1
|
Carmona NE, Starick E, Millett GE, Green SM, Carney CE. Sleep effects of psychological therapies for menopausal symptoms in women with hot flashes and night sweats: A systematic review. Post Reprod Health 2024:20533691241246365. [PMID: 38804110 DOI: 10.1177/20533691241246365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Sleep disturbance is frequently reported by women during the menopausal transition due to various physiological changes and environmental factors. Insomnia is a critical treatment target for its deleterious effects on daytime functioning and quality of life and increased risk of developing a depressive disorder. Due to medication side effects and patient preferences, there is increased interest in the use of psychological treatments that address the myriad of menopausal symptoms, including cognitive-behavioural therapy, clinical hypnosis and mindfulness-based therapies. The objective of this article is to review the effects of psychological treatments for menopausal symptoms on sleep disturbance in peri-/postmenopausal women. We conducted a systematic review of the literature using PubMed and reference lists from inception until May 2023, including 12 studies that evaluated sleep as a secondary outcome. Most studies found that group and self-help (guided and unguided) cognitive-behavioural therapies and clinical hypnosis for menopausal symptoms have positive effects on sleep among women with significant vasomotor symptoms. There was preliminary support for mindfulness-based stress reduction. Future research including more diverse samples and women with sleep disorders is needed. Evaluating the implementation of psychological therapies in clinics where menopausal women seek care is an important next step.
Collapse
Affiliation(s)
- Nicole E Carmona
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Elisha Starick
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Geneva E Millett
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Sheryl M Green
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Women's Health Concerns Clinic, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Colleen E Carney
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| |
Collapse
|
2
|
Thurston RC, Chang Y, Kline CE, Swanson LM, El Khoudary SR, Jackson EA, Derby CA. Trajectories of Sleep Over Midlife and Incident Cardiovascular Disease Events in the Study of Women's Health Across the Nation. Circulation 2024; 149:545-555. [PMID: 38284249 PMCID: PMC10922947 DOI: 10.1161/circulationaha.123.066491] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/06/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Up to 50% of women report sleep problems in midlife, and cardiovascular disease (CVD) is the leading cause of death in women. How chronic poor sleep exposure over decades of midlife is related to CVD risk in women is poorly understood. We tested whether trajectories of insomnia symptoms or sleep duration over midlife were related to subsequent CVD events among SWAN (Study of Women's Health Across the Nation) participants, whose sleep was assessed up to 16 times over 22 years. METHODS At baseline, SWAN participants (n=2964) were 42 to 52 years of age, premenopausal or early perimenopausal, not using hormone therapy, and free of CVD. They completed up to 16 visits, including questionnaires assessing insomnia symptoms (trouble falling asleep, waking up several times a night, or waking earlier than planned ≥3 times/week classified as insomnia), typical daily sleep duration, vasomotor symptoms, and depressive symptoms; anthropometric measurements; phlebotomy; and CVD event ascertainment (ie, fatal or nonfatal myocardial infarction, stroke, heart failure, revascularization). Sleep trajectories (ie, insomnia, sleep duration) were determined by means of group-based trajectory modeling. Sleep trajectories were tested in relation to CVD in Cox proportional hazards models (multivariable models: site, age, race and ethnicity, education, CVD risk factors averaged over visits; additional covariates: vasomotor symptoms, snoring, depression). RESULTS Four trajectories of insomnia symptoms emerged: low insomnia symptoms (n=1142 [39% of women]), moderate insomnia symptoms decreasing over time (n=564 [19%]), low insomnia symptoms increasing over time (n=590 [20%]), and high insomnia symptoms that persisted (n=668 [23%]). Women with persistently high insomnia symptoms had higher CVD risk (hazard ratio, 1.71 [95% CI, 1.19, 2.46], P=0.004, versus low insomnia; multivariable). Three trajectories of sleep duration emerged: persistently short (~5 hours: n=363 [14%]), moderate (~6 hours: n=1394 [55%]), and moderate to long (~8 hours: n=760 [30%]). Women with persistent short sleep had marginally higher CVD risk (hazard ratio, 1.51 [95% CI, 0.98, 2.33], P=0.06, versus moderate; multivariable). Women who had both persistent high insomnia and short sleep had significantly elevated CVD risk (hazard ratio, 1.75 [95% CI, 1.03, 2.98], P=0.04, versus low insomnia and moderate or moderate to long sleep duration; multivariable). Relations of insomnia to CVD persisted when adjusting for vasomotor symptoms, snoring, or depression. CONCLUSIONS Insomnia symptoms, when persistent over midlife or occurring with short sleep, are associated with higher CVD risk among women.
Collapse
Affiliation(s)
- Rebecca C. Thurston
- University of Pittsburgh School of Medicine, Department of Psychiatry
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology
| | - Yuefang Chang
- University of Pittsburgh School of Medicine, Department of Neurological Surgery
| | - Christopher E. Kline
- University of Pittsburgh School of Education, Department of Health and Human Development
| | | | - Samar R. El Khoudary
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology
| | - Elizabeth A. Jackson
- University of Alabama at Birmingham School of Medicine, Department of Medicine, Division of Cardiology
| | - Carol A. Derby
- Albert Einstein College of Medicine, Department of Neurology and Department of Epidemiology and Population Health
| |
Collapse
|
3
|
Wang H, Yu X, Hu J, Zheng Y, Hu J, Sun X, Ren Y, Chen Y. Effect of Electroacupuncture Versus Cognitive Behavioral Therapy for Perimenopausal Insomnia: Protocol for a Noninferiority Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e51767. [PMID: 37943587 PMCID: PMC10667986 DOI: 10.2196/51767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Perimenopausal insomnia (PMI) has a high global incidence, which is common in middle-aged women and is more severe than nonmenopausal insomnia. Effective treatments with fewer side effects and more consistent repeatable results are needed. Acupuncture, a therapy based on traditional Chinese medicine, is safe and may be effective for PMI. It is widely accepted in Western countries, and evidence supports the use of acupuncture as a main or supplementary therapy. Cognitive behavioral therapy is also used to improve sleep quality. It has structured sessions and has been recommended as a first-line treatment for insomnia (cognitive behavioral therapy for insomnia [CBT-I]) by the American Association of Physicians. However, few randomized controlled trials have been conducted to compare the effectiveness of these 2 therapies. This study will be performed in perimenopausal women with insomnia to determine the efficacy of electroacupuncture (EA) versus CBT-I. OBJECTIVE This study aimed to compare the preliminary effectiveness and safety of EA and CBT-I for PMI through a randomized controlled noninferiority study design. METHODS This study is designed as an assessor-blinded, noninferiority, randomized controlled trial. A total of 160 eligible participants with PMI will be randomly divided into 2 groups to receive either EA or CBT-I. Participants in the EA group will receive electroacupuncture for 8 weeks. The intervention will be delivered 3 times weekly for a total of 12 sessions and 2 times weekly for the next 4 weeks. Meanwhile, participants in the control group will undergo CBT-I (once a week) for 8 weeks. Treatment will use 7 main acupoints (GV20, DU24, EX-HN3, EX-HN18, EX-CA1, RN6, and RN4) and an extra 4 acupoints based on syndrome differentiation. The primary outcome is the Insomnia Severity Index. The secondary outcome measures are the Pittsburgh Sleep Quality Index; Menopause-Specific Quality of Life; Menopause Rating Scale; Hamilton Depression Scale; Hamilton Anxiety Scale; hot flash score; and the level of estradiol, follicle-stimulating hormone, and luteinizing hormone in serum. Sleep architecture will be assessed using polysomnograms. RESULTS Participants are currently being recruited. The first participant was enrolled in January 2023, marking the initiation of the recruitment phase. The recruitment process is expected to continue until January 2025, at which point data collection will commence. CONCLUSIONS This trial represents a pioneering effort to investigate the efficacy and safety of EA and CBT-I as interventions for PMI. It is noteworthy that this study is conducted solely within a single center and involves Chinese participants, which is a limitation. Nonetheless, the findings of this study are expected to contribute valuable insights for clinicians engaged in the management of PMI. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300070981; https://www.chictr.org.cn/showprojEN.html?proj=194561. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51767.
