Effects of paroxetine combined with low-dose quetiapine on stress response and endocrine function in patients with treatment-resistant depression and sleep disorders.

Objective To study the influence of hierarchical psychological nursing on anxiety, depression and sleep quality of thoracic surgery patients. Methods Totals of 82 thoracic surgery patients were randomly divided into two groups. The control group (41 cases) was given routine care including conventional psychological nursing. Based on this, the research group (41 cases) was given hierarchical psychological nursing. Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate psychological status of two groups before and after surgery. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the quality of sleep before and after operation. Results Fifteen days after the operation, SAS and SDS scores of the research group were (37.68±3.41) and (38.12±3.17), respectively. Those scores of the control group were (41.23±3.07) and (41.82±2.64). The differences were significant (t=4.954, 8.847, respectively; P<0.05). Fifteen days after the operation, the total score of PSQI was (6.99±0.86) in the research group and (9.02±1.21) in the control group. There was a significant difference between two groups (t=8.756, P<0.05). The scores of sleep quality, time to fall asleep, sleep time, sleep efficiency, sleep disturbance, hypnotic drugs and daytime dysfunction in the research group were significantly lower than those in the control group(P<0.05). Conclusions Hierarchical psychological nursing can decrease anxiety, depression and improve sleep quality of thoracic surgery patients. It is worthy of clinical promotion and popularization. Key words: Anxiety; Depression; Sleep disorder; Cardiothoracic surgery; Hierarchical psychological nursing

Febrile convulsions are a common pediatric emergency that imposes significant psychological stress on children and their families. Targeted emergency care and psychological nursing are widely applied in clinical practice, but their value and impact on the management of pediatric febrile convulsions are unclear. To determine the impact of targeted emergency nursing combined with psychological nursing on satisfaction in children with febrile convulsions. Data from 111 children with febrile convulsions who received treatment at Nantong Maternal and Child Health Care Hospital between June 2021 and October 2022 were analyzed. The control group consisted of 44 children who received conventional nursing care and the research group consisted of 67 children who received targeted emergency and psychological nursing. The time to fever resolution, time to resolution of convulsions, length of hospital stays, Pittsburgh Sleep Quality Index, patient compliance, nursing satisfaction of the parents, occurrence of complications during the nursing process, and parental anxiety and depression were compared between the control and research groups. Parental anxiety and depression were assessed using the Hamilton Rating Scale for Depression (HAMD) and the Hamilton Rating Scale for Anxiety (HAMA). The fever resolution, convulsion disappearance, and hospitalization times were longer in the control group compared with the research group (P < 0.0001). The time to falling asleep, sleep time, sleep quality, sleep disturbance, sleep efficiency, and daytime status scores were significantly better in the research group compared with the control group (P < 0.0001). The HAMD and HAMA scores for parents of children in the research group were lower than the scores in the control group after nursing (P < 0.05). Compliance with treatment of children in the research group was higher than in the control group (P < 0.05). Parental satisfaction with nursing in the research group was higher than in the control group (P < 0.05). The total complication rate of children in the control group was higher than in the research group (P < 0.05). Combining psychological nursing with targeted emergency nursing improved the satisfaction of children's families and compliance with treatment and promoted early recovery of clinical symptoms and improvement of sleep quality.

Objective: To explore the effects of motion-guided imagination training combined with eszopiclone therapy on sleep status, neurological function, negative emotion and quality of life in patients with post-stroke sleep disorders. Methods: A total of 90 patients with post-stroke sleep disorders treated from March 2021 to December 2023 were collected and divided into two groups: study group (n = 45; motion-guided imagination training combined with eszopiclone treatment for 2 weeks) and control group (n = 45; eszopiclone treatment for 2 weeks). The sleep conditions of the two groups were compared at different time points, and the differences of neurological function scores, serum indexes, negative emotions and quality of life indexes before and after treatment were recorded. Results: After 1 and 2 weeks of treatment, the Pittsburgh Sleep Quality Index (PSQI) score, awakening frequency and awakening time of both groups were decreased, and the sleeping time was increased. The changes were more apparent in the study group than the control group (p &lt; 0.05). After treatment, the scores of National Institutes of Health Stroke Scale (NIHSS), Self Rating Anxiety Scale (SAS) and Self Rating Depression Scale (SDS) were lowered, and the scores of Quality of Life (QOL) scale, 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) were elevated in both groups. The changes were more evident in the study group than the control group (p &lt; 0.05). Conclusion: Motion-guided imagination training combined with eszopiclone may have a good effect in the treatment of sleep disorders after stroke, which can enhance sleep quality, promote neurological function recovery and improve negative emotions and quality of life, with clinical application value.

