Fei-Yi Zhao , Sarah J. Spencer , Gerard A. Kennedy , Zhen Zheng , Russell Conduit , Wen-Jing Zhang , Peijie Xu , Li-Ping Yue , Yan-Mei Wang , Yan Xu , Qiang-Qiang Fu , Yuen-Shan Ho
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引用次数: 0
摘要
原发性失眠(PI)是现代社会日益关注的问题。认知行为疗法是治疗失眠的一线推荐疗法,但其有限的可用性和成本阻碍了它的广泛使用。虽然催眠药经常被使用,但如何在其益处与不良反应风险之间取得平衡是一项挑战。本综述总结了针灸治疗 PI 的临床和临床前证据,讨论了针灸缓解失眠的潜在机制和作用。临床试验表明,针灸可改善主观睡眠质量、疲劳、认知障碍和情绪症状,且不良反应极少。针灸还对客观睡眠过程产生积极影响,包括延长总睡眠时间、提高睡眠效率、减少睡眠开始潜伏期和睡眠开始后唤醒,以及增强睡眠结构/构造,包括增加 N3% 和 REM%,减少 N1%。然而,一些试验在方法上的缺陷降低了证据的整体质量。动物研究表明,针灸可恢复睡眠不足的啮齿动物的昼夜节律,并改善其行为测试表现,这可能是由各种临床变量和途径介导的。这些可能涉及神经递质、脑源性神经营养因子、炎症细胞因子、下丘脑-垂体-肾上腺轴、肠道微生物群和其他细胞事件。虽然现有研究结果表明针灸是一种很有前景的 PI 治疗策略,但还需要更多高质量的试验来验证其疗效。
Acupuncture for primary insomnia: Effectiveness, safety, mechanisms and recommendations for clinical practice
Primary insomnia (PI) is an increasing concern in modern society. Cognitive-behavioral therapy for insomnia is the first-line recommendation, yet limited availability and cost impede its widespread use. While hypnotics are frequently used, balancing their benefits against the risk of adverse events poses challenges. This review summarizes the clinical and preclinical evidence of acupuncture as a treatment for PI, discussing its potential mechanisms and role in reliving insomnia. Clinical trials show that acupuncture improves subjective sleep quality, fatigue, cognitive impairments, and emotional symptoms with minimal adverse events. It also positively impacts objective sleep processes, including prolonging total sleep time, improving sleep efficiency, reducing sleep onset latency and wake after sleep onset, and enhancing sleep architecture/structure, including increasing N3% and REM%, and decreasing N1%. However, methodological shortcomings in some trials diminish the overall quality of evidence. Animal studies suggest that acupuncture restores circadian rhythms in sleep-deprived rodents and improves their performance in behavioral tests, possibly mediated by various clinical variables and pathways. These may involve neurotransmitters, brain-derived neurotrophic factors, inflammatory cytokines, the hypothalamic-pituitary-adrenal axis, gut microbiota, and other cellular events. While the existing findings support acupuncture as a promising therapeutic strategy for PI, additional high-quality trials are required to validate its benefits.
期刊介绍:
Sleep Medicine Reviews offers global coverage of sleep disorders, exploring their origins, diagnosis, treatment, and implications for related conditions at both individual and public health levels.
Articles comprehensively review clinical information from peer-reviewed journals across various disciplines in sleep medicine, encompassing pulmonology, psychiatry, psychology, physiology, otolaryngology, pediatrics, geriatrics, cardiology, dentistry, nursing, neurology, and general medicine.
The journal features narrative reviews, systematic reviews, and editorials addressing areas of controversy, debate, and future research within the field.