Jia-rui Zhang , Yi Ruan , Xin Wang , Yan-li You , Zi-fei Yin , Wei Gu
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Publication bias was assessed by funnel plots.</p></div><div><h3>Results</h3><p>A total of 16 studies involving 1555 participants met the inclusion criteria. Twelve RCTs had low or moderate risk of bias and four RCTs had high risk of bias. Overall, the findings indicated that TEAS was effective in improving sleep quality (mean difference (MD) -2.22; 95% confidence interval (CI) [-3.29, -1.15]; <em>p</em><0.0001) with high heterogeneity (I<sup>2</sup>=92%; <em>p</em><0.00001). Among different causes of insomnia, TEAS was found to be effective in patients with postoperative insomnia (MD -0.95; 95% CI [-1.62, -0.27]; <em>p</em>=0.006; I<sup>2</sup>=66%). Subgroup analyses showed that TEAS was more effective in middle-aged patients (MD -1.60; 95% CI [-2.14, -1.06]; <em>p</em><0.00001; I<sup>2</sup>=0%), and Neiguan (PC6) and Hegu (LI4) were effective acupoints during the perioperative period (MD -1.45; 95% CI [-1.95, -0.95]; <em>p</em><0.00001; I<sup>2</sup>=6%). 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引用次数: 0
摘要
导言：睡眠质量差可能会对健康产生负面影响。临床研究评估了经皮穴位电刺激（TEAS）改善睡眠质量的能力。本综述旨在探讨经皮穴位电刺激对改善睡眠质量的有效性和安全性，以及经皮穴位电刺激最有前景的应用场景。方法检索了从开始到2023年3月25日的8个数据库，以确定与假刺激或药物治疗相比，经皮穴位电刺激对睡眠质量影响的随机对照试验（RCT）。在荟萃分析中，匹兹堡睡眠质量指数（PSQI）总分是主要结果。采用科克伦偏倚风险工具评估了每篇纳入文章的方法学质量。结果 共有 16 项研究符合纳入标准，涉及 1555 名参与者。其中 12 项研究存在低度或中度偏倚风险，4 项研究存在高度偏倚风险。总体而言，研究结果表明，TEAS能有效改善睡眠质量（平均差（MD）-2.22；95%置信区间（CI）[-3.29，-1.15]；p<0.0001），异质性较高（I2=92%；p<0.00001）。在不同的失眠原因中，TEAS对术后失眠患者有效（MD -0.95；95% CI [-1.62，-0.27]；P=0.006；I2=66%）。亚组分析显示，TEAS对中年患者更有效（MD-1.60；95% CI [-2.14，-1.06]；p<0.00001；I2=0%），内关（PC6）和合谷（LI4）是围手术期的有效穴位（MD-1.45；95% CI [-1.95，-0.95]；p<0.00001；I2=6%）。四项研究报告了不良反应，均不严重。对于术后失眠，TEAS对中年患者的效果更为显著，同时刺激PC6和LI4有效。然而，由于纳入的研究数量较少，且患者类型存在差异，因此需要就TEAS对睡眠质量的影响进行更多高质量、大规模、多中心的RCT研究。
Effect of transcutaneous electrical acupoint stimulation on sleep quality: A systematic review and meta-analysis
Introduction
Poor sleep quality may have a negative effect on health. Clinical studies have assessed the ability of transcutaneous electrical acupoint stimulation (TEAS) to improve sleep quality. This review aims to explore the efficacy and safety of TEAS to improve sleep quality, as well as the most promising application scenarios for TEAS.
Methods
Eight databases were searched from their inception to 25 March 2023 to identify randomized controlled trials (RCTs) of the effects of TEAS on sleep quality compared to sham stimulation or pharmacotherapy. In the meta-analysis, Pittsburgh sleep quality index (PSQI) global score was the main outcome. The methodological quality of each included article was assessed using the Cochrane Risk of Bias tool. Publication bias was assessed by funnel plots.
Results
A total of 16 studies involving 1555 participants met the inclusion criteria. Twelve RCTs had low or moderate risk of bias and four RCTs had high risk of bias. Overall, the findings indicated that TEAS was effective in improving sleep quality (mean difference (MD) -2.22; 95% confidence interval (CI) [-3.29, -1.15]; p<0.0001) with high heterogeneity (I2=92%; p<0.00001). Among different causes of insomnia, TEAS was found to be effective in patients with postoperative insomnia (MD -0.95; 95% CI [-1.62, -0.27]; p=0.006; I2=66%). Subgroup analyses showed that TEAS was more effective in middle-aged patients (MD -1.60; 95% CI [-2.14, -1.06]; p<0.00001; I2=0%), and Neiguan (PC6) and Hegu (LI4) were effective acupoints during the perioperative period (MD -1.45; 95% CI [-1.95, -0.95]; p<0.00001; I2=6%). Four studies reported adverse effects, none of which were serious.
Conclusions
TEAS could effectively improve postoperative insomnia. For postoperative insomnia, the effect of TEAS was more significant in middle-aged patients, and simultaneous stimulation of PC6 and LI4 was effective. However, due to the small number of included studies and variation in patient types, additional high-quality, large-scale, multicenter RCTs of the effect of TEAS on sleep quality are needed.
Registration
CRD42023440453.
Funding
Military Special Program to Cultivate and Improve TCM Service Capability [2021ZY002]; Shanghai “Science and Technology Innovation Action Plan” Yangfan Project [23YF1459200].
期刊介绍：
The European Journal of Integrative Medicine (EuJIM) considers manuscripts from a wide range of complementary and integrative health care disciplines, with a particular focus on whole systems approaches, public health, self management and traditional medical systems. The journal strives to connect conventional medicine and evidence based complementary medicine. We encourage submissions reporting research with relevance for integrative clinical practice and interprofessional education.
EuJIM aims to be of interest to both conventional and integrative audiences, including healthcare practitioners, researchers, health care organisations, educationalists, and all those who seek objective and critical information on integrative medicine. To achieve this aim EuJIM provides an innovative international and interdisciplinary platform linking researchers and clinicians.
The journal focuses primarily on original research articles including systematic reviews, randomized controlled trials, other clinical studies, qualitative, observational and epidemiological studies. In addition we welcome short reviews, opinion articles and contributions relating to health services and policy, health economics and psychology.
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