Objective To investigate the mediating effect of nursing intervention of sleep hygiene on insomnia in patients with liver cirrhosis. Methods One hundred and eighteen cirrhotic patients with grade-A liver function and insomnia treated between June 2012 and January 2015 were divided into control group (n=52) and intervention group (n=66) with random number table method. The control group received conventional nursing only, while the intervention group was given nursing intervention of sleep hygiene. The sleep quality of patients in the two groups on admission and discharge were surveyed and compared based on Pittsburgh sleep quality index (PSQI). The nursing effect was also compared between the two groups on discharge. Results There was no statistically significant difference in total score and scores for each factor of PSQI between the two groups of patients on admission (P>0.05). However, the total score and scores for each factor of PSQI on discharge in both groups were significantly lower than those on admission (P<0.05). Besides, the scores in the intervention group were significantly lower than those in the control group (P<0.05). The effect of nursing in the intervention group was superior to that in the control group (P<0.001). Conclusions Nursing intervention of sleep hygiene can effectively improve sleep quality in cirrhotic patients with grade-A liver function. The role of nursing intervention in the treatment of insomnia should be taken seriously.
Objective To evaluate the effectiveness and safety of doxepin in the treatment of primary insomnia. Methods We searched The Cochrane Library (Issue 4, 2009), PubMed (1966 to December 2009), EMbase (1974 to December 2009), ISI (1961 to December 2009), CNKI (1979 to December 2009), VIP (1989 to December 2008), CBM (1978 to December 2009), and WANFANG Data (1998 to December 2009). We also searched the correlated grey literature and conference literature for complement. Data were extracted, methodologically evaluated, and cross-checked by two reviewers independently. RevMan 5.0 was used for statistical analysis. Results One randomized controlled trial and three cross trials involving 171 patients were included. The results of meta-analyses showed that total sleep time (TST), wake time during sleep (WTDS), wake time after sleep (WTAS), and sleep efficiency (SE) were improved by low and medium dosage of doxepin (1-25 mg) with statistically significant difference compared with placebo. On the contrary, most indicators of sleep quality had no statistically significant difference between high dose doxepin (50 mg) and placebo. While the sleeping structural indicators of rapid eye movement sleep (REM), rapid-eyemovement latency (REM-L), and sleep stage II (St.II) were changed by high and medium dosage of doxepin (25-50 mg) with statistically significant difference. Conclusions Low and medium dosage of doxepin (1-25 mg) is effective in improvement of the sleep quality in patients with primary insomnia, but it is necessary to concern the side effects and the effects on sleep structure when treating primary insomnia with medium dosage of doxepin (25 mg). High dosage of doxepin (50 mg) is not recommended to treat primary insomnia. However, this conclusion still needs clinical trials to be further validated.
Objective To explore the risk factors of perioperative insomnia in young patients with breast masses undergoing ambulatory Mammotome (MMT) minimally invasive surgery. Methods A total of 166 young female patients who were ≤40 years old, diagnosed with breast masses, undergoing ambulatory MMT between June and December 2016 in West China Hospital of Sichuan University were included in this study. Questionnaire survey and data about general condition, preoperative and postoperative Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale, and postoperative pain Visual Analogue Scale were collected in the enrolled population. Univariate analysis was used to screen the factors that might cause insomnia, and then multiple logistic regression analysis was performed to identify possible risk factors of insomnia. Results In the 166 young female patients, the mean age was (30.90±5.96) years, and the mean perioperative ISI score was 8.83±4.97. Slight insomnia was found in 39.7% (66/166) of the patients, moderate insomnia was found in 12.7% (21/166), and severe insomnia was found in 2.4% (4/166). The results of multiple logistic regression suggested that the number of breast masses [taking the number=1 as the reference, when the number=4, odds ratio (OR)=2.269, 95% confidence interval (CI) (1.917, 13.818), P=0.001; when the number>4,OR=9.359, 95%CI (4.507, 19.433), P<0.001] and the maximum diameter of breast masses [taking 1–10 mm as the reference, when the maximum diameter was 26–30 mm,OR=6.989, 95%CI (1.488, 32.785), P=0.014; when the maximum diameter >30 mm, OR=17.290, 95%CI (4.664, 64.071), P<0.001] were independent risk factors of the severity of perioperative insomnia in these young women. Conclusion It is recommended that psychological nursing and comprehensive admission education should be enhanced for young patients who have >3 breast masses or the diameter of the mass is >25 mm, aiming to improve the postoperative recovery of patients with high risk of insomnia.
