非药物干预改善围绝经期失眠症状疗效的网状Meta分析

Efficacy of Non-pharmacological Interventions to Improve Perimenopausal Insomnia Symptoms:a Network Metaanalysis

背景失眠症状的出现会降低围绝经期女性生活质量,并且会增加其罹患其他疾病的风险。目前,可用于改善围绝经期失眠症状的非药物干预措施众多,何种干预措施效果最好尚有分歧。目的采用网状Meta分析方法评价非药物干预对改善围绝经期失眠症状的效果。方法于2022年3月,检索Cochrane Library、PubMed、EmBase、Web of Science、中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库和中国生物医学文献数据库中关于非药物干预改善围绝经期失眠症状的随机对照试验(RCT),检索时限均为建库至2022年3月。在两名研究者独立筛选文献、提取数据,并采用Cochrane系统评价手册5.1.0推荐的RCT偏倚风险评估工具评价纳入文献的偏倚风险之后,采用R 4.1.3软件和GeMTC包对不同非药物干预措施下,围绝经期失眠症状改善的总有效率,以及匹兹堡睡眠质量指数量表(PSQI)评分、kupperman评分、雌二醇(E2)水平改善情况进行贝叶斯网状Meta分析。结果共纳入44项RCT,包括3354例患者,涉及12种非药物干预措施(艾灸、电针、耳穴压豆、刮痧、火龙罐、揿针、推拿、温针、蜂针、穴位埋线、音乐疗法、针刺)。网状Meta分析结果显示:在改善围绝经期失眠症状的总有效率方面,艾灸、电针、针刺的效果优于镇静安眠西药(P<0.05),艾灸成为最佳干预措施的可能性最大。在改善PSQI评分方面,艾灸、电针、刮痧、针刺的效果优于镇静安眠西药(P<0.05),艾灸的效果优于温针(P<0.05),艾灸成为最佳干预措施的可能性最大。在改善kupperman评分方面,不同干预措施的效果比较,差异均无统计学意义(P>0.05),刮痧成为最佳干预措施的可能性最大。在改善E2水平方面,不同干预措施的效果比较,差异均无统计学意义(P>0.05),针刺成为最佳干预措施的可能性最大。结论当前证据显示,对于围绝经期女性而言,艾灸在改善失眠症状总有效率和PSQI评分,刮痧在改善kupperman评分,针刺在提高E2水平方面具有优势,但还需要通过开展更多高质量的研究进一步验证此结论。

Background The presence of insomnia symptoms reduces the quality of life of perimenopausal women and increases their risk of developing other diseases.Currently,there are numerous non-pharmacological interventions available to improve perimenopausal insomnia symptoms,with disagreement as to which intervention is most effective.Objective To evaluate the efficacy of non-pharmacological interventions in improving perimenopausal insomnia symptoms using a network meta-analysis.Methods In March 2022,Cochrane Library,PubMed,EmBase,Web of Science,CNKI,Wanfang Data Knowledge Service Platform,VIP and CBM were searched for the randomized controlled trials(RCTs)on the improvement of perimenopausal insomnia symptoms by non-pharmacological interventions from inception to March 2022.Two investigators independently screened the literature,extracted data,and evaluated the risk of bias of the included literature using the RCT bias risk assessment tool recommended by the Cochrane Manual of Systematic Review 5.1.0.A Bayesian network meta-analysis was performed on the overall response rate to the improvement of perimenopausal insomnia symptoms,as well as improvement in Pittsburgh Sleep Quality Index Scale(PSQI)score,Kupperman score and estradiol(E2)level under different nonpharmacological interventions by using R 4.1.3 software and the GeMTC package.Results A total of 44 RCTs including 3354 patients were selected,involving 12 non-pharmacological interventions(moxibustion,electroacupuncture,acupoint pressing with beans,scraping,fire dragon pot,thumbtack needle,massage,warm acupuncture,bee acupuncture,acupoint embedding,music therapy,acupuncture).The results of meta-analysis showed that moxibustion,electroacupuncture,and acupuncture were superior to sedative-hypnotic western drugs in overall response rate to the improvement of perimenopausal insomnia symptoms(P<0.05),and moxibustion was identified as the most probable superior intervention.Moxibustion,electroacupuncture,scraping,and acupuncture were superior to sedative-hypnotic western drugs(P<0.05),moxibustion was more effective than warm acupuncture(P<0.05)in the improvement of PSQI score and identified as the most probable superior intervention.There was no significant difference in the improvement of Kupperman score and E2 level among different interventions(P>0.05),with scraping emerging and acupuncture as the most probable superior intervention,respectively.Conclusion Current evidence demonstrates that moxibustion is superior in overall response rate to the improvement of perimenopausal insomnia symptoms and PSQI score in perimenopausal women,while scraping is superior in improving Kupperman score and acupuncture has advantages in improving E2 level,however,further validation of this conclusion is needed by conducting more high-quality studies.