耳压疗法治疗阻塞型睡眠呼吸暂停综合征的临床研究
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摘要
优质的睡眠质量不但可以让生理与心理能得到充分的休息与调适,进而会提升生活质量和学习与工作效率,以创造和谐的家庭及社会关系和公司绩效,甚至可以减少交通或工安意外所造成的公共安全问题,因此关于睡眠的研究是一项值得注意的议题。而在睡眠的相关的疾病中,以睡眠呼吸暂停综合征最为困扰着人们的生活,根据调查,在台湾估计有超过四十万人患有这项疾病,其中阻塞型睡眠呼吸暂停综合征与许多疾病互为因果关系,例如心血管疾病与肥胖等代谢性疾病。西方主流医学在治疗方面包括了保守治疗、连续气道正压呼吸器(CPAP)治疗、口内装置治疗,以及手术,中医则以中药及针灸治疗为主,但是针刺有人害怕,服用中药更有人嫌苦,因此无创的「耳穴治疗」可说是中医的第三条思路。
1研究目的：
1.1研究耳压治疗阻塞型睡眠呼吸暂停综合征的临床疗效。
1.2研究阻塞型睡眠呼吸暂停综合征在中医体质证型之分类统计。
1.3研究耳穴贴压治疗阻塞型睡眠呼吸暂停综合征对睡眠呼吸、睡眠质量及睡眠效率的影响。
2研究方法：
本研究通过前瞻性随机对照试验,将2010年11月～2012年4月就诊于台湾彰滨秀传医院睡眠中心符合诊断标准和纳入标准的合格受试对象60例,随机分为耳穴磁珠贴压组30人(治疗组)、耳穴胶布贴压组30人(对照组)。两组耳穴取穴相同,治疗组给予耳穴磁珠贴压治疗,对照组给予胶布贴于耳穴并指压之。两组均每周贴敷1次,两次为1个疗程。治疗前两组均填写嗜睡量表、阿森斯失眠量表、匹兹堡睡眠品质量表、打鼾问卷、倦怠评量表及医院焦虑与忧郁量表,并进行中医体质的评估；治疗前后监测PSG睡眠监测参数的变化,包括呼吸紊乱指数(AHI)、打鼾指数、最低血氧饱和度(LSaO2).氧降指数(Denaturation Index)、治疗前后的4期睡眠时间比率(S1、S2、S3、S4)快速动眼期比率(REM%)、全部入眠时间(TST)、睡眠效率(Sleeping Effieciency)、总觉醒次数(Total Arousal)、与周期性肢动指数(PLM)等指标。试验结束后对本病中医体质辨证及改善睡眠的疗效进行评估。
3结果：
3.1一般资料
治疗组和对照组在年龄、治疗前BMI、性别构成、运动状况、抽烟状况及喝酒状况方面比较,均无统计学差异(P>0.05)。两组具有可比性。
3.2阻塞型睡眠呼吸暂停综合征的中医体质辨证
研究发现阻塞型睡眠呼吸暂停综合征病患大多不具单纯一种体质,多为兼夹数种体质,其中具有气虚体质和痰湿体质的各占65%,具有血瘀体质的占38%、气郁体质的占33%、阴虚体质的占38%、湿热体质的占40%。
3.3耳穴治疗对阻塞型睡眠呼吸暂停综合征患者睡眠的改善治疗前两组的AHI、打鼾次数、打鼾指数、LSaO2比较,差异均无统计学意义(P>0.05)。
治疗组AHI治疗前后比较,差异具有显着的统计学意义(P<0.01)；对照组AHI治疗前后比较,差异具有统计学意义(P<0.05)；两组治疗后AHI降低程度的比较,差异具有显着的统计学意义(P<0.01)。
治疗组打鼾次数及打鼾指数治疗前后比较,差异均具有显着的统计学意义(P<0.01)；对照组打鼾次数治疗前后比较,差异均具有显着的统计学意义(P<0.01)；两组治疗后打鼾次数降低程度的比较,差异均具有显着的统计学意义(P<0.01)。
治疗组LSaO：治疗前后比较,差异无统计学意义(P>0.05)；对照组LSaO。治疗前后比较,差异无统计学意义(P>0.05)；两组治疗后LSaO2改善情况的比较,差异无统计学意义(P>0.05)。然而,治疗前两组氧降指数比较,差异无统计学意义(P>0.05)；治疗组和对照组的氧降指数治疗前后比较,差异均具有显着的统计学意义(P0.05)
两组治疗前各睡眠结构参数(四期睡眠时间比率、快速动眼期比率)的差异均无统计学意义(P>0.05)。
治疗组S1治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组S1治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后S1降低的比较,差异无统计学意义(P>0.05)
治疗组S2、S3、S4治疗前后比较,差异无统计学意义(P>0.05)；对照组S2、S3、S4治疗前后比较,差异无统计学意义(P>0.05)；两组治疗后S2、S3、S4改变的比较,差异无统计学意义(P>0.05)
治疗组REM%治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组REM%治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后REM%提高情况的比较,差异具有显着性统计学意义(P<0.01)。
治疗前两组全部入眠时间(TST)、睡眠效率(SE)、总觉醒时间(Total Arousal)、周期性肢动指数(PLM)比较,差异无统计学意义(P>0.05)。
治疗组TST治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组TST治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后TST改变的比较,差异具有显着性统计学意义(P<0.01)。
治疗组SE治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组SE治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后SE改变的比较,差异无统计学意义(P>0.05)
治疗组Total Arousal治疗前后比较,差异具有统计学意义(P<0.05)；对照组Total Arousal治疗前后比较,差异具有统计学意义(P<0.05)：两组治疗后Total Arousal改变的比较,差异无统计学意义(P>0.05)
治疗组PLM治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组PLM治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后PLM改变的比较,差异无统计学意义(P>0.05)
4结论：
4.1阻塞型睡眠呼吸暂停综合征患者的体质类型主要为气虚体质和痰湿体质；
4.2耳穴贴压治疗能有效改善阻塞型睡眠呼吸暂停综合征的呼吸、睡眠质量及睡眠效率。
