Auricular acupressure helps improve sleep quality for severe insomnia in maintenance hemodialysis patients: a pilot study

The effect of auriculotherapy on improving sleep quality in postmenopausal women aged 45-60 years: A clinical trial study

BACKGROUND

Menopause is one of the developmental stages of women. One of the most common problems during this period is sleep disorders. Sleep disorders can affect the quality of life of these people. To improve sleep disorders, auriculotherapy has received less attention due to its low cost and effectiveness, and side effects. Therefore, the aim of this study was to determine the effect of auriculotherapy on improving sleep quality in postmenopausal women aged 45-60 years.

MATERIALS AND METHODS

The present study is a clinical trial study that was performed on 82 postmenopausal women aged 45-60 years under the auspices of health centers in Mahshahr city, Iran from 2021-2022. Women with inclusion criteria were randomly divided into two groups (intervention and control). The intervention group underwent auriculotherapy for 4 weeks. The St. Petersburg Sleep Quality Questionnaire was completed by both groups at the beginning and 4 weeks after the start of the intervention. Finally, the data were analyzed by SPSS software version 22 and independent t-test, paired t-test and Chi-square test.

RESULTS

At the beginning of the study, both groups were homogeneous in terms of demographic variables. The results of data analysis using independent t-test showed that before the intervention, mental quality (P = 0.513), length of incubation period (P = 0.285), sleep duration (P = 0.121), sleep efficiency (P = 0.513), sleep disorders (P = 0.685), use of sleeping pills (P = 0.530), daily functioning (P = 0.60), and overall sleep quality score (P = 0.30) in the control and intervention groups were not statistically significant. However, comparing the mean scores after the intervention in the control and intervention groups showed that mental quality (P < 0.001), incubation period (P < 0.001), sleep duration (P < 0.001), sleep efficiency (P < 0.001), sleep disorders (P < 0.001), use of hypnotics (P = 0.002), daily functioning (P = 0.001), overall sleep quality score (P < 0.001), sleep duration (P = 0.822), sleep efficiency (P = 0.889), sleep disorders (P = 0.889), use of sleeping pills (P = 1.00), daily performance (P = 0.767), overall sleep quality score (P = 0.69) were statistically significant between the two groups. In-group comparison using paired t-test in the control group showed that mental quality (P = 0128), length of the incubation period (P = 1.00), and before and after the intervention did not differ significantly in the mean scores. However, a within-group comparison in the intervention group showed that mental quality (P < 0.001), incubation period (P < 0.001), sleep duration (P < 0.001), sleep efficiency (P < 0.001), sleep disorders (P = 0.003), use of sleeping pills (P = 0.007), daily functioning (P < 0.001), and overall sleep quality score (P < 0.001) before and after the intervention had a significant difference in the mean scores.

CONCLUSION

The results showed that auriculotherapy has significant effectiveness in improving the quality of sleep, and its dimensions and can be used as an effective method in this area that can be implemented at a low cost and easily. According to reports from participants and previous studies in this field, auriculotherapy did not have any side effects and can be used as a safe way to improve sleep quality.

Auricular acupuncture for sleep quality in participants with mental and behavioral disorders due to prior multiple drug use: a retrospective consecutive case series

BACKGRUOUND

Poor sleep quality is associated with psychoactive substance abuse/addiction/withdrawal. Auricular acupuncture (AA) is a nonpharmacological method used for the treatment of sleep disturbances. This study aimed to examine the quality of sleep before and after AA in participants with mental and behavioral disorders due to prior multiple drug use in the therapeutic community.

METHODS

This was a consecutive case series of 27 participants (25 male [92.6%]). The median age was 35.0 years (interquartile range [IQR], 29.0-37.2 years), methadone/buprenorphine were not used, and the participants were treated with AA (median number of treatments, 15.0 [IQR, 12.0-18.0]) during a median period of 51.0 days (IQR, 49.0-51.0 days) according to the National Acupuncture Detoxification Association (NADA)-Acudetox protocol. Sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI), a self-rated questionnaire that assesses sleep quality and disturbances over a 1-month interval.

