Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau SAR 999078, China.
Zhuhai Campus, Zunyi Medical University, Zhuhai 519041, China.
Complement Ther Med. 2024 Nov;86:103087. doi: 10.1016/j.ctim.2024.103087. Epub 2024 Sep 17.
Breast cancer-related insomnia is one of the most common symptoms in patients with breast cancer, and acupuncture has been increasingly used in the treatment. However, there has been no meta-analysis that specifically explores the efficacy and safety of acupuncture in treating insomnia related to breast cancer.
The aim of this review was to systematically analyze the existing literature through a meta-analysis to evaluate the effectiveness and safety of acupuncture for breast cancer-related insomnia.
Six medical databases were comprehensively searched for previous randomized controlled trials (RCTs) up to April 2024. The Pittsburgh Sleep Quality Index (PSQI) score was the primary outcome. The secondary outcomes include the Insomnia Severity Index (ISI), Sleep Onset Latency (SOL), Wake After Sleep Onset (WASO), Total Sleep Time (TST), and Sleep Efficiency (SE), and the later four outcomes were measured by Actiwatch and sleep diary, respectively.
A total of seven articles with 434 participants were included. The meta-analysis revealed that acupuncture produced a significant improvement in the total PSQI score (MD 95 %CI = -2.16[-2.88, - 1.45], P < 0.001), but had no statistical significance on ISI scores compared with controls (MD 95 %CI = -1.53[-3.97, 0.91], P = 0.22). From the Actiwatch, there was no substantial disparity observed in the enhancement of Sleep Onset Latency (SOL) (MD 95 %CI = -6.40[-13.19, 0.39], P = 0.06), Wake After Sleep Onset (WASO) (MD 95 %CI = -1.45[-7.09, 4.20], P = 0.62), or Total Sleep Time (TST) (MD 95 %CI = 3.54 [-4.71, 11.79], P = 0.40) between the experimental group and the control group. However, a significant distinction was observed in Sleep Efficiency (SE) improvement (MD 95 %CI = 2.43 [0.14, 4.72], P = 0.04). From the sleep diary, there was a significant difference in the amelioration of SOL (MD 95 %CI = -9.15[-16.48, - 1.81], P = 0.01), TST (MD 95 %CI = 29.92 [16.74, 43.10], P < 0.001), and SE (MD 95 %CI = 4.57 [1.92, 7.23], P = 0.0007) between the experimental group and the control group. However, no significant divergence was observed in the improvement of WASO (MD 95 %CI = 4.53[-4.81, 13.87], P = 0.34). All reported acupuncture-related adverse events were mild in severity.
Acupuncture can partially alleviate insomnia symptoms in breast cancer patients. Moreover, acupuncture is safe and may serve as a dependable alternative therapy in clinical settings. Owing to the limited number of studies included, potential biases of heterogeneous interventions, and methodological weaknesses of long-term follow-up, more high-quality RCTs with large sample sizes should be conducted to evaluate acupuncture treatment.
乳腺癌相关失眠是乳腺癌患者最常见的症状之一，针灸在治疗中得到了越来越多的应用。然而，目前还没有专门针对针灸治疗乳腺癌相关失眠疗效和安全性的荟萃分析。
本综述旨在通过荟萃分析系统地分析现有文献，评估针灸治疗乳腺癌相关失眠的疗效和安全性。
全面检索截至 2024 年 4 月的 6 个医学数据库，以获取先前的随机对照试验（RCT）。匹兹堡睡眠质量指数（PSQI）评分是主要结局。次要结局包括失眠严重程度指数（ISI）、睡眠潜伏期（SOL）、睡眠后觉醒时间（WASO）、总睡眠时间（TST）和睡眠效率（SE），后四个结局分别通过 Actiwatch 和睡眠日记测量。
共纳入 7 篇文章，涉及 434 名参与者。荟萃分析显示，与对照组相比，针灸治疗可显著改善总 PSQI 评分（MD 95%CI=-2.16[-2.88, -1.45]，P<0.001），但对 ISI 评分无统计学意义（MD 95%CI=-1.53[-3.97, 0.91]，P=0.22）。从 Actiwatch 来看，实验组和对照组之间，睡眠潜伏期（SOL）（MD 95%CI=-6.40[-13.19, 0.39]，P=0.06）、睡眠后觉醒时间（WASO）（MD 95%CI=-1.45[-7.09, 4.20]，P=0.62）或总睡眠时间（TST）（MD 95%CI=3.54[-4.71, 11.79]，P=0.40）的改善均无显著差异。然而，实验组的睡眠效率（SE）（MD 95%CI=2.43[0.14, 4.72]，P=0.04）有显著提高。从睡眠日记来看，实验组 SOL（MD 95%CI=-9.15[-16.48, -1.81]，P=0.01）、TST（MD 95%CI=29.92[16.74, 43.10]，P<0.001）和 SE（MD 95%CI=4.57[1.92, 7.23]，P=0.0007）的改善明显优于对照组，但实验组与对照组之间，WASO（MD 95%CI=4.53[-4.81, 13.87]，P=0.34）的改善无显著差异。所有报告的针灸相关不良事件均为轻度。
针灸可部分缓解乳腺癌患者的失眠症状。此外，针灸安全可靠，可能是临床治疗中一种可靠的替代疗法。由于纳入的研究数量有限，干预措施存在异质性，且缺乏长期随访的方法学弱点，因此应开展更多高质量、大样本量的 RCT 来评估针灸治疗。