Good quality of sleep not only comforts human body physiologically and psychologically but also increases life quality and learning and working efficiency. Besides, it further creates harmonious family and social relationship and corporative performance. Moreover, it could decrease the public security problems caused by traffic and industrial accidence. Therefore, sleep related studies worth being concerned. Among the sleep related diseases, sleep apnea syndrome annoys people mostly. According to a survey, it is estimated to have over four hundred thousand people caught by this disease. Among them, obstructive sleep apnea syndrome has causal relationships with many diseases, such as CVA disease and obesity related metabolic diseases. The treatment methods in western medicine include conservative treatment, CPAP, oral device, and surgery. In TCM, Chinese herbal medicine and acupuncture treatment are the mainstream, but some people are afraid of acupuncture, some people detest bitterness of taking herbal medicine. Therefore, auricular points treatment might be the third train of thought in TCM.
1. Object ive
1.1The research is to study the clinical effect of the auricular therapy on the Obstructive Sleep Apnea Syndrome.
1.2It is also to find out the constitution of TCM syndrome classification statistics of the OSA patients.
1.3The research also study how this treatment affect the Sleep and Respiratory System, sleep quality and sleep efficiency.
2. Methods
The prospective randomized controlled study chose60cases from Taiwan Chang foreshore show Chwan Hospital Sleep Center during December2010to April2012, which were in accordance with the diagnostic and indrawing standards, to be the subjects of the study. The patients were randomly divided into2groups, with30cases in the treatment group treated with auricular point sticking and pressing bead and30cases in the control group treated with auricular point sticking plaster pressure. The two groups were treated with same auricular point, once a week. With two weeks a course, both groups received one course in total. Before treatment two groups were filled in sleepiness scale, Athens' insomnia scale, Pittsburgh sleep quality index, snoring, Burnout Fatigue Severity Scale and the Hospital Anxiety and Depression Scale, and traditional Chinese medicine constitution assessment; before and after treatment monitoring of PSG sleep monitoring parameters, Including the respiratory disturbance index (AHI), snoring index, the lowest oxygen saturation (LSaO2), mean oxygen saturation decreased index (Denaturation Index), before and after treatment of stage4sleep time ratio (S1, S2, S3, S4), a rapid eye movement stage ratio (REM%), total sleep time, sleep efficiency (TST)(Sleeping Effieciency), the total number of awakening (Total Arousal), and periodic limb movement index (PLM) and other indicators. After the test we have an assessment of the disease in traditional Chinese medicine constitution differentiation and improving sleep effect.