Collapse
Affiliation(s)
- Huixian Wang
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xintong Yu
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Hu
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanting Zheng
- Shanghai Yangpu Mental Health Center, Shanghai, China
| | - Jia Hu
- Shanghai Yangpu Mental Health Center, Shanghai, China
| | - Xuqiu Sun
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Ren
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yunfei Chen
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
4
|
Salari N, Hasheminezhad R, Hosseinian-Far A, Rasoulpoor S, Assefi M, Nankali S, Nankali A, Mohammadi M. Global prevalence of sleep disorders during menopause: a meta-analysis. Sleep Breath 2023; 27:1883-1897. [PMID: 36892796 PMCID: PMC9996569 DOI: 10.1007/s11325-023-02793-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Sleep disorders are conditions that have long-term effects on health, quality of sexual function, productivity at work, and overall quality of life. Considering that reports on menopausal sleep disorders are heterogeneous, the aim of this research was to determine the global prevalence of sleep disorders during menopause by meta-analysis. METHODS PubMed, Google Scholar, Scopus, WoS, ScienceDirect, and Embase databases were checked with suitable keywords. All screening stages of articles were reviewed based on PRISMA and their quality was determined based on STROBE. Data analysis, examination of heterogeneity, and publication bias of factors affecting heterogeneity were performed in CMA software. RESULTS The overall prevalence of sleep disorders among postmenopausal women was 51.6% (95% CI: 44.6-58.5%). The upper prevalence of sleep disorders was among postmenopausal women at 54.7% (95% CI: 47.2-62.1%). The upper prevalence of sleep disorders in the same population category was related to restless legs syndrome with a prevalence of 63.8% (95% CI: 10.6-96.3%). CONCLUSION In this meta-analysis, sleep disorders during menopause were found to be common and significant. Therefore, it is recommended that health policymakers offer pertinent interventions in relation to the health and hygiene of sleep for women in menopause.
Collapse
Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Razie Hasheminezhad
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Shabnam Rasoulpoor
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Marjan Assefi
- Doctorate of Health Care Administration, University Of North Carolina, Greensboro, NC 27412 USA
| | - Sohila Nankali
- Department of Obstetrics and Gynecology, University of Northcentral, Scottsdale, AZ 85255 USA
| | - Anisodowleh Nankali
- Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| |
Collapse
|
5
|
Terauchi M, Cheng JY, Yardley J, Pinner K, Moline M, Malhotra M, Inabe K, Nishida M, Pappadopulos E. Efficacy and safety of lemborexant in midlife women with insomnia disorder. Menopause 2023; 30:839-848. [PMID: 37339396 PMCID: PMC10389212 DOI: 10.1097/gme.0000000000002209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/20/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Insomnia is common in midlife women. The efficacy and safety of lemborexant (LEM), a competitive dual orexin receptor antagonist, was assessed for 12 months in a subgroup of midlife women (age, 40-58 y) from Study E2006-G000-303 (Study 303; SUNRISE-2). METHODS This was a randomized, double-blind, placebo (PBO)-controlled (first 6 mo) study of adults with insomnia disorder ( N = 949). During treatment period 1 (TP1), participants received PBO or LEM 5 mg (LEM5) or 10 mg (LEM10). During TP2 (second 6 mo), LEM participants continued their assigned dose; PBO participants were rerandomized to LEM5 or LEM10. Assessments included patient-reported sleep- and fatigue-related measures and treatment-emergent adverse events. RESULTS The midlife female subgroup comprised 280 of 949 participants (TP1: PBO, n = 90 of 318 [28.3%]; LEM5, n = 82 of 316 [25.9%]; LEM10, n = 108 of 315 [34.3%]). At 6 months, median changes from baseline in subjective sleep-onset latency (in minutes) were -17.9, -20.7, and - 30.4 for PBO, LEM5, and LEM10 (vs PBO: LEM5, P = not significant; LEM10, P = 0.0310). At 6 months, mean changes from baseline in subjective wake after sleep onset (in minutes) were -37.0 (59.6), -50.1 (74.5), and -54.5 (65.4) for PBO, LEM5, and LEM10 (vs PBO: LEM5 and LEM10, P = not significant), with benefits sustained through 12 months. Greater decreases from baseline (improvement) in Insomnia Severity Index total score and Fatigue Severity Scale total score were seen with LEM versus PBO at 6 months; benefits continued through 12 months. Most treatment-emergent adverse events were mild to moderate in severity. CONCLUSIONS Consistent with the total population, subjective sleep parameters improved, and improvement was sustained over time in midlife women. LEM was well tolerated, suggesting that LEM may be a potential treatment option for midlife women with insomnia.
