针灸和耳穴按压与癌症幸存者睡眠障碍改善的关联：一项系统评价和荟萃分析。
Association of Acupuncture and Auricular Acupressure With the Improvement of Sleep Disturbances in Cancer Survivors: A Systematic Review and Meta-Analysis.
作者信息
Wan Qingyun, Luo Shuting, Wang Xiaoqiu, Tian Qianmo, Xi Hanqing, Zheng Shiyu, Fang Qinqin, Chen Hao, Wu Wenzhong, Pan Rui
机构信息
Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Acupuncture and Rehabilitation, Nanjing Traditional Chinese Medicine Hospital, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
出版信息
Front Oncol. 2022 May 18;12:856093. doi: 10.3389/fonc.2022.856093. eCollection 2022.
BACKGROUND
Studies on the efficacy of acupuncture and auricular acupressure on sleep disturbances in cancer patients have been growing, but there is no specific and comprehensive systematic review and meta-analysis. This review aims to evaluate the efficacy and safety of acupuncture and auricular acupressure on sleep disturbances in cancer survivors based on existing randomized clinical trials (RCTs).
METHODS
Four English-language and four Chinese-language biomedical databases were searched for RCTs published from database inception to July 30, 2021. RCTs comparing acupuncture and auricular acupressure with sham control, drug therapy, behavior therapy, or usual care for managing cancer were included. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias (ROB) tool. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for the effect sizes.
RESULTS
Thirteen RCTs with 961 patients were included. The risk of performance bias or reporting bias for most of the included trials was high or unclear. Evidence was not found for short-term effects on sleep scales compared to sham control (MD, 1.98; 95% CI, 0.33-3.64; = 0.02; = 36%), wait list control (MD, 0.40; 95% CI, -0.87-1.68; = 0.54; = 49%), drug therapy (MD, 1.18; 95% CI, -3.09-5.46; = 0.59; = 98%). For long-term effect, two sham-controlled RCTs showed no significance of acupuncture on insomnia scale scores (MD, 1.71; 95% CI, -2.38-5.81; = 0.41; = 89%). Subgroup analyses suggested no evidence that auricular acupressure (MD, 3.14; 95% CI=1.52, 4.76; = 0.0001; I = 0%) or acupuncture (MD, 0.54; 95% CI=-1.27, 2.34; = 0.56; I = 0%) was associated with the reduction in insomnia scale scores.
CONCLUSIONS
This systematic review and meta-analysis found no evidence about acupuncture or auricular acupressure in the improvement of sleep disturbances in cancer survivors in terms of short- or long-term effect. Adverse events were minor. The finding was inconsistent with previous research and suggested that more well-designed and large-scale randomized controlled trials are needed to identify the efficacy of acupuncture and auricular acupressure for sleep disturbances in cancer survivors.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, CRD42020171612.
背景
关于针灸和耳穴按压对癌症患者睡眠障碍疗效的研究不断增加，但尚无具体全面的系统评价和荟萃分析。本综述旨在基于现有随机临床试验（RCT）评估针灸和耳穴按压对癌症幸存者睡眠障碍的疗效和安全性。
方法
检索了四个英文和四个中文生物医学数据库，以查找从数据库建立至2021年7月30日发表的RCT。纳入比较针灸和耳穴按压与假对照、药物治疗、行为治疗或常规癌症护理的RCT。使用Cochrane协作偏倚风险（ROB）工具评估RCT的质量。计算效应量的平均差（MD）和95%置信区间（CI）。
结果
纳入13项RCT，共961例患者。大多数纳入试验的实施偏倚或报告偏倚风险高或不清楚。与假对照（MD，1.98；95%CI，0.33 - 3.64；P = 0.02；I² = 36%）、等待列表对照（MD，0.40；95%CI， - 0.87 - 1.68；P = 0.54；I² = 49%）、药物治疗（MD，1.18；95%CI， - 3.09 - 5.46；P = 0.59；I² = 98%）相比，未发现对睡眠量表的短期影响证据。对于长期影响，两项假对照RCT显示针灸对失眠量表评分无显著影响（MD，1.71；95%CI， - 2.38 - 5.81；P = 0.41；I² = 89%）。亚组分析表明，没有证据表明耳穴按压（MD，3.14；95%CI = 1.52，4.76；P = 0.0001；I² = 0%）或针灸（MD，0.54；95%CI = - 1.27，2.34；P = 0.56；I² = 0%）与失眠量表评分降低有关。
结论
本系统评价和荟萃分析未发现针灸或耳穴按压在改善癌症幸存者睡眠障碍的短期或长期效果方面的证据。不良事件轻微。该发现与先前研究不一致，提示需要更多设计良好的大规模随机对照试验来确定针灸和耳穴按压对癌症幸存者睡眠障碍的疗效。
系统评价注册
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