Abstract

Background. Perioperative sleep disorders exert a severe adverse impact on postoperative recovery. Recently, some observational studies reported that acupuncture-point stimulation (APS) provided benefits for promoting perioperative sleep quality. However, the effects of APS on perioperative sleep disorders following general anesthesia have not been thoroughly assessed by any systematic study and meta-analysis. Therefore, we conducted this systematic review and meta-analysis to reveal the effects of APS on perioperative sleep disorders. Methods. Eight databases (Chinese: CNKI, VIP, CBM, and Wanfang; English: PubMed, Embase, Web of Science, and Cochrane Library) were thoroughly searched to find randomized controlled trials (RCTs) that indicated a link between APS and the occurrence of perioperative sleep disorders. We applied RevMan 5.4 (Cochrane Collaboration) and Stata 16.0 (Stata Corp) to conduct our meta-analysis. In addition, the trial sequential analysis (TSA) tool was utilized to estimate the validity and reliability of the data. Results. In this study, nine RCTs with 719 patients were conducted. Compared to the control group, APS significantly improved perioperative subjective sleep quality (SMD: −۱٫۳۶; ۹۵% CI: −۱٫۷۱ to −۱٫۰۱; ). Besides, it increased perioperative TST (preoperative period MD = ۲۴٫۲۹, ۹۵% CI: 6.4 to 42.18, ; postoperative period MD = ۴۵٫۸۶, ۹۵% CI: 30.00 to 61.71, ) and SE (preoperative MD = ۳٫۶۲, ۹۵% CI: 2.84 to 4.39, ; postoperative MD = ۶٫۴۳, ۹۵% CI: 0.95 to 11.73, ). The consequence of trial sequential analysis further confirmed the reliability of our meta-analysis results. Conclusion. According to the currently available evidence, APS could effectively improve perioperative sleep quality and play an essential role in decreasing the incidence of perioperative sleep disorders.

Introduction

Sleep is vital for overall health as it influences the quality of life and physical functioning [1]. Good sleep quality is a sign of wellbeing, whereas poor sleep quality raises comorbidity, mortality, and medical expenses [2]. Despite advances in operative and anesthetic procedures, sleep disorders continue to be a concern in the perioperative period. Perioperative sleep problems, as compared to household sleep disorders, have gained more attention recently, such as reduced nighttime sleep, fragmentation of sleep, and circadian rhythm disruptions at night after admission [3,C4]. The proportion of sleep disorders in hospitalized patients (64%–۷۳٫۱%) is much higher than that in people at home (30.6%–۴۱٫۲%) due to the surgical stress response, ward environment, and patients’ underlying diseases [5–۷]. Perioperative sleep problems were noted in several observational studies to be important risk factors for poor recovery [8] and were associated with anxiety, altered pain perception, and postoperative cognitive dysfunction (such as delirium), further deteriorating the patient’s physical state [1, 6, 7, 9]. Moreover, it was suggested that perioperative sleep disorders might lead to postoperative fatigue, episodic hypoxemia, cardiovascular disorders, metabolic impairment, and immune disorders [10, 11]. Enhancing perioperative sleep quality is probably related to improved health, surgery effect, and patient safety [9]. Unfortunately, there are no specific therapeutic strategies for perioperative sleep disorders. Even though it was reported that pharmaceutical therapies, such as benzodiazepines and other sedating agents, might improve perioperative sleep quality, the potentially addictive nature and risk of tolerance restricted their clinical application [9].

In complementary and alternative medicine, acupuncture-point stimulation (APS) was employed to improve perioperative sleep quality [12]. According to the theory of traditional Chinese medicine (TCM), APS refers to stimulating the body’s acupoints with various methods, including acupressure (manual stimulation), acupuncture (sterile needle stimulation), laser acupuncture, electrical stimulation (transcutaneous electrical acupoint stimulation and electrical acupuncture), magnetic acupuncture (stimulation with special equipment), moxibustion therapy, and auricular point pressing, with the goal of achieving therapeutic effects such as sleep improvement and pain management [13–۱۸]. APS has been an integral part of traditional Chinese medicine treatment. Based on the traditional Chinese medicine meridian theory, the body’s qi circulation is restored when target acupoints along meridians are stimulated [14]. It was reported that APS might lower the risk of poor sleep quality due to its considerable analgesic and sedative effects [19, 20]. Recently, a significant number of RCTs were carried out on the effects of APS on perioperative sleep disorders [8, 15]. Besides, a previous review concluded that EA might work to alter neurotransmitter concentrations and reduce the levels of norepinephrine and dopamine so as to enhance the quality of postoperative sleep quality after general anesthesia [12]. However, this study not only did not conduct a statistical assessment of the efficiency of EA on inpatients’ sleep quality during the postoperative period but also did not examine preoperative sleep quality thoroughly [12].

Conclusion

Taken together, our systematic review and meta-analysis suggested that APS could effectively improve perioperative sleep disorders, indicating that it was worthwhile to offer such therapies in perioperative healthcare institutions. Although our results had certain clinical implications of APS for the treatment of perioperative sleep disorders, more studies are needed to offer stronger evidence to further verify our conclusions in the future.