RESULTS

The global PSQI score dropped (indicating better sleep quality) by a median of 3.0 points (IQR, 0.0-8.0 points) after treatment. In the multivariate logistic regression analysis, with an increase in global PSQI score during AA by 1 point, there was a 0.73-fold reduction in the risk of poor sleep quality post-AA (adjusted odds ratio, 0.73; 95% confidence interval, 0.52-1.01; p<0.055; Nagelkerke's R2=0.66).

CONCLUSION

The results revealed a positive effect of AA (by the NADA-Acudetox protocol) on sleep quality (as measured by PSQI) among participants in a treatment center with mental and behavioral disorders due to multiple drug use.

Auricular Acupressure for Improving Sleep Quality in Patients With Lung Cancer: A Systematic Review and Meta-analysis

This meta-analysis was conducted to systematically evaluate the efficacy and safety of auricular acupressure on sleep quality in patients with lung cancer. Nine articles with a total of 802 patients were retrieved after searching on 11 electronic databases. Results of the meta-analysis showed that auricular acupressure improved sleep score (standard mean difference: -0.80, 95% confidence intervals: -1.30 to -0.30, P = .002) and reduced sleep disturbance rate (risk ratio: 0.65, 95% confidence intervals: 0.51-0.84, P = .001) and sleep medicine usage (risk ratio: 0.26, 95% confidence intervals: 0.11-0.65, P = .004) significantly. Our review suggests that auricular acupressure is effective and relatively safe in improving sleep quality among patients with lung cancer.

Auricular Acupressure for Hemodialysis Patients with Insomnia: A Multicenter Double-Blind Randomized Sham-Controlled Trial

Background and objectives: The effect of auricular acupressure (AA) for maintenance hemodialysis (MHD) patients with insomnia has been controversial. This study assessed the efficacy and safety of AA for MHD patients with chronic insomnia. Design, setting, participants, and measurements: This was a multicenter, double-blind (participant and assessor), randomized sham-controlled trial. A total of 133 subjects were randomized to receive AA on active points (AA group, n = 64) or on sham auricular acupressure (SAA) points (SAA group, n = 69) for 8 weeks and followed up for 12 weeks. AA was provided by assigned qualified nurses who were not involved in assessment. The primary outcome was the clinical response rate, which was defined as the percentage of participants who reached a reduction of Pittsburgh Sleep Quality Index (PSQI) global score ≥3 in each group. Secondary outcomes included changes in PSQI scores over time, PSQI scores and hypnotics use at each visit, and changes in the weekly dose of hypnotics for drug-dependent subjects. Results: At week 8, the AA group yielded a higher clinical response rate than the SAA group (AA: 55% vs. SAA: 36%, odds ratio: 1.5, 95% confidence interval: 1.0-2.2, p = 0.033). Both groups showed a reduction in PSQI global scores during treatment and follow-up, compared with the baseline, respectively. A significant change of PSQI global score was observed over time (F = 28.387, p < 0.001). PSQI global score of the AA group was relatively lower than that of the SAA group at each visit (p < 0.05 at week 16 and 20). For those depending on hypnotics, AA reduced their consumption of hypnotics. The intervention was safe, and its adherence was satisfactory. Conclusion: AA could serve as a complementary or alternative therapy for MHD patients with insomnia by improving their sleep quality and reducing their use of hypnotics. Clinical trial registration: Clinicaltrials.gov, Identifier: NCT03015766.

Auricular Acupressure Therapy for Patients with Cancer with Sleep Disturbance: A Systematic Review and Meta-Analysis

Aim

We aim to provide available synthesized evidence of the efficacy and safety of auricular acupressure for cancer patients with sleep disturbance.

