不同运动方式对失眠患者睡眠影响效果的网状Meta分析

Effects of Different Exercise Types on Sleep in Insomnia Patients:a Network Meta-analysis

背景失眠问题不仅会降低人们的生活质量和工作效率,而且还与多种疾病之间有密切的关系,合理的运动方案可以在一定程度上改善失眠质量,但目前缺乏不同运动方式对其睡眠结局影响效果的比较研究。目的比较不同运动方式对失眠患者睡眠影响的效果,为该人群制定改善睡眠的运动处方提供借鉴。方法通过PubMed、Web of Science、EBSCO、Scopus、中国知网、万方数据知识服务平台检索不同运动方式对失眠患者睡眠影响的随机对照试验(RCT),检索时间为建库至2023年12月。使用Jadad量表对文献质量进行评价,使用Stata 17.0软件的频率学框架的随机效应模型进行网状Meta统计,使用偏倚漏斗图观察发表偏倚。结果共纳入36篇文献,包含2706例受试者,涉及5类干预措施:有氧运动(AE)、抗阻运动(RT)、身心运动(ME)、运动时间延长(PTE)、有氧与抗阻结合的运动(AE+RT)。网状Meta分析结果显示,AE和空白对照(CT)组(SMD=2.20,95%CI=0.35~4.05)对主观评价工具总评分的影响比较,差异有统计学意义(P<0.05);累积排序概率图下面积(SUCRA)排序结果为AE(82.2%)>ME(71.1%)>AE+RT(54.2%)>RT(38.9%)>CT(29.2%)>PTE(24.4%)。PTE与AE+RT(SMD=-14.66,95%CI=-28.60~-0.72),AE+RT与RT(SMD=21.32,95%CI=6.24~36.40)以及AE+RT与AE(SMD=11.19,95%CI=1.56~20.81)对睡眠潜伏期的影响比较,差异有统计学意义(P<0.05);SUCRA概率排序结果显示,AE+RT(96.7%)>CT(77.1%)>ME(49.5%)>AE(42.6%)>PTE(27.9%)>RT(6.1%)。AE与CT(SMD=4.59,95%CI=1.59~7.58)对睡眠效率的影响比较,差异有统计学意义(P<0.05);SUCRA概率排序结果显示AE(83.1%)>AE+RT(59.9%)>RT(50.7%)>ME(46.9%)>PTE(35.5%)>CT(23.9%)。PTE与RT(SMD=23.39,95%CI=14.67~32.02),PTE与AE(SMD=14.86,95%CI=4.64~36.40),PTE与CT(SMD=12.11,95%CI=7.62~16.59),RT与ME(SMD=-27.61,95%CI=-40.49~-14.73),RT与CT(SMD=-11.28,95%CI=-20.86~-1.70),ME与AE(SMD=19.08,95%CI=5.18~32.98),ME与CT(SMD=16.33,95%CI=7.26~25.40)对睡眠觉醒时间的影响比较,差异有统计学意义(P<0.05);SUCRA概率排序结果显示,RT(94.7%)>CT(80.2%)>AE(41.8%)>ME(31.5%)>PTE(1.7%)。RT与AE(SMD=-20.84,95%CI=-38.46~-3.23),AE与CT(SMD=12.02,95%CI=2.96~21.08)对总睡眠时长的影响比较,差异有统计学意义(P<0.05);SUCRA概率排序结果显示,AE(87.2%)>AE+CT(71.6%)>PTE(53.8%)>ME(40.6%)>CT(35.9%)>RT(10.8%)。各项干预措施对睡眠质量的影响比较,差异均无统计学意义(P>0.05);SUCRA概率排序结果显示,AE(84.2%)>AE+CT(75.5%)>ME(24.9%)>CT(15.4%)。对主观评价工具总评分、睡眠潜伏期、睡眠效率、睡眠觉醒时间、总睡眠时长、睡眠质量进行发表偏倚分析,发现6个结局指标均存在一定的不对称性,提示存在一定的发表偏倚风险。结论鉴于AE对多个睡眠指标有较好的改善作用,推荐失眠患者进行3次/周、30 min/次的中等强度AE,如慢跑、快走等,此外,也可以选择4~5次/周中等强度的RT或AE+RT,在进行上述运动时需要额外注意时间段选择,尽量避免睡前3h内进行运动。

