The effects of Citrus aurantium aroma on anxiety and fatigue in patients with acute myocardial infarction: A two-center, randomized, controlled trial

Effects of Aromatherapy on Anxiety and Blood Pressure in Patients with Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Introduction: Patients with acute coronary syndrome (ACS) often experience high levels of anxiety, which can significantly impact their prognosis. However, evidence regarding anxiety reduction by aromatherapy in patients with ACS is lacking. This study aimed to investigate the effects of aromatherapy on anxiety in patients with ACS. Methods: The literature search was conducted using PubMed, CINAHL, Embase, Web of Science, Cochrane Library, and PsycINFO from their inception until February 21, 2024. Based on inclusion criteria, randomized controlled trials (RCTs) on aromatherapy in patients with ACS aged ≥ 18 years were included. The risk of bias in the included studies was assessed using the revised Cochrane risk-of-bias tool for RCTs. Results: A total of 14 studies were included in the final analysis. Aromatherapy significantly reduced anxiety among patients with ACS, with a large effect size (standardized mean difference [SMD] = -1.66, 95% confidence interval [CI]: -2.47 to -0.85). The effect on systolic blood pressure (SBP) was -0.65 (95% CI: -1.15 to -0.15), indicating a moderate effect size, whereas there was no significant effect on diastolic blood pressure. Inhalation therapy demonstrated a large effect size (SMD = -1.70, 95% CI: -2.33 to -1.08), whereas massage therapy did not show a significant effect on reducing anxiety. Discussion/Conclusions: The findings show that aromatherapy can effectively reduce anxiety and SBP in patients with ACS. In particular, inhalation therapy showed a significant effect on reducing anxiety levels. Applying aromatherapy in clinical settings to reduce anxiety among patients with ACS should be considered. However, the limited number of studies analyzed hinders a comprehensive evaluation of the effectiveness of massage therapy. Hence, further research is necessary to elucidate its potential role in reducing anxiety among patients with ACS.

Scented Solutions: Examining the Efficacy of Scent Interventions in Mitigating Driving Fatigue

Fatigued driving threatens the safety of people's lives and property. Scent countermeasures offer minimal disruption and high efficacy, making them a promising approach. The aim of this study was to explore the application of scent countermeasures in alleviating fatigued driving. This study explored changes in EEG frequency bands (alpha, beta, theta, and gamma) and the activity of EEG metrics (R(α/β), Rθ/(α+β) and R(α+θ)/(α+β)) in the temporal lobe during driving tasks, selected fatigued driving identifiers, and aided validation by investigating subjective fatigue with the Karolinska Sleepiness Scale (KSS). The EEG indicators all increased, with a significant increase in R(α/β). R(α/β) was combined with the KSS to explore the effects of three scents, peppermint, grapefruit, and lavender, on driving fatigue. The subjective questionnaire results indicated that all three scents significantly improved driving fatigue, with significantly lower levels of driving fatigue compared to the control group. The analysis of EEG signals revealed a significant decrease in R(α/β) after the implementation of scent countermeasures. Moreover, R(α/β) was found to be lower in all three odor intervention groups compared to the control group. All three scents were found to significantly alleviate driving fatigue. The grapefruit scent had a better timely effect in relieving driving fatigue and the lavender scent had a longer effectiveness. This study provides further exploration for the application of odor interventions to alleviate driving fatigue. This study provides a practical reference for drivers to use odors to avoid fatigue in order to improve road safety.

Benefit of inhalation aromatherapy as a complementary treatment for stress and anxiety in a clinical setting – A systematic review

OBJECTIVE

The purpose of this systematic review is to ascertain the impact of inhalation aromatherapy on stress and anxiety in clinical settings.

METHODS

A search strategy was developed using various databases. Randomised Controlled Trials (RCTs) as well as single and double-blind pilot clinical studies (non-RCT) using inhalation aromatherapy with an essential oil blend or a single essential oil were examined. All studies included a control intervention and use of a validated measurement tool. The time period under review was years 2000-2021. Due to the high level of heterogeneity and element of bias, a narrative synthesis was conducted.

RESULTS

The search strategy initially retrieved 628 studies and through application of the selection criteria and the removal of duplicates, 76 studies were selected for review with a total of 6539 patients. In 42% of the RCTs, physiological measures including vital signs and/or salivary cortisol were used in addition to questionnaires. Over 70% of the studies reported a positive effect on anxiety levels in the aromatherapy intervention groups compared with the control. However, in many cases this is limited by the absence of safety data, imprecise reporting of plant species and dosage of essential oil.

