Pei Ming, Chen Junli, Dong Shuo, Yang Bo, Yang Kang, Wei Lijuan, Zhai Jingbo, Yang Hongtao
Division of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
Front Psychiatry. 2021 Jul 19;12:576050. doi: 10.3389/fpsyt.2021.576050. eCollection 2021.
Insomnia is one of the common problems in patients with maintenance hemodialysis (MHD). Previous studies have reported the beneficial effects of auricular acupressure (AA) for insomnia in patients with MHD. This study aimed to critically evaluate the efficacy and safety of AA for insomnia in patients with MHD. Web of Science, Embase, PubMed, Cochrane Library, Chinese Biomedical Database, Wanfang Data, Chinese Science and Technology Periodicals database, and China National Knowledge Infrastructure were systematically searched from inception to April 30, 2020, to identify any eligible randomized controlled trials. MHD patients with insomnia were included regardless of age, gender, nationality, or race. The experimental interventions included AA alone or AA combined with other therapies. The control interventions included placebo, no treatment, or other therapies. The primary outcome was sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). RevMan 5.3 software was used for statistical analysis. Eight studies involving 618 participants were included for statistical analysis. A meta-analysis showed no significant difference of PSQI global score after 8 weeks of AA treatment compared with estazolam ( = 0.70). Other narrative analyses revealed that PSQI global score was significantly attenuated after AA treatment in comparison with mental health education ( = 0.03, duration of 4 weeks; = 0.02, duration of 8 weeks), AA plus routine nursing care compared with routine nursing care alone ( < 0.0001), and AA plus footbath compared with footbath alone ( = 0.01), respectively. A meta-analysis showed that AA could significantly increase the response rate (reduction of PSQI global score by 25% and more) in comparison with estazolam ( = 0.01). Other narrative analyses reported that the response rate was significantly increased after AA treatment compared with sham AA ( = 0.02), AA compared with mental health education ( = 0.04), and AA plus routine nursing care compared with routine nursing care alone ( = 0.0003), respectively. The present findings suggest that AA may be an alternative treatment for insomnia in patients with MHD. However, more large-scale, high-quality trials are still warranted to confirm these outcomes.
失眠是维持性血液透析（MHD）患者的常见问题之一。既往研究报道了耳穴按压（AA）对MHD患者失眠的有益作用。本研究旨在严格评估AA对MHD患者失眠的疗效和安全性。从创刊至2020年4月30日，系统检索了Web of Science、Embase、PubMed、Cochrane图书馆、中国生物医学数据库、万方数据、中国科技期刊数据库和中国知网，以确定任何符合条件的随机对照试验。纳入患有失眠的MHD患者，无论其年龄、性别、国籍或种族。实验性干预措施包括单独使用AA或AA联合其他疗法。对照性干预措施包括安慰剂、不治疗或其他疗法。主要结局是通过匹兹堡睡眠质量指数（PSQI）测量的睡眠质量。使用RevMan 5.3软件进行统计分析。八项涉及618名参与者的研究纳入统计分析。一项荟萃分析显示，与艾司唑仑相比，AA治疗8周后PSQI总分无显著差异（ = 0.70）。其他叙述性分析显示，与心理健康教育相比，AA治疗后PSQI总分显著降低（ = 0.03，持续4周； = 0.02，持续8周），AA加常规护理与单纯常规护理相比（ < 0.0001），以及AA加足浴与单纯足浴相比（ = 0.01）。一项荟萃分析显示，与艾司唑仑相比AA可显著提高缓解率（PSQI总分降低25%及以上）（ = 0.01）。其他叙述性分析报告称，与假AA相比，AA治疗后缓解率显著提高（ = 0.02）。与心理健康教育相比，AA治疗后缓解率显著提高（ = 0.04），AA加常规护理与单纯常规护理相比（ = 0.0003）。目前的研究结果表明，AA可能是MHD患者失眠的一种替代治疗方法。然而，仍需要更多大规模、高质量的试验来证实这些结果。
