Effect of Electroacupuncture on Insomnia in Patients With Depression

匹兹堡睡眠质量指数 活动记录 医学 随机对照试验 原发性失眠 失眠症 萧条(经济学) 物理疗法 焦虑 评定量表 睡眠障碍 内科学 精神科 心理学 睡眠质量 经济 宏观经济学 发展心理学
作者
Xuan Yin,Wei Li,Tingting Liang,Bing Lu,Hongyu Yue,Shanshan Li,Victor Zhong,Wei Zhang,Xia Li,Shuang Zhou,Yiqun Mi,Huangan Wu,Shifen Xu
出处
期刊:JAMA network open [American Medical Association]
卷期号:5 (7): e2220563-e2220563 被引量:49
标识
DOI:10.1001/jamanetworkopen.2022.20563
摘要

Importance

Electroacupuncture (EA) is a widely recognized therapy for depression and sleep disorders in clinical practice, but its efficacy in the treatment of comorbid insomnia and depression remains uncertain.

Objective

To assess the efficacy and safety of EA as an alternative therapy in improving sleep quality and mental state for patients with insomnia and depression.

Design, Setting, and Participants

A 32-week patient- and assessor-blinded, randomized, sham-controlled clinical trial (8-week intervention plus 24-week observational follow-up) was conducted from September 1, 2016, to July 30, 2019, at 3 tertiary hospitals in Shanghai, China. Patients were randomized to receive EA treatment and standard care, sham acupuncture (SA) treatment and standard care, or standard care only as control. Patients were 18 to 70 years of age, had insomnia, and met the criteria for depression as classified in theDiagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Data were analyzed from May 4 to September 13, 2020.

Interventions

All patients in the 3 groups were provided with standard care guided by psychiatrists. Patients in the EA and SA groups received real or sham acupuncture treatment, 3 sessions per week for 8 weeks, for a total of 24 sessions.

Main Outcomes and Measures

The primary outcome was change in Pittsburgh Sleep Quality Index (PSQI) from baseline to week 8. Secondary outcomes included PSQI at 12, 20, and 32 weeks of follow-up; sleep parameters recorded in actigraphy; Insomnia Severity Index; 17-item Hamilton Depression Rating Scale score; and Self-rating Anxiety Scale score.

Results

Among the 270 patients (194 women [71.9%] and 76 men [28.1%]; mean [SD] age, 50.3 [14.2] years) included in the intention-to-treat analysis, 247 (91.5%) completed all outcome measurements at week 32, and 23 (8.5%) dropped out of the trial. The mean difference in PSQI from baseline to week 8 within the EA group was −6.2 (95% CI, −6.9 to −5.6). At week 8, the difference in PSQI score was −3.6 (95% CI, −4.4 to −2.8;P < .001) between the EA and SA groups and −5.1 (95% CI, −6.0 to −4.2;P < .001) between the EA and control groups. The efficacy of EA in treating insomnia was sustained during the 24-week postintervention follow-up. Significant improvement in the 17-item Hamilton Depression Rating Scale (−10.7 [95% CI, −11.8 to −9.7]), Insomnia Severity Index (−7.6 [95% CI, −8.5 to −6.7]), and Self-rating Anxiety Scale (−2.9 [95% CI, −4.1 to −1.7]) scores and the total sleep time recorded in the actigraphy (29.1 [95% CI, 21.5-36.7] minutes) was observed in the EA group during the 8-week intervention period (P< .001 for all). No between-group differences were found in the frequency of sleep awakenings. No serious adverse events were reported.

Conclusions and Relevance

In this randomized clinical trial of EA treatment for insomnia in patients with depression, quality of sleep improved significantly in the EA group compared with the SA or control group at week 8 and was sustained at week 32.

Trial Registration

ClinicalTrials.gov Identifier:NCT03122080
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