Collapse
Affiliation(s)
- Masakazu Terauchi
- From the Department of Women’s Health, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Morssinkhof MWL, Wiepjes CM, Bosman BW, Kinds J, Fisher AD, Greenman Y, Kreukels BPC, T'Sjoen G, van der Werf YD, Heijer MD, Broekman BFP. Sex hormones, insomnia, and sleep quality: Subjective sleep in the first year of hormone use in transgender persons. Sleep Med 2023; 107:316-326. [PMID: 37271109 DOI: 10.1016/j.sleep.2023.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 06/06/2023]
Abstract
STUDY OBJECTIVES Transgender persons can use gender-affirming hormone therapy (GAHT) to align their physical appearance with their identified gender. Many transgender persons report poor sleep, but the effects of GAHT on sleep are unknown. This study examined the effects of a 12 months of GAHT use on self-reported sleep quality and insomnia severity. METHODS A sample of 262 transgender men (assigned female at birth, started masculinizing hormone use) and 183 transgender women (assigned male at birth, started feminizing hormone use), completed self-report questionnaires on insomnia (range 0-28), sleep quality (range 0-21) and sleep onset latency, total sleep time and sleep efficiency before start of GAHT and after 3, 6, 9, and 12 months of GAHT. RESULTS Reported sleep quality showed no clinically significant changes after GAHT. Insomnia showed significant but small decreases after 3 and 9 months of GAHT in trans men (-1.11; 95%CI: -1.82; -0.40 and -0.97; 95%CI: -1.81; -0.13, respectively) but no changes in trans women. In trans men, reported sleep efficiency decreased by 2.8% (95%CI: -5.5%; -0.2%) after 12 months of GAHT. In trans women, reported sleep onset latency decreased by 9 min (95%CI: -15; -3) after 12 months of GAHT. CONCLUSIONS These findings show that 12 months of GAHT use did not result in clinically significant changes in insomnia or sleep quality. Reported sleep onset latency and reported sleep efficiency showed small to modest changes after 12 months of GAHT. Further studies should focus on underlying mechanisms by which GAHT could affect sleep quality.
Collapse
Affiliation(s)
- Margot W L Morssinkhof
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; OLVG Hospital, Department of Psychiatry and Medical Psychology, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Endocrinology, Department of Internal Medicine, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam, the Netherlands.
| | - Chantal M Wiepjes
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Endocrinology, Department of Internal Medicine, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam, the Netherlands
| | - Breanna W Bosman
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands
| | - Jim Kinds
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Yona Greenman
- The Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam, the Netherlands
| | - Guy T'Sjoen
- Dept. of Endocrinology and Centre for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Ysbrand D van der Werf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neuroscience, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity Impulsivity and Attention, Amsterdam, the Netherlands
| | - Martin den Heijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Endocrinology, Department of Internal Medicine, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam, the Netherlands
| | - Birit F P Broekman
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; OLVG Hospital, Department of Psychiatry and Medical Psychology, Amsterdam, the Netherlands; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A⁎STAR), Singapore
| |
Collapse
|
7
|
Faubion SS, Ghaith S, Kling JM, Mara K, Enders F, Starling AJ, Kapoor E. Migraine and sleep quality: does the association change in midlife women? Menopause 2023; 30:376-382. [PMID: 36720087 PMCID: PMC10038841 DOI: 10.1097/gme.0000000000002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare the association between migraine and sleep quality in premenopausal versus perimenopausal women. METHODS A cross-sectional analysis from the Data Registry on the Experiences of Aging, Menopause and Sexuality was conducted using questionnaire data from premenopausal and perimenopausal women seen at women's health clinics at 3 geographic locations from 2015 to 2021. Sleep quality and duration were assessed with the Pittsburgh Sleep Quality Index. Associations between poor sleep quality (Pittsburgh Sleep Quality Index >5) and self-reported migraine history (Y/N) were evaluated using a multivariable logistic regression model, adjusting for body mass index, anxiety, depression, and vasomotor symptoms. RESULTS Of 2,067 women (mean age 43.2 years) included in the analysis, 594 (28.7%) reported a migraine history. Women were mostly white (92.2%), partnered (75.1%), and educated (86% with at least some college); 46.5% (n = 962) were premenopausal, 53.5% (n = 1,105) were perimenopausal, and 71.2% met the criteria for poor sleep. In univariate analysis, migraine history predicted poor sleep in both premenopausal and perimenopausal women ( P = 0.005 and P = 0.004, respectively). However, in multivariable analysis, migraine history remained associated with poor sleep in premenopausal women ( P = 0.044), but not in perimenopausal women ( P = 0.46). CONCLUSIONS A migraine history was associated with poor sleep in premenopausal women. The relationship in perimenopausal women seemed to be influenced by confounding factors that are more prevalent during the menopause transition and are known to affect the frequency of migraine and sleep disturbances, such as anxiety, depression, and vasomotor symptoms. These conditions may need to be the focus of management in migraineurs with sleep disturbances during the menopause transition.
Collapse
Affiliation(s)
- Stephanie S. Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
- Mayo Clinic Center for Women’s Health, Rochester, MN
| | - Summer Ghaith
- Mayo Clinic Alix School of Medicine, Scottsdale/Phoenix, AZ
| | - Juliana M. Kling
- Mayo Clinic Center for Women’s Health, Rochester, MN
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Felicity Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Ekta Kapoor
- Mayo Clinic Center for Women’s Health, Rochester, MN
- Women’s Health Research Center, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| |
Collapse
|
8
|
Thongchumnum W, Vallibhakara SAO, Sophonsritsuk A, Vallibhakara O. Effect of Vitamin E Supplementation on Chronic Insomnia Disorder in Postmenopausal Women: A Prospective, Double-Blinded Randomized Controlled Trial. Nutrients 2023; 15:nu15051187. [PMID: 36904186 PMCID: PMC10005674 DOI: 10.3390/nu15051187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/03/2023] Open
Abstract
Chronic insomnia disorder is one of the most common problems in postmenopausal women, exacerbated by underdiagnosis and improper treatment. This double-blinded, randomized, placebo-controlled trial was conducted to evaluate the potential of vitamin E to treat chronic insomnia as an alternative to sedative drugs and hormonal therapy. The study enrolled 160 postmenopausal women with chronic insomnia disorder, divided randomly into two groups. The vitamin E group received 400 units of mixed tocopherol daily, while the placebo group received an identical oral capsule. The primary outcome of this study was sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI), a self-evaluated and standardized questionnaire. The secondary outcome was the percentage of participants using sedative drugs. There were no significant differences in baseline characteristics between the study groups. However, the median PSQI score at baseline was slightly higher in the vitamin E group compared with the placebo (13 (6, 20) vs. 11 (6, 20); p-value 0.019). After one month of intervention, the PSQI score was significantly lower (indicating better sleep quality) in the vitamin E group compared with the placebo (6 (1, 18) vs. 9 (1, 19); p-value 0.012). Moreover, the improvement score was significantly higher in the vitamin E group compared with the placebo (5 (-6, 14) vs. 1 (-5,13); p-value < 0.001). In addition, there was a significant reduction in the percentage of patients using sedative drugs in the vitamin E group (15%; p-value 0.009), while this reduction was not statistically significant in the placebo group (7.5%; p-value 0.077). This study demonstrates vitamin E's potential as an excellent alternative treatment for chronic insomnia disorder that improves sleep quality and reduces sedative drug use.
