International Health Program, National Yang-Ming University, Taiwan.
Department of Traditional Chinese Medicine, Taipei Medical University Hospital, Taiwan.
Sleep Med Rev. 2018 Feb;37:24-34. doi: 10.1016/j.smrv.2016.12.004. Epub 2016 Dec 22.
Acupressure is a non-invasive treatment in which pressure is applied to specific body points. Following public health concerns about poor sleep quality and increasing interest in alternative treatments, a systematic review and a meta-analysis were designed to evaluate the effects of acupressure on the quality of sleep. Ten English (PubMed, CENTRAL, CINAHL etc.) and five Chinese (CNKI, WANFANG etc.) databases were searched and the validity of the eligible studies was critically appraised. Thirty-two eligible randomized controlled trials of moderate to high quality which employed polysomnography, actigraphy, or self-assessment sleep quality tools were included. We conducted a meta-analysis using a random effects model with the Pittsburgh sleep quality index (PSQI) as the primary outcome measure (968 adult patients, 13 trials) for trials investigating the effects of traditional Chinese medicine acupressure compared with standard and sham treatments. We performed subgroup analyses to detect sources of heterogeneity, identify the use of acupoints in different populations and explore the contributions of PSQI domains to the total score change. Comparison with the sham group (7 trials with 385 patients) yielded low heterogeneity and an overall effect of 13%-19% improvement in the PSQI score (MD = -3.41, 95% CI -4.08, -2.75; I = 12%). Based on data from four trials (n = 250), sleep latency and sleep duration were most affected. No adverse effects were reported in any of the reviewed trials. Within the limitations of clinical heterogeneity, the results showed that even fragile populations such as the elderly and dialysis patients can benefit from acupressure. Standardized treatment protocols involved 3-5 kg of pressure for one to five minutes per acupoint, delivered three to seven times a week for three to four weeks with the HT7 (Shenmen) acupoint used in most procedures. A high risk of bias due to absence of blinding of patients and personnel remains a serious methodological challenge for acupressure trials and poses a main limitation to presented results. This review has been registered in PROSPERO (registration number CRD42015025013).
acupressure 是一种非侵入性的治疗方法，通过对特定身体部位施加压力来实现。鉴于公众对睡眠质量差的担忧以及对替代疗法兴趣的增加，我们进行了一项系统评价和荟萃分析，以评估 acupressure 对睡眠质量的影响。我们检索了 10 种英文（PubMed、CENTRAL、CINAHL 等）和 5 种中文（CNKI、WANFANG 等）数据库，并对合格研究的有效性进行了批判性评估。共纳入 32 项高质量的随机对照试验，这些试验采用多导睡眠图、活动记录仪或自我评估睡眠质量工具，研究 acupressure 对睡眠质量的影响。我们使用随机效应模型对纳入的 13 项试验（968 名成年患者）进行了荟萃分析，这些试验比较了传统中医 acupressure 与标准和假治疗的效果，以匹兹堡睡眠质量指数（PSQI）作为主要结局指标。我们进行了亚组分析，以发现异质性的来源，确定在不同人群中使用 acupoints 的情况，并探讨 PSQI 各领域对总分变化的贡献。与假治疗组（7 项试验，385 名患者）相比，总体效应为 PSQI 评分改善 13%-19%（MD=-3.41，95%CI-4.08，-2.75；I=12%），异质性较低。基于 4 项试验（n=250）的数据，发现睡眠潜伏期和睡眠时间受影响最大。在所有纳入的试验中，均未报告任何不良反应。在临床异质性的限制内，结果表明，即使是脆弱的人群，如老年人和透析患者，也可以从 acupressure 中受益。标准化治疗方案涉及每个 acupoint 施加 1 至 5 分钟、3 至 5kg 的压力，每周 3 至 7 次，持续 3 至 4 周，大多数程序中都使用 HT7（Shenmen） acupoint。由于患者和人员的盲法缺失， acupressure 试验的偏倚风险较高，这是对研究结果的主要限制。本综述已在 PROSPERO（注册号 CRD42015025013）中注册。
