慢性疲劳综合征睡眠障碍特征及针刺干预评价研究
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摘要
目的：
探索慢性疲劳综合征(Chronic Fatigue Syndrome, CFS)睡眠障碍的主客观评价特征,并探讨针刺对CFS睡眠障碍的干预作用。
方法：
1.采用病例对照研究方法,以72例CFS患者和72例健康受试者为研究对象,多导睡眠图(Polysomnogram, PSG)参数为睡眠障碍的客观评价指标,清晨问卷、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index, PSQI)量表为主观评价指标,观察CFS睡眠障碍患者的睡眠特征。
2.采用随机、对照试验方法,通过计算机中央随机系统将符合纳入标准的72例CFS患者,按照2：1比例随机分为针刺组(A组)、安慰针刺组(B组)。采用不同的针具(德国进口针灸套针Streitberger Placebo-needle,A组采用针灸针,B组采用安慰针),不同的取穴方案(A组选用经穴肝俞、肾俞、足三里、神门,B组选用4个非经非穴点),两组受试者第一周接受5次治疗,第二周、第三周各接受3次治疗,第四周接受2次治疗,共治疗13次。入组0周、4周时以睡眠知觉(Sleep perception, SP)为主要结局指标,PSG睡眠参数、清晨问卷、PSQI量表为次要结局指标,观察针刺对CFS睡眠障碍的干预作用。
结果：
1.CFS睡眠障碍患者的睡眠特征：①两组受试者各项指标基线分析均无统计学意义(P>0.05),可比性良好。②客观评价方面,CFS患者和健康受试者总卧床时间、睡眠潜伏期、总睡眠时间、睡眠效率、NREM (Non-Rapid-Eye-Movement)睡眠各期百分比、REM (Rapid-Eye-Movement)睡眠期百分比差异均无统计学意义(P>0.05)。但CFS患者觉醒次数、觉醒时间有高于健康受试者的趋势,NREM睡眠3期百分比低于健康受试者的趋势。③主观评价方面,CFS患者和健康受试者睡眠潜伏期、总睡眠时间、觉醒次数、觉醒时间比较差异具有统计学意义(P<0.05)。两组受试者PSQI量表各项目评分及总分差异具有统计学意义(P<0.05)。④睡眠知觉方面：CFS患者和健康受试者睡眠知觉比较差异具有统计学意义(P<0.05)。
2.针刺对CFS睡眠障碍的干预作用：①针刺组(A组)与安慰针刺组(B组)各项指标基线分析均无统计学意义(P>0.05),可比性良好。②睡眠知觉方面：针刺组(A组)与安慰针刺组(B组)在睡眠知觉改善值方面差异具有统计学意义(P<0.05)。③客观评价方面：针刺组(A组)明显减少CFS患者觉醒次数(P<0.05)和降低觉醒时间的趋势。治疗后两组总卧床时间、睡眠潜伏期、总睡眠时间、睡眠效率、NREM睡眠各期百分比、REM期睡眠百分比、觉醒次数、觉醒时间差异没有统计学意义(P>0.05)。④主观评价方面：针刺组(A组)与安慰针刺组(B组)在改善主观总睡眠时间、睡眠潜伏期、睡眠质量方面差异具有统计学意义(P<0.05)。针剌组有改善主观觉醒次数、觉醒时间的趋势。
结论：
1.CFS患者存在睡眠知觉障碍。CFS患者客观睡眠结构没有特征性的改变,觉醒次数和觉醒时间有高于健康受试者的趋势,NREM睡眠3期百分比有低于健康受试者的趋势。CFS患者主观睡眠潜伏期、觉醒次数、觉醒时间较健康受试者延长,总睡眠时间较健康受试者减少,睡眠质量较健康受试者差,影响到患者的日间功能。
2.针刺对CFS睡眠知觉障碍改善作用明显优于安慰针刺。针刺对CFS患者睡眠客观评价参数的影响与安慰针刺相比无显著性差异,但针刺对客观觉醒次数、觉醒时间有改善的趋势。针刺对CFS患者主观总睡眠时间、睡眠潜伏期、睡眠质量改善作用明显优于安慰针刺。针刺有改善主观睡眠觉醒次数、觉醒时间的趋势。
Aim:
To explore the characteristics of objective sleep measures and subjective sleep evaluation, sleep quality between Chronic Fatigue Syndrome patients and healthy individuals. And to evaluate the efficacy of acupuncture for CFS sleep disorders.
Methods:
1. Case-controlled trials was designed. A total of72CFS patients and72healthy individuals were recruited in, Polysomnogram parameters was employed to evaluate the objective sleep, morning questionnaire and PSQI scores to evaluate subjective sleep.