The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep. This study included older adults (n = 163; mean age 79.7 ± 6.9 years, 31% female) undergoing inpatient post-acute rehabilitation. Upon admission to inpatient post-acute rehabilitation, patients completed the Pittsburgh Sleep Quality Index (PSQI) retrospectively regarding their sleep prior to hospitalization. They subsequently completed the PSQI at discharge, and 3 months, 6 months, 9 months, and 1 year post discharge. Patient demographic and clinical characteristics (pain, depression, cognition, comorbidity) were collected upon admission. Using latent class analysis methods, older adults could be classified into (1) Consistently Good Sleepers and (2) Chronically Poor Sleepers based on patterns of self-reported sleep quality pre-illness, during, and up to 1 year following inpatient rehabilitation. This pattern was maintained regardless of the clinical cutoff employed (> 5 or > 8). Logistic regression analyses indicated that higher pain and depressive symptoms were consistently associated with an increased likelihood of being classified as a chronic poor sleeper. While there was substantial classification discordance based on clinical cutoff employed, no significant predictors of this discordance emerged. Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern.

ObjectiveTo investigate the application effect of hospice care in patients with advanced esophageal cancer (EC), provide a practical basis for improving sleep quality, dignity, and subjective well-being, and relieving depression and anxiety in patients with advanced EC.MethodsA randomized cluster sampling method was used to select 60 patients with advanced EC who received routine intervention (control group) and 64 patients with advanced EC who received hospice care (study group). The intervention time was three months, and the self-rated anxiety scale (SAS) before and after the interventions was compared between the two groups. The Hamilton Depression Scale (HAMD), the Pittsburgh Sleep Quality Index (PSQI), the General Well-being Scale (GWB), the Patient Dignity Scale (PDI), and patients’ physical pain state were recorded.ResultsNo significant differences were found in the HAMD, SAS, PSQI, GWB, or PDI scores between the two groups before the interventions (P > 0.05); after the interventions, the HAMD, SAS, PSQI, and PDI scores of the two groups were significantly decreased, and the HAMD, SAS, PSQI, and PDI scores of the study group were lower compared with the control group. The GWB scores of the two groups were significantly increased, and those of the study group were significantly higher compared with the control group; the difference was statistically significant (P < 0.05). After the interventions, pain grades of III and above decreased in both groups to grade II, and pain sensation in the study group was lower compared with the control group; the difference was statistically significant (P < 0.05).ConclusionHospice care can reduce the level of pain related to depression and anxiety in patients with advanced EC and improve their sleep quality, as well as their sense of dignity and subjective well-being.

The present study aimed at further investigating trait aspects of sleep-related cognitive arousal and general cognitive arousal and their association with both objective and subjective sleep parameters in primary insomnia patients. A clinical sample of 182 primary insomnia patients and 54 healthy controls was investigated using 2 nights of polysomnography, subjective sleep variables, and a questionnaire on sleep-related and general cognitive arousal. Compared to healthy controls, primary insomnia patients showed both more sleep-related and general cognitive arousal. Furthermore, sleep-related cognitive arousal was closely associated with measures of sleep-onset and sleep-maintenance problems, while general cognitive arousal was not. Cognitive-behavioral treatment for insomnia might benefit from dedicating more effort to psychological interventions that are able to reduce sleep-related cognitive arousal.

Effects of combined auricular pressure bean and group guidance on sleep disorders in patients undergoing maintenance hemodialysis.