Background Insomnia not only decreases the quality of life and working efficiency,but also relates to other deceases.Suitable exercises may be useful to improve sleep quality.However,comparative studies on the effects of different types of exercise on sleep outcomes are currently lacked.Objective To compare the effects of different exercise types on sleep in insomnia patients and to provide insights for developing exercise prescriptions to improve sleep in this population.Methods Randomized controlled trials(RCT)investigating the effects of different types of exercises on the sleep of people with insomnia were retrieved from the PubMed,Web of Science,EBSCO,Scopus,China National Knowledge Infrastructure(CNKI),and Wanfang Data Knowledge Service Platform from database inception to December 2023.The quality of the literatures was assessed using the Jadad scale.A network meta-analysis was performed using the random-effects model of the frequency framework in Stata 17.0 software,and publication bias was observed using a funnel plot.Results A total of 36 articles representing 2706 participants were included in this study.Exercise interventions were categorized into five types,including the aerobic exercise(AE),resistance training(RT),mind-body exercise(ME),prolonged time of exercise(PTE),and AE combined with RT(AE+RT).The results of the network meta-analysis showed that there was a significant difference in the total score of the subjective evaluation tools between AE group and blank control group(SMD=2.20,95%CI=0.35-4.05,P<0.05).The maximum surface under the cumulative ranking curve(SUCRA)of the total score of the subjective evaluation tools was detected in AE group(82.2%),followed by ME(71.1%),AE+RT(54.2%),RT(38.9%),controlled trial(CT)(29.2%)and PTE groups(24.4%).There was a significant difference in sleep latency(SL)between PTE group versus AE+RT group(SMD=-14.66,95%CI=-28.60 to-0.72),between AE+RT group versus RT group(SMD=21.32,95%CI=6.24-36.40),and between AE+RT group versus AE group(SMD=11.19,95%CI=1.56-20.81)(all P<0.05).The maximum SUCRA of SL was detected in AE+RT group(96.7%),followed by CT(77.1%),ME(49.5%),AE(42.6%),PTE(27.9%)and RT groups(6.1%).There was a significant difference in sleep efficacy(SE)between AE group versus CT group(SMD=4.59,95%CI=1.59-7.58,P<0.05).The maximum SUCRA of SE was detected in the AE group(83.1%),followed by AE+RT(59.9%),RT(50.7%),ME(46.9%),PTE(35.5%)and CT groups(23.9%).There was a significant difference in wake time after sleep onset(WASO)between PTE group versus RT group(SMD=23.39,95%CI=14.67-32.02),between PTE group versus AE group(SMD=14.86,95%CI=4.64-36.40),between PTE group versus CT group(SMD=12.11,95%CI=7.62-16.59),between RT group versus ME group(SMD=-27.61,95%CI=-40.49 to-14.73),between RT group versus CT group(SMD=-11.28,95%CI=-20.86 to-1.70),between ME group versus AE group(SMD=19.08,95%CI=5.18-32.98),and between ME group versus CT group(SMD=16.33,95%CI=7.26-25.40)(all P<0.05).The maximum SUCRA of WASO was detected in the RT group(94.7%),followed by CT(80.2%),AE(41.8%),ME(31.5%)and PTE groups(1.7%).There was a significant difference in the total sleep time(TST)between RT group versus AE group(SMD=-20.84,95%CI=-38.46 to-3.23),between AE group versus CT group(SMD=12.02,95%CI=2.96-21.08)(all P<0.05).The maximum SUCRA of TST was detected in the AE group(87.2%),followed by AE+CT(71.6%),PTE(53.8%),ME(40.6%),CT(35.9%)and RT groups(10.8%).There was no significant difference in the sleep quality(SQ)among groups(P>0.05).The maximum SUCRA of SQ was detected in the AE group(84.2%),followed by AE+CT(75.5%),ME(24.9%)and CT groups(15.4%).Publication bias analysis of the total score of subjective evaluation tools,SL,SE,WASO,TST,and SQ revealed some asymmetry in all six outcome indicators,indicating a certain risk of publication bias.Conclusion Given the favorable effects of AE on multiple sleep parameters,we recommend insomnia patients engage in moderate-intensity AE,such as jogging or brisk walking,three times a week for approximately 30 minutes.Additionally,options include moderate-intensity RT or AE+RT four to five times a week.When engaging in the above exercises,attention should be paid to the choice of time period,and exercise within 3 hours before bedtime should be avoided as much as possible.