Methods

Randomized controlled clinical trials (RCTs) were identified from PubMed, EMBASE, Web of Science, The Cochrane Library, PsycINFO, Chinese Biomedical Database, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang Data, and the search date ranged from the inception of the databases to May 2021. Literature screening and data extraction were independently performed by three researchers. The Cochrane collaboration's tool for assessing the risk of bias was applied to evaluate the risk of bias of the RCTs included. The extracted data were analyzed using Rev-Man 5.4.1 software.

Results

Nine trials involving 688 participants met the inclusion criteria and were included in the qualitative analysis; 6 trials involving 485 participants were included in the meta-analysis. Synthesized results showed that auricular acupressure had a significant effect on reducing the total Pittsburgh Sleep Quality Index (PSQI) score (MD = −3.88, 95% CI (−5.24, −2.53), P < 0.00001), and the scores of five PSQI components, sleep latency (MD = −0.53, 95% CI (−0.73, −0.32), P < 0.00001), subjective sleep quality (MD = −0.79, 95% CI (−1.05, −0.53), P < 0.00001), sleep duration (MD = −0.50, 95% CI (−0.69, −0.31), P < 0.0001), daytime dysfunction (MD = −0.53, 95% CI (−0.77, −0.29), P < 0.0001), and sleep disturbances (MD = −0.54, 95% CI (−0.60, −0.49), P < 0.00001), were also obviously decreased after the intervention of auricular acupressure. Shenmen and heart were the most commonly selected auricular acupoints, the main intervention durations ranged from 10 to 42 days, and the pressing times of auricular acupoints were 1–6 times a day, 1–5 min each time. One trial reported slight and transient pain caused by auricular acupressure, while the remaining 8 trials did not report obvious side effects.

Conclusion

Auricular acupressure can significantly improve the sleep quality of cancer patients with sleep disturbance, with no obvious side effects. Rigorously designed clinical trials are necessary for the further support of the clinical application.

The Effect of Acupressure on Daytime Sleepiness and Sleep Quality in Hemodialysis Patients

This study was carried out to evaluate the effect of acupressure applied to hemodialysis patients on the level of daytime sleepiness and sleep quality. The data were collected using the Descriptive Information Form, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. In the study, a total of 12 sessions of acupressure were applied to the Shenmen (HT7), Sanyingjao (Sp6), and Yungquan (KI1) points in the experimental group for 4 weeks. No intervention was applied to the control group. After the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group and that daytime sleepiness was less compared with the control group. After the acupressure, it was determined that the sleep latency of the experimental group was statistically significantly less and their total sleep duration was higher compared with the control group (P < .05). Although there was a decrease in the sleep quality of the experimental group 1 month after the cessation of the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group (P < .05). It was concluded that acupressure was an effective nursing intervention in increasing sleep quality and decreasing daytime sleepiness of hemodialysis patients.

Complementary and alternative treatments for insomnia/insomnia -depression-anxiety symptom cluster: Meta-analysis of English and Chinese literature

This study systematically reviewed randomized controlled trials (RCT), published in English or Chinese, investigating the effect of complementary and alternative medicines (CAM) on significant insomnia/poor sleep quality and accompanying depression and/or anxiety symptoms. A meta-analysis was completed by calculating within-group effect size (ES) of each CAM treatment on sleep, depression and/or anxiety measures. Moderating analyses of study quality, language, treatment duration and presence of physical diseases were conducted to evaluate their impact on ESs. Between-group ES of CAM (vs. non-specific/placebo controls) were computed among high-quality studies. From an initial pool of 5047 articles, a total of 72 studies were included in the meta-analysis (44 in English; 28 in Chinese). All CAM modalities yielded significant, moderate to large effect sizes on sleep, depression, and anxiety symptoms yet with high heterogeneity. Significant between-group differences on sleep measures were found only between mindfulness-based treatment and non-specific/placebo controls. Chinese literature are associated with larger ESs. Future study should examine the presence and nature of the active components in different CAM approaches.