3.Results
3.1Physical Datas
There were no significant differences in the age, BMI before the treatment, gender, exercise, smoking and drinking status were not statistically different (P>0.05). The two groups were comparable.
3.2Obstructive sleep apnea syndrome differentiation of traditional Chinese Medicine physique
The study find that the obstructive sleep apnea syndrome patients are more likely with a composite constitution, for several physical and clamp, which has the constitution of qi deficiency and phlegm dampness constitution each accounted for65%, with blood stasis constitution accounted for38%, qi stagnation constitution accounted for33%, accounting for38%of yin deficiency constitution, damp heat constitution accounted for40%.
3.3The sleep improvement of OSAS patients with auricular therapy
In two groups before treatment, the number of AHI snoring, snoring index, LSaO2comparison, there were no significant differences between them (P>0.05). Comparing the AHI before and after treatment, significant differences could be seen in both groups (P<0.01in treatment group, P<0.05in control group), comparison of AHI reduction of two groups after treatment has statistical significance (P<0.01).
Comparing the number of snoring and the snoring index before and after treatment, significant differences could be seen in both groups (P <0.01), comparison of the number of snoring and the snoring index reduction of two groups after treatment have statistical significance (P<0.01).
LSaO2in both groups before and after treatment, the difference were not statistically significant (P>0.05), the LSaO2improvemen t after treatment between two groups was not statistically significa nt (P>0.05).
The sleep structure parameters (stage4sleep time ratio, REM ra tio) in two groups were not statistically significant (P>0.05). Com paring the S1before and after treatment, significant differences co uld be seen in both groups (P<0.01). Comparison of S1reduction of two groups after treatment has no statistical significance (P>0.05).
Comparing the S2, S3, S4before and after treatment, no signific ant differences could be seen in both groups (P>0.05). Comparison o f S2, S3, S4change of two groups after treatment have no statistica1significance (P>0.05).
But in the contrast of REM%before and after treatment, there were significant differece in both groups (P<0.01). And there was significant differece in the REM%improvement (P<0.01)
There were no significant differences in the total sleep time (TST), and sleep efficiency (SE), total wake time (Total Arousal), periodic limb movement index (PLM) in both groups before treatment (P>0.05).
Comparing the TST before and after treatment, significant differences could be seen in both groups (P<0.01). Comparison of TST change in two groups after treatment has statistical significance (P<0.01).
Comparing the SE before and after treatment, significant differences could be seen in both groups (P<0.01). Comparison of SE change in two groups after treatment has no statistical significance (P>0.05).
Comparing the Total Arousal before and after treatment, significant differences could be seen in both groups (P<0.05). Comparison of Total Arousal change intwo groups after treatment has no statistical significance (P>0.05).
Comparing the PLM before and after treatment, significant differences could be seen in both groups (P<0.01). Comparison of PLM change in two groups after treatment has no statistical significance (P>0.05).
4. Conclusion
4.1In patients with obstructive sleep apnea syndrome constitution types are mainly QI deficiency and phlegm dampness constitution;
4.2Auricular therapy can effectively improve obstructive sleep apnoea breathing, sleep quality and sleep efficiency.