Collapse
Affiliation(s)
- Wirun Thongchumnum
- Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sakda Arj-Ong Vallibhakara
- Faculty of Medicine, BangkokThonburi University, Bangkok 10170, Thailand
- Child Safety Promotion and Injury Prevention Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Areepan Sophonsritsuk
- Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Orawin Vallibhakara
- Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Correspondence:
| |
Collapse
|
9
|
Carmona NE, Millett GE, Green SM, Carney CE. Cognitive-behavioral, behavioural and mindfulness-based therapies for insomnia in menopause. Behav Sleep Med 2022:1-12. [PMID: 35942653 DOI: 10.1080/15402002.2022.2109640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Insomnia is frequently reported by women during menopause due to physiological changes and environmental factors and is associated with negative daytime sequelae. Due to medication side effects and patient preferences, there is increased interest in the use of psychological treatments for menopausal insomnia. The primary objective of this review is to review the efficacy of cognitive-behavioral, behavioral, and mindfulness-based (CBBMB) therapies in treating insomnia in peri- and post-menopausal women. The secondary objective is to review the effect of CBBMB therapies on relevant secondary outcomes to gain a comprehensive understanding of their impacts. METHODS We conducted a narrative review of the literature. A search of PubMed and Google Scholar was conducted between January 2020 and March 2021. RESULTS Cognitive-behavioral therapy (CBT) for insomnia is efficacious, with corollary improvements in mood, functional outcomes and potential mechanistic factors (e.g., unhelpful beliefs). Sleep restriction therapy is also efficacious, with somewhat poorer effects on secondary outcomes relative to CBT. Mindfulness meditation and relaxation for insomnia demonstrated promise, but its long-term effects remain unknown. CONCLUSIONS Research with more diverse samples and head-to-head comparisons is needed. Dissemination of CBBMBs for insomnia in clinics where menopausal women seek care is an important next step.
Collapse
Affiliation(s)
- Nicole E Carmona
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Geneva E Millett
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Sheryl M Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Colleen E Carney
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| |
Collapse
|
10
|
Ballot O, Ivers H, Ji X, Morin CM. Sleep Disturbances During the Menopausal Transition: The Role of Sleep Reactivity and Arousal Predisposition. Behav Sleep Med 2022; 20:500-512. [PMID: 34176385 DOI: 10.1080/15402002.2021.1937171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep disturbances are common during the menopausal transition and several factors can contribute to this increased incidence. This study examined the association between sleep reactivity, arousal predisposition, sleep disturbances, and menopause. METHODS Data for this study were derived from a longitudinal, population-based study on the natural history of insomnia. A total of 873 women (40-60 years) were divided into two groups according to their menopausal status at baseline: reproductive (n = 408) and postmenopausal (n = 465). Participants were evaluated annually throughout the five-year follow-up period. Four questionnaires were used to examine sleep quality, insomnia severity, sleep reactivity, and arousal predisposition. The data were analyzed using two approaches: cross-sectional with a multivariate analysis and binary regression, and longitudinal with a linear mixed models using menopausal groups (3) x time (5) design. RESULTS Cross-sectional analyses showed that postmenopausal women reported significantly more severe insomnia and poorer sleep quality than reproductive women. Sleep reactivity and arousal predisposition were significant predictors of sleep disturbances. Longitudinal analyses revealed increased sleep disturbances in the two years before and after the menopausal transition. Sleep reactivity and arousal predisposition did not moderate the temporal relationship between menopausal transition and sleep disturbances. CONCLUSION More sleep disturbances were reported during the menopausal transition, but those difficulties were not explained by sleep reactivity and arousal predisposition. These results suggest the involvement of other psychophysiological factors in the development of sleep disturbances during the menopause.
Collapse
Affiliation(s)
- O Ballot
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - H Ivers
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - X Ji
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - C M Morin
- École de Psychologie, Université Laval, Québec, QC, Canada
| |
Collapse
|
11
|
Cienfuegos S, Gabel K, Kalam F, Ezpeleta M, Pavlou V, Lin S, Wiseman E, Varady KA. The effect of 4-h versus 6-h time restricted feeding on sleep quality, duration, insomnia severity and obstructive sleep apnea in adults with obesity. Nutr Health 2022; 28:5-11. [PMID: 33759620 PMCID: PMC8460695 DOI: 10.1177/02601060211002347] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Time restricted feeding (TRF) involves deliberately restricting the times during which energy is ingested. Preliminary findings suggest that 8-10-h TRF improves sleep. However, the effects of shorter TRF windows (4-6 h) on sleep, remain unknown. AIMS This study compared the effects of 4-h versus 6-h TRF on sleep quality, duration, insomnia severity and the risk of obstructive sleep apnea. METHODS Adults with obesity (n = 49) were randomized into one of three groups: 4-h TRF (eating only between 3 and 7 p.m.), 6-h TRF (eating only between 1 and 7 p.m.), or a control group (no meal timing restrictions) for 8 weeks. RESULTS After 8 weeks, body weight decreased (p < 0.001) similarly by 4-h TRF (-3.9 ± 0.4 kg) and 6-h TRF (-3.4 ± 0.4 kg), versus controls. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), did not change by 4-h TRF (baseline: 5.9 ± 0.7; week 8: 4.8 ± 0.6) or 6-h TRF (baseline: 6.4 ± 0.8; week 8: 5.3 ± 0.9), versus controls. Wake time, bedtime, sleep duration and sleep onset latency also remained unchanged. Insomnia severity did not change by 4-h TRF (baseline: 4.4 ± 1.0; week 8: 4.7 ± 0.9) or 6-h TRF (baseline: 8.3 ± 1.2; week 8: 5.5 ± 1.1), versus controls. Percent of participants reporting obstructive sleep apnea symptoms did not change by 4-h TRF (baseline: 44%; week 8: 25%) or 6-h TRF (baseline: 47%; week 8: 20%), versus controls. CONCLUSION These findings suggest that 4- and 6-h TRF have no effect on sleep quality, duration, insomnia severity, or the risk of obstructive sleep apnea.
