■由于生活习惯的改变,失眠的年发病率持续增加,工作压力加大,增加了环境污染。近年来,越来越多的外用疗法已被证明对治疗失眠有效,并已被广泛使用。然而,外部治疗的相对益处和危害仍然不确定,最佳治疗策略尚未确定。
■进行了网络荟萃分析,以评估和比较多种外用疗法对失眠患者的疗效和安全性。
■从成立到2023年6月,对八个电子数据库进行了全面搜索,以获取相关文献。我们还搜索了灰色文献,并回顾了相关系统综述的参考文献列表。两名独立的审核员进行了研究选择,数据提取,使用Cochrane审阅者手册对纳入的随机对照试验(RCT)进行偏倚评估,使用Stata和RevMan软件进行网络荟萃分析。
■总共,确定了14,826项研究。其中,83项研究,包括9个外部疗法和6100个病人,被认为符合本网络荟萃分析的条件。除了SL结果,在改善睡眠质量方面,每种外用疗法均优于常规药物和假干预(SI)。在改善失眠患者心理状态指标方面,每种外用疗法均优于SI;每种外用疗法对单胺类神经递质的调节均有较好的效果。推拿可能是提高总有效率最有效的干预措施,匹兹堡睡眠质量指数得分,和SL。重复经颅磁刺激(rTMS)可能导致总睡眠时间和觉醒时间的最佳改善(累积排序曲线下的表面[SUCRA]=78.3和75.4%,分别);艾灸(MB)和高压氧(HBO)在降低焦虑自评量表和抑郁自评量表评分方面最有效。在提高单胺神经递质5-羟色胺方面,去甲肾上腺素,还有多巴胺,最好的干预措施是穴位埋线,电针,和推拿(SUCRA=82.0、69.9和90.3%,分别)。安全性结果表明,三种最安全的干预措施是SI,推拿,和足浴。所有研究均未报告严重不良事件,最常见的轻微不良事件包括嗜睡,疼痛,过度口渴,还有血肿.
■推拿和rTMS都对改善睡眠质量有显著作用,但rTMS的安全性较低。因此,推拿可以推荐作为改善睡眠质量的第一线治疗。如果患者的焦虑和抑郁症状明显,可根据实际情况选择MB或HBO进行治疗。改善睡眠质量的外治法可能与单胺类神经递质的调节有关,这可能是一种潜在的作用机制。
■https://www.crd.约克。AC.uk/PROSPERO/display_record。php?RecordID=440882。
UNASSIGNED: The annual incidence of insomnia continues to increase owing to changes in lifestyle habits, increased work pressure, and increased environmental pollution. In recent years, an increasing number of external therapies have been proven effective in treating insomnia and have been widely used. However, the relative benefits and harms of external therapies remain uncertain, and an optimal treatment strategy has not yet been determined.
UNASSIGNED: A network meta-analysis was performed to evaluate and compare the efficacy and safety of multiple external therapies for patients with insomnia.
UNASSIGNED: Eight electronic databases were comprehensively searched from their inception to June 2023 for relevant literature. We also searched the grey literature and reviewed the reference lists of related systematic reviews. Two independent reviewers performed the study selection, data extraction, and bias assessment of the included randomized controlled trials (RCTs) using the Cochrane Reviewers\' Handbook, and a network meta-analysis was conducted using Stata and RevMan software.
UNASSIGNED: In total, 14,826 studies were identified. Of these, 83 studies, including 9 external therapies and 6,100 patients, were deemed eligible for the present network meta-analysis. Except for the SL outcome, each external therapy was better than conventional medicine and the sham intervention (SI) in improving sleep quality. In terms of improving the psychological state indices of insomnia patients, each external therapy was superior to the SI; each external therapy had a better effect on the regulation of monoamine neurotransmitters. Tuina may be the most effective intervention in improving the total effective rate, Pittsburgh sleep quality index score, and SL. Repetitive transcranial magnetic stimulation (rTMS) perhaps resulted in the best improvement in total sleep time and awakening time (surface under the cumulative ranking curve [SUCRA] = 78.3 and 75.4%, respectively); and moxibustion (MB) and hyperbaric oxygen (HBO) were the most effective in reducing Self-rating Anxiety Scale and Self-rating Depression Scale scores. In terms of improving the monoamine neurotransmitters 5-hydroxytryptamine, norepinephrine, and dopamine, the best interventions were acupoint catgut embedding, electroacupuncture, and Tuina (SUCRA = 82.0, 69.9 and 90.3%, respectively). Safety results showed that the three safest interventions were the SI, Tuina, and foot bath. No serious adverse events were reported across the studies, and the most common minor adverse events included drowsiness, pain, excessive thirst, and hematoma.
UNASSIGNED: Both Tuina and rTMS have significant effects on improving sleep quality, but the safety of rTMS is low. Therefore, Tuina can be recommended as the first line of treatment to improve sleep quality. If a patient\'s anxiety and depression symptoms are evident, MB or HBO can be selected for treatment based on the actual situation. External therapy to improve sleep quality may be related to the regulation of monoamine neurotransmitters, which may be a potential mechanism of action.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=440882.