1研究目的：
1.1研究耳压治疗阻塞型睡眠呼吸暂停综合征的临床疗效。
1.2研究阻塞型睡眠呼吸暂停综合征在中医体质证型之分类统计。
1.3研究耳穴贴压治疗阻塞型睡眠呼吸暂停综合征对睡眠呼吸、睡眠质量及睡眠效率的影响。
2研究方法：
本研究通过前瞻性随机对照试验,将2010年11月～2012年4月就诊于台湾彰滨秀传医院睡眠中心符合诊断标准和纳入标准的合格受试对象60例,随机分为耳穴磁珠贴压组30人(治疗组)、耳穴胶布贴压组30人(对照组)。两组耳穴取穴相同,治疗组给予耳穴磁珠贴压治疗,对照组给予胶布贴于耳穴并指压之。两组均每周贴敷1次,两次为1个疗程。治疗前两组均填写嗜睡量表、阿森斯失眠量表、匹兹堡睡眠品质量表、打鼾问卷、倦怠评量表及医院焦虑与忧郁量表,并进行中医体质的评估；治疗前后监测PSG睡眠监测参数的变化,包括呼吸紊乱指数(AHI)、打鼾指数、最低血氧饱和度(LSaO2).氧降指数(Denaturation Index)、治疗前后的4期睡眠时间比率(S1、S2、S3、S4)快速动眼期比率(REM%)、全部入眠时间(TST)、睡眠效率(Sleeping Effieciency)、总觉醒次数(Total Arousal)、与周期性肢动指数(PLM)等指标。试验结束后对本病中医体质辨证及改善睡眠的疗效进行评估。
3结果：
3.1一般资料
治疗组和对照组在年龄、治疗前BMI、性别构成、运动状况、抽烟状况及喝酒状况方面比较,均无统计学差异(P>0.05)。两组具有可比性。
3.2阻塞型睡眠呼吸暂停综合征的中医体质辨证
研究发现阻塞型睡眠呼吸暂停综合征病患大多不具单纯一种体质,多为兼夹数种体质,其中具有气虚体质和痰湿体质的各占65%,具有血瘀体质的占38%、气郁体质的占33%、阴虚体质的占38%、湿热体质的占40%。
3.3耳穴治疗对阻塞型睡眠呼吸暂停综合征患者睡眠的改善治疗前两组的AHI、打鼾次数、打鼾指数、LSaO2比较,差异均无统计学意义(P>0.05)。
治疗组AHI治疗前后比较,差异具有显着的统计学意义(P<0.01)；对照组AHI治疗前后比较,差异具有统计学意义(P<0.05)；两组治疗后AHI降低程度的比较,差异具有显着的统计学意义(P<0.01)。
治疗组打鼾次数及打鼾指数治疗前后比较,差异均具有显着的统计学意义(P<0.01)；对照组打鼾次数治疗前后比较,差异均具有显着的统计学意义(P<0.01)；两组治疗后打鼾次数降低程度的比较,差异均具有显着的统计学意义(P<0.01)。
治疗组LSaO：治疗前后比较,差异无统计学意义(P>0.05)；对照组LSaO。治疗前后比较,差异无统计学意义(P>0.05)；两组治疗后LSaO2改善情况的比较,差异无统计学意义(P>0.05)。然而,治疗前两组氧降指数比较,差异无统计学意义(P>0.05)；治疗组和对照组的氧降指数治疗前后比较,差异均具有显着的统计学意义(P
两组治疗前各睡眠结构参数(四期睡眠时间比率、快速动眼期比率)的差异均无统计学意义(P>0.05)。
治疗组S1治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组S1治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后S1降低的比较,差异无统计学意义(P>0.05)
治疗组S2、S3、S4治疗前后比较,差异无统计学意义(P>0.05)；对照组S2、S3、S4治疗前后比较,差异无统计学意义(P>0.05)；两组治疗后S2、S3、S4改变的比较,差异无统计学意义(P>0.05)
治疗组REM%治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组REM%治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后REM%提高情况的比较,差异具有显着性统计学意义(P<0.01)。
治疗前两组全部入眠时间(TST)、睡眠效率(SE)、总觉醒时间(Total Arousal)、周期性肢动指数(PLM)比较,差异无统计学意义(P>0.05)。
治疗组TST治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组TST治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后TST改变的比较,差异具有显着性统计学意义(P<0.01)。
治疗组SE治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组SE治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后SE改变的比较,差异无统计学意义(P>0.05)
治疗组Total Arousal治疗前后比较,差异具有统计学意义(P<0.05)；对照组Total Arousal治疗前后比较,差异具有统计学意义(P<0.05)：两组治疗后Total Arousal改变的比较,差异无统计学意义(P>0.05)
治疗组PLM治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组PLM治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后PLM改变的比较,差异无统计学意义(P>0.05)
4结论：
4.1阻塞型睡眠呼吸暂停综合征患者的体质类型主要为气虚体质和痰湿体质；
4.2耳穴贴压治疗能有效改善阻塞型睡眠呼吸暂停综合征的呼吸、睡眠质量及睡眠效率。
Good quality of sleep not only comforts human body physiologically and psychologically but also increases life quality and learning and working efficiency. Besides, it further creates harmonious family and social relationship and corporative performance. Moreover, it could decrease the public security problems caused by traffic and industrial accidence. Therefore, sleep related studies worth being concerned. Among the sleep related diseases, sleep apnea syndrome annoys people mostly. According to a survey, it is estimated to have over four hundred thousand people caught by this disease. Among them, obstructive sleep apnea syndrome has causal relationships with many diseases, such as CVA disease and obesity related metabolic diseases. The treatment methods in western medicine include conservative treatment, CPAP, oral device, and surgery. In TCM, Chinese herbal medicine and acupuncture treatment are the mainstream, but some people are afraid of acupuncture, some people detest bitterness of taking herbal medicine. Therefore, auricular points treatment might be the third train of thought in TCM.