Collapse
Affiliation(s)
- Sofia Cienfuegos
- Department of Kinesiology and Nutrition, 12247University of Illinois at Chicago, USA
| | - Kelsey Gabel
- Department of Kinesiology and Nutrition, 12247University of Illinois at Chicago, USA
| | - Faiza Kalam
- Department of Kinesiology and Nutrition, 12247University of Illinois at Chicago, USA
| | - Mark Ezpeleta
- Department of Kinesiology and Nutrition, 12247University of Illinois at Chicago, USA
| | - Vicky Pavlou
- Department of Kinesiology and Nutrition, 12247University of Illinois at Chicago, USA
| | - Shuhao Lin
- Department of Kinesiology and Nutrition, 12247University of Illinois at Chicago, USA
| | - Eric Wiseman
- Department of Kinesiology and Nutrition, 12247University of Illinois at Chicago, USA
| | - Krista A Varady
- Department of Kinesiology and Nutrition, 12247University of Illinois at Chicago, USA
| |
Collapse
|
12
|
Rodrigues-Santos I, Kalil-Cutti B, Anselmo-Franci JA. Low Corticosterone Response to Stress in a Perimenopausal Rat Model Is Associated with the Hypoactivation of PaMP Region of the Paraventricular Nucleus and Can Be Corrected by Exogenous Progesterone Supplementation. Neuroendocrinology 2022; 112:467-480. [PMID: 34348338 DOI: 10.1159/000518336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/30/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The transition to menopause is characterized by mood, behavioral and metabolic changes. However, little is known about the changes in adrenal response to stress. AIMS The aim of the study was to evaluate, in an animal model of perimenopause induced by 4-vinylcyclohexene diepoxide (VCD), (1) the endocrine and neuronal stress system activity in response to acute restraint stress and (2) the effect of hormonal therapy in this response. METHODS Prepubertal female Wistar rats received daily injections (s.c) of oil or VCD (160 mg/kg) for 15 days. On 56th-66th days after treatment onset, the groups to be stressed received s.c implants containing placebo (PL), 17β-estradiol (E2), progesterone (P4), or E2P4. At 80 ± 5 days after VCD/oil injections, stress was applied for 30 min. Blood samples were collected immediately after and 60 min after the end of stress session from the tail tip followed by transcardial perfusion with PFA 4% for the assessment of c-Fos expression in the medial and posterior parvocellular (PaMP and PaPo) subdivisions of the paraventricular nucleus (PVN) and c-Fos/tyrosine hydroxylase in the locus coeruleus (LC) using immunohistochemistry. Control groups were not stressed nor received hormone therapy. RESULTS While basal corticosterone levels were similar between VCD-periestropausal and control rats, the secretion in response to stress in the VCD group was lower. This effect was prevented by P4 therapy. Inversely, basal levels of P4 were lower in VCD-periestropausal rats than in the controls, and no differences were found in response to stress between the groups. As expected, 30-min restraint stress increased c-Fos immunoreactivity in all brain areas studied in both control and VCD-periestropausal rats. However, the c-Fos increase in the PaMP region was attenuated. In all areas examined, there were no significant differences in the number of c-Fos-positive neurons across hormonal therapies. DISCUSSION/CONCLUSION This is the first study to demonstrate in a perimenopausal rat model that reproductive aging is accompanied by inadequate secretion of corticosterone in response to acute stress in association with the hypoactivation of the PaMP region of the PVN, while adrenal P4 response is preserved. Moreover, P4 therapy was shown to attenuate the effects of progressive ovarian failure on adrenal functioning during stress.
Collapse
Affiliation(s)
- Isabelle Rodrigues-Santos
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil,
| | - Bruna Kalil-Cutti
- Department of Physiology, Institute of Biomedical Science, Federal University of Alfenas, Alfenas, São Paulo, Brazil
| | - Janete Aparecida Anselmo-Franci
- Department of Basic and Oral Biology of Dentistry School of Ribeirão Preto, Laboratory of Neuroendocrinology, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
13
|
Pan C, Wang Z, Zhang F, Zeng Y, Chen X, Huang J, Wang C. Acupuncture for perimenopausal insomnia: a case report. Acupunct Med 2021; 39:740-741. [PMID: 34231419 DOI: 10.1177/09645284211026316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Chaoran Pan
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhengyan Wang
- Sichuan Integrative Medicine Hospital, Chengdu, China
| | - Feng Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Zeng
- Southwest Medical University, Luzhou, China
| | - Xingliang Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jingxian Huang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chao Wang
- Sichuan Integrative Medicine Hospital, Chengdu, China
| |
Collapse
|
14
|
Comparative Utility of Acupuncture and Western Medication in the Management of Perimenopausal Insomnia: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5566742. [PMID: 33986818 PMCID: PMC8093060 DOI: 10.1155/2021/5566742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022]
Abstract
Background Many women with perimenopausal insomnia (PMI) have sought alternative therapies such as acupuncture because of concerns about risks associated with hormone replacement therapy (HRT) and/or psychotropic drugs. This systematic review aimed to clarify if acupuncture alone or combined with standard Western pharmacotherapy (HRT and/or psychotropic drugs) is more effective in ameliorating PMI in comparison to pharmacotherapy alone. Methods Randomized controlled trials (RCTs) of PMI treatment via acupuncture alone or combined with Western pharmacotherapy versus Western pharmacotherapy were searched for from eleven databases from inception to March 2020. Cochrane criteria were followed. Results Fifteen studies involving 1410 women were analyzed. Meta-analysis indicated that acupuncture significantly reduced the global scores of Pittsburgh Sleep Quality Index (PSQI) [MD = −2.38, 95% CI (−3.38, −1.37), p < 0.01] and Kupperman Index [MD = −5.95, 95% CI (−10.68, −1.21), p = 0.01], compared with hypnotics. Acupuncture combined with hypnotics was more effective than hypnotics alone in decreasing PSQI scores [MD = −3.13, 95% CI (−5.43, −0.83), p < 0.01]. Too few RCTs were available to investigate the clinical efficacy differences between acupuncture and HRT/psychotropic drugs other than hypnotics. Conclusions Despite limited evidence, in comparison to hypnotics, acupuncture was associated with significant improvements in PMI, and reductions of other menopausal symptoms. This finding suggests that acupuncture may be a useful addition to treatment for PMI.
Collapse
|
15
|
Kling JM, Kapoor E, Mara K, Faubion SS. Associations of sleep and female sexual function: good sleep quality matters. Menopause 2021; 28:619-625. [PMID: 33878089 DOI: 10.1097/gme.0000000000001744] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate associations between sleep and female sexual function. METHODS A cross-sectional analysis from the Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS) was performed using questionnaires in women presenting for menopause or sexual health consult at Mayo Clinic from December, 2016 to September, 2019. Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and the Pittsburgh Sleep Quality Index (PSQI) assessed sexual function and sleep parameters, respectively. Associations between sleep quality (PSQI score ≥ 5 poor sleep quality), sleep durations (< 5 h, 5-6 h, 6-7 h, > 7 h) and female sexual dysfunction (FSFI ≤ 26.55 and FSDS-R ≥ 11) were evaluated utilizing a multivariable logistic model adjusting for multiple factors. A secondary analysis evaluated sleep quality by sexual activity and also included sexually inactive women. RESULTS A total of 3,433 women were included (mean age 53). Sexually active women (N = 2,487; 72.4%) were included in the primary analysis; 75% had poor sleep quality, and 54% met criteria for female sexual dysfunction. On multivariable analysis, women with poor sleep quality were 1.48 times more likely to report female sexual dysfunction (95% CI 1.21-1.80, P < 0.001). Of women who reported sleeping < 5 hours nightly, 63.3% had female sexual dysfunction, and their Female Sexual Function Index total and domain scores were significantly lower than women sleeping > 7 hours nightly (P = 0.004); however, this was not statistically significant in multivariable analysis. Sexually active women were more likely to report good sleep quality compared with sexually inactive women (25.3% vs 20.5%, P = 0.003). CONCLUSIONS Poor sleep quality, but not sleep duration, was associated with greater odds of female sexual dysfunction. Good sleep quality was linked to sexual activity. In addition to its myriad effects on health, poor sleep quality is associated with female sexual dysfunction.
