Introduction

Poor sleep quality may have a negative effect on health. Clinical studies have assessed the ability of transcutaneous electrical acupoint stimulation (TEAS) to improve sleep quality. This review aims to explore the efficacy and safety of TEAS to improve sleep quality, as well as the most promising application scenarios for TEAS.

Methods

Eight databases were searched from their inception to 25 March 2023 to identify randomized controlled trials (RCTs) of the effects of TEAS on sleep quality compared to sham stimulation or pharmacotherapy. In the meta-analysis, Pittsburgh sleep quality index (PSQI) global score was the main outcome. The methodological quality of each included article was assessed using the Cochrane Risk of Bias tool. Publication bias was assessed by funnel plots.

Results

A total of 16 studies involving 1555 participants met the inclusion criteria. Twelve RCTs had low or moderate risk of bias and four RCTs had high risk of bias. Overall, the findings indicated that TEAS was effective in improving sleep quality (mean difference (MD) -2.22; 95% confidence interval (CI) [-3.29, -1.15]; p<0.0001) with high heterogeneity (I²=92%; p<0.00001). Among different cause of insomnia, TEAS was found to be effective in patients with postoperative insomnia (MD -0.95; 95% CI [-1.62, -0.27]; p=0.006; I²=66%). Subgroup analyses showed that TEAS was more effective in middle-aged patients (MD -1.60; 95% CI [-2.14, -1.06]; p<0.00001; I²=0%), and Neiguan (PC6) and Hegu (LI4) were effective acupoints during perioperative period (MD -1.45; 95% CI [-1.95, -0.95]; p<0.00001; I²=6%). Four studies reported adverse effects, none of which were serious.

Conclusions

TEAS could effectively improve postoperative insomnia. For postoperative insomnia, the effect of TEAS was more significant in middle-aged patients, and simultaneous stimulation of PC6 and LI4 was effective. However, due to the small number of included studies and variation in patient types, additional high-quality, large-scale, multicenter, RCTs of the effect of TEAS on sleep quality are needed.

Registration

CRD42023440453.

Funding

Military Special Program to Cultivate and Improve TCM Service Capability [2021ZY002]; Shanghai “Science and Technology Innovation Action Plan” Yangfan Project [23YF1459200].

中文翻译：

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经皮穴位电刺激对睡眠质量的影响：系统评价与荟萃分析

介绍

睡眠质量不佳可能会对健康产生负面影响。临床研究评估了经皮穴位电刺激（TEAS）改善睡眠质量的能力。本综述旨在探讨TEAS改善睡眠质量的有效性和安全性，以及TEAS最有前景的应用场景。

方法

检索了从成立到 2023 年 3 月 25 日的八个数据库，以确定与假刺激或药物治疗相比 TEAS 对睡眠质量影响的随机对照试验 (RCT)。在荟萃分析中，匹兹堡睡眠质量指数（PSQI）总体评分是主要结果。使用 Cochrane 偏倚风险工具评估每篇纳入文章的方法学质量。通过漏斗图评估发表偏倚。

结果

共有 16 项研究涉及 1555 名参与者，符合纳入标准。十二项随机对照试验具有低或中等偏倚风险，四项随机对照试验具有高偏倚风险。总体而言，研究结果表明 TEAS 可有效改善睡眠质量（平均差 (MD) -2.22；95% 置信区间 (CI) [-3.29, -1.15]；p <0.0001），且异质性较高 (I ² =92%) ；p <0.00001)。在不同原因的失眠中，TEAS被发现对术后失眠患者有效(MD -0.95; 95% CI [-1.62, -0.27]; p =0.006; I ² =66%)。亚组分析显示，TEAS 对中年患者更有效（MD -1.60；95% CI [-2.14，-1.06]；p <0.00001；I ² =0%）以及内关（PC6）和合谷（LI4）是围手术期有效的穴位（MD -1.45；95% CI [-1.95，-0.95]；p <0.00001；I ² =6%）。四项研究报告了不良反应，但没有一项是严重的。

结论

TEAS可以有效改善术后失眠。对于术后失眠，中年患者TEAS效果更显着，同时刺激PC6和LI4有效。然而，由于纳入的研究数量较少且患者类型存在差异，因此需要额外的高质量、大规模、多中心随机对照试验来研究 TEAS 对睡眠质量的影响。

登记

CRD42023440453。

资金

军队培育和提升中医药服务能力专项规划[2021ZY002]；上海市“科技创新行动计划”扬帆项目[23YF1459200]。