Abstract：
BACKGROUND: Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) and acupuncture on sleep in adults with stroke.
METHODS: Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed.
RESULTS: A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited.
CONCLUSIONS: Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed.
BACKGROUND: PROSPERO No. CRD42020194029 and No. CRD42020194030.
METHODS: Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed.
RESULTS: A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited.
CONCLUSIONS: Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed.
BACKGROUND: PROSPERO No. CRD42020194029 and No. CRD42020194030.
摘要：
背景：失眠在中风患者中非常普遍；然而，没有理想的干预。本系统评价了中草药（CHM）和针灸对成人中风患者睡眠的影响和安全性。
方法：从开始到2023年6月检索了六个数据库，以确定随机对照试验（RCT）。主要结果是匹兹堡睡眠质量指数（PSQI）评分。评估偏倚风险和证据质量。进行了成对随机效应荟萃分析。
结果：在55篇文章中发表的54项RCT最终被纳入系统综述，包括35例CHM和19例针灸治疗。与安慰剂/假手术相比，CHM和针灸在改善PSQI评分方面更有效。中等质量的证据表明，CHM优于苯二氮卓类药物（BZDs），同时在改善睡眠质量方面表现出与非BZDs相似的效果。CHM和针灸也为单独用药物治疗的患者提供了额外的益处。然而,个别CHM处方特有的证据在于各种因素和方法学质量，关于针灸和其他疗法相对有效性的证据是相互矛盾或有限的。
结论：总体而言，单独使用CHM和针灸或与药物治疗联合使用可以安全地改善中风失眠患者的睡眠。在未来,需要对优秀的CHM处方进行RCT，并进行针灸与其他疗法之间的比较有效性研究。
背景：PROSPERONo.CRD42020194029和编号CRD42020194030。
方法：从开始到2023年6月检索了六个数据库，以确定随机对照试验（RCT）。主要结果是匹兹堡睡眠质量指数（PSQI）评分。评估偏倚风险和证据质量。进行了成对随机效应荟萃分析。
结果：在55篇文章中发表的54项RCT最终被纳入系统综述，包括35例CHM和19例针灸治疗。与安慰剂/假手术相比，CHM和针灸在改善PSQI评分方面更有效。中等质量的证据表明，CHM优于苯二氮卓类药物（BZDs），同时在改善睡眠质量方面表现出与非BZDs相似的效果。CHM和针灸也为单独用药物治疗的患者提供了额外的益处。然而,个别CHM处方特有的证据在于各种因素和方法学质量，关于针灸和其他疗法相对有效性的证据是相互矛盾或有限的。
结论：总体而言，单独使用CHM和针灸或与药物治疗联合使用可以安全地改善中风失眠患者的睡眠。在未来,需要对优秀的CHM处方进行RCT，并进行针灸与其他疗法之间的比较有效性研究。
背景：PROSPERONo.CRD42020194029和编号CRD42020194030。