BACKGROUNDThe hospice care system of traditional Chinese medicine (TCM) provides a reference for relieving depression, anxiety, and sleep disorders in patients with advanced cancer.AIMTo explore the effects of TCM hospice care on depression, anxiety, and sleep disorders in patients with advanced cancer.METHODSThis prospective study was conducted between July 2023 and June 2024. Patients with advanced cancer were selected and divided into observation and control groups (n = 34 per group). The observation group received TCM hospice care, with a 4-week treatment cycle. The control group received routine hospice care. The Hamilton Depression Rating Scale, Hamilton Self-Rating Anxiety Scale, and Pittsburgh Sleep Quality Index were used to assess depression, anxiety, and sleep quality changes, and Statistical Package for the Social Sciences 26.0 was used for data analysis.RESULTSNo significant differences were found in age, sex, cancer type, disease course, or baseline mental symptom scores between the groups (P > 0.05). After treatment, the observation group showed significantly greater improvements in depression, anxiety, and sleep quality (P < 0.05). The depression, anxiety, and sleep scores in the observation group decreased to 7.21 ± 2.48, 6.12 ± 2.39, and 4.53 ± 1.89, respectively. In the control group, these scores decreased to 11.42 ± 3.12, 10.14 ± 3.21, and 6.21 ± 1.79. The observation group demonstrated superior efficacy (P < 0.05). Depression, anxiety, and sleep quality were significantly positively correlated (P < 0.05). Logistic regression analysis identified the TCM hospice care system as an independent factor improving patients’ health.CONCLUSIONThe TCM hospice care system effectively improves depression, anxiety, and sleep disorders in patients with advanced cancer, offering comprehensive care suitable for clinical promotion and application.

With population ageing, the number of elderly cancer chemotherapy survivors has been increasing. In addition, the elderly often face problems, such as pain, sleep disorders, anxiety and depression, which seriously affect their quality of life. We explored the effects of hospice care on pain, sleep quality, anxiety, depression, quality of life, chemotherapy-related adverse reactions and readmission rate in elderly cancer survivors after chemotherapy to supply evidence for the clinical promotion of this nursing model. A total of 240 elderly cancer survivors who completed at least 4 cycles of chemotherapy (January 2022-June 2024) and had a 3-month follow-up were retrospectively enrolled. They were divided into the observation (hospice care + routine nursing, n = 124) and control (routine nursing, n = 116) groups. After 1:1 propensity score matching, 98 cases per group were analysed. Core (Visual Analogue Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Short Form-36 Health Survey (SF-36)) and extended indicators (chemotherapy-related adverse reactions, 3-month readmission rate and nursing satisfaction) were compared pre- and postintervention. Pre-intervention, no significant differences were found between groups (p > 0.05). Post-intervention, the observation group had significantly lower VAS (2.08 ± 0.85), PSQI (5.25 ± 1.32), SAS (38.15 ± 4.15) and SDS (38.86 ± 4.40) scores than the control group (4.68 ± 1.33, 8.92 ± 1.65, 49.32 ± 5.40 and 50.65 ± 5.80, respectively; all p < 0.05). The observation group showed significant improvements in all eight dimensions of SF-36 (p < 0.05), with a larger improvement range than the control group. In addition, the observation group had lower incidence of chemotherapy-related adverse reactions (nausea and vomiting: 8.16%, fatigue: 16.33%), lower readmission rate (7.14%) and higher nursing satisfaction (95.92%) than the control group (24.49%, 31.63%, 19.39% and 82.65%, respectively; all p < 0.05). Hospice care can effectively alleviate pain, sleep disorders, anxiety and depression in elderly cancer chemotherapy survivors, improve their quality of life, reduce adverse reactions and readmission rate and enhance nursing satisfaction and is thus worthy of clinical promotion.