2. The randomized controlled trials was carried out,72CFS was randomized divided into2groups followed the ration of2:1, named acupuncture (group A) group and placebo acupuncture (group B). According to different acupoints and acupuncture needles, four sessions of treatment were required in each group,5days in the first week,3days in the seconed and the third weeks, and2days in the forth week, totally13days in the whole period. The primary clinical curative effects of groups were assessed by sleep perception during the enrollment, after4sessions of treatment.The secondary clinical curative effects of groups were assessed by other sleep parameters from PSG, and PSQI scores for the sleep quality during the enrollment, after4sessions of treatment.
Results:
1. The characteristics of CFS sleep disorders represents as:
1)In objective sleep aspect, group CFS patients and healthy individuals group has no statistically difference in total sleep time, sleep latent, awakening number, awakening time, sleep efficiency (P>0.05). But CFS patients has a trend of increased awakening number, awakening time.
2) In subjective sleep aspect, the following outcomes of in group CFS patients and healthy individuals were statistically difference:total sleep time, sleep latent, awakening number, awakening time of morning questionnaire (P<0.05).
3) Group CFS patients was statistically different from group healthy individuals in PSQI scores and subscales (P<0.05).
4)Group CFS patients was statistically different from group healthy individuals in sleep perception (P<0.05).
2. The efficacy of acupuncture for CFS sleep disorders represents as:
1)Group A was statistically different from group B in sleep perception after treatment (P<0.05).
2)The objective sleep evaluation frome PSG showed no statistically difference between group A and group B after treatment (P>0.05). But there has a trend of Group A for reducing the awakening number and awakening time.
3)Group A was statistically different from group B in total sleep time, sleep latent, PSQI scores and subscales after treatment (P<0.05).
Conclusions:
1. CFS patient has a feature of sleep state misperception. The objective sleep architecture has no characteristic change. Compared with healthy individuals, CFS patients has prolonged sleep latent, awakening number, awakening time, and reduced total sleep time of morning questionnaire, CFS patients has poor sleep quality and daytime dysfunction.
2. Acupuncture is more efficacious than placebo acupuncture in relieving sleep state misperception. The objective sleep evaluation frome PSG showed no statistically difference between acupuncture and placebo acupuncture after treatment. But there has a improve trend of awakening number, awakening time. Acupuncture can improve the sleep qulity and total sleep time, reduce sleep latent, PSQI scores and subscales of CFS.
探索慢性疲劳综合征(Chronic Fatigue Syndrome, CFS)睡眠障碍的主客观评价特征,并探讨针刺对CFS睡眠障碍的干预作用。
方法：
1.采用病例对照研究方法,以72例CFS患者和72例健康受试者为研究对象,多导睡眠图(Polysomnogram, PSG)参数为睡眠障碍的客观评价指标,清晨问卷、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index, PSQI)量表为主观评价指标,观察CFS睡眠障碍患者的睡眠特征。
2.采用随机、对照试验方法,通过计算机中央随机系统将符合纳入标准的72例CFS患者,按照2：1比例随机分为针刺组(A组)、安慰针刺组(B组)。采用不同的针具(德国进口针灸套针Streitberger Placebo-needle,A组采用针灸针,B组采用安慰针),不同的取穴方案(A组选用经穴肝俞、肾俞、足三里、神门,B组选用4个非经非穴点),两组受试者第一周接受5次治疗,第二周、第三周各接受3次治疗,第四周接受2次治疗,共治疗13次。入组0周、4周时以睡眠知觉(Sleep perception, SP)为主要结局指标,PSG睡眠参数、清晨问卷、PSQI量表为次要结局指标,观察针刺对CFS睡眠障碍的干预作用。
结果：
1.CFS睡眠障碍患者的睡眠特征：①两组受试者各项指标基线分析均无统计学意义(P>0.05),可比性良好。②客观评价方面,CFS患者和健康受试者总卧床时间、睡眠潜伏期、总睡眠时间、睡眠效率、NREM (Non-Rapid-Eye-Movement)睡眠各期百分比、REM (Rapid-Eye-Movement)睡眠期百分比差异均无统计学意义(P>0.05)。但CFS患者觉醒次数、觉醒时间有高于健康受试者的趋势,NREM睡眠3期百分比低于健康受试者的趋势。③主观评价方面,CFS患者和健康受试者睡眠潜伏期、总睡眠时间、觉醒次数、觉醒时间比较差异具有统计学意义(P<0.05)。两组受试者PSQI量表各项目评分及总分差异具有统计学意义(P<0.05)。④睡眠知觉方面：CFS患者和健康受试者睡眠知觉比较差异具有统计学意义(P<0.05)。
