针灸缓解更年期相关的睡眠问题


  【24drs.com】根据一篇新的系统回顾与统合分析,针灸有助于缓解停经后妇女的睡眠问题。
  
  研究者写道,研究结果显示,针灸与改善更年期及停经后妇女的睡眠问题有实质关联。
  
  台湾台北医学大学附设医院睡眠科学中心、台北医学大学护理学院护理系邱晓彦博士等人在2月4日的妇产科期刊在线发表这项研究。
  
  该研究纳入以英文和中文发表的随机控制试验,包括比较针灸和无活性(例如:假的针灸)或有活性(例如:中草药和安眠药及荷尔蒙治疗)介入方式之对照组用于缓解停经相关睡眠问题的试验。他们定义的针灸包括:手工针灸、针压法、电针灸、雷射针灸和耳针。
  
  研究者共分析了34篇试验,包括2,433名被随机分组的患者、平均年龄51.1岁(范围44.1 - 63.0岁),大部份是以中国妇女为对象进行的研究,其中4篇专注在有乳癌的妇女,这些试验采纳这些妇女的睡眠改善报告,以确认治疗效果。
  
  作者们指出,最经常使用的穴位为脾脏6、心脏7和督脉,三阴交穴与女性生育力及生殖体内平衡有关。
  
  研究者将大多数试验分级为,在研究对象与研究人员双盲、选择性报告、不知情评估结果与隐蔽分配方面,偏见风险高或不清楚。
  
  相较于对照组,针灸和缓解睡眠问题有关,总合胜算比(OR)为0.21 (95%信赖区间[CI]为0.14 - 0.31;P < .001)。
  
  另外,针灸组研究对象的血清雌二醇值显著上升(汇整差异平均值为7.56 pg/mL;95% CI, 4.03 - 11.08;P < .001)。针灸也和滤泡刺激素值显著降低(汇整差异平均值为-6.75 milli-international units/mL;95% CI, -12.16 至-1.34; P = .02)以及促黄体激素显著降低(汇整差异平均值为 -2.71;95% CI, -4.22 至-1.20;P < .001)有关。
  
  在针灸引起血清雌二醇改变的大型研究中,睡眠问题机率(OR为0.07;P = .02)显著低于小型到中型研究(OR, 0.36;P = .02),研究者认为,针灸缓解停经相关睡眠问题的可能机转是血清雌二醇值增加。
  
  作者们解释,一篇停经妇女研究指出,产生雌二醇会因诱导外围皮肤血管扩张而对体温有影响(一种主要的热损失效应),因此降低核心体温,随后引发睡眠。
  
  作者们指出,在探讨选用三阴交穴的研究中,血清雌二醇值增加也比较多(OR, 10.51 vs 1.38;P < .001)。
  
  作者们结论指出,对于发生停经相关睡眠问题的妇女,除了当前的常规疗法(例如:荷尔蒙治疗),我们建议,针灸可作为改善睡眠的替代或补充疗法。有兴趣采用针灸治疗作为改善停经相关睡眠问题之传统治疗的替代疗法者,应与他们的针灸治疗师讨论,以三阴交穴作为刺激提升血清雌二醇值的首选穴位。
  
  资料来源:http://www.24drs.com/
  
  Native link:Acupuncture Relieves Menopause-Related Sleep Problems
  

Acupuncture Relieves Menopause-Related Sleep Problems

By Troy Brown, RN
Medscape Medical News

Acupuncture can help relieve sleep disturbances in perimenopausal and postmenopausal women, according to a new systematic review and meta-analysis.

"[T]he present findings show a substantial association of acupuncture with improved sleep disturbances in perimenopausal and postmenopausal women," the researchers write.

Hsiao-Yean Chiu, RN, PhD, from the School of Nursing, College of Nursing, Taipei Medical University, and the Sleep Science Center, Taipei Medical University Hospital, Taiwan, and colleagues present their findings in an article published online February 4 in Obstetrics & Gynecology.

The researchers included randomized controlled trials published in English and Chinese. The included trials compared acupuncture with control groups that received inactive (eg, sham acupuncture) or active (eg, Chinese herbs and hypnotics and hormone therapy) interventions for relief of menopause-related sleep disturbances. They defined acupuncture as manual acupuncture, acupressure, electroacupuncture, laser acupuncture, or auricular acupuncture.

The investigators analyzed 34 trials that included 2433 randomly assigned patients with a mean age of 51.1 years (range of means, 44.1 - 63.0 years). Most of the studies were of women in China, and four of the trials concentrated on women with breast cancer. The trials used the women's reports of sleep improvement to determine the efficacy of treatments.

The most frequently used acupoints were Spleen 6, Heart 7, and Governing Vessel. The Sanyinjiao acupoint is associated with female fertility and reproductive homeostasis, the authors note.

The researchers graded most of the trials as "high or unclear risk of bias in blinding of participants and personnel, selective reporting, blinding of outcome assessment, and concealed allocation."

Acupuncture was associated with relief of sleep disturbances, with a summary odds ratio (OR) of 0.21 (95% confidence interval [CI], 0.14 - 0.31; P < .001), compared with control treatments.

In addition, participants in the acupuncture groups experienced significant elevations of serum estradiol levels (pooled difference in means, 7.56 pg/mL; 95% CI, 4.03 - 11.08; P < .001). Acupuncture was also associated with significantly decreased levels of follicle-stimulating hormone (pooled difference in means, ?6.75 milli-international units/mL; 95% CI, ?12.16 to ?1.34; P = .02) and luteinizing hormone (pooled difference in means, ?2.71; 95% CI, ?4.22 to ?1.20; P < .001).

The odds of sleep disturbances were significantly lower in the studies with a large effect size of acupuncture-induced serum estradiol changes (OR, 0.07; P = .02) than in studies with small-to-moderate effect sizes (OR, 0.36; P = .02). The researchers suggest that increased serum estradiol levels might be a possible mechanism underlying the ability of acupuncture to relieve menopause-related sleep disturbances.

"A study on postmenopausal women indicated that estradiol production exerts thermoregulation effects by inducing peripheral skin vasodilatation (a major heat loss effector), thereby reducing the core body temperature and subsequently causing the onset of sleep," the authors explain.

Serum estradiol level elevations were also significantly larger in studies that selected the Sanyinjiao acupoint, the authors note (OR, 10.51 vs 1.38; P < .001).

"[W]e recommend that acupuncture should be adopted as an alternative or complementary therapy for improving sleep in addition to current conventional therapies (eg, [hormone therapy]) in women experiencing menopause-related sleep disturbances," the authors conclude. "Individuals who are interested in adopting acupuncture therapy as an alternative therapy to conventional treatments for improving menopause-related sleep disturbances should talk to their acupuncturists about the Sanyinjiao acupoint as the preferred acupoint to stimulate the secretion of serum estradiol levels."

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2016;127:507-515.

    
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