痴呆患者睡眠障碍非药物干预的系统评价

Efficacy and safety of non-pharmacological interventions for sleep disturbance in dementia: a systematic review

目的系统评价非药物干预对痴呆患者睡眠障碍的有效性,为临床实践提供参考。方法计算机检索CNKI、WanFang Data、VIP、PubMed、EMbase和The Cochrane Library数据库,搜集非药物干预痴呆患者睡眠障碍的随机对照试验,检索时限均从建库至2020年5月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入9个研究,包括720例患者。最常用的非药物干预措施是光照,其次是个性化活动和睡眠教育计划。Meta分析结果显示:与普通室内光照相比,定制光照在改善社区或护理机构痴呆患者的睡眠效率[MD=2.21,95%CI(1.09,3.33),P=0.0001]和夜间睡眠时间[MD=14.27,95%CI(5.01,23.53),P=0.003]方面更好;与一般常规护理相比,个性化活动在改善夜间睡眠时间方面更好[MD=29.74,95%CI(20.44,39.04),P<0.00001],睡眠教育计划在改善睡眠效率[MD=6.19,95%CI(5.22,7.16),P<0.00001]和夜间睡眠时间[MD=33.95,95%CI(25.40,42.50),P<0.00001]方面更好;与每天光照30 min相比,每天光照120 min或60 min在改善痴呆患者匹兹堡睡眠质量指数[RR=-2.62,95%CI(-3.56,-1.68),P<0.001]和爱普沃斯嗜睡量表[RR=-4.75,95%CI(-5.71,-3.42),P<0.001]方面更好。但120 min光照不良反应率更高[RR=2.57,95%CI(1.44,4.58),P=0.001]。结论现有证据表明非药物干预对痴呆患者睡眠效率和夜间睡眠时间有益。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of non-pharmacological interventions for sleep disturbance in dementia,and to provide evidence for clinical practice.Methods Databases including CNKI,WanFang Data,VIP,PubMed,EMbase and The Cochrane Library were searched to collect randomized controlled trials(RCTs)on non-pharmacological interventions for sleep disturbance in dementia from inception to May 2020.Two reviewers independently screened literature,extracted data,and assessed risk of bias of included studies.Meta-analysis was then performed using RevMan 5.3 software.Results A total of 9 RCTs were included,involving 720 patients.Light therapy was the most commonly used treatment,followed by special activity and sleep education program.The results of meta-analysis showed that compared with the control intervention,light therapy could improve sleep efficiency(MD=2.21,95%CI 1.09 to 3.33,P=0.0001)and the night-time sleep(MD=14.27,95%CI 5.01 to 23.53,P=0.003)of patients with dementia in the community and nursing institutions,special activity could increase the night-time sleep(MD=29.74,95%CI 20.44 to 39.04,P<0.00001),and sleep education program could also improve sleep efficiency(MD=6.19,95%CI 5.22 to 7.16,P<0.00001)and night-time sleep(MD=33.95,95%CI 25.40 to 42.50,P<0.00001).In addition,it was superior to obtain 120 or 60 minutes of light exposure than 30 minutes to improve the quality of sleep(RR=-2.62,95%CI-3.56 to-1.68,P<0.001)and reduce daytime sleep(RR=-4.75,95%CI-5.71 to-3.42,P<0.001).However,there was significant difference in incidence of adverse reactions between groups of 120 minutes and 30 minutes of light exposure(RR=2.57,95%CI 1.44 to 4.58,P=0.001).Conclusions The current evidence shows that non-pharmacological intervention can improve sleep efficiency and night-time sleep in patients with dementia.Due to limited quantity and quality of the included studies,more high quality studies are required to verify above conclusions.