1. Object ive
1.1The research is to study the clinical effect of the auricular therapy on the Obstructive Sleep Apnea Syndrome.
1.2It is also to find out the constitution of TCM syndrome classification statistics of the OSA patients.
1.3The research also study how this treatment affect the Sleep and Respiratory System, sleep quality and sleep efficiency.
2. Methods
The prospective randomized controlled study chose60cases from Taiwan Chang foreshore show Chwan Hospital Sleep Center during December2010to April2012, which were in accordance with the diagnostic and indrawing standards, to be the subjects of the study. The patients were randomly divided into2groups, with30cases in the treatment group treated with auricular point sticking and pressing bead and30cases in the control group treated with auricular point sticking plaster pressure. The two groups were treated with same auricular point, once a week. With two weeks a course, both groups received one course in total. Before treatment two groups were filled in sleepiness scale, Athens' insomnia scale, Pittsburgh sleep quality index, snoring, Burnout Fatigue Severity Scale and the Hospital Anxiety and Depression Scale, and traditional Chinese medicine constitution assessment; before and after treatment monitoring of PSG sleep monitoring parameters, Including the respiratory disturbance index (AHI), snoring index, the lowest oxygen saturation (LSaO2), mean oxygen saturation decreased index (Denaturation Index), before and after treatment of stage4sleep time ratio (S1, S2, S3, S4), a rapid eye movement stage ratio (REM%), total sleep time, sleep efficiency (TST)(Sleeping Effieciency), the total number of awakening (Total Arousal), and periodic limb movement index (PLM) and other indicators. After the test we have an assessment of the disease in traditional Chinese medicine constitution differentiation and improving sleep effect.
3.Results
3.1Physical Datas
There were no significant differences in the age, BMI before the treatment, gender, exercise, smoking and drinking status were not statistically different (P>0.05). The two groups were comparable.
3.2Obstructive sleep apnea syndrome differentiation of traditional Chinese Medicine physique
The study find that the obstructive sleep apnea syndrome patients are more likely with a composite constitution, for several physical and clamp, which has the constitution of qi deficiency and phlegm dampness constitution each accounted for65%, with blood stasis constitution accounted for38%, qi stagnation constitution accounted for33%, accounting for38%of yin deficiency constitution, damp heat constitution accounted for40%.
3.3The sleep improvement of OSAS patients with auricular therapy
In two groups before treatment, the number of AHI snoring, snoring index, LSaO2comparison, there were no significant differences between them (P>0.05). Comparing the AHI before and after treatment, significant differences could be seen in both groups (P<0.01in treatment group, P<0.05in control group), comparison of AHI reduction of two groups after treatment has statistical significance (P<0.01).
Comparing the number of snoring and the snoring index before and after treatment, significant differences could be seen in both groups (P <0.01), comparison of the number of snoring and the snoring index reduction of two groups after treatment have statistical significance (P<0.01).