2.针刺对CFS睡眠障碍的干预作用：①针刺组(A组)与安慰针刺组(B组)各项指标基线分析均无统计学意义(P>0.05),可比性良好。②睡眠知觉方面：针刺组(A组)与安慰针刺组(B组)在睡眠知觉改善值方面差异具有统计学意义(P<0.05)。③客观评价方面：针刺组(A组)明显减少CFS患者觉醒次数(P<0.05)和降低觉醒时间的趋势。治疗后两组总卧床时间、睡眠潜伏期、总睡眠时间、睡眠效率、NREM睡眠各期百分比、REM期睡眠百分比、觉醒次数、觉醒时间差异没有统计学意义(P>0.05)。④主观评价方面：针刺组(A组)与安慰针刺组(B组)在改善主观总睡眠时间、睡眠潜伏期、睡眠质量方面差异具有统计学意义(P<0.05)。针剌组有改善主观觉醒次数、觉醒时间的趋势。
结论：
1.CFS患者存在睡眠知觉障碍。CFS患者客观睡眠结构没有特征性的改变,觉醒次数和觉醒时间有高于健康受试者的趋势,NREM睡眠3期百分比有低于健康受试者的趋势。CFS患者主观睡眠潜伏期、觉醒次数、觉醒时间较健康受试者延长,总睡眠时间较健康受试者减少,睡眠质量较健康受试者差,影响到患者的日间功能。
2.针刺对CFS睡眠知觉障碍改善作用明显优于安慰针刺。针刺对CFS患者睡眠客观评价参数的影响与安慰针刺相比无显著性差异,但针刺对客观觉醒次数、觉醒时间有改善的趋势。针刺对CFS患者主观总睡眠时间、睡眠潜伏期、睡眠质量改善作用明显优于安慰针刺。针刺有改善主观睡眠觉醒次数、觉醒时间的趋势。
Aim:
To explore the characteristics of objective sleep measures and subjective sleep evaluation, sleep quality between Chronic Fatigue Syndrome patients and healthy individuals. And to evaluate the efficacy of acupuncture for CFS sleep disorders.
Methods:
1. Case-controlled trials was designed. A total of72CFS patients and72healthy individuals were recruited in, Polysomnogram parameters was employed to evaluate the objective sleep, morning questionnaire and PSQI scores to evaluate subjective sleep.
2. The randomized controlled trials was carried out,72CFS was randomized divided into2groups followed the ration of2:1, named acupuncture (group A) group and placebo acupuncture (group B). According to different acupoints and acupuncture needles, four sessions of treatment were required in each group,5days in the first week,3days in the seconed and the third weeks, and2days in the forth week, totally13days in the whole period. The primary clinical curative effects of groups were assessed by sleep perception during the enrollment, after4sessions of treatment.The secondary clinical curative effects of groups were assessed by other sleep parameters from PSG, and PSQI scores for the sleep quality during the enrollment, after4sessions of treatment.
Results:
1. The characteristics of CFS sleep disorders represents as:
1)In objective sleep aspect, group CFS patients and healthy individuals group has no statistically difference in total sleep time, sleep latent, awakening number, awakening time, sleep efficiency (P>0.05). But CFS patients has a trend of increased awakening number, awakening time.
2) In subjective sleep aspect, the following outcomes of in group CFS patients and healthy individuals were statistically difference:total sleep time, sleep latent, awakening number, awakening time of morning questionnaire (P<0.05).
3) Group CFS patients was statistically different from group healthy individuals in PSQI scores and subscales (P<0.05).
4)Group CFS patients was statistically different from group healthy individuals in sleep perception (P<0.05).
2. The efficacy of acupuncture for CFS sleep disorders represents as:
1)Group A was statistically different from group B in sleep perception after treatment (P<0.05).
2)The objective sleep evaluation frome PSG showed no statistically difference between group A and group B after treatment (P>0.05). But there has a trend of Group A for reducing the awakening number and awakening time.
3)Group A was statistically different from group B in total sleep time, sleep latent, PSQI scores and subscales after treatment (P<0.05).
Conclusions:
1. CFS patient has a feature of sleep state misperception. The objective sleep architecture has no characteristic change. Compared with healthy individuals, CFS patients has prolonged sleep latent, awakening number, awakening time, and reduced total sleep time of morning questionnaire, CFS patients has poor sleep quality and daytime dysfunction.
2. Acupuncture is more efficacious than placebo acupuncture in relieving sleep state misperception. The objective sleep evaluation frome PSG showed no statistically difference between acupuncture and placebo acupuncture after treatment. But there has a improve trend of awakening number, awakening time. Acupuncture can improve the sleep qulity and total sleep time, reduce sleep latent, PSQI scores and subscales of CFS.
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