Collapse
Affiliation(s)
- Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
- Mayo Clinic Center for Women's Health, Mayo Clinic, Rochester, MN
| | - Ekta Kapoor
- Mayo Clinic Center for Women's Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Kristin Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Stephanie S Faubion
- Mayo Clinic Center for Women's Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
16
|
Miller MB, Curtis AF, Chan WS, Deroche CB, McCrae CS. Daily associations between sleep and opioid use among adults with comorbid symptoms of insomnia and fibromyalgia. J Clin Sleep Med 2021; 17:729-737. [PMID: 33226334 DOI: 10.5664/jcsm.9002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Disturbed sleep and use of opioid pain medication are common among individuals with chronic pain. Anecdotally, opioids are thought to promote sleep by relieving pain. This study aimed to determine whether opioid use is associated with daily sleep parameters (and vice versa) in adults with comorbid symptoms of insomnia and fibromyalgia. METHODS Individuals reporting symptoms of insomnia and opioid use for fibromyalgia (n = 65, 93% women, 79% White) wore wrist actigraphy and completed daily diaries for 14 days (910 observations). Analyses examined daily associations between opioid dose (measured in lowest recommended dosage units) and three sleep parameters (actigraphy/self-reported total wake time and self-reported sleep quality). Multilevel models were used to account for the clustering of daily sleep and opioid assessments (level 1) within individuals (level 2). RESULTS Opioid use did not have a significant daily effect on total wake time or sleep quality, and sleep parameters did not significantly impact opioid use the next day; however, participants reported worse sleep quality and greater doses of opioids on evenings that they experienced greater pain. CONCLUSIONS Among adults reporting symptoms of insomnia and opioid use for fibromyalgia pain, opioid use is not reliably associated with wake time or sleep quality that night, and these sleep parameters are not significantly associated with opioid use the next day; however, evening pain has an adverse daily impact on both sleep quality and opioid use. Studies identifying strategies to prevent and manage fibromyalgia pain are needed, especially for individuals reporting comorbid insomnia and opioid use.
Collapse
Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri.,Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Wai Sze Chan
- Department of Psychology, The University of Hong Kong, Hong Kong
| | - Chelsea B Deroche
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri
| |
Collapse
|
17
|
Kline CE, Colvin AB, Pettee Gabriel K, Karvonen-Gutierrez CA, Cauley JA, Hall MH, Matthews KA, Ruppert KM, Neal-Perry GS, Strotmeyer ES, Sternfeld B. Associations between longitudinal trajectories of insomnia symptoms and sleep duration with objective physical function in postmenopausal women: the Study of Women's Health Across the Nation. Sleep 2021; 44:6168369. [PMID: 33705558 DOI: 10.1093/sleep/zsab059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/17/2021] [Indexed: 12/26/2022] Open
Abstract
STUDY OBJECTIVES Examine the association between trajectories of self-reported insomnia symptoms and sleep duration over 13 years with objective physical function. METHODS We utilized data from 1627 Study of Women's Health Across the Nation (SWAN) participants, aged 61.9±2.7 y at the end of the 13-y follow-up. Latent class growth models identified trajectories of insomnia symptoms (trouble falling asleep, frequent night-time awakenings, and/or early-morning awakening) and sleep duration over 13 y. Physical function tests were performed at the end of the 13-y period: 40-ft walk, 4-m walk, repeated chair stand, grip strength, and balance. Multivariable regression analyses examined each physical function measure according to the insomnia symptom or sleep duration trajectory group. RESULTS Five insomnia symptom trajectories and two sleep duration trajectories were identified. Women with a consistently high likelihood of insomnia symptoms and women with a decreased likelihood of insomnia symptoms (i.e., improving) had slower gait speed (3.5% slower 40-ft walk [consistently high], 3.7% slower 4-m walk [improving]; each P≤.05) than those with a consistently low likelihood of insomnia symptoms. In contrast, women with a steep increase in the likelihood of insomnia symptoms over time and women with persistent insufficient sleep duration had lower odds of having a balance problem (odds ratio [OR]=0.36 and OR=0.61, respectively; each P<.02) compared to those with a consistently low likelihood of insomnia symptoms and those with persistent sufficient sleep duration, respectively. CONCLUSION These results suggest that women's sleep during midlife has important implications for maintaining physical function during the transition into older adulthood.
Collapse
Affiliation(s)
| | | | | | | | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh.,Department of Psychology, University of Pittsburgh
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh.,Department of Psychology, University of Pittsburgh
| | | | | | | | | |
Collapse
|
18
|
Zhao FY, Fu QQ, Spencer SJ, Kennedy GA, Conduit R, Zhang WJ, Zheng Z. Acupuncture: A Promising Approach for Comorbid Depression and Insomnia in Perimenopause. Nat Sci Sleep 2021; 13:1823-1863. [PMID: 34675729 PMCID: PMC8520448 DOI: 10.2147/nss.s332474] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/24/2021] [Indexed: 12/12/2022] Open
Abstract
Comorbid depression and insomnia are ubiquitous mental complaints among women going through the perimenopausal stage of life and can result in major decline in quality of life. Antidepressive agents combined with/without hypnotics, and/or hormone therapy are currently the most common treatment for perimenopausal depression (PMD) and insomnia (PMI). Balancing the benefits of these pharmacotherapies against the risk of adverse events (AEs) is a difficult task for both clinicians and women. There has been a growing body of research regarding the utilization of acupuncture for treatment of PMD or PMI, whereas no studies of acupuncture for comorbid PMD and PMI have appeared. In this review, we summarize the clinical and preclinical evidence of acupuncture as a treatment for PMD or PMI, and then discuss the potential mechanisms involved and the role of acupuncture in helping women during this transition. Most clinical trials indicate that acupuncture ameliorates not only PMD/PMI but also climacteric symptoms with minimal AEs. It also regulates serum hormone levels. The reliability of trials is however limited due to methodological flaws in most studies. Rodent studies suggest that acupuncture prolongs total sleep time and reduces depression-like behavior in PMI and PMD models, respectively. These effects are possibly mediated through multiple mechanisms of action, including modulating sex hormones, neurotransmitters, hypothalamic-pituitary-adrenal axis/hypothalamic-pituitary-ovary axis, oxidative stress, signaling pathways, and other cellular events. In conclusion, acupuncture is a promising therapeutic strategy for comorbid depression and insomnia during perimenopause. Neuroendocrine modulation is likely to play a major role in mediating those effects. High-quality trials are required to further validate acupuncture's effectiveness.
