Objective: To observe the clinical effect of acupuncture for delayed sleep-wake phase disorder (DSWPD).
Methods: A total of 84 patients with DSWPD were randomized into an observation group (42 cases, 2 cases dropped off) and a control group (42 cases, 3 cases dropped off). On the basis of sleep hygiene education, acupuncture was applied at Shenmai (BL 62), Zhaohai (KI 6), Hegu (LI 4), Taichong (LR 3), Zusanli (ST 36) and Sanyinjiao (SP 6) in the observation group, while placebo acupuncture was applied at the same acupoints in the control group. The treatment lasted for 8 weeks, once every other day, 3 times a week in the 1st to 4th weeks; once every 3 days, 2 times a week in the 5th to 8th weeks. Before and after treatment, the actigraphy (ACT) indexes of objective sleep (total time of stay in bed, total sleep time, sleep efficiency, the number of awakenings and the wake time after falling asleep) and plasma cortisol (CORT) level were observed; before and after treatment and in follow-up of 1, 3 months after treatment, the scores of morningness-eveningness questionnaire (MEQ), insomnia severity index (ISI), fatigue severity scale (FSS) and Epworth sleepiness scale (ESS) were observed in the two groups.
Results: Compared before treatment, the total sleep time was prolonged, the sleep efficiency was improved, the number of awakenings was reduced, and the wake time after falling asleep was shortened after treatment in the observation group (P<0.01, P<0.05), and those in the observation group after treatment were superior to the control group (P<0.01, P<0.05). Compared before treatment, the MEQ scores after treatment in both groups and in the follow-up of 1, 3 months after treatment in the observation group were increased (P<0.01), and the MEQ score of each time point after treatment in the observation group was higher than the control group (P<0.01). The scores of ISI, FSS and ESS after treatment, and the scores of ISI、ESS in follow-up of 1, 3 months after treatment in the observation group were decreased compared with those before treatment (P<0.01, P<0.05), and in the observation group, the scores of ISI, FSS and ESS of each time point after treatment were lower than those in the control group (P<0.01, P<0.05). After treatment, the plasma CORT level in the observation group was decreased compared with that before treatment and that in the control group (P<0.01, P<0.05).
Conclusion: Acupuncture can improve the sleep and wake phase of patients with DSWPD, improve sleep quality and daytime function, and its mechanism may be related to the down-regulation of plasma CORT level.
目的：观察针刺治疗睡眠觉醒时相延迟障碍（DSWPD）的临床疗效。方法：将84例DSWPD患者随机分为观察组（42例，脱落2例）和对照组（42例，脱落3例）。两组均予睡眠卫生健康宣教，在此基础上，观察组针刺申脉、照海、合谷、太冲、足三里、三阴交，对照组于相同穴位予安慰针刺，均治疗8周，第1~4周隔日 1次，每周3次；第5~8周隔2 d 1次，每周2次。治疗前后，观察两组患者睡眠体动记录仪（ACT）客观睡眠指标（总卧床时间、总睡眠时间、睡眠效率、觉醒次数、入睡后觉醒时间）及血浆皮质醇（CORT）含量；治疗前后及治疗结束后1、3个月随访时，观察两组患者早-晚问卷（MEQ）、失眠严重程度指数（ISI）、疲劳严重程度量表（FSS）、Epworth嗜睡量表（ESS）评分。结果：与治疗前比较，治疗后观察组总睡眠时间延长、睡眠效率提高、觉醒次数减少、入睡后觉醒时间缩短（P<0.01，P<0.05），且治疗后观察组上述指标均优于对照组（P<0.01， P<0.05）。与治疗前比较，两组治疗后及观察组随访1、3个月MEQ评分升高（P<0.01），且治疗后各时间点观察组MEQ评分均高于对照组（P<0.01）。观察组治疗后ISI、FSS、ESS评分及随访1、3个月ISI、ESS评分均较治疗前下降（P<0.01，P<0.05），且观察组治疗后各时间点ISI、FSS、ESS评分均低于对照组（P<0.01，P<0.05）。治疗后，观察组血浆CORT含量较治疗前降低（P<0.01），且低于对照组（P<0.05）。结论：针刺可改善DSWPD患者睡眠觉醒时相，提高其睡眠质量和日间功能状态，其机制可能与降低血浆CORT含量相关。.
Keywords: acupuncture; circadian rhythm; delayed sleep-wake phase disorder; randomized controlled trial (RCT); sleep-wake.