Auricular Acupressure for Insomnia in Patients With Maintenance Hemodialysis: A Systematic Review and Meta-Analysis

Background: Insomnia is one of the common problems in patients with maintenance hemodialysis (MHD). Previous studies have reported the beneficial effects of auricular acupressure (AA) for insomnia in patients with MHD. This study aimed to critically evaluate the efficacy and safety of AA for insomnia in patients with MHD. Methods: Web of Science, Embase, PubMed, Cochrane Library, Chinese Biomedical Database, Wanfang Data, Chinese Science and Technology Periodicals database, and China National Knowledge Infrastructure were systematically searched from inception to April 30, 2020, to identify any eligible randomized controlled trials. MHD patients with insomnia were included regardless of age, gender, nationality, or race. The experimental interventions included AA alone or AA combined with other therapies. The control interventions included placebo, no treatment, or other therapies. The primary outcome was sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). RevMan 5.3 software was used for statistical analysis. Results: Eight studies involving 618 participants were included for statistical analysis. A meta-analysis showed no significant difference of PSQI global score after 8 weeks of AA treatment compared with estazolam (p = 0.70). Other narrative analyses revealed that PSQI global score was significantly attenuated after AA treatment in comparison with mental health education (p = 0.03, duration of 4 weeks; p = 0.02, duration of 8 weeks), AA plus routine nursing care compared with routine nursing care alone (p < 0.0001), and AA plus footbath compared with footbath alone (p = 0.01), respectively. A meta-analysis showed that AA could significantly increase the response rate (reduction of PSQI global score by 25% and more) in comparison with estazolam (p = 0.01). Other narrative analyses reported that the response rate was significantly increased after AA treatment compared with sham AA (p = 0.02), AA compared with mental health education (p = 0.04), and AA plus routine nursing care compared with routine nursing care alone (p = 0.0003), respectively. Conclusion: The present findings suggest that AA may be an alternative treatment for insomnia in patients with MHD. However, more large-scale, high-quality trials are still warranted to confirm these outcomes.

The Effect of Auricular Acupressure on Sleep Disturbance Among Patients With Leukemia: A Feasibility Study

Auricular acupressure (AA) is widely used in East Asia and Europe to manage patients with sleep disturbance. This feasibility study was performed to demonstrate the potential of AA for sleep disturbance in patients with leukemia. Thirty-two patients with leukemia with poor sleep quality received AA 3 times a day for a total of 4 weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality at baseline, at a 2-week intervention, and after a 4-week intervention. Compared with baseline scores, PSQI scores and the use of sleep medicine were significantly improved at week 2 and week 4 (P < .05). As a potential safety therapy, AA could be an alternative or complementary intervention to improve sleep quality for patients with leukemia with sleep disturbance.

Effect of Auricular Acupressure on Sleep and Pruritus in Patients Undergoing Hemodialysis

Purpose: The aim of this study was to evaluate the effects of auricular acupressure on sleep quality and pruritus in patients undergoing hemodialysis and to propose an effective and evidence-based nursing intervention.Methods: This was a single-blind, nonequivalent, group comparison study with 42 participants. The experimental period was a total of 8 weeks, and five different acupressure sites were applied in each group. Dependent variables were measured before the intervention, at the 4th week of the intervention, and at the 8th week of the intervention.Results: There were significant differences in the Pittsburgh sleep quality index, total sleep time, sleep efficiency, sleep onset latency, light sleep, deep sleep, number of awakenings, serum melatonin levels, subjective pruritus and skin hydration. No significant difference was found in skin pH between the two groups. Conclusion: Auricular acupressure was found to be an effective nursing intervention to improve sleep quality and to reduce pruritus in patients undergoing hemodialysis.

Can non-pharmacological interventions improve sleep quality for haemodialysis patients?

Poor sleep quality is a major issue for haemodialysis (HD) patients, with as many as 80% reporting problems with sleep. Poor sleep has a negative impact on HD patients' mental health, quality of life and day-to-day functioning, along with increasing morbidity and mortality risks. Non-pharmacological interventions have fewer side-effects compared to hypnotic medications and have been shown to be effective in research studies. Ruth Edley examines acupressure, massage, aerobic and non-aerobic exercise and cognitive behavioural therapy. All have been shown in small-scale studies to improve sleep quality in HD patients, although no intervention has been found to improve sleep quality to normal levels. It is recommended that further research using larger, randomised controlled trials is undertaken to increase confidence in the benefits of these interventions.

