Abstract
Background: Insomnia is one of the common problems in patients with maintenance hemodialysis (MHD). Previous studies have reported the beneficial effects of auricular acupressure (AA) for insomnia in patients with MHD. This study aimed to critically evaluate the efficacy and safety of AA for insomnia in patients with MHD.Methods: Web of Science, Embase, PubMed, Cochrane Library, Chinese Biomedical Database, Wanfang Data, Chinese Science and Technology Periodicals database, and China National Knowledge Infrastructure were systematically searched from inception to April 30, 2020, to identify any eligible randomized controlled trials. MHD patients with insomnia were included regardless of age, gender, nationality, or race. The experimental interventions included AA alone or AA combined with other therapies. The control interventions included placebo, no treatment, or other therapies. The primary outcome was sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). RevMan 5.3 software was used for statistical analysis.Results: Eight studies involving 618 participants were included for statistical analysis. A meta-analysis showed no significant difference of PSQI global score after 8 weeks of AA treatment compared with estazolam (p = 0.70). Other narrative analyses revealed that PSQI global score was significantly attenuated after AA treatment in comparison with mental health education (p = 0.03, duration of 4 weeks; p = 0.02, duration of 8 weeks), AA plus routine nursing care compared with routine nursing care alone (p < 0.0001), and AA plus footbath compared with footbath alone (p = 0.01), respectively. A meta-analysis showed that AA could significantly increase the response rate (reduction of PSQI global score by 25% and more) in comparison with estazolam (p = 0.01). Other narrative analyses reported that the response rate was significantly increased after AA treatment compared with sham AA (p = 0.02), AA compared with mental health education (p = 0.04), and AA plus routine nursing care compared with routine nursing care alone (p = 0.0003), respectively.Conclusion: The present findings suggest that AA may be an alternative treatment for insomnia in patients with MHD. However, more large-scale, high-quality trials are still warranted to confirm these outcomes.
Highlights
Insomnia is one of the common problems in patients with maintenance hemodialysis (MHD) (1–3)
Insomnia may be caused by a variety of factors, including restlessness, pain, long duration on dialysis, and unhealthy lifestyle behavior (2, 4, 5), which might potentially exert a negative impact on quality of life in dialysis patients (6)
There is no specific recommendation for insomnia management in MHD patients according to the present clinical practice guidelines (7–10)
Summary
Insomnia is one of the common problems in patients with maintenance hemodialysis (MHD) (1–3). Insomnia may be caused by a variety of factors, including restlessness, pain, long duration on dialysis, and unhealthy lifestyle behavior (2, 4, 5), which might potentially exert a negative impact on quality of life in dialysis patients (6). Therapies for insomnia include both pharmacologic (e.g., benzodiazepines, non-benzodiazepine hypnotics) and nonpharmacologic treatments (e.g., cognitive behavioral therapies) (7). The effective administration of cognitive behavioral therapy might be limited in dialysis patients due to low patient adherence, lack of trained therapists, etc. Insomnia is one of the common problems in patients with maintenance hemodialysis (MHD). Previous studies have reported the beneficial effects of auricular acupressure (AA) for insomnia in patients with MHD.
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