School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan QLD 4111, Australia.
Helsinki University Hospital, HUS FI-00029, Finland.
Int J Nurs Stud. 2020 Jul;107:103582. doi: 10.1016/j.ijnurstu.2020.103582. Epub 2020 Mar 20.
Pharmacological interventions for sleep (analgesic, sedative and hypnotic agents) can both disrupt and induce sleep and have many negative side effects within the intensive care population. The use of complementary and alternative medicine therapies to assist with sleep has been studied but given the variety of modalities and methodological limitations no reliable conclusions have been drawn.
To synthesise research findings regarding the effectiveness of using complementary and alternative medicine interventions within the domains of mind and body practices (relaxation techniques, acupuncture) and natural biologically based products (herbs, vitamins, minerals, probiotics) on sleep quality and quantity in adult intensive care patients.
Systematic review.
Five databases were searched in August 2018 and updated in February 2019 and 2020.
Searches were limited to peer reviewed randomised controlled trials, published in English involving adult populations in intensive care units. Interventions were related to the complementary and alternative medicine domains of mind and body practices and natural products. Included studies were assessed using Cochrane's risk of bias tool.
Seventeen studies were included. The interventions used varied: 4 investigated melatonin; 4 music +/- another therapy; 3 acupressure; 2 aromatherapy and 1 each for relaxation and imagery, reflexology, bright light exposure and inspiratory muscle training. Measurement of sleep quantity and quality was also varied: 5 studies used objective measures such as Polysomnography and Bispectral index with the remaining using subjective patient or clinician assessment (for example, Richards-Campbell Sleep Questionnaire, Pittsburgh Sleep Quality Index, observation). Given the different interventions, outcomes and measures used in the studies a meta-analysis was not possible. Generally, the results support the use of complementary and alternative medicine for assisting with sleep with 11 out of 17 trials reporting significant results for the interventions examined.
Complementary and alternative medicine interventions, in particular, melatonin and music, have shown promise for improving sleep in adults with critical conditions; however, further research that addresses the limitations of small sample sizes and improved techniques for measuring sleep is needed.
药物干预睡眠（镇痛药、镇静剂和催眠药）既可以扰乱睡眠，也可以诱导睡眠，并且在重症监护人群中会产生许多负面副作用。已经研究了使用补充和替代医学疗法来辅助睡眠，但由于各种方法和方法学限制，没有得出可靠的结论。
综合研究结果，评估在成人重症监护患者中使用身心实践（放松技术、针灸）和天然生物基产品（草药、维生素、矿物质、益生菌）的补充和替代医学干预措施对睡眠质量和数量的有效性。
系统综述。
2018 年 8 月在五个数据库中进行了检索，并于 2019 年 2 月和 2020 年进行了更新。
检索仅限于同行评审的随机对照试验，发表在英语期刊上，涉及重症监护病房的成年人群。干预措施与身心实践和天然产品的补充和替代医学领域有关。纳入的研究使用 Cochrane 偏倚风险工具进行评估。
纳入了 17 项研究。使用的干预措施各不相同：4 项研究涉及褪黑素；4 项研究涉及音乐 +/- 另一种疗法；3 项研究涉及穴位按压；2 项研究涉及芳香疗法，1 项研究涉及放松和意象、反射疗法、明亮光照暴露和吸气肌训练。睡眠数量和质量的测量也各不相同：5 项研究使用客观措施，如多导睡眠图和双谱指数，其余研究使用主观的患者或临床医生评估（例如，理查兹-坎贝尔睡眠问卷、匹兹堡睡眠质量指数、观察）。由于研究中使用的干预措施、结果和测量方法不同，因此无法进行荟萃分析。一般来说，这些结果支持使用补充和替代医学来辅助睡眠，17 项研究中有 11 项报告了所检查的干预措施的显著结果。
补充和替代医学干预措施，特别是褪黑素和音乐，已显示出在改善有危急病情的成年人睡眠方面的潜力；然而，需要进一步的研究来解决样本量小和改善睡眠测量技术的局限性。
