From the Department of Biology, McMaster University, Hamilton, Ontario, Canada.
Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada.
Menopause. 2022 Oct 1;29(10):1210-1221. doi: 10.1097/GME.0000000000002051. Epub 2022 Sep 6.
Perimenopausal and postmenopausal women commonly report sleep disruption and insomnia. Behavioral interventions may be safe alternatives for patients who are unwilling to begin pharmacological treatments because of adverse effects, contraindications, or personal preference.
The primary objective is to assess the efficacy of behavioral interventions on sleep outcomes among perimenopausal and postmenopausal women, as measured using standardized scales and objective methods (polysomnography, actigraphy). The secondary objective is to evaluate the safety of these methods through occurrence of adverse events.
Searches were performed within MEDLINE (OVID interface, 1946 onward), Embase (OVID interface, 1974 onward), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Web of Science (Core collection) using a search strategy developed in consultation with a health sciences librarian. Title/abstract and full-text screenings were performed in duplicate, and relevant studies were selected based on inclusion and exclusion criteria set to identify randomized controlled trials evaluating the effects of behavioral interventions on sleep quality. Risk of bias assessments were done using the Cochrane Risk of Bias 2 tool, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of the body of evidence. Data were pooled in a meta-analysis using a random-effects model.
Nineteen articles reporting results from 16 randomized controlled trials were included, representing a total of 2,108 perimenopausal and postmenopausal women. Overall, behavioral interventions showed a statistically significant effect on sleep outcomes (standardized mean difference [SMD], -0.62; 95% confidence interval [CI], -0.88 to -0.35; I2 = 93.4%). Subgroup analyses revealed that cognitive behavioral therapy (SMD, -0.40; 95% CI, -0.70 to -0.11; I2 = 72.7%), physical exercise (SMD, -0.57; 95% CI, -0.94 to -0.21; I2 = 94.0%), and mindfulness/relaxation (SMD, -1.28; 95% CI, -2.20 to -0.37; I2 = 96.0%) improved sleep, as measured using both subjective (eg, Pittsburg Sleep Quality Index) and objective measures. Low-intensity (SMD, -0.91; 95% CI, -1.59 to -0.24; I2 = 96.8) and moderate-intensity exercise (SMD, -0.21; 95% CI, -0.34 to -0.08; I2 = 0.0%) also improved sleep outcomes. No serious adverse events were reported. Overall risk of bias ranged from some concern to serious, and the certainty of the body of evidence was assessed to be of very low quality.
This meta-analysis provides evidence that behavioral interventions, specifically, cognitive behavioral therapy, physical exercise, and mindfulness/relaxation, are effective treatments for improving sleep outcomes among perimenopausal and postmenopausal women.
围绝经期和绝经后妇女常报告睡眠中断和失眠。对于因不良反应、禁忌症或个人偏好而不愿意开始药物治疗的患者，行为干预可能是安全的替代方法。
主要目的是评估行为干预对围绝经期和绝经后妇女睡眠结果的疗效，使用标准化量表和客观方法（多导睡眠图、活动记录仪）进行测量。次要目的是通过不良事件的发生来评估这些方法的安全性。
在 MEDLINE（OVID 界面，1946 年以后）、Embase（OVID 界面，1974 年以后）、Cochrane 对照试验中心注册库（CENTRAL）、PubMed 和 Web of Science（核心合集）中进行了检索，检索策略是与健康科学图书馆员协商制定的。通过重复进行标题/摘要和全文筛选，并根据纳入和排除标准选择相关研究，以确定评估行为干预对睡眠质量影响的随机对照试验。使用 Cochrane 偏倚风险 2 工具进行偏倚风险评估，并使用推荐评估、制定和评估方法（Grading of Recommendations Assessment, Development and Evaluation approach）评估证据体的确定性。使用随机效应模型对数据进行荟萃分析。
19 篇报告了 16 项随机对照试验结果的文章被纳入，共代表了 2108 名围绝经期和绝经后妇女。总体而言，行为干预对睡眠结果有统计学意义上的影响（标准化均数差[SMD]，-0.62；95%置信区间[CI]，-0.88 至-0.35；I2 = 93.4%）。亚组分析显示，认知行为疗法（SMD，-0.40；95%CI，-0.70 至-0.11；I2 = 72.7%）、体育锻炼（SMD，-0.57；95%CI，-0.94 至-0.21；I2 = 94.0%）和正念/放松（SMD，-1.28；95%CI，-2.20 至-0.37；I2 = 96.0%）改善了睡眠，使用主观（如匹兹堡睡眠质量指数）和客观测量。低强度（SMD，-0.91；95%CI，-1.59 至-0.24；I2 = 96.8）和中等强度运动（SMD，-0.21；95%CI，-0.34 至-0.08；I2 = 0.0%）也改善了睡眠结果。未报告严重不良事件。总体偏倚风险从关注到严重不等，证据体的确定性评估为极低质量。
这项荟萃分析提供了证据，表明行为干预，特别是认知行为疗法、体育锻炼和正念/放松，是改善围绝经期和绝经后妇女睡眠结果的有效治疗方法。
