■需要对失眠使用补充和替代医学(CAM)进行循证指导,因为它的广泛利用以及缺乏对利弊平衡的指导。本系统综述旨在从现有的综合临床实践指南(CPG)中确定和总结与失眠治疗和护理相关的CAM建议。对符合条件的准则的质量进行了评估,以评估这些建议的可信度。
■从成立到2023年1月,在七个数据库中搜索了正式发布的CPG,其中包含了针对失眠管理的CAM建议。还检索了NCCIH网站和六个国际准则制定机构网站。使用AGREEII工具和RIGHT声明评估了每个纳入指南的方法和报告质量,分别。
■包括17个合格的GCP,14人被判定为中等至较高的方法和报告质量。合格CPG的报告率为42.9%至97.1%。涉及22种CAM模式,涉及营养或天然产品,物理CAM,心理CAM,顺势疗法,芳香疗法,和正念的动作。这些模式的建议大多不清楚,明确,不确定,或冲突。缺乏支持CAM在失眠治疗和/或护理中使用的逻辑解释分级建议。通过阅读疗法,太极,瑜伽,基于很少和薄弱的证据,建议积极使用鼓风疗法。唯一的共识是四种植物疗法,包括缬草,洋甘菊,卡瓦,由于风险状况和/或获益有限,不建议将芳香疗法用于失眠管理.
■现有指南通常仅限于提供明确的,由于在CPG开发中缺乏高质量的证据和多学科咨询,因此对使用CAM疗法进行失眠管理的循证建议。因此,迫切需要更精心设计的研究来提供可靠的临床证据。允许一系列跨学科利益相关者参与未来的CPG更新也是必要的。
■https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=369155,标识符:CRD42022369155。
There is a need for evidence-informed guidance on the use of complementary and alternative medicine (CAM) for insomnia because of its widespread utilization and a lack of guidance on the balance of benefits and harms. This systematic review aimed to identify and summarize the CAM recommendations associated with insomnia treatment and care from existing comprehensive clinical practice guidelines (CPGs). The quality of the eligible
guidelines was appraised to assess the credibility of these recommendations.
Formally published CPGs incorporating CAM recommendations for insomnia management were searched for in seven databases from their inception to January 2023. The NCCIH website and six websites of international
guideline developing institutions were also retrieved. The methodological and reporting quality of each included
guideline was appraised using the AGREE II instrument and RIGHT statement, respectively.
Seventeen eligible GCPs were included, and 14 were judged to be of moderate to high methodological and reporting quality. The reporting rate of eligible CPGs ranged from 42.9 to 97.1%. Twenty-two CAM modalities were implicated, involving nutritional or natural products, physical CAM, psychological CAM, homeopathy, aromatherapy, and mindful movements. Recommendations for these modalities were mostly unclear, unambiguous, uncertain, or conflicting. Logically explained graded recommendations supporting the CAM use in the treatment and/or care of insomnia were scarce, with bibliotherapy, Tai Chi, Yoga, and auriculotherapy positively recommended based on little and weak evidence. The only
consensus was that four phytotherapeutics including valerian, chamomile, kava, and aromatherapy were not recommended for insomnia management because of risk profile and/or limited benefits.
Existing
guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development. More well-designed studies to provide reliable clinical evidence are therefore urgently needed. Allowing the engagement of a range of interdisciplinary stakeholders in future updates of CPGs is also warranted.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=369155, identifier: CRD42022369155.