Objective To evaluate the systematic reviews of repetitive transcranial magnetic stimulation (rTMS) for insomnia, to provide supporting evidence for clinical practice. Methods PubMed, Embase, Web of Science, Cochrane Library, Elsevier Science Direct, China National Knowledge Infrastructure, SinoMed, Wanfang and Chongqing VIP were searched from databases establishment to May 30, 2022, to find systematic reviews on the treatment of insomnia with rTMS as the main method. The methodological quality, reporting quality and evidence quality of outcome indicators were evaluated by AMSTAR 2, PRISMA 2020 and GRADE. Results A total of 4 systematic reviews published between 2018 and 2021 were included. Further analysis showed that one of the systematic reviews had a low AMSTAR 2 quality rating and the remaining systematic reviews were very low. The average PRISMA 2020 score of these 4 systematic reviews was (20.75±3.27) points, of which 3 systematic reviews had some defects in their reports, and the other one had relatively complete reports. The GRADE evidence quality assessment showed that there were 40 outcome indicators in the included literature, of which 3 outcome indicators (sleep quality, the percentage of S2 sleep in total sleep time, and S3 sleep in percentage of total sleep time) were rated as moderate, 17 were rated as low and 20 were rated as very low. Conclusions The treatment of insomnia by rTMS has achieved certain effects in clinical practice, but the systematic review of rTMS as the main intervention measure for insomnia needs to further improve the quality and standardize related research. The clinical application of rTMS for insomnia should be treated as appropriate.
ObjectiveTo investigate the chronic insomnia incidence and traditional Chinese medical (TCM) constitution of students in Southern Medical University, in order to discover the correlation between chronic insomnia and TCM constitution. MethodsA survey by means of the TCM Constitution Scales, the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and the Deep Sleep Scale (DSS) in 110 participants studying in Southern Medical University between September 2009 and July 2014 was conducted. We analyzed the characteristics of chronic insomnia in subjects of qi-deficiency type and gentleness type. ResultsA total of 115 questionnaires were sent out, and 110 were recovered with a recovery rate of 95.65%. All the 110 questionnaires were useful and the effective rate was 100%. There were 34 cases of gentleness type and 44 cases of qi-deficiency type in the 110 participants. It was found that qideficiency type got significantly different scores for all the three types of scales, compared with gentleness type (P＜ 0.01) . Meanwhile, qi-deficiency type showed significant differences in terms of sleep quality, sleep time, sleep disorder and daytime dysfunction from gentleness type (P＜ 0.05) . We also found that the incidences of shallow sleep and insomnia for qi-deficiency type were higher than those for gentleness type (P=0.002, 0006) , respectively. Finally, it was detected that the level of insomnia for qi-deficiency type was higher than that for gentheness type (P＜ 0.01) . Conclusions This study has revealed that there is a statistically significant association between qi-deficiency type and chronic insomnia. It is suggested that further research should be conducted for cure of chronic insomnia from the perspective of changing TCM constitution.
Insomnia is a major challenge to human health at present. A clear diagnosis of insomnia is very important for health assessment. The World Federation of Societies of Biological Psychiatry Working Group on Sleep Disorders has reached consensus on the value of physiological measurement tools and biomarkers in the diagnosis of insomnia. Based on this consensus, this paper interprets it in order to provide relevant help for clinical practice and scientific research.
As a common public health problem, insomnia has brought a serious social burden. In recent years, with the rapid development of sleep medicine, mindfulness meditation has gradually emerged in the field of insomnia as a new non-drug therapy. This article will review the current status of insomnia treatment, the related concepts, principles of regulating insomnia, intervention methods, and application in different insomnia groups of mindfulness meditation, and summarize the current problems of mindfulness meditation in regulating insomnia through literature analysis. It aims to raise the attention of medical staff to insomnia, promote the development of localized mindfulness meditation theory in China, provide new ideas for insomnia management, and further improve the sleep quality of the population.
目的 探討原發性失眠患者日間功能損害及其影響因素。 方法 選取2010年3月－12月符合美國《精神障礙診斷與統計手冊》第4版診斷標準的原發性失眠者62例，另選擇性別、年齡匹配的健康睡眠者53例。失眠組和對照組均采用匹茨堡睡眠質量指數量表（PSQI）評估1個月的主觀睡眠質量，多導睡眠監測（PSG）評估客觀睡眠質量，并通過“主觀睡眠時間/客觀睡眠時間×100%”計算睡眠知覺，PSG監測后受試者完成一系列日間功能評定，包括Epworth嗜睡量表（ESS）評價嗜睡程度、Flinders疲勞量表（FFS）評價疲勞程度、貝克抑郁量表（BDI）和狀態-特質焦慮量表（STAI）評估情緒狀態。 結果 ① 與對照組相比，失眠組主客觀睡眠質量均較差；PSQI分數更高[（14.37 ± 2.44）、（2.74 ± 1.79）分，P＜0.001）]；睡眠知覺差[（49.76 ± 33.29）、（99.36 ± 12.79）分，P＜0.001）]。② 失眠組FSS、BDI、SAI、TAI分數明顯高于對照組，ESS分數低于對照組（P值均＜0.05）。③ PSQI總分與ESS呈負相關（r=?0.17，P＜0.01），與FSS、BDI、SAI、TAI分數呈正相關（r=0.54，r=0.66，r=0.70，r=0.87）（P值均＜0.01）。客觀睡眠時間與ESS（r=?0.01，P=0.138）、FSS（r=?0.02，P=0.019）、BDI（r=?0.03，P=0.022）、SAI（r=?0.03，P=0.086）、TAI（r=?0.04，P=0.015）分數均無明顯相關性。 結論 原發性失眠者主觀睡眠質量與多項日間功能損害相關，這為有效的治療失眠和改善日間癥狀提供理論依據。