Simple SummarySleep disorders have been increasingly investigated in several medical illnesses as their presence may affect patients’ quality of life. However, the research examining sleep disorders in oral cancer is relatively weak. Indeed, the majority of the available studies present a cross-sectional or retrospective designs. Moreover, very few of them have evaluated quality of sleep in oral cancer survivors (OC survivors). We aimed to carry out a case-control study with the purpose to investigate sleep disorders and mood impairment in 50 OC survivors. Our research has shown that quality of sleep is significantly affected in OC survivors compared to a healthy population and that OC survivors suffers from higher levels of anxiety and depression. Our results may suggest that an appropriate assessment of quality of sleep and psychological profile should be performed in OC survivors as a prompt treatment for both sleep and mood disorders is crucial for the overall improvement of patients’ quality of life.Quality of sleep (QoS) and mood may impair oral cancer survivors’ wellbeing, however few evidences are currently available. Therefore, we aimed to assess the prevalence of sleep disorders, anxiety and depression among five-year oral cancer survivors (OC survivors). 50 OC survivors were compared with 50 healthy subjects matched for age and sex. The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Hamilton Rating Scales for Depression and Anxiety (HAM-D, HAM-A), the Numeric Rating Scale (NRS), the Total Pain Rating Index (T-PRI) were administered. The global score of the PSQI, ESS, HAM-A, HAM-D, NRS, T-PRI, was statistically higher in the OC survivors than the controls (p-value: <0.001). QoS of OC survivors was significantly impaired, especially with regard to some PSQI sub-items as the subjective sleep quality, sleep latency and daytime dysfunction (p-value: 0.001, 0.029, 0.004). Moreover, poor QoS was negatively correlated with years of education (p-value: 0.042 *) and positively correlated with alcohol consumption (p-value: 0.049 *) and with the use of systemic medications (p-value: 0.044 *). Sleep disorders and mood disorders are common comorbidities in OC survivors; therefore, early assessment and management before, during and after treatment should be performed in order to improve the quality of life of OC survivors.

ObjectiveLong-term physiological, psychological, economic, and lifestyle pressures make maintenance hemodialysis (MHD) patients prone to anxiety and depression. This study aims to evaluate the effects of mindfulness meditation combined with progressive muscle relaxation on sleep and emotional disorders in hemodialysis patients with sarcopenia.MethodsPatients with uremic sarcopenia and sleep issues were randomly divided into a control group (n=24) and an intervention group (n=25), with an average age of 45.4 ± 4.77 years and an average dialysis duration of 56.86 ± 17.48 months. The control group received standard treatment (hemodialysis three times per week, medication, health education, dietary guidance, and exercise recommendations), while the intervention group additionally underwent home-based mindfulness and relaxation training for at least 0.5 hours daily over 12 weeks. Sleep quality, emotional states, and quality of life were assessed using the Pittsburgh Sleep Quality Index (PSQI), Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and 36-Item Short Form Health Survey (SF-36). Data analysis included descriptive statistics, t-tests, analysis of covariance, Mann-Whitney U tests, and chi-square tests.ResultsBefore the intervention, there were no significant differences between the two groups in sleep, anxiety, depression, or quality of life (P>0.05). After the intervention, the intervention group showed significant improvements in all PSQI dimensions (e.g., sleep medication use, sleep quality, and sleep duration) (P<0.01), significant reductions in SAS and SDS scores (P<0.05), and significantly higher SF-36 scores compared to the control group (P<0.05).ConclusionMindfulness and muscle relaxation training can alleviate psychological stress, reduce skeletal muscle tension, promote muscle anabolism, and significantly improve sleep quality, anxiety, and depression in hemodialysis patients with sarcopenia. This approach is simple, unrestricted, and widely applicable, making it worthy of clinical promotion.LimitationsThe study had a small sample size and a short follow-up period.Clinical trial registrationhttps://register.clinicaltrials.gov/, identifier NCT06261372.

