Tang Nicole K Y, Lereya S Tanya, Boulton Hayley, Miller Michelle A, Wolke Dieter, Cappuccio Francesco P
Department of Psychology, University of Warwick, Coventry, UK.
Warwick Medical School, University of Warwick, Coventry, UK.
Sleep. 2015 Nov 1;38(11):1751-64. doi: 10.5665/sleep.5158.
Insomnia is a debilitating comorbidity of chronic pain. This study evaluated the effect of nonpharmacological sleep treatments on patient-reported sleep quality, pain, and well-being in people with long-term cancer and non-cancer (e.g., back pain, arthritis, fibromyalgia) pain conditions.
We systematically searched Cochrane CENTRAL, MEDLINE, Embase, and PsychINFO for relevant studies. Search period was set to inception of these databases to March 2014. Studies were included if they were: original randomized controlled trials (RCTs); testing a nonpharmacological intervention; that targets sleep; in adults; with painful health conditions; that has a control group; includes a measure of sleep quality; and at least one other health and well-being outcome.
Means and standard deviations of sleep quality, pain, fatigue, depression, anxiety, physical and psychological functioning were extracted for the sleep treatment and control groups at baseline, posttreatment and final follow-up. Methodological details concerning the treatment, participants, and study design were abstracted to guide heterogeneity and subgroup analyses. Eleven RCTs involving 1,066 participants (mean age 45-61 years) met the criteria for the meta-analysis. There was no systematic evidence of publication bias. Nonpharmacological sleep treatments in chronic pain patients were associated with a large improvement in sleep quality (standardized mean difference = 0.78, 95% Confidence Interval [0.42, 1.13]; P < 0.001), small reduction in pain (0.18 [0, 0.36] P < 0.05), and moderate improvement in fatigue (0.38 [0.08, 0.69]; P < 0.01) at posttreatment. The effects on sleep quality and fatigue were maintained at follow-up (up to 1 year) when a moderate reduction in depression (0.31, [0.09, 0.53]; P < 0.01) was also observed. Both cancer and non-cancer pain patients benefited from nonpharmacological sleep treatments. Face-to-face treatments achieved better outcomes than those delivered over the phone/internet.
Although the body of evidence was small, nonpharmacological sleep interventions may represent a fruitful avenue for optimizing treatment outcomes in patients with chronic pain.
PROSPERO registration: CRD42013004131.
失眠是慢性疼痛的一种使人衰弱的合并症。本研究评估了非药物睡眠治疗对长期患有癌症及非癌症（如背痛、关节炎、纤维肌痛）疼痛病症患者报告的睡眠质量、疼痛及幸福感的影响。
我们系统检索了Cochrane CENTRAL、MEDLINE、Embase和PsychINFO中的相关研究。检索时间段设定为这些数据库创建至2014年3月。纳入的研究需满足以下条件：原始随机对照试验（RCT）；测试非药物干预措施；以睡眠为目标；针对成年人；患有疼痛性健康状况；设有对照组；包括睡眠质量测量；以及至少一项其他健康和幸福感指标。
在基线、治疗后及最终随访时，提取睡眠治疗组和对照组在睡眠质量、疼痛、疲劳、抑郁、焦虑、身体和心理功能方面的均值及标准差。提取有关治疗、参与者和研究设计的方法学细节，以指导异质性和亚组分析。11项涉及1066名参与者（平均年龄45 - 61岁）的随机对照试验符合荟萃分析标准。没有系统性证据表明存在发表偏倚。慢性疼痛患者的非药物睡眠治疗与睡眠质量的大幅改善相关（标准化均值差 = 0.78，95%置信区间[0.42, 1.13]；P < 0.001），疼痛小幅减轻（0.18 [0, 0.36] P < 0.05），治疗后疲劳有中度改善（0.38 [0.08, 0.69]；P < 0.01）。在随访（长达1年）时，睡眠质量和疲劳的改善效果得以维持，同时抑郁也有中度减轻（0.31，[0.09, 0.53]；P < 0.01）。癌症和非癌症疼痛患者均从非药物睡眠治疗中获益。面对面治疗比通过电话/互联网提供的治疗取得更好的效果。
尽管证据量较少，但非药物睡眠干预可能是优化慢性疼痛患者治疗效果的有效途径。
PROSPERO注册编号：CRD42013004131。