Impact of hot stone massage therapy on sleep quality in patients on maintenance hemodialysis: A randomized controlled trial

Background:

Many patients on maintenance hemodialysis experience sleep disorders. This problem is related to depression, anxiety, hospitalizations, chronic medical conditions, decreased quality of life, and increasing mortality rate in patients on maintenance hemodialysis. The objective of this research is to determine the impact of massage therapy by hot stone on quality of sleep in patients on maintenance hemodialysis.

Materials and Methods:

This was a randomized controlled trial conducted on 60 patients on maintenance hemodialysis. They were assigned via random allocation process into two groups of study: intervention group (n = 30), or control group (n = 30). Patients in the experimental group received massage therapy by hot basalt stone for 12 séances. During the massage therapy, each of five basalt stones were placed at the sites of the fifth, fourth, third, second, and first chakra. Control group received their treatment as usual without any massage therapy. Using Pittsburgh Sleep Quality Index (PSQI), the global score and its components were computed in both groups of study, two times (before the intervention and 1 month after the intervention).

Results:

Although there were not any baseline differences between the two groups of study for the mean of global PSQI score (P = 0.92) before the study, the mean of global PSQI score in the intervention group, after the intervention decreased to 5.7 ± 3.06, but in the control group sleep quality increased to 10.7 ± 3.6. The difference between the mean of global score of PSQI among two groups of study after the massage therapy was statistically significant (P < 0.001).

Conclusion:

Applying massage therapy by hot stone in hemodialysis patients may contribute in enhancing their quality of sleep.

Auricular acupressure for insomnia in hemodialysis patients: study protocol for a randomized controlled trial

Background

Patients on maintenance hemodialysis (MHD) frequently complain of insomnia. Poor sleep quality impairs their quality of life and adversely affects long-term outcome. Previously we applied auricular acupressure therapy (AAT) for MHD patients with insomnia and yielded favorable results. AAT probably improves sleep quality by stimulating the vagus nerve and inhibiting sympathetic overactivity. However, the efficacy of AAT for insomnia in this population is still lacking. The proposed randomized controlled trial (RCT) will evaluate the efficacy and safety of AAT for improvement of sleep quality in MHD patients with insomnia.

Methods/design

The proposed study is a multi-center, double-blind (participants and assessors), parallel-group RCT. A total of 112 participants with insomnia will be recruited from six hemodialysis centers in Guangzhou, China, and randomly allocated in a 1:1 ratio to receive auricular acupressure on either active points (AA group) or control points (points irrelevant to insomnia management, SAA group). The treatment will last for 8 weeks prior to a follow-up period of 12 weeks. Evaluation by blinded assessors at baseline, at 8 weeks (end of treatment) as well as at 4-week, 8-week and 12-week follow-ups (after intervention) will include Pittsburgh Sleep Quality Index (PSQI) scores and average weekly dose of hypnotics. The primary endpoint is clinical response rate (percentage of participants who reach a reduction of PSQI global score ≥ 3 in each group) at 8 weeks from baseline. Secondary endpoints include the changes in PSQI scores over time from baseline, as well as the changes in weekly dose of hypnotics.

Discussion

This paper describes the rationale and design of a double-blind RCT that aims to determine the efficacy and safety of AAT for insomnia of hemodialysis patients. If successful, this project will provide evidence of the efficacy and safety of AAT for insomnia of hemodialysis patients.

Trial registration

ClinicalTrials.gov, Identifier: NCT03015766. Registered on 22 December 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2546-2) contains supplementary material, which is available to authorized users.

Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments

Since time immemorial, complementary and alternative medicines (CAM) have played a significant role in human health care. CAM is known to have a strong reputation and reliability within every culture to provide basic health care treatment for patients. CAM acts as a better therapeutic option in human being for treating various diseases and improving quality of life with apt consideration to the economic aspects. Acupressure, one of the known CAM, originated in ancient China is based on the principal of acupoints activation across the meridians which correct the imbalance between Qi. Activation of specific points on the meridians is known to facilitate reduction of pain at the local sites. It also reduces the pain from other body parts. This review outlines various types, devices and mechanisms involved in the acupressure treatment.

Acupuncture and related interventions for symptoms of chronic kidney disease

BACKGROUND

People living with chronic kidney disease (CKD) experience a range of symptoms and often have complex comorbidities. Many pharmacological interventions for people with CKD have known risks of adverse events. Acupuncture is widely used for symptom management in patients with chronic diseases and in other palliative care settings. However, the safety and efficacy of acupuncture for people with CKD remains largely unknown.

OBJECTIVES

We aimed to evaluate the benefits and harms of acupuncture, electro-acupuncture, acupressure, moxibustion and other acupuncture-related interventions (alone or combined with other acupuncture-related interventions) for symptoms of CKD. In particular, we planned to compare acupuncture and related interventions with conventional medicine, active non-pharmacological interventions, and routine care for symptoms of CKD.

SEARCH METHODS

We searched the Cochrane Kidney and Transplant Specialised Register up to 28 January 2016 through contact with the Information Specialist using search terms relevant to this review. We also searched Korean medical databases (including Korean Studies Information, DBPIA, Korea Institute of Science and Technology Information, Research Information Centre for Health Database, KoreaMed, the National Assembly Library) and Chinese databases (including the China Academic Journal).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs that investigated the effects of acupuncture and related point-stimulation interventions with or without needle penetration that involved six sessions or more in adults with CKD stage 3 to 5, regardless of the language and type of publication. We excluded studies that used herbal medicine or co-interventions administered unequally among the study groups.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed risk of bias. We calculated the mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI) for continuous outcomes and risk ratio (RR) for dichotomous outcomes. Primary outcomes were changes in pain and depression, and occurrence of serious of adverse events.

MAIN RESULTS

We included 24 studies that involved a total of 1787 participants. Studies reported on various types of acupuncture and related interventions including manual acupuncture and acupressure, ear acupressure, transcutaneous electrical acupuncture point stimulation, far-infrared radiation on acupuncture points and indirect moxibustion. CKD stages included pre-dialysis stage 3 or 4 and end-stage kidney disease on either haemodialysis or peritoneal dialysis.None of the included studies assessed pain outcomes, nor formally addressed occurrence of serious adverse events, although three studies reported three participant deaths and three hospitalisations as reasons for attrition. Three studies reported minor acupuncture-related harms; the remainder did not report if those events occurred.All studies were assessed at high or unclear risk of bias in terms of allocation concealment. Seventeen studies reported outcomes measured for only two months.There was very low quality of evidence that compared with routine care, manual acupressure reduced scores of the Beck Depression Inventory score (scale from 0 to 63) (3 studies, 128 participants: MD -4.29, 95% CI -7.48 to -1.11, I(2) = 0%), the revised Piper Fatigue Scale (scale from 0 to 10) (3 studies, 128 participants: MD -1.19, 95% CI -1.77 to -0.60, I(2) = 0%), and the Pittsburgh Sleep Quality Index (scale from 0 to 21) (4 studies, 180 participants: MD -2.46, 95% CI -4.23 to -0.69, I(2) = 50%).We were unable to perform further meta-analyses because of the paucity of data and problems with clinical heterogeneity, such as different interventions, comparisons and timing of outcome measurements.

AUTHORS' CONCLUSIONS

There was very low quality of evidence of the short-term effects of manual acupressure as an adjuvant intervention for fatigue, depression, sleep disturbance and uraemic pruritus in patients undergoing regular haemodialysis. The paucity of evidence indicates that there is little evidence of the effects of other types of acupuncture for other outcomes, including pain, in patients with other stages of CKD. Overall high or unclear risk of bias distorts the validity of the reported benefit of acupuncture and makes the estimated effects uncertain. The incomplete reporting of acupuncture-related harm does not permit us to assess the safety of acupuncture and related interventions. Future studies should investigate the effects and safety of acupuncture for pain and other common symptoms in patients with CKD and those undergoing dialysis.