CONCLUSION

Inhalation aromatherapy has the potential to reduce stress and anxiety with data emerging to further support this result across a wide modality of clinical treatments. However, there is a clear need for the development of standard protocols for research in this area, generating measurable results which will create the opportunity for more rigorous evidence-based outcomes.

Effect of Citrus aurantium Aroma on the Happiness of Pre-Hospital Emergency Staff: A Randomized Controlled Trial

Happiness is a positive internal experience and an indicator of mental health. Having happy and efficient employees is one of the ideals of healthcare organizations, given its impact on the quality of healthcare services. Emergency healthcare staff members face various unpleasant and stressful events. It has been suggested that fragrant herbs such as Citrus aurantium can have cheerfulness effects on individuals. Therefore, this study was conducted to investigate the effect of Citrus aurantium aroma on the happiness of pre-hospital emergency staff. A randomized placebo controlled clinical trial was carried out on 167 prehospital emergency medical staff who were randomly assigned into two groups of aromatherapy and placebo. The participants received Citrus aurantium aromatherapy and placebo for five work shifts and for two consecutive weeks. Aromatherapy was performed using 10% Citrus aurantium scent applied via a pendant containing 1.5 cc of Citrus aurantium scent. The distance from the nose to the container was about 20 cm with the neck straight and the head in a balanced position. Data regarding staff happiness were collected using the Oxford Happiness Questionnaire, which were analyzed using descriptive and inferential statistics. The mean level of happiness did not differ between the intervention and control groups (p = 0.99). Work experience had a statistically significant inverse association with happiness (coefficient = -0.76, 95% CI: -1.49, -0.03). The findings of this randomized controlled trial indicate that Citrus aurantium aroma has no effect on the happiness of prehospital emergency medical services workers. There is a need to study the effect of a combination of complementary and alternative methods on the creation of positive psychological feelings among pre-hospital emergency staff.

The effect of aromatherapy with rose essential oil on apparent anxiety in patients with myocardial infarction

OBJECTIVES

Acute myocardial infarction (MI) and hospitalization are one of the most stressful situations for many patients. Aromatherapy is a branch of the complementary medicine that is effective in anxiety. The present study aims to determine the effect of aromatherapy with rose essential oil (REO) on apparent anxiety in patients with acute MI.

METHODS

This randomized clinical trial was carried out on patients with acute MI admitted to the cardiac ward of Heshmatieh Hospital in Sabzevar. Eighty patients were randomly assigned to two aromas and placebo groups, who received three drops of REO or placebo by inhalation three times a day for 3 days. Before and after the intervention, patients' anxiety levels were measured by the Spielberger questionnaire. Data were analyzed by chi-square and the independent and paired and t-tests.

RESULTS

Before the intervention, the mean of apparent anxiety was not significantly different in the intervention and control groups (48.44 ± 3.81 and 51.38 ± 7.21, respectively, p=0.16) while this parameter was significant after the intervention in both experimental groups (47.27 ± 7.11 and 44.16 ± 4.63, respectively, p=0.000), with a reduction in the mean of apparent anxiety in the intervention group. Moreover, the results of paired t-test revealed that the anxiety scores decreased significantly in the test group before and after the intervention (51.38 ± 7.21 and 44.16 ± 4.63, p=0.000).

CONCLUSIONS

Considering the positive effects of REO used in this study to reduce anxiety in patients with acute MI, the use of REO is recommended as a complementary treatment to reduce anxiety in these patients.

Effectiveness of Aromatherapy on Ameliorating Fatigue in Adults: A Meta-Analysis

Background

Fatigue is a common symptom in adults that may cause physical and psychological problems and reduce quality of life. Aromatherapy could possibly provide relief for those suffering from fatigue. Here, we evaluated the effect of aromatherapy on fatigue in adults.

Methods

We searched the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature, SinoMed, Wanfang, and Chinese Scientific Journal Database databases for randomized controlled trials of aromatherapy treatment for fatigue in adults from their inception to June 2021. Two reviewers searched independently, extracted the characteristics of the studies, and assessed the risk of bias using the Cochrane risk-of-bias tool and Stata v. 14.0.

Results

Nineteen studies were included in this systematic review. Aromatherapy had a significant effect on fatigue (standardized mean difference −0.64, 95% confidence interval−1.14, −0.15, I² 94.4%, P < 0.001). Subgroup analysis according to aromatic type, substance, frequency, treatment duration, intervention, outcomes measurement, and population type showed that aromatherapy had a significantly greater effect in the intervention group, compared to the control group. Funnel plots and Egger's test indicated no significant publication bias.

