針灸緩解更年期相關的睡眠問題


  【24drs.com】根據一篇新的系統回顧與統合分析,針灸有助於緩解停經後婦女的睡眠問題。
  
  研究者寫道,研究結果顯示,針灸與改善更年期及停經後婦女的睡眠問題有實質關聯。
  
  台灣台北醫學大學附設醫院睡眠科學中心、台北醫學大學護理學院護理系邱曉彥博士等人在2月4日的婦產科期刊線上發表這項研究。
  
  該研究納入以英文和中文發表的隨機控制試驗,包括比較針灸和無活性(例如:假的針灸)或有活性(例如:中草藥和安眠藥及荷爾蒙治療)介入方式之對照組用於緩解停經相關睡眠問題的試驗。他們定義的針灸包括:手工針灸、針壓法、電針灸、雷射針灸和耳針。
  
  研究者共分析了34篇試驗,包括2,433名被隨機分組的患者、平均年齡51.1歲(範圍44.1 - 63.0歲),大部份是以中國婦女為對象進行的研究,其中4篇專注在有乳癌的婦女,這些試驗採納這些婦女的睡眠改善報告,以確認治療效果。
  
  作者們指出,最經常使用的穴位為脾臟6、心臟7和督脈,三陰交穴與女性生育力及生殖體內平衡有關。
  
  研究者將大多數試驗分級為,在研究對象與研究人員雙盲、選擇性報告、不知情評估結果與隱蔽分配方面,偏見風險高或不清楚。
  
  相較於對照組,針灸和緩解睡眠問題有關,總合勝算比(OR)為0.21 (95%信賴區間[CI]為0.14 - 0.31;P < .001)。
  
  另外,針灸組研究對象的血清雌二醇值顯著上升(彙整差異平均值為7.56 pg/mL;95% CI, 4.03 - 11.08;P < .001)。針灸也和濾泡刺激素值顯著降低(彙整差異平均值為-6.75 milli-international units/mL;95% CI, -12.16 至-1.34; P = .02)以及促黃體激素顯著降低(彙整差異平均值為 -2.71;95% CI, -4.22 至-1.20;P < .001)有關。
  
  在針灸引起血清雌二醇改變的大型研究中,睡眠問題機率(OR為0.07;P = .02)顯著低於小型到中型研究(OR, 0.36;P = .02),研究者認為,針灸緩解停經相關睡眠問題的可能機轉是血清雌二醇值增加。
  
  作者們解釋,一篇停經婦女研究指出,產生雌二醇會因誘導週邊皮膚血管擴張而對體溫有影響(一種主要的熱損失效應),因此降低核心體溫,隨後引發睡眠。
  
  作者們指出,在探討選用三陰交穴的研究中,血清雌二醇值增加也比較多(OR, 10.51 vs 1.38;P < .001)。
  
  作者們結論指出,對於發生停經相關睡眠問題的婦女,除了當前的常規療法(例如:荷爾蒙治療),我們建議,針灸可作為改善睡眠的替代或補充療法。有興趣採用針灸治療作為改善停經相關睡眠問題之傳統治療的替代療法者,應與他們的針灸治療師討論,以三陰交穴作為刺激提升血清雌二醇值的首選穴位。
  
  資料來源: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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