LSaO2in both groups before and after treatment, the difference were not statistically significant (P>0.05), the LSaO2improvemen t after treatment between two groups was not statistically significa nt (P>0.05).
The sleep structure parameters (stage4sleep time ratio, REM ra tio) in two groups were not statistically significant (P>0.05). Com paring the S1before and after treatment, significant differences co uld be seen in both groups (P<0.01). Comparison of S1reduction of two groups after treatment has no statistical significance (P>0.05).
Comparing the S2, S3, S4before and after treatment, no signific ant differences could be seen in both groups (P>0.05). Comparison o f S2, S3, S4change of two groups after treatment have no statistica1significance (P>0.05).
But in the contrast of REM%before and after treatment, there were significant differece in both groups (P<0.01). And there was significant differece in the REM%improvement (P<0.01)
There were no significant differences in the total sleep time (TST), and sleep efficiency (SE), total wake time (Total Arousal), periodic limb movement index (PLM) in both groups before treatment (P>0.05).
Comparing the TST before and after treatment, significant differences could be seen in both groups (P<0.01). Comparison of TST change in two groups after treatment has statistical significance (P<0.01).
Comparing the SE before and after treatment, significant differences could be seen in both groups (P<0.01). Comparison of SE change in two groups after treatment has no statistical significance (P>0.05).
Comparing the Total Arousal before and after treatment, significant differences could be seen in both groups (P<0.05). Comparison of Total Arousal change intwo groups after treatment has no statistical significance (P>0.05).
Comparing the PLM before and after treatment, significant differences could be seen in both groups (P<0.01). Comparison of PLM change in two groups after treatment has no statistical significance (P>0.05).
4. Conclusion
4.1In patients with obstructive sleep apnea syndrome constitution types are mainly QI deficiency and phlegm dampness constitution;
4.2Auricular therapy can effectively improve obstructive sleep apnoea breathing, sleep quality and sleep efficiency.
引文
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[33]王鹏,王威,贾成文.耳穴贴压治疗失眠症32例[J].上海针灸杂志,2006：25(9)：27.
[34]王秀香,郭益莉,李绣彩,锺聿琳等.某区域医院护理人员耳穴贴压对其失眠之成效探讨[J].实证护理,2005;1(4)：283-291.
[35]王建渝.耳针与副交感神经系统关系的探讨[J].中华中西医杂志,2006;7(7)：23
[36]王翔宇,霍永芳.单用耳穴贴压治疗失眠症总结与分析[J].上海针灸杂志,2007：26(4)：47-48.
[37]易世新.耳穴压豆治疗失眠[J].中国护理研究,2004;18(5B)：902.
[38]王晓红,肖兰英,王保法等.耳穴贴压疗法对阻塞性睡眠呼吸暂停综合征患者睡眠结构的影响及其疗效研究[J].中国全科医学,2006;9(23)：1947-1950.
[39]Wang XH, Yuan YD, Wang BF, et al. Auricular acupoint pressing therapy in the treatment of obstructive sleep apnea syndrome[J]. Chinese Journal of Clinical Rehabilitation,2006; 10(31):165-167.
[40]Buysse DJ, Reynolds CF, Monk TH. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research [J]. Psychiatry Research,1989; 28:193-213.
[41]Buysse DJ, Renolds CF, Monk TH. Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index [J]. Sleep,1991; 14(4),331-338.
[42]Carole S. The Pittsburgh sleep quality index[J]. Journal of Gerontological Nursing,1999; 25(12):10-11.
[43]中华医学会耳鼻咽喉科学分会,中华耳鼻咽喉科杂志编委会.阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)[J].2002：37(6)：403.
[44]王桂芝.睡眠呼吸暂停综合征602例的护理[J].中国误诊学杂志,2008;8(20)：4927.
[45]Gugger M, Keller U, Mathis J. Arousal Responses to Inspireatory Resistive Loading During REM and Non-REM Sleep in Normal Men after Short-term Fragmentation Deprivation[J]. Schweiz Med Woehenschr, 1998; 128(18):696-702.
[46]王琦.人分九种-人体体质辨识与养生[M],中国广州科技出版社,2011.
[47]王琦.论中医体质研究的3个关键的问题(上)[J].中医杂志,2006;47(4)：250-252.
