Abstract: Objective To analyze the changes of brain small-world and node function network properties in patients with insomnia following radiotherapy for cervical cancer based on graph theory analysis and explore the correlation between functional networks and the clinical efficacy of individual- target transcranial magnetic stimulation (IT-TMS) for treatment of insomnia. Methods The resting state functional magnetic resonance imaging (rs-fMRI) data were collected from 30 patients with insomnia following radiotherapy for cervical cancer and 30 matched healthy individuals. All the patients received accelerated intelligent neuromodulation TMS therapy. Using graph theory analysis and GRETNA software, the functional connectivity matrices were constructed and the attribute features were extracted. The scores on the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Self- Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) of the participants were collected before and after IT-TMS, and the correlation between improvement in insomnia and the functional network was investigated. Results The two groups matched for age, gender, and education level (P>0.05) showed significant differences in PSQI, ISI, SAS and SDS scores (P<0.05). Both groups showed attributes of the small-world network. Compared with the healthy individuals, the patients showed significantly decreased σ, EI, Cp and Lp (P<0.05) and increased Eg (P<0.05) at baseline, which, along with insomnia symptoms, were all improved after IT-TMS treatment. The patients showed reduced functional connections of the node network at follow-up compared with the baseline, and the low functional connectivity between the right insula and left superior frontal gyrus was correlated with the improvement of ISI scores. Conclusion The patients with insomnia following radiotherapy for cervical cancer have impaired information integration ability of the brain network, IT-TMS can significantly improve insomnia symptoms by reducing the hyperconnectivity between the default mode network and the salience network.

Key words: cervical cancer; radiotherapy; insomnia; graph theory analysis; small-world network; individual-transcranial magnetic stimulation