Collapse
Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China.,Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, People's Republic of China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People's Republic of China
| | - Sarah J Spencer
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,ARC Centre of Excellence for Nanoscale Biophotonics, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,School of Science, Psychology and Sport, Federation University, Mount Helen, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| |
Collapse
|
19
|
Zhao FY, Zhang WJ, Kennedy GA, Conduit R, Zheng Z, Fu QQ. The Role of Acupuncture in Treating Perimenopausal Insomnia: An Overview and Quality Assessment of Systematic Reviews and Meta-Analyses. Neuropsychiatr Dis Treat 2021; 17:3325-3343. [PMID: 34795484 PMCID: PMC8593691 DOI: 10.2147/ndt.s337504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/22/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To summarize and critically assess the reliability of the methodological quality and outcome measures from systematic reviews (SRs)/meta-analyses (MAs) and provide an overall verdict about the therapeutic value of acupuncture for perimenopausal insomnia (PMI). METHODS We conducted a comprehensive literature search for SRs/MAs of seven major databases (English and Chinese). For each included review, the methodological quality was appraised according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the evidence quality was classified on the basis of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), and reporting quality was evaluated complying with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 (PRISMA-2009). Veritas plots were used to quantify the quality of included SRs/MAs. RESULTS Nine SRs/MAs were deemed eligible for the present overview. Considering the assessment of results from the AMSTAR-2 checklist, the methodological quality of one SR/MA was considered low, and the remaining eight were critically low. Major methodological deficiencies were concentrated on item 2 (the lack of protocol and/or registration information), item 7 (the lack of a list of excluded studies), and item 10 (the lack of reports on funding sources for individual studies included in the SRs/MAs). For the GRADE system, of the 25 outcomes, only three (12%) were rated as moderate-quality, while the remaining 22 were rated between low- and very low-quality. The PRISMA-2009 statement indicated three major reporting quality limitations in most SRs/MAs, namely: 1) only search terms without specific retrieval strategy; 2) incomplete descriptions for study characteristics, particularly the specific dosage and frequency of interventions in treatment/control groups; and 3) inadequate investigation and explanation of the source of high heterogeneity among original randomized control trials included. According to Veritas plots, quality rank scores of included SRs/MAs ranged from 3.3 to 8.3, with an average score of 6.4 ± 1.7. CONCLUSION Acupuncture appears to be beneficial for PMI management, but the quality of evidence is weakened by the unsatisfactory quality of both SRs/MAs and original trials included.
Collapse
Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, People's Republic of China.,Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,School of Science, Psychology and Sport, Federation University, Mount Helen, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Qiang-Qiang Fu
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People's Republic of China
| |
Collapse
|
20
|
Insomnia symptoms in relation to menopause among middle-aged Chinese women: Findings from a longitudinal cohort study. Maturitas 2020; 141:1-8. [DOI: 10.1016/j.maturitas.2020.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 01/31/2023]
|
21
|
Efficacy of transcutaneous electrical acupoint stimulation (TEAS) for menopausal insomnia and its effect on serum hormone levels. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2020. [DOI: 10.1007/s11726-020-1173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Boddu SA, Bojanowski CM, Lam MT, Advani IN, Scholten EL, Sun X, Montgrain P, Malhotra A, Jain S, Alexander LEC. Use of Electronic Cigarettes with Conventional Tobacco Is Associated with Decreased Sleep Quality in Women. Am J Respir Crit Care Med 2020; 200:1431-1434. [PMID: 31314572 DOI: 10.1164/rccm.201904-0890le] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Christine M Bojanowski
- Tulane UniversityNew Orleans, Louisiana.,Southeastern Louisiana Veterans Healthcare SystemNew Orleans, Louisiana
| | - Michael T Lam
- University of California, San DiegoSan Diego, California.,Hennepin HealthcareMinneapolis, Minnesotaand
| | - Ira N Advani
- University of California, San DiegoSan Diego, California
| | - Eric L Scholten
- Veterans Affairs San Diego Healthcare SystemLa Jolla, California
| | - Xiaoying Sun
- University of California, San DiegoSan Diego, California
| | - Philippe Montgrain
- University of California, San DiegoSan Diego, California.,Veterans Affairs San Diego Healthcare SystemLa Jolla, California
| | - Atul Malhotra
- University of California, San DiegoSan Diego, California
| | - Sonia Jain
- University of California, San DiegoSan Diego, California
| | - Laura E Crotty Alexander
- University of California, San DiegoSan Diego, California.,Veterans Affairs San Diego Healthcare SystemLa Jolla, California
| |
Collapse
|
23
|
Zhao FY, Kim JH, Yue LP, Yan HX, Song HL, Xu Y, Xu H, Hong YF, Fu QQ. SOOJI CHIM (Koryo hand acupuncture) for perimenopausal insomnia: Evidence from actigraphy and serum hormone testing. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2019. [DOI: 10.1016/j.wjam.2019.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
Mikkelsen KB, Tabar YR, Kappel SL, Christensen CB, Toft HO, Hemmsen MC, Rank ML, Otto M, Kidmose P. Accurate whole-night sleep monitoring with dry-contact ear-EEG. Sci Rep 2019; 9:16824. [PMID: 31727953 PMCID: PMC6856384 DOI: 10.1038/s41598-019-53115-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/28/2019] [Indexed: 01/23/2023] Open
Abstract
Sleep is a key phenomenon to both understanding, diagnosing and treatment of many illnesses, as well as for studying health and well being in general. Today, the only widely accepted method for clinically monitoring sleep is the polysomnography (PSG), which is, however, both expensive to perform and influences the sleep. This has led to investigations into light weight electroencephalography (EEG) alternatives. However, there has been a substantial performance gap between proposed alternatives and PSG. Here we show results from an extensive study of 80 full night recordings of healthy participants wearing both PSG equipment and ear-EEG. We obtain automatic sleep scoring with an accuracy close to that achieved by manual scoring of scalp EEG (the current gold standard), using only ear-EEG as input, attaining an average Cohen's kappa of 0.73. In addition, this high performance is present for all 20 subjects. Finally, 19/20 subjects found that the ear-EEG had little to no negative effect on their sleep, and subjects were generally able to apply the equipment without supervision. This finding marks a turning point on the road to clinical long term sleep monitoring: the question should no longer be whether ear-EEG could ever be used for clinical home sleep monitoring, but rather when it will be.
Collapse
Affiliation(s)
| | - Yousef R Tabar
- Department of Engineering, Aarhus University, Aarhus, Denmark
| | - Simon L Kappel
- Department of Engineering, Aarhus University, Aarhus, Denmark
- Department of Electronic & Telecommunication Engineering, University of Moratuwa, Katubedda, Sri Lanka
| | | | | | | | | | - Marit Otto
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Preben Kidmose
- Department of Engineering, Aarhus University, Aarhus, Denmark.
| |
Collapse
|
25
|
Barewal RM. Obstructive Sleep Apnea: The Role of Gender in Prevalence, Symptoms, and Treatment Success. Dent Clin North Am 2019; 63:297-308. [PMID: 30825992 DOI: 10.1016/j.cden.2018.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this article is to provide an overview of known similarities and differences between genders relative to presenting symptoms, demographics, and severity of obstructive sleep apnea. There is a relationship of risk of disease occurrence relative to stages of reproductive life of a woman, indicating that chronologic age might not be as important as timing of pregnancy and menopausal transition. The current understanding of gender differences in treatment success and compliance with oral appliance therapy is limited and requires further investigation.