[48]梁云花,李利容,谌朝霞等.耳穴磁珠治疗失眠患者观察与护理[J].国际护理学杂志,2006：25(10)：803-805.
[49]陈晓云,沈梅.失眠患者的耳穴诊断及耳穴贴压疗效观察[J].大连大学学报,2003；24(2)：86-88.
[50]黄翠华,翟文献.耳压疗法治疗失眠50例[J].中国民间疗法,2004;11(2)：22-23.
[51]黄宝荃.耳穴压丸法治疗老年失眠症35例[J].中国民间疗法,2004;32(11)：17-18.
[52]彭美芳.耳穴贴压治疗失眠30例小结[J].湖南中医药导报,2003;9(10)：40.
[53]景莉玲,陈更业,陈东毅.失眠患者耳穴贴压治疗后的慢波睡眠结构分析与疗效观察[J].宁夏医学杂志,2007;29(1)：53-54.
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[55]Lorna KP, Thomas KS, Albert WN. Effectiveness of auricular herapy on sleep promotion in the elderly [J]. The American Journal of Chinese Medicine,2002; 30(4):429-449.
[56]李楚凌,吴陆敬,何利兴等CAUP术联合舌根消融治疗重度阻塞性睡眠呼吸暂停低通气综合症[J].暨南大学学报,2008：29(2)：190-193.
[2]林诜淳,杨建铭,许世杰.原发性失眠患者的心理认知因素与减药行为之关系[J].应用心理研究,2006：(50)：43-80.
[3]刘艳骄,高荣林.中医睡眠医学[M],北京：人民卫生出版社,2003.
[4]伊明瑞,江柏华.不寐的心理因素及临床治疗[J].黑龙江中医药,2000;(3)：61.
[5]郁青萍,高翔.左归丸治疗神经系统疾病体会[J].实用中医药杂志,2006;22(2)：114-115.
[6]陈武山.“引火归根”治失眠[J].医药世界,2006：(05)：165-166.
[7]张其慧.从调肝理脾论治失眠[J].四川中医,2005;23(12)：9-11.
[8]许映絮,陈英杰.失眠的辨证施治及其遣方用[J].实用中医药杂志,2003;(4)：278.
[9]唐国斌.预防和治疗顽固性失眠应时时顾护阳气[J].国医论坛,2004；19(4)：20-21.
[10]孙建平.治疗失眠宜用半夏[J].光明中医,2004;19(4)：36.
[11]赵成志,李雪倩,申保国.血府逐瘀汤的临床应用心得[J].河北中医,2006：28(5)：359-360.
[12]连玲霞.清浊安神汤治疗失眠21例临床观察[J].吉林中医药,2006;26(6)：17.
[13]王昆.自拟地黄枣仁汤治疗糖尿病失眠症30例临床观察[J].中国民族民间医药杂志,2006：(80)：146.
[14]许英章.淫羊藿有益气安神之效[J].中医杂志,1999;40(12)：709.
[15]付美琴.失眠结合辨证治疗功能性失眠120例[J].四川中医,2000;18(3)：20-21.
[16]张洪俊.辨证运用中成药治疗顽固性失眠[J].中国民间疗法,2001;9(1)：35-36.
[17]刘月芝.清上补下法治疗失眠症100例[J].中国针灸,2006;(5)：342.
[18]刘瑞云.针刺阴经为主治疗老年人失眠症38例[J].河南中医.2006;26(6)：71-72.
[19]向诗余,周中元.针刺治疗失眠59例[J].湖北中医杂志,2001;(10)：49.
[20]樊留博,马利中,李瀛.皮内针治疗失眠症的疗效观察[J].上海针灸杂志,2006：(6)：24.
[21]徐宓宓.艾灸治疗失眠79例[J].实用中医药杂志.2001;17(10)：37.
[22]成为品.浅谈按摩治疗失眠补泻手法的应用[M],中国盲人按摩学会医院管理工作委员会及教育分会学术研讨会论文汇编,2001.
[23]华新宇.捏脊疗法治疗失眠症临床观察[J].中医外治杂志,2001;10(4)：33.
