Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China; The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
Sleep Med. 2024 Aug;120:65-84. doi: 10.1016/j.sleep.2024.05.006. Epub 2024 May 11.
Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) and acupuncture on sleep in adults with stroke.
Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed.
A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited.
Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed.
PROSPERO No. CRD42020194029 and No. CRD42020194030.
失眠在中风患者中极为普遍，但目前尚无理想的干预措施。本系统评价旨在评估中草药（CHM）和针灸对中风成人睡眠的影响和安全性。
从建库至 2023 年 6 月，检索了 6 个数据库，以识别随机对照试验（RCT）。主要结局为匹兹堡睡眠质量指数（PSQI）评分。评估了偏倚风险和证据质量。采用成对随机效应荟萃分析。
最终纳入了 54 项 RCT，共 55 篇文章，包括 35 项 CHM 治疗和 19 项针刺治疗。与安慰剂/假手术相比，CHM 和针刺在改善 PSQI 评分方面更有效。中等质量证据表明，CHM 在改善睡眠质量方面优于苯二氮䓬类药物（BZDs），而与非苯二氮䓬类药物效果相当。CHM 和针刺还为单独使用药物治疗的患者提供了额外的益处。然而，针对个别 CHM 处方的证据存在于各种因素和方法学质量中，且关于针刺与其他疗法比较有效性的证据存在冲突或有限。
总体而言，CHM 和针刺单独或联合药物治疗可安全改善失眠中风患者的睡眠。未来需要进行 RCT 研究，以评估优秀的 CHM 处方，以及针刺与其他疗法的比较效果。
PROSPERO 注册号为 CRD42020194029 和 CRD42020194030。