Collapse
Affiliation(s)
- Reva Malhotra Barewal
- Department of Pulmonology and Critical Care, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| |
Collapse
|
26
|
Li D, Kong J, Yang Y, Wang S, Wu J, Chao J. Group cognitive behavioural therapy of physical and psychological menopausal symptoms of Chinese women, delivered via Internet and mobile phone versus face to face: A protocol for a randomized non-inferiority trial. Maturitas 2019; 129:23-29. [PMID: 31547909 DOI: 10.1016/j.maturitas.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/05/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Menopause syndrome generally includes psychological problems. Group treatment delivered via the Internet and mobile phone (imGT) may improve women's physiological and psychological conditions. OBJECTIVE To investigate the efficacy of group cognitive behavioural therapy of menopause-related mood swings and quality of life, delivered face to face or via the Internet and mobile phone. METHODS This protocol is for a randomized controlled clinical trial with a sample of 140 menopausal women divided into 2 groups: imGT and face-to-face group treatment (ffGT). The primary outcome will be the improvement in the menopausal symptoms of the two groups, as assessed by the Greene Climacteric Scale. The secondary outcomes will be: quality of life, assessed by the Short Form 36 Health Survey Questionnaire; insomnia, assessed by the Pittsburgh Sleep Quality Inventory; anxiety, assessed by the Hamilton Anxiety Rating Scale; and therapeutic alliance, assessed by the Working Alliance Inventory-Short Revised and Client Sat-is-fac-tion Qes-tion-naire-8. imGT will be performed once a week for 1.5 h for 10 weeks with a daily 'Punched-in' on the WeChat app; ffGT will be performed once a week for 1.5 h for 10 weeks. All outcomes will be assessed at baseline, at a post-intervention evaluation (week 10), and at a follow-up evaluation (week 22). DISCUSSION This study will be the first clinical trial to examine the effects of imGT on menopausal women in China. If imGT is found to be non-inferior to ffGT, it will facilitate access to menopausal health services.
Collapse
Affiliation(s)
- Dan Li
- Southeast University, China
| | - Jing Kong
- Nanjing Maternity and Child Health Care Hospital, China
| | - Ying Yang
- Nanjing Maternity and Child Health Care Hospital, China
| | - Suli Wang
- Nanjing Maternity and Child Health Care Hospital, China
| | - Jiangping Wu
- Nanjing Maternity and Child Health Care Hospital, China
| | | |
Collapse
|
27
|
Abstract
Although more than 80% of women experience some degree of psychological or physical symptoms around menopause, both women and clinicians have misconceptions about how hormonal changes relate to menopausal symptoms and psychological conditions. Recently, several large-scale, longitudinal studies have been conducted to better characterize symptoms and changes that occur around menopause. This article offers current evidence for symptoms that occur in the early menopause transition, including vasomotor symptoms, mood changes, sleep problems, and changes in sexual functioning.
Collapse
|
28
|
|
29
|
Pengo MF, Won CH, Bourjeily G. Sleep in Women Across the Life Span. Chest 2018; 154:196-206. [PMID: 29679598 PMCID: PMC6045782 DOI: 10.1016/j.chest.2018.04.005] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 02/07/2023] Open
Abstract
There are many ways in which women experience sleep differently from men. Women contending with distinct sleep challenges respond differently to sleep disorders, as well as sleep deprivation and deficiency, and face particular health outcomes as a result of poor sleep. Idiosyncrasies, including changes that occur with the biological life cycles of menstruation, pregnancy, and menopause, make the understanding of sleep in women an important topic to study. Each phase of a woman's life, from childhood to menopause, increases the risk of sleep disturbance in unique ways that may require distinct management. Indeed, new research is unraveling novel aspects of sleep pathology in women and the fundamental role that sex hormones play in influencing sleep regulation and arousals and possibly outcomes of sleep conditions. Moreover, studies indicate that during times of hormonal change, women are at an increased risk for sleep disturbances such as poor sleep quality and sleep deprivation, as well as sleep disorders such as OSA, restless legs syndrome, and insomnia. This article reviews sleep changes in female subjects from neonatal life to menopause.
Collapse
Affiliation(s)
- Martino F Pengo
- Sleep Disorder Center, Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Christine H Won
- Yale Center for Sleep Medicine, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Ghada Bourjeily
- Department of Medicine, Divisions of Pulmonary, Critical Care, Sleep Medicine and Obstetric Medicine, Warren Alpert Medical School of Brown University, Providence, RI.
| |
Collapse
|
30
|
Guo T, Jia M, Jin Y, Xu N, Peng T. Acupuncture for perimenopausal insomnia: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2018; 97:e11083. [PMID: 29901620 PMCID: PMC6023653 DOI: 10.1097/md.0000000000011083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Perimenopausal insomnia (PI) is one of the most common complaints in women. Acupuncture is used to treat PI increasingly considering its less side effect. The subject of this study is to explore the effectiveness and safety of acupuncture for PI. METHODS All the randomized controlled trials(RCT) literatures of acupuncture for PI will be searched in the databases of MEDLINE, Cochrane Library, Web of Science, EMBASE, Springer, WHO International Clinical Trials Registry Platform (ICTRP), China National Knowledge Infrastructure (CNKI), Wan fang, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP), and other available resources using the subject terms of 'acupuncture" and "perimenopausal insomnia" and their synonyms. The languages are limited as English and Chinese. Non-RCT literatures will be screened and relative information will be extracted. Sleep quality values is considered as the primary outcome. Secondary outcomes include biochemical indicators, such as hormone levels, side effects caused by acupuncture, total scores on the insomnia severity index and traditional Chinese medicine symptom changes. RESULTS This systematic review study will provide an evidence of acupuncture for PI. CONCLUSION The study will give an explicit evidence to evaluate the effectiveness and side effects of acupuncture for PI. PROSPERO REGISTRATION NUMBER CRD42018092917.
Collapse
Affiliation(s)
- Taipin Guo
- Yunnan University of Traditional Chinese Medicine, Kunming
| | - Man Jia
- The People's Hospital of Wenshan Prefecture, Wenshan, Yunnan Province
| | - Yuhao Jin
- Yunnan University of Traditional Chinese Medicine, Kunming
| | - Na Xu
- Yunnan University of Traditional Chinese Medicine, Kunming
| | - Tianzhong Peng
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi Province, China
| |
Collapse
|