[24]黄剑萍,朱秀平.中药浸泡配合足部按摩治疗失眠42例临床观察[J].中国医师杂志,2006;增刊：309-310.
[25]姚子杨.耳穴贴压治疗失眠60例[J].国医论坛,2003;18(6)：30-31.
[26]胡卫东,陈更业,鞠光亚.耳穴贴压治疗失眠患者睡眠结构的分析与疗效 观察[J].宁夏医学杂志,2003：25(11)：6.
[27]唐春芹,高志强.耳穴压豆治疗失眠80例[J].中国民间疗法,2003;12(2)：22.
[28]张颖新、彭国富.耳穴贴压治疗失眠100例[J].中国康复,2003;3;194.
[29]尉迟静.试论耳经与耳穴[J].黑龙江中医药,1991;(03)：41-42.
[30]何成江,胡增珍,蒋美英等.耳穴局部隆起对肝癌等疾病的诊断意义[J].上海中医药杂志,1981：(09)：26-28.
[31]邵文斌.耳针疗法并耳廓压痛点的临床意义——附一百例统计分析[J].西安交通大学学报(医学版),1959;(03)：67-73.
[32]刘维洲,杨云碧,刘士佩等.关于耳穴相关群现象及认识[M],世界针灸学会联合会成立暨第一届世界针灸学术大会论文摘要选编,1987.
[33]王鹏,王威,贾成文.耳穴贴压治疗失眠症32例[J].上海针灸杂志,2006：25(9)：27.
[34]王秀香,郭益莉,李绣彩,锺聿琳等.某区域医院护理人员耳穴贴压对其失眠之成效探讨[J].实证护理,2005;1(4)：283-291.
[35]王建渝.耳针与副交感神经系统关系的探讨[J].中华中西医杂志,2006;7(7)：23
[36]王翔宇,霍永芳.单用耳穴贴压治疗失眠症总结与分析[J].上海针灸杂志,2007：26(4)：47-48.
[37]易世新.耳穴压豆治疗失眠[J].中国护理研究,2004;18(5B)：902.
[38]王晓红,肖兰英,王保法等.耳穴贴压疗法对阻塞性睡眠呼吸暂停综合征患者睡眠结构的影响及其疗效研究[J].中国全科医学,2006;9(23)：1947-1950.
[39]Wang XH, Yuan YD, Wang BF, et al. Auricular acupoint pressing therapy in the treatment of obstructive sleep apnea syndrome[J]. Chinese Journal of Clinical Rehabilitation,2006; 10(31):165-167.
[40]Buysse DJ, Reynolds CF, Monk TH. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research [J]. Psychiatry Research,1989; 28:193-213.
[41]Buysse DJ, Renolds CF, Monk TH. Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index [J]. Sleep,1991; 14(4),331-338.
[42]Carole S. The Pittsburgh sleep quality index[J]. Journal of Gerontological Nursing,1999; 25(12):10-11.
[43]中华医学会耳鼻咽喉科学分会,中华耳鼻咽喉科杂志编委会.阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)[J].2002：37(6)：403.
[44]王桂芝.睡眠呼吸暂停综合征602例的护理[J].中国误诊学杂志,2008;8(20)：4927.
[45]Gugger M, Keller U, Mathis J. Arousal Responses to Inspireatory Resistive Loading During REM and Non-REM Sleep in Normal Men after Short-term Fragmentation Deprivation[J]. Schweiz Med Woehenschr, 1998; 128(18):696-702.
[46]王琦.人分九种-人体体质辨识与养生[M],中国广州科技出版社,2011.
[47]王琦.论中医体质研究的3个关键的问题(上)[J].中医杂志,2006;47(4)：250-252.
[48]梁云花,李利容,谌朝霞等.耳穴磁珠治疗失眠患者观察与护理[J].国际护理学杂志,2006：25(10)：803-805.
[49]陈晓云,沈梅.失眠患者的耳穴诊断及耳穴贴压疗效观察[J].大连大学学报,2003；24(2)：86-88.
[50]黄翠华,翟文献.耳压疗法治疗失眠50例[J].中国民间疗法,2004;11(2)：22-23.
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