Department of Psychiatry, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
Sleep Med Rev. 2011 Apr;15(2):99-106. doi: 10.1016/j.smrv.2010.04.001. Epub 2010 Jun 8.
In concert with growing public interest in complementary and alternative medicine (CAM), these therapies and products have been increasingly studied over the past two decades for the treatment of sleep disorders. While systematic reviews have been conducted on acupuncture and valerian in the treatment of insomnia, to date no comprehensive review has been conducted on all major CAM treatments. We sought to address this via a rigorous systematic review of hypnotic CAM interventions, including herbal and nutritional medicine, acupuncture, acupressure, yoga, tai chi, massage, aromatherapy and homoeopathy. The electronic databases MEDLINE (PubMed), CINAHL, PsycINFO, and The Cochrane Library were accessed during late 2009 for CAM randomized controlled trials (RCTs) in the treatment of chronic insomnia. Sixty-four RCTs were identified, of which 20 studies involving eight CAM interventions met final inclusion criteria. Effect size calculations (where possible) and a quality control analysis using a modified Jadad scale were undertaken. Many RCTs lacked methodological rigor, and were commonly excluded due to small sample size or an inadequate control condition. Among the studies that met inclusion criteria, there was evidentiary support in the treatment of chronic insomnia for acupressure (d=1.42-2.12), tai chi (d=0.22-2.15), yoga (d=0.66-1.20), mixed evidence for acupuncture and L-tryptophan, and weak and unsupportive evidence for herbal medicines such as valerian. Surprisingly, studies involving several mainstream CAM therapies (e.g., homoeopathy, massage, or aromatherapy) were not located or did not meet basic inclusion criteria. If CAM interventions are to be considered as viable stand-alone or adjuvant treatments for sleep disorders, future researchers are urged to use acceptable methodology, including appropriate sample sizes and adequate controls. RCTs evaluating other untested CAM therapies such as massage, homoeopathy, or osteopathy are encouraged, as is the exploration of using CAM therapies adjuvantly with conventional therapies.
随着公众对补充和替代医学（CAM）的兴趣日益浓厚，在过去的二十年中，这些疗法和产品越来越多地被用于治疗睡眠障碍。虽然已经对针灸和缬草根治疗失眠进行了系统评价，但迄今为止，尚未对所有主要的 CAM 治疗方法进行全面评价。我们试图通过对催眠 CAM 干预措施（包括草药和营养医学、针灸、指压按摩、瑜伽、太极、按摩、芳香疗法和顺势疗法）进行严格的系统评价来解决这个问题。2009 年末，我们检索了 MEDLINE（PubMed）、CINAHL、PsycINFO 和 The Cochrane Library 电子数据库，以获取关于慢性失眠症治疗的 CAM 随机对照试验（RCT）。确定了 64 项 RCT，其中 20 项涉及 8 种 CAM 干预措施的研究符合最终纳入标准。（在可能的情况下）进行了效应大小计算，并使用改良 Jadad 量表进行了质量控制分析。许多 RCT 缺乏方法学严谨性，由于样本量小或对照条件不足，通常被排除在外。在符合纳入标准的研究中，有证据支持指压按摩（d=1.42-2.12）、太极（d=0.22-2.15）、瑜伽（d=0.66-1.20）治疗慢性失眠症，针灸和 L-色氨酸的证据混合，而缬草根等草药的证据薄弱且不支持。令人惊讶的是，没有找到或不符合基本纳入标准的涉及几种主流 CAM 疗法（例如顺势疗法、按摩或芳香疗法）的研究。如果 CAM 干预措施被认为是可行的独立或辅助治疗睡眠障碍的方法，未来的研究人员应使用可接受的方法学，包括适当的样本量和充足的对照。鼓励评估其他未经测试的 CAM 疗法（例如按摩、顺势疗法或整骨疗法）的 RCT，并鼓励探索将 CAM 疗法与传统疗法联合使用。