Background and objectives: Alzheimer’s disease is a progressive brain degeneration and is associated with a high prevalence of sleep disorders. Amyloid β peptide-42/40 (Aβ42/40) and Tau-pT181 are the core biomarkers in cerebrospinal fluid and blood. Accumulated data from studies in mouse models and humans demonstrated an aberrant elevation of these biomarkers due to sleep disturbance, especially sleep-disordered breathing (SDB). However, it is not clear if sleep quality improvement reduces the blood levels of Ab42/40 ratio and Tau-pT181 in Alzheimer’s disease patients. Materials and Methods: In this prospective study, a longitudinal analysis was conducted on 64 patients with mild–moderate cognition impairment (MCI) due to Alzheimer’s disease accompanied by SDB. Another 33 MCI cases without sleep-disordered breathing were included as the control group. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) score system. Neuropsychological assessments were conducted using the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), Clinical Dementia Rating (CDR), 24-h Hamilton Rating Scale for Depression (HRSD-24), and Hamilton Anxiety Rating Scale (HAMA) scoring systems. Aβ42, Aβ40, and Tau-pT181 protein levels in blood specimens were measured using ELISA assays. All patients received donepezil treatment for Alzheimer’s disease. SDB was managed with continuous pressure ventilation. Results: A significant correlation was found among PSQI, HRSD-24, HAMA, Aβ42/40 ratio, and Tau-pT181 level in all cases. In addition, a very strong and negative correlation was discovered between education level and dementia onset age. Compared to patients without SDB (33 non-SD cases), patients with SDB (64 SD cases) showed a significantly lower HRSD-24 score and a higher Aβ42/40 ratio Tau-pT181 level. Sleep treatment for patients with SDB significantly improved all neuropsychological scores, Aβ42/40 ratio, and Tau-pT181 levels. However, 11 patients did not completely recover from a sleep disorder (PSQI > 5 post-treatment). In this subgroup of patients, although HAMA score and Tau-pT181 levels were significantly reduced, MoCA and HRSD-24 scores, as well as Aβ42/40 ratio, were not significantly improved. ROC analysis found that the blood Aβ42/40 ratio held the highest significance in predicting sleep disorder occurrence. Conclusions: This is the first clinical study on sleep quality improvement in Alzheimer’s disease patients. Sleep quality score was associated with patient depression and anxiety scores, as well as Aβ42/40 ratio and Tau-pT181 levels. A complete recovery is critical for fully improving all neuropsychological assessments, Aβ42/40 ratio, and Tau-pT181 levels. Blood Aβ42/40 ratio is a feasible prognostic factor for predicting sleep quality.

To evaluate the response and safety of combining acupuncture based on the Dunhuang "Moxibustion Classic" with carbamazepine in the treatment of neuropathic tinnitus. A retrospective analysis was conducted on 105 patients with neuropathic tinnitus treated at The First People's Hospital of Lanzhou City from January 2019 to February 2023. Of these, 49 patients received acupuncture based on the Dunhuang "Moxibustion Classic" (research group), while 56 patients received conventional acupuncture (control group). Both groups were treated with carbamazepine in combination. The Tinnitus Handicap Inventory (THI), Tinnitus Evaluation Questionnaire (TEQ), Visual Analogue Scale for Aural Fullness (VAS), Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD) scores were compared between the two groups. Treatment response and Pittsburgh Sleep Quality Index (PSQI) scores were also analyzed. Logistic regression analysis was performed to identify risk factors affecting patients' sleep quality. The overall response rate in the control group was significantly lower than that in the research group (P = 0.037). After treatment, THI, PSQI, TEQ, VAS, HAMA, and HAMD scores were higher in the control group than in the research group (P<0.05). The incidence of adverse reactions was significantly higher in the control group than in the research group (P = 0.025). Multivariate logistic regression analysis identified treatment options (P = 0.002, OR = 8.612, 95% CI = 2.466-39.565), disease duration (P = 0.687, OR = 0.779, 95% CI = 0.219-2.544), pre-treatment THI (P = 0.002, OR = 7.061, 95% CI = 2.17-26.368), pre-treatment TEQ (P<0.001, OR = 14.654, 95% CI = 4.196-65.376), and pre-treatment HAMA (P = 0.019, OR = 3.805, 95% CI = 1.271-12.209) as independent risk factors for impaired sleep quality. The combination of Dunhuang "Moxibustion Classic" acupuncture with carbamazepine is an effective and safe treatment for neuropathic tinnitus, leading to greater improvements in symptoms, sleep quality, anxiety, and depression compared to conventional acupuncture.

