Electroacupuncture for Residual Insomnia Associate.docx
- 文档编号:26730919
- 上传时间:2023-06-22
- 格式:DOCX
- 页数:18
- 大小:73.31KB
Electroacupuncture for Residual Insomnia Associate.docx
《Electroacupuncture for Residual Insomnia Associate.docx》由会员分享,可在线阅读,更多相关《Electroacupuncture for Residual Insomnia Associate.docx(18页珍藏版)》请在冰豆网上搜索。
ElectroacupunctureforResidualInsomniaAssociate
ElectroacupunctureforResidualInsomniaAssociatedwithMajorDepressiveDisorder:
ARandomizedControlledTrial
Abstract
StudyObjectives:
Toevaluatetheefficacyandsafetyofelectroacupunctureasanadditionaltreatmentforresidualinsomniaassociatedwithmajordepressivedisorder(MDD).
Design:
Randomized,placebo-controlled.
Setting:
Apsychiatricoutpatientclinic.
Participants:
78ChinesepatientswithDSM-IV-diagnosedMDD,insomniacomplaint,aHamiltonRatingScaleforDepression(HDRS17)score≤18,andfixedantidepressantdosage.
Intervention:
Electroacupuncture,minimalacupuncture(superficialneedlingatnon-acupuncturepoints),ornoninvasiveplaceboacupuncture3sessionsweeklyfor3weeks.
MeasurementsandResults:
InsomniaSeverityIndex(ISI),PittsburghSleepQualityIndex(PSQI),HDRS17,1weeksleepdiaries,and3dayactigraphywereadministeredatbaseline,1weekpost-treatment,and4weekpost-treatment.TherewassignificantgroupbytimeinteractioninISI,PSQI,andsleepdiary-derivedsleepefficiency(mixed-effectsmodels,P=0.04,P=0.03,andP=0.01,respectively).PosthocpairwisecomparisonsrevealedthatelectroacupunctureandminimalacupunctureweremoreefficaciousthanplaceboacupunctureinISIandPSQIat1weekand4weekpost-treatment.Minimalacupunctureresultedingreaterimprovementinsleepdiary-derivedsleepefficiencythanplaceboacupunctureat1weekpost-treatment.Therewasnosignificantbetween-groupdifferenceinactigraphymeasures,depressivesymptoms,dailyfunctioning,andhypnoticconsumption,andnodifferenceinanymeasuresbetweenelectroacupunctureandminimalacupuncture.
Conclusion:
Comparedwithplaceboacupuncture,electroacupunctureandminimalacupunctureresultedingreaterimprovementinsubjectivesleepmeasuresat1weekand4weekpost-treatment.Nosignificantdifferencewasfoundbetweenelectroacupunctureandminimalacupuncture,suggestingthattheobserveddifferencescouldbeduetononspecificeffectsofneedling,regardlessofwhetheritisdoneaccordingtotraditionalChinesemedicinetheory.
ClinicalTrialInformation:
AcupunctureforResidualInsomniaAssociatedwithMajorDepressiveDisorder;Registration#NCT00838994;URL-http:
//clinicaltrials.gov/ct2/show/NCT00838994?
term=NCT00838994&rank=1
Citation:
YeungWF;ChungKF;TsoKC;ZhangSP;ZhangZJ;HoLM.Electroacupunctureforresidualinsomniaassociatedwithmajordepressivedisorder:
arandomizedcontrolledtrial.SLEEP2011;34(6):
807-815.
Keywords:
Acupuncture,electroacupuncture,insomnia,residualinsomnia,majordepressivedisorder,randomizedcontrolledtrial
Goto:
INTRODUCTION
Majordepressivedisorder(MDD)isoneofthemostcommonanddisablingmentalhealthproblems.1AlthougheffectivepharmacologicalandpsychologicaltreatmentsforMDDareavailable,asizableproportionarepartiallyrespondedtotreatmentandleftwithresidualdepressivesymptoms.2Insomniaisoneofthemostcommonandclinicallyimportantresidualsymptoms.Nierenbergetal.3foundahighresidualinsomniarate(44%)amongpatientswhoshowedremissionofotherMDDsymptomsafterfluoxetine20mgfor8weeks.InaSTAR*Dreportof943depressionremittersaftertreatmentwithcitalopram,themostcommonresidualsymptomdomainwassleepdisturbance(72%),followedbyappetiteandweightdisturbance(36%).4Carneyetal.5foundthattherateofresidualinsomniaafterpharmacotherapyandcognitivebehavioraltherapywas53%and50%,respectively,suggestingthatdrugsideeffectscouldnotaccountforalltheresidualinsomniasymptoms.Thereareanumberoflongitudinalstudiesshowingthatresidualinsomniahindersresponsetotreatmentandconfersanincreasedriskfordepressionrelapse.6,7
Severalreportshaveshownthataugmentingantidepressantswithshort-actingbenzodiazepines,non-benzodiazepinehypnotics,orcognitive-behavioraltherapyforinsomniacanalleviatebothdepressionandinsomniainpatientswithcomorbidMDDandinsomnia.8–10Therehavebeenlimitedstudiesonthetreatmentofresidualinsomniaafterremissionorpartialresponseofdepression.Asnisetal.11showedthatcomparedwithplacebogroup,depressedpatientswithpersistentinsomniawhoreceivedzolpidemhadsignificantlybettersleepanddaytimefunctioning.InarandomizedcontrolledtrialofMDDpatientstreatedwithfluoxetineorbupropion,theneithertrazodoneorplacebo,trazodoneaugmentationwasassociatedwithsignificantimprovementinanumberofsleepparameterscomparedwithplacebo.12
Althoughpharmacologictreatmentorcognitive-behavioraltherapywillalleviateresidualinsomniaassociatedwithMDD,pharmacotherapiesareassociatedwithdependence,potentialabuse,andadverseeffects,13andcognitive-behavioraltherapyhasremainedunderutilizedbecauseofthetime-intensivenature,requirementofsignificanttraining,andethnoculturalissues.14,15Facedwiththelimitationsofthecurrentlyavailabletreatments,wehaveconductedthefirstrandomizedcontrolledtrialofelectroacupunctureasanadditionaltreatmentforresidualinsomniaassociatedwithMDD.Therehavebeencontroversiesaboutthephysiologicalmechanismsofacupuncture,andhencethemethodofneedlingpractices,optimalmodeofstimulationandselectionofacupuncturepoints.16Inthepresentstudy,wecomparedtheefficacyofelectroacupuncture,minimalacupunctureandplaceboacupunctureforresidualinsomniainMDDpatientsafterremissionorpartialresponsewithastabledosageofantidepressants.
