Zhongguo quanke yixue (Nov 2023)
Efficacy of Non-pharmacological Interventions to Improve Perimenopausal Insomnia Symptoms: a Network Meta-analysis
Abstract
Background The presence of insomnia symptoms reduces the quality of life of perimenopausal women and increases their risk of developing other diseases. Currently, there are numerous non-pharmacological interventions available to improve perimenopausal insomnia symptoms, with disagreement as to which intervention is most effective. Objective To evaluate the efficacy of non-pharmacological interventions in improving perimenopausal insomnia symptoms using a network meta-analysis. Methods In March 2022, Cochrane Library, PubMed, EmBase, Web of Science, CNKI, Wanfang Data Knowledge Service Platform, VIP and CBM were searched for the randomized controlled trials (RCTs) on the improvement of perimenopausal insomnia symptoms by non-pharmacological interventions from inception to March 2022. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias of the included literature using the RCT bias risk assessment tool recommended by the Cochrane Manual of Systematic Review 5.1.0. A Bayesian network meta-analysis was performed on the overall response rate to the improvement of perimenopausal insomnia symptoms, as well as improvement in Pittsburgh Sleep Quality Index Scale (PSQI) score, Kupperman score and estradiol (E2) level under different non-pharmacological interventions by using R 4.1.3 software and the GeMTC package. Results A total of 44 RCTs including 3 354 patients were selected, involving 12 non-pharmacological interventions (moxibustion, electroacupuncture, acupoint pressing with beans, scraping, fire dragon pot, thumbtack needle, massage, warm acupuncture, bee acupuncture, acupoint embedding, music therapy, acupuncture). The results of meta-analysis showed that moxibustion, electroacupuncture, and acupuncture were superior to sedative-hypnotic western drugs in overall response rate to the improvement of perimenopausal insomnia symptoms (P<0.05), and moxibustion was identified as the most probable superior intervention. Moxibustion, electroacupuncture, scraping, and acupuncture were superior to sedative-hypnotic western drugs (P<0.05), moxibustion was more effective than warm acupuncture (P<0.05) in the improvement of PSQI score and identified as the most probable superior intervention. There was no significant difference in the improvement of Kupperman score and E2 level among different interventions (P>0.05), with scraping emerging and acupuncture as the most probable superior intervention, respectively. Conclusion Current evidence demonstrates that moxibustion is superior in overall response rate to the improvement of perimenopausal insomnia symptoms and PSQI score in perimenopausal women, while scraping is superior in improving Kupperman score and acupuncture has advantages in improving E2 level, however, further validation of this conclusion is needed by conducting more high-quality studies.
Keywords