Objective To investigate the effect of acupoint catgut embedding combined with Ziwu-Liuzhu theory based acupuncture on the clinical efficacy and sleep quality of depressive patients. Methods A total of 64 patients who met the inclusion criteria were randomly divided into two groups, 32 in each group. The control group was treated with routine electro-acupuncture, while the observation group was treated with acupoint catgut embedding combined with Ziwu-Liuzhu theory based acupuncture. Both groups were treated for 8 weeks. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and depression was assessed by Hamilton Depression Scale (HAMD) to evaluate the clinical efficacy. Results After treatment, the HAMD score (11.3 ± 2.4 vs. 14.5 ± 2.6, t=4.986) and PSQI index (9.6 ± 2.3 vs. 11.8 ± 2.5, t=3.307) in the observation group were significantly lower than those in the control group (P<0.01). The quality of life (12.9 ± 2.3 vs. 11.3 ± 2.5, t=2.598) and mental health score (13.5 ± 2.4 vs. 11.3 ± 2.6, t=3.413) of WHOQOL-BREF scale in the observation group were significantly higher than those in the control group (P<0.01). The total effective rate was 93.8% (30/32) in the observation group and 75.0% (24/32) in the control group. There were significant differences between the two groups (χ2=4.246, P=0.038). Conclusions Acupoint catgut embedding combined with Ziwu-Liuzhu theory based acupuncture can effectively improve depressive state, sleep quality and quality of life in patients with depression, and the curative effect is better than conventional electro- acupuncture treatment. Key words: Catgut embedment in acupoint therapy; Midnightnoon ebbflow acupoint selection; Zi Wu Liu Zhu Na Jia method; Depression; Sleep; Sleep disorders; Quality of life

Objective To evaluate the clinical effect of Huanglian-Wendan Decoction combined with Estazolam tablets in the treatment of post-stroke sleep disorders (PSSD) with syndrome of internal disturbance of phlegm-heat. Methods A total of 96 patients with PSSD who met the inclusion criteria in the People's Hospital of Shenzhen Luohu District from September 2016 to June 2018 were randomly divided into the control group (47 cases) and the study group (49 cases) by random number table method. The control group took Estazolam tablets based on routine treatment, and the intervention group took Huanglian-Wendan Decoction based on the control group. Both groups were treated for 2 weeks. The TCM syndromes were recorded and scored before and after the treatment. The anxiety symptoms were assessed by Hamilton Anxiety Scale (HAMA) and the depression symptoms were assessed by Hamilton Depression Scale (HAMD) respectively. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI). The level of brain-derived neurotrophic factor (BDNF) was detected by ELISA, the level of 5-hydroxytryp-tamine (5-HT) was detected by high performance liquid-phase electrochemical detector. The adverse reactions were recorded and clinical efficacy was evaluated. Results The total clinical effective rate of the intervention group was 91.8% (45/49), and 76.6% (36/47) in the control group. There was significant difference between the two groups (χ2=4.227, P=0.040). After the treatment, the scores of HAMA, HAMD and PSQI in the intervention group were significantly lower than that of the control group (t value were 4.081, 4.869 and 3.900, respectively, all Ps<0.001). The levels of serum BDNF (42.36 ± 6.78 ng/ml vs. 33.98 ± 6.41 ng/ml, t=6.217), 5-HT (127.21 ± 12.39 ng/ml vs. 101.46 ± 11.70 ng/ml, t=10.460) were significantly higher than that of the control group (P<0.01). During the treatment, the incidence of adverse reactions was 14.9% (7/47) in the control group and 8.2% (4/49) in the intervention group, and there was no significant difference between the two groups (χ2=1.071, P=0.301). Conclusions Huanglian-Wendan Decoction combined with Estazolam tablets can improve the clinical symptoms, relieve anxiety and depression of PSSD patients with syndrome of internal disturbance of phlegm-heat, and improve sleep quality and clinical efficacy. Key words: Stroke; Sleep disorders; Syndrome of internal disturbance of phlegm-heat; Huanglian-Wendan Decoction; Estazolam tablets; Comparative effectiveness research