The History, Mechanism, and Clinical Application of Auricular Therapy in Traditional Chinese Medicine

Auricular therapy includes acupuncture, electroacupuncture, acupressure, lasering, cauterization, moxibustion, and bloodletting in the auricle. For 2500 years, people have employed auricular therapy for treating diseases, but the methods have been limited to bloodletting and cauterization. Only after 1957, the international scientific community became aware that the map of the ear resembles an inverted fetus, its introduction has led to auricular acupuncture (AA) becoming a more systemic approach, and, following the identification and standardization of more precise points, AA has been employed in clinical applications. The mechanisms of AA are considered to have a close relationship with the autonomic nervous system, the neuroendocrine system, neuroimmunological factors, neuroinflammation, and neural reflex, as well as antioxidation. Auricular therapy has been applied, for example, for pain relief, for the treatment of epilepsy, anxiety, and obesity, and for improving sleep quality. However, the mechanisms and evidence for auricular therapy warrant further study.

Auricular acupressure on specific points for hemodialysis patients with insomnia: a pilot randomized controlled trial

OBJECTIVES

To assess the feasibility and acceptability of a randomized controlled trial compared auricular acupressure (AA) on specific acupoints with AA on non-specific acupoints for treating maintenance hemodialysis (MHD) patients with insomnia.

METHODS

Sixty three (63) eligible subjects were randomly assigned into either AA group received AA on specific acupoints (n=32), or sham AA (SAA) group received AA on points irrelevant to insomnia treatment (n=31) for eight weeks. All participants were followed up for 12 weeks after treatments. The primary outcome was clinical response at eight weeks after randomization, defined as a reduction of Pittsburgh Sleep Quality Index (PSQI) global score by 3 points and more.

RESULTS

Fifty-eight (58) participants completed the trial and five dropped out. Twenty participants in AA group (62.5%) and ten in SAA group (32.3%) responded to the eight-week interventions (χ2 = 5.77, P = 0.02). PSQI global score declined 3.75 ± 4.36 (95%CI -5.32, -2.18) and 2.26 ± 3.89 (95%CI -3.68, -0.83) in AA group and SAA group respectively. Three participants died during the follow-up period. No evidence supported their deaths were related to the AA intervention. No other adverse event was observed.

CONCLUSION

Feasibility and logistics of patient recruitment, randomization procedure, blinding approach, interventions application and outcome assessment had been tested in this pilot trial. The preliminary data appeared to show a favorable result on AA treatment. A full-scale trial is warranted.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-TRC-12002272.

Acupuncture antiarrhythmic effects on drug refractory persistent atrial fibrillation: study protocol for a randomized, controlled trial

Background. Atrial fibrillation (AF) is the most common form of arrhythmia. Several trials have suggested that acupuncture may prevent AF. However, the efficacy of acupuncture for AF prevention has not been well investigated. Therefore, we designed a prospective, two-parallel-armed, participant and assessor blinded, randomized, sham-controlled clinical trial to investigate acupuncture in persistent AF (ACU-AF). Methods. A total of 80 participants will be randomly assigned to active acupuncture or sham acupuncture groups in a 1 : 1 ratio. Both groups will take the same antiarrhythmic medication during the study period. Patients will receive 10 sessions of acupuncture treatment once a week for 10 weeks. The primary endpoint is AF recurrence rate. Secondary endpoints are left atrium (LA) and left atrial appendage (LAA) changes in function and volume, and inflammatory biomarker changes. Ethics. This study protocol was approved by the institutional review boards (IRBs) of Kyung Hee University Hospital (number 1335-04). This trial is registered with clinicaltrials.gov NCT02110537.