Ou Yangxu, Lin Dezhi, Ni Xixiu, Li Simeng, Wu Kexin, Yuan Lu, Rong Jing, Feng Chengzhi, Liu Junqian, Yu Yang, Wang Xiao, Wang Linjia, Tang Zili, Zhao Ling
Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Traditional Chinese Medicine School, Hunan University of Traditional Chinese Medicine, Changsha, China.
Front Psychiatry. 2023 Feb 16;14:1108686. doi: 10.3389/fpsyt.2023.1108686. eCollection 2023.
Cancer-related insomnia (CRI) is one of the most common and serious symptoms in patients with cancer. Acupuncture and moxibustion have been widely applied in the treatment of CRI. Nevertheless, the comparative efficacy and safety of different acupuncture and moxibustion techniques remain unclear. This study aimed to evaluate and compare the efficacy and safety of different acupuncture and moxibustion techniques in the treatment of CRI.
Eight medical databases were comprehensively searched for relevant randomized controlled trials (RCTs) as of June 2022. Two independent reviewers assessed the risk of bias and conducted the research selection, data extraction, and quality assessment of the included RCTs. A network meta-analysis (NMA) was performed using frequency models, combining all available direct and indirect evidence from RCTs. The Pittsburgh Sleep Quality Index (PSQI) was set as the primary outcome, and adverse events and effective rates were set as the secondary outcomes. The efficacy rate was calculated as the ratio of patients with insomnia symptom relief to the total number of patients.
Thirty-one RCTs with 3,046 participants were included, including 16 acupuncture- and moxibustion-related therapies. Transcutaneous electrical acupoint stimulation [surface under the cumulative ranking curve (SUCRA) 85.7%] and acupuncture and moxibustion (SUCRA 79.1%) were more effective than Western medicine, routine care, and placebo-sham acupuncture. Furthermore, Western medicine showed significantly better effects than placebo-sham acupuncture. In the NMA, the acupuncture and moxibustion treatments with the best therapeutic effects for CRI were transcutaneous electrical acupoint stimulation (SUCRA 85.7%), acupuncture and moxibustion (SUCRA 79.1%), auricular acupuncture (SUCRA 62.9%), routine care combined with intradermal needling (SUCRA 55.0%), and intradermal needling alone (SUCRA 53.3%). No serious acupuncture- or moxibustion-related adverse events were reported in the included studies.
Acupuncture and moxibustion are effective and relatively safe in treating CRI. The relatively conservative recommended order of acupuncture- and moxibustion-related therapies for CRI is as follows: transcutaneous electrical acupoint stimulation, acupuncture and moxibustion, and auricular acupuncture. However, the methodological quality of the included studies was generally poor, and further high-quality RCTs are needed to strengthen the evidence base.
癌症相关失眠（CRI）是癌症患者最常见且严重的症状之一。针灸已广泛应用于CRI的治疗。然而，不同针灸技术的相对疗效和安全性仍不明确。本研究旨在评估和比较不同针灸技术治疗CRI的疗效和安全性。
全面检索截至2022年6月的八个医学数据库，查找相关随机对照试验（RCT）。两名独立评价者评估偏倚风险，并进行纳入RCT的研究选择、数据提取和质量评估。使用频率模型进行网络荟萃分析（NMA），整合RCT中所有可用的直接和间接证据。将匹兹堡睡眠质量指数（PSQI）设定为主要结局，不良事件和有效率设定为次要结局。有效率计算为失眠症状缓解患者数与患者总数之比。
纳入31项RCT，共3046名参与者，包括16种与针灸相关的疗法。经皮穴位电刺激[累积排序曲线下面积（SUCRA）85.7%]和针灸（SUCRA 79.1%）比西药、常规护理和安慰剂假针刺更有效。此外，西药的效果明显优于安慰剂假针刺。在NMA中，对CRI治疗效果最佳的针灸疗法为经皮穴位电刺激（SUCRA 85.7%）、针灸（SUCRA 79.1%）、耳针（SUCRA 62.9%）、常规护理联合皮内针（SUCRA 55.0%）和单纯皮内针（SUCRA 53.3%）。纳入研究中未报告严重的针灸相关不良事件。
针灸治疗CRI有效且相对安全。CRI相对保守的针灸相关疗法推荐顺序如下：经皮穴位电刺激、针灸和耳针。然而，纳入研究的方法学质量普遍较差，需要进一步高质量的RCT来加强证据基础。
