ObjectiveInsomnia Disorder (ID) is associated with significant health burdens. First-line treatments are limited by accessibility or side effects, necessitating alternative approaches. rTMS, a noninvasive neuromodulation technique, has shown promise in treating various neuropsychiatric disorders by modulating cortical excitability. This comprehensive meta-analysis explores the effect of rTMS on ID and identifies possible factors that influence it.MethodsA comprehensive search of the Cochrane Library, Embase, Web of Science, PubMed, CNKI, and Wanfang databases identified RCTs evaluating the effects of rTMS on insomnia disorder. Data synthesis and subgroup analysis were performed via SMD, WMD, relative risk (RR), and 95% CI to evaluate the effects of rTMS and its influencing factors. The review protocol was prospectively registered in PROSPERO (CRD42024626833).ResultsNineteen studies contributed 23 trials involving 1,690 adult participants. The rTMS group demonstrated markedly improved sleep quality compared with sham rTMS recipients in individuals with insomnia disorder. (PSQI total scores; ISI; p < 0.001); (PSG (SE); p = 0.003). Combined rTMS and medication were more effective than medication alone. (PSQI total scores; p = 0.003). In the subgroup analysis, after excluding a study with high heterogeneity, the rTMS cohort showed greater improvement in sleep quality than the other treatment groups. (PSQI total scores; p = 0.03).ConclusionIndependent rTMS and rTMS-medication combinations significantly improve sleep patterns and rest quality in patients with Insomnia Disorder. The safety and efficacy of LF-rTMS are also significant. The duration of the disease, treatment duration, and stimulation site may influence the sleep quality of patients with ID.
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