Manual acupuncture for patients with major depressive disorder and comorbid insomnia:Evidence from polysomnography and serum biomarkers

手捻针干预重症抑郁障碍共病失眠:证据来自多导睡眠图及血清生物标志物

Objective:This study is conducted to determine effects of manual acupuncture(MA)in patients with a diagnosis of major depressive disorder(MDD)and comorbid insomnia.Methods:A total of 67 participants who met the inclusion criteria were randomly enrolled in a two-arm randomized,placebo controlled,patients-blind trial and allocated to a real-MA group(patients=34)and a sham-MA group(patients=33).Patients in the real-MA group were treated on‘Five-shen acupoints’,including Sishencong(四神聪EX-HN 1),Shenting(神庭GV 24),Shendao(神道GV 11),bilateral Benshen(本神GB 13),and bilateral Shenmen(神门HT 7).Though being punctured on the same acupoints,patients in the sham-MA group were treated by a placebo acupuncture approach(Streitberger Placeboneedle).Each group received corresponding interventions every other day,three times a week for total eight weeks.Both polysomnography(PSG)and testing of serum biological markers such as neuropeptide Y(NPY)and substance P(SP)were performed at pre-and post-treatment.Additionally,the global scores of Pittsburgh sleep quality index(PSQI)and the global scores of 17-items Hamilton Depression Rating Scale(HAMD17)were used for assessing the subjective sleep and emotion experience of patients,respectively.Meanwhile,adverse effects were monitored and recorded.Results:After eight-week treatment,the global scores of PSQI and global scores of HAMD17 declined significantly(both P<0.05)in the real-MA group but not in the sham-MA group(both P>0.05).According to the parameters of PSG,striking decline were observed in sleep latency(SL)and wake after sleep onset(WASO)and striking climb were observed in total sleep time(TST)and sleep efficiency(SE)in the real-MA group after treatment(P<0.05,respectively)but not in the sham-MA group(P>0.05,respectively).Additionally,there were no significant differences in awakening times(ATs)and rapid eyes movement sleep latency(REM-SL)in both two groups after treatment(both P>0.05).Meanwhile,the expression of NPY increased significantly and the expression of SP decreased significantly in the real-MA group after interventions(both P<0.05)while those indicators only slightly fluctuated in the sham-MA group(P>0.05).No serious adverse event was reported in either real-or sham-MA group.Conclusion:(1)MA may be a potential alternative therapy for improving MDD and comorbid insomnia(particularly in extending total sleep time and shortening wake-up duration and sleep latency)via upregulating the expression of NPY and downregulating the expression of SP;more importantly,this efficacy of acupuncture can not be replaced by sham-acupuncture acting on the same acupoints with the same treatment frequency.(2)There is insufficient evidence to prove that MA can effectively reduce the number of arousals.