","year":"2010","journal-title":"Cell Biochem Biophys"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"560","DOI":"10.3760\/cma.j.cn113694-20240406-00209","article-title":"Guidelines for the diagnosis and treatment of adult insomnia in China (2023 edition)","volume":"57","author":"Wang","year":"2024","journal-title":"Chin J Neurol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.3390\/ijerph18031106","article-title":"Study protocol on the validation of the quality of sleep data from Xiaomi domestic wristbands","volume":"18","author":"Concheiro-Moscoso","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1080\/07420528.2017.1413578","article-title":"A validation study of Fitbit charge 2TM compared with polysomnography in adults","volume":"35","author":"de Zambotti","year":"2017","journal-title":"Chronobiol Int"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"zsaa045","DOI":"10.1093\/sleep\/zsaa045","article-title":"Detecting sleep using heart rate and motion data from multisensor consumer-grade wearables, relative to wrist actigraphy and polysomnography","volume":"43","author":"Roberts","year":"2020","journal-title":"Sleep"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"215","DOI":"10.19845\/j.cnki.zfysjjbzz.2024.0041","article-title":"Clinical preliminary study on self sleep management based on cognitive behavioral therapy for improving chronic insomnia","volume":"41","author":"Gong","year":"2024","journal-title":"J Apoplexy Nerv Dis"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"677","DOI":"10.3969\/j.issn.1006-5725.2019.04.039","article-title":"Effects of dexmedetomidine on hemodynamics and gastrointestinal function recovery in ICU patients with mechanical ventilation after craniocerebral injury surgery","volume":"35","author":"Wang","year":"2019","journal-title":"Pract J Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1097\/aln.0b013e318286cf36","article-title":"Neuroprotective effects of dexmedetomidine against glutamate agonist-induced neuronal cell death are related to increased astrocyte brain-derived neurotrophic factor expression","volume":"118","author":"Degos","year":"2013","journal-title":"Anesthesiology"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"6033","DOI":"10.3892\/mmr.2018.8597","article-title":"Effects of dexmedetomidine post-treatment on BDNF and VEGF expression following cerebral ischemia\/reperfusion injury in rats","volume":"17","author":"Li","year":"2018","journal-title":"Mol Med Rep"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.smrv.2015.01.009","article-title":"The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis","volume":"25","author":"Mollayeva","year":"2016","journal-title":"Sleep Med Rev"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1093\/sleep\/31.2.283","article-title":"Comparison of sleep parameters from actigraphy and polysomnography in older women: the SOF study","volume":"31","author":"Blackwell","year":"2008","journal-title":"Sleep"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1109\/jbhi.2015.2487446","article-title":"Detection of nocturnal slow wave sleep based on cardiorespiratory activity in healthy adults","volume":"21","author":"Long","year":"2017","journal-title":"IEEE J Biomed Health Inform"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"103","DOI":"10.2114\/jpa2.30.103","article-title":"Automatic sleep\/wake scoring from body motion in bed: validation of a newly developed sensor placed under a mattress","volume":"30","author":"Kogure","year":"2011","journal-title":"J Physiol Anthropol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1111\/jsr.12594","article-title":"European guideline for the diagnosis and treatment of insomnia","volume":"26","author":"Riemann","year":"2017","journal-title":"J Sleep Res"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1249\/MSS.0000000000001947","article-title":"Wearable sleep technology in clinical and research settings","volume":"51","author":"de Zambotti","year":"2019","journal-title":"Med Sci Sports Exerc"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.5664\/jcsm.9310","article-title":"Multimodal sleep, an innovation for treating chronic insomnia: case report and literature review","volume":"17","author":"Zhang","year":"2021","journal-title":"J Clin Sleep Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"816893","DOI":"10.3389\/fpsyt.2022.816893","article-title":"Intranasal dexmedetomidine for the treatment of pre-operative anxiety and insomnia: a prospective, randomized, controlled, and clinical trial","volume":"13","author":"Zeng","year":"2022","journal-title":"Front Psych"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.2147\/nss.s262991","article-title":"Feasibility of patient-controlled sleep with dexmedetomidine in treating chronic intractable insomnia","volume":"12","author":"An","year":"2020","journal-title":"Nat Sci Sleep"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.2147\/nss.s551748","article-title":"Ultrasound-guided stellate ganglion block with Cervicotemporal myofascial trigger point acupuncture for insomnia with comorbid anxiety and depression: a retrospective observational study","volume":"17","author":"Li","year":"2025","journal-title":"Nat Sci Sleep"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e14035","DOI":"10.1111\/jsr.14035","article-title":"The European insomnia guideline: An update on the diagnosis and treatment of insomnia 2023","volume":"32","author":"Riemann","year":"2023","journal-title":"J Sleep Res"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"2005","DOI":"10.1001\/jama.2009.682","article-title":"Cognitive Behavioral therapy, singly and combined with medication, for persistent insomnia","volume":"301","author":"Morin","year":"2009","journal-title":"JAMA"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1705","DOI":"10.3760\/cma.j.cn112137-20210202-00323","article-title":"Application of wearable devices in the field of sleep medicine","volume":"101","author":"Zhang","year":"2021","journal-title":"Natl Med J China"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1877949\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:38:08Z","timestamp":1787031488000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1877949\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":45,"alternative-id":["10.3389\/fmed.2026.1877949"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1877949","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1877949"}}