Goto:
METHODS
StudyDesign
Thisisarandomized,single-blinded,parallel-groupstudydesignedtoexaminetheshort-termeffectsofacupuncture.Majorassessmentswereatbaseline,1weekpost-treatment,and4weekpost-treatment.WefollowedtheCONSORTandSTRICTArecommendationsindesigningandreportingofcontrolledtrials.17,18
Subjects
ThestudywasconductedattheoutpatientclinicoftheDepartmentofPsychiatryatQueenMaryHospital,aregionalteachinghospitalinHongKong.SubjectswererecruitedfromDecember2007toApril2009throughreferralsfrompsychiatristsandadvertisementattheclinic.Theinclusioncriteriawere:
(1)ethnicChinese;
(2)age18to65years;(3)chiefcomplaintofinsomnia;(4)previousdiagnosisofMDDbasedontheDSM-IVcriteria,asassessedbyaclinician;(5)17itemHamiltonRatingScaleforDepression(HDRS17)score≤18atscreeningandbaseline;and(6)takingthesameantidepressantsatafixeddosefor12weekspriortobaseline.PreviousstudiesofresidualinsomniaassociatedwithMDDhaveexaminedpatientswithvariouslevelsofdepressionseverity.3–7,11,12Weaimedtoobtainabroadergroupofdepressedpatientswithinsomniacomplaint,hencehadusedawiderrangeofHDRS17score.
Subjectswereexcludedifthey:
(1)hadanysymptomssuggestiveofspecificsleepdisorders,asassessedbyInsomniaInterviewSchedule,asemi-structuredface-to-faceinterview19;
(2)hadasignificantriskofsuicide;(3)hadpreviousdiagnosisofschizophrenia,otherpsychoticdisorders,bipolardisorder,oralcoholorsubstanceusedisorder;(4)werepregnant,breast-feeding,orawomanofchildbearingpotentialnotusingadequatecontraception;(5)hadvalvularheartdefectsorbleedingdisordersorweretakinganticoagulantdrugs;(6)hadinfectionorabscessclosetothesiteofselectedacupoints;(7)hadanyseriousphysicalillness;or(8)weretakingChineseherbalmedicineorover-the-counterdrugsintendedforinsomnia.Additionalexclusioncriterionwasanapnea-hypopneaindex≥10oraperiodiclimbmovementdisorderindexwitharousal≥15,asassessedbyovernightpolysomnographyinasubgroupofparticipantswhoconsentedtotheinvestigation.Nosubjectswerepaidforparticipation.However,theacupuncturetreatment,whichcostsUS$20-30persessioninHongKong,wasprovidedfreeofcharge.
StudyProcedure
Allproceduresusedinthepresentstudywerereviewedandapprovedbythelocalinstitutionalreviewboard.Subjectsshowinganinterestinparticipatinginthestudywereinitiallyassessedviatelephone.Aftergivenwritteninformedconsent,potentialsubjectsparticipatedinacomprehensiveface-to-faceinterviewtoprovideamoredetailedhistory.Laboratory-basedovernightpolysomnography(Alice4DiagnosticsSystem,Respironics,Atlanta,GA)wasarrangedtoruleoutspecificsleepdisordersin45participantswhoconsentedtotheinvestigation.Electroencephalography(C3/A2andC4/A1),electrooculography,andsubmentalandbilateralanteriortibialiselectromyographywererecordedusingsurfaceelectrodes.Airflowwasmeasuredbythermistors,respiratorymovementsbyimpedanceplethysmography,andarterialoxygensaturationbypulseoximetry.Theelectrocardiogramwasalsoassessed.SleepvariableswereanalyzedaccordingtothestandardRechtschaffenandKalescriteria20byaregisteredpolysomnographictechnologist.
Thesubjectscompleteda1weeksleepdiaryanda3dayactigraphyrecordingintheweekpriortoascheduledbaselinevisit.Atthebaselinevisit,thesubjectsreturnedthecompletedsleeprecords,filledoutasetofself-reportedquestionnaires,andwereassessedusingtheHDRS17.Eligiblesubjectswerethenrandomlyassignedtoelectroacupuncture,minimalacupuncture,orplaceboacupunctureinaratioof1:
1:
1byanindependentadministratorusingacomputer-generatedlistofnumbers21withablocksizeof6andreceivedtheirfirsttreatmentonthesameday.At1weekand4weekpost-treatmentvisits,thesubjectsreturnedthe1weeksleepdiaryand3dayactigraphrecordingforthepreviousweekandcompletedthesameassessments.
Thesubjectswereexplainedthatinthisstudy,differenttypesofacupuncturewouldbecom
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- Electroacupuncture for Residual Insomnia Associate
![提示](https://static.bdocx.com/images/bang_tan.gif)
链接地址:https://www.bdocx.com/doc/26730919.html