不同运动方式治疗血液透析患者睡眠障碍的网状Meta分析

Treatment of sleep disorder in hemodialysis patient with different exercise modalities：a network Meta-analysis

关键词:  血液透析  睡眠障碍  运动  网状Meta分析  八段锦

Key words:  hemodialysis  sleep disorder  exercise  network Meta-analysis  Baduanjin

摘要:

[目的] 基于网状 Meta 分析评价不同运动方式治疗血液透析患者睡眠障碍的有效性和安全性，为临床治疗提供循证医学证据。[方法] 计算机检索 PubMed、The Cochrane Library、EMbase、Web of Science、 维普（VIP）、 万方（WanFang）和 中国知网（CNKI）数据库，搜集不同运动方式治疗血液透析患者睡眠障碍的随机对照试验（RCT），检索时限从建库至 2023 年 5 月 31 日。由 2 名研究者独立筛选文献、 提取资料并评价纳入研究的偏倚风险后， 应用RevMan 5.4 和 Stata 16.0 软件进行 Meta 分析。[结果] 共纳入 32 篇文献，包括 2 567 例患者，涉及 8 种不同的运动方式（有氧运动、有氧+抗阻运动、有氧运动+太极拳、抗阻运动+八段锦、渐进性肌肉放松训练、八段锦、太极拳和普拉提）。网状 Meta 分析结果显示：改善匹兹堡睡眠质量指数（PSQI）总分方面排名前 3（括号内为等级概率值）的治疗措施为：八段锦（76.7%）＞普拉提（72.5%）＞有氧运动（67.6%）；睡眠质量评分方面排名前 3 的治疗措施为：有氧+抗阻运动（96.9%）＞抗阻运动+八段锦（68.4%）＞有氧运动（62.6%）；入睡时间评分方面排名前 3 的治疗措施为：八段锦（100%）＞渐进性肌肉放松训练（76.9%）＞有氧+抗阻运动（62.3%）；睡眠时间评分方面排名前 3 的治疗措施为：八段锦（97.9%）＞有氧+抗阻运动（67.3%）＞抗阻运动+八段锦（63.2%）；睡眠效率评分方面排名前 3 的治疗措施为：太极拳（91.7%）＞有氧+抗阻运动（85.3%）＞抗阻运动+八段锦（69.4%）；睡眠障碍评分方面排名前 3 的治疗措施为：八段锦（100%）＞抗阻运动+八段锦（74.4%）＞有氧运动（67.0%）；日间功能障碍评分方面排名前 3 的治疗措施为：八段锦（100%）＞抗阻运动+八段锦（81.6%）＞有氧+抗阻运动（59.0%）；催眠药物评分方面排名前 3 的治疗措施为：八段锦（78.7%）＞有氧运动（71.2%）＞有氧+抗阻运动（63.3%）。[结论] 当前证据显示，在常规治疗的基础上联合这 8 种不同的运动方式有助于改善血液透析患者的睡眠情况，其中以八段锦综合疗效最优；但受限于纳入研究的数量与质量，还需要开展更多高质量的 RCT 进一步验证此结论。

Abstract:

[Objective] To evaluate the efficacy and safety of different exercise modalities on sleep disorder in hemodialysis patients based on network Meta-analysis and to provide evidence-based medical evidence for clinical use. [Methods] A computerized search of PubMed，The Cochrane Library，EMbase，Web of Science，VIP，WanFang and CNKI databases was performed to collect randomized controlled trials （RCTs） of different exercise modalities on sleep disorder in hemodialysis patients. The search timeframe was from the construction of the library to May 31，2023. Meta-analysis was performed using RevMan 5.4 software and Stata 16.0 software after 2 investigators independently screened the literature，extracted the information and evaluated the risk of bias of the included studies. [Results] A total of 32 papers and 2 567 patients were included，involving 7 different exercise modalities （aerobic training，aerobic training + resistance training，aerobic training + Taichi，resistance training + Baduanjin，progressive muscle relaxation，Baduanjin，Taichi and Pilates）. The results of the network Meta-analysis showed that，the top 3 interventions（SUCRA in parentheses） in terms of PSQI total were：Baduanjin（76.7%）＞Pilates（72.5%）＞aerobic training（67.6%）. The top 3 interventions in terms of sleep quality were：aerobic training + resistance training（96.9%）＞resistance training + Baduanjin（68.4%）＞aerobic training（62.6%）. The top 3 interventions in terms of sleep latency were：Baduanjin（100%）＞progressive muscle relaxation training（76.9%）＞aerobic training + resistance training （62.3%）. The top 3 interventions in terms of sleep duration were：Baduanjin（97.9%）＞aerobic training + resistance training（67.3%）＞resistance training + Baduanjin （63.2%）. The top 3 interventions in terms of sleep efficiency were：Taichi （91.7%）＞aerobic training + resistance training（85.3%）＞resistance training + Baduanjin（69.4%）. The top 3 interventions in terms of sleep disorder were：Baduanjin （100%）＞resistance training + Baduanjin （74.4%）＞aerobic training （67%）. The top 3 interventions in terms of daytime dysfunction were：Baduanjin（100%）>resistance training + Baduanjin（81.6%）＞aerobic training + resistance training（67%）. The top 3 interventions in terms of use of sleep medication were：Baduanjin（78.7%）＞aerobic training（71.2%）＞aerobic training + resistance training（63.3%）. [Conclusion] Current evidence suggests that combining these eight different exercise modalities with conventional treatment can alleviate sleep disorder in hemodialysis patients，with the combined efficacy of the Baduanjin being the most effective. However，due to the number and quality of included studies，more high-quality RCTs need to be conducted to further validate this conclusion.