针刺对于不宁腿综合征睡眠质量影响的Meta分析

Effect of acupuncture on sleep quality in patients with restless legs syndrome:A Meta-analysis

目的 系统评价针刺对于不宁腿综合征(restless legs syndrome,RLS)睡眠质量的影响程度。方法 计算机检索中国知网(CNKI)、WanFang Data数据库、中国生物医学文献数据库(CBM)、维普、PubMed、Web of Science、SD数据库,搜集有关针刺影响R LS睡眠质量的随机对照试验(R CT),检索时间从建库至2022年10月25日。由两名评价员独立筛选文献、提取资料并评价纳入文献的质量,运用Rev Man 5.3进行Meta分析。结果 共13项R CT被纳入,总样本量916人。Meta分析结果显示,针刺治疗R LS在不宁腿严重程度量表(IR LS)评分[SMD=-1.33,95%CI(-1.90,-0.76),P<0.01],匹兹堡睡眠质量指数(PSQI)评分[SMD=-1.12,95%CI(-1.88,-0.37),P <0.01],总有效率[R R=1.26,95%CI (1.12,1.42),P <0.01],汉密尔顿焦虑量表(HAMA)评分[SMD=-2.10,95%CI(-3.46,-0.74),P<0.01],不宁腿综合征生活质量评定量表(R LSQOL)评分[SMD=1.36,95%CI(0.59,2.12),P<0.01]方面均优于对照组;两组不良反应发生率差异无统计学意义[R R=0.57,95%CI(0.29,1.09),P>0.05]。亚组分析显示,4周<疗程≤6周观察组和对照组IRLS评分相当[SMD=-1.44,95%CI(-2.86,-0.02),P=0.05];2周<疗程≤4周[SMD=-1.55,95%CI(-2.81,-0.29),P<0.05],疗程≤2周[SMD=-1.25,95%CI(-1.65,-0.86),P<0.05]观察组IR LS评分均低于对照组。结论 针刺可以提高R LS总有效率,缓解R LS严重程度,改善因R LS而伴发的睡眠障碍和焦虑情绪,缓解腿部疼痛不适,提高睡眠质量及生活质量,且不良反应不会增加。

Objective To systematically evaluate the effect of acupuncture on sleep quality of patients with restless legs syndrome(RLS).Methods Randomized controlled trials(RCTs)of acupuncture on sleep quality of RLS patients published before October 25,2022 were searched in online databases,including CNKI,WanFang database,CBM,VIP,PubMed,Web of Science and SD databases.Two reviewers independently screened the literature,extracted the data,and evaluated the quality of the included literatures.Meta-analysis was conducted by RevMan 5.3.Results A total of 13 RCTs were included with a total sample size of 916.The results of meta-analysis showed that the International restless legs scale(IRLS)scores(SMD=-1.33,95%CI[-1.90,-0.76],P<0.01),Pittsburgh sleep quality index(PSQI)scores(SMD=-1.12,95%CI[-1.88,-0.37],P<0.01),total effective rate(RR=1.26,95%CI[1.12,1.42],P<0.01),Hamilton anxiety rating scale(HAMA)scores(SMD=-2.10,95%CI[-3.46,-0.74],P<0.01),and restless legs syndrome quality of life(RLSQOL)scores(SMD=1.36,95%CI[0.59,2.12],P<0.01)were significantly better in RLS patients treated with acupuncture than those in the control group.There was no significant difference in the incidence of adverse events between the two groups(RR=0.57,95%CI[0.29,1.09],P>0.05).Subgroup analysis showed that the IRLS scores were comparable between acupuncture-treated RLS patients with the treatment course of 4-6 weeks and those of controls(SMD=-1.44,95%CI[-2.86,-0.02],P=0.05),which were significantly lower in acupuncture-treated RLS patients with the treatment course of 2-4 weeks(SMD=-1.55,95%CI[-2.81,-0.29],P<0.05)and shorter than 2 weeks(SMD=-1.25,95%CI[-1.65,-0.86],P<0.05)than those of controls.Conclusion Acupuncture can improve the total effective rate,alleviate the severity,sleep disorders and anxiety associated with RLS,leg pain and discomfort,sleep quality and quality of life in RLS patients without increasing the incidence of adverse events.