Conclusion

Our results suggest that aromatherapy ameliorates fatigue in adults who suffer from chronic diseases. A rigorous intervention program and larger randomized controlled trials are needed.

Evaluation of the Effect of Lavender Aroma on Fatigue Among Hemodialysis Patients

Fatigue is a complication of hemodialysis (HD). We examined the effect of aromatherapy on fatigue in 62 HD patients. Data were collected using a questionnaire and the Piper Fatigue Scale. It was found that fatigue decreased in the intervention group (P < .05). Lavender aromatherapy is useful in reducing fatigue.

Effectiveness of aromatherapy inhalation on anxiety and haemodynamic variables for patients with cardiovascular disease: A systematic review and meta-analysis

BACKGROUND

Anxiety can negatively affect patients' prognosis in cardiovascular disease. Aromatherapy helps reduce anxiety level in chronic diseases. However, the effectiveness of aromatherapy on anxiety and haemodynamic variables remains uncertain.

OBJECTIVE

To evaluate the evidence for the effectiveness of aromatherapy on anxiety and haemodynamic variables in patients with cardiovascular disease.

DESIGN

A systematic review and meta-analysis.

REVIEW METHODS

The CINAHL COMPLETE, Cochrane Central, Web of Science, Pubmed, Scopus, Science Direct, Ovid and ProQuest databases were searched. The study was conducted in line with the Cochrane and PRISMA guideline. Examination for bias in the included studies was conducted with the Cochrane bias guideline. Heterogeneity and publication bias were evaluated.

RESULTS

Twelve studies published from 2012 to 2020 were included in the meta-analysis. Lavender aromatherapy inhalation was used the most for anxiety in patients. Aromatherapy had a highly significant effect on anxiety, systolic blood pressure and heart rate, a moderate effect on breathing rate and a non-significant effect on diastolic blood pressure. The Cochrane GRADE approach was used to assess the rating of the certainty of evidence. A high level of evidence was found for the effect of aromatherapy on heart rate, a moderate level for the effect of aromatherapy on anxiety and breathing rate and a low level for the effects of aromatherapy on blood pressure and lavender on anxiety.

CONCLUSION

It was found that aromatherapy reduced anxiety, systolic blood pressure, heart rate and breathing rate in patients with cardiovascular disease. This study provides information to researchers and health professionals about the effectiveness of aromatherapy on decreasing anxiety and haemodynamic variables in patients with cardiovascular disease. Also, the study can contribute to planning studies which are better designed, conducted and reported.

The Effects of Lavender and Citrus aurantium on Anxiety and Agitation of the Conscious Patients in Intensive Care Units: A Parallel Randomized Placebo-Controlled Trial

Background

Conscious patients admitted to intensive care units (ICU) suffer from anxiety and agitation for various reasons, which can affect their recovery processes.

Aims

To compare the effects of lavender and Citrus aurantium essential oils on anxiety and agitation of conscious patients admitted to ICUs.

Design

A randomized parallel placebo-controlled trial.

Methods

One hundred and fifty conscious patients admitted to ICUs were selected by convenience sampling and were randomly divided into three groups, groups of lavender aromatherapy and Citrus aurantium aromatherapy, in addition to the routine care and inhalation of five drops of lavender or Citrus aurantium essential oils for 30 minutes. The placebo group, in addition to routine care, was provided with 5 drops of normal saline for 30 minutes. Anxiety was assessed with the state subscale of State-Trait Anxiety Inventory, and agitation was examined with Richmond Agitation-Sedation Scale before, immediately, one hour, and three hours after the intervention.

Results

All three groups suffered from relatively severe state anxiety before the intervention. The level of anxiety in the lavender and Citrus aurantium groups was significantly lower than that of the placebo group immediately and three hours after the intervention (P < 0.05). No significant difference was observed between the two groups of lavender and Citrus aurantium. The majority of the samples in all three groups were agitated before the intervention, but agitation of all three groups decreased after the intervention. Restless/agitation reduced significantly in all three groups. Although restless/agitation of the lavender and Citrus aurantium groups reduced more than that of the placebo, no significant difference was found between the three groups.

Conclusion

The results of the present study showed the positive effects of lavender aromatherapy and Citrus aurantium aromatherapy on reducing the anxiety of patients admitted to ICUs. Relevance to Clinical Practice. Aromatherapy can be used as an effective and safe intervention to reduce anxiety in ICUs.