不同运动方式对失眠患者睡眠影响效果的网状 Meta 分析
Effects of Different Exercise Types on Sleep in Insomnia Patients:a Network Meta-analysis
背景 失眠问题不仅会降低人们的生活质量和工作效率,而且还与多种疾病具有密切的关系,合理的运动方案可以一定程度上改善失眠质量,但目前缺乏不同运动方式对其睡眠结局影响效果的比较研究。目的 比较不同运动方式对失眠患者睡眠影响的效果,为该人群制定改善睡眠的运动处方提供借鉴。方法 通过Pubmed、Web ofScience、EBSCO、Scopus、中国知网、万方数据知识服务平台检索不同运动方式对失眠患者睡眠影响的随机对照试验(RCT),检索时间为建库至2023年12月。使用Jadad量表对文献质量进行评价,使用Stata 17.0软件的频率学框架的随机效应模型进行网状Meta统计,使用偏倚漏斗图观察发表偏倚。结果 共纳入36篇文章,包含2 706例受试者,涉及5类干预措施:有氧运动(AE)、抗阻运动(RT)、身心运动(ME)、运动时间延长(PTE)、有氧与抗阻结合的运动(AE+RT)。网状Meta分析结果显示,AE和空白对照组(SMD=2.20,95%CI=0.35~4.05)对主观评价工具总评分的影响比较,差异有统计学意义(P<0.05);累积排序概率图下面积(SUCRA)排序结果为AE(82.2%)>ME(71.1%)>AE+RT(54.2%)>RT(38.9%)>对照措施(CT)(29.2%)>PTE(24.4%)。PTE与AE+RT(SMD=-14.66,95%CI=-28.60~-0.72),AE+RT与RT(SMD=21.32,95%CI=6.24~36.40)以及AE+RT与AE(SMD=11.19,95%CI=1.56~20.81)对睡眠潜伏期的影响比较,差异有统计学意义(P<0.05);SUCRA概率排序结果显示,AE+RT(96.7%)>CT(77.1%)>ME(49.5%)>AE(42.6%)>PTE(27.9%)>RT(6.1%)。AE与CT(SMD=4.59,95%CI=1.59~7.58)对睡眠效率的影响比较,差异有统计学意义(P<0.05);SUCRA概率排序结果显示AE(83.1%)>AE+RT(59.9%)>RT(50.7%)>ME(46.9%)>PTE(35.5%)>CT(23.9%)。PTE与RT(SMD=23.39,95%CI=14.67~32.02),PTE与AE(SMD=14.86,95%CI=4.64~36.40),PTE与CT(SMD=12.11,95%CI=7.62~16.59),RT与ME(SMD=-27.61,95%CI=-40.49~-14.73),RT与CT(SMD=-11.28,95%CI=-20.86~-1.70),ME与AE(SMD=19.08,95%CI=5.18~32.98),ME与CT(SMD=16.33,95%CI=7.26~25.40)对睡眠觉醒时间的影响比较,差异有统计学意义(P<0.05);SUCRA概率排序结果显示,RT(94.7%)>CT(80.2%)>AE(41.8%)>ME(31.5%)>PTE(1.7%)。RT与AE(SMD=-20.84,95%CI=-38.46~-3.23),AE与CT(SMD=12.02,95%CI=2.96~21.08)对总睡眠时长的影响比较,差异有统计学意义(P<0.05);SUCRA概率排序结果显示,AE(87.2%)>AE+CT(71.6%)>PTE(53.8%)>ME(40.6%)>CT(35.9%)>RT(10.8%)。各个干预措施对睡眠质量的影响比较,差异均无统计学意义(P>0.05);SUCRA概率排序结果显示,AE(84.2%)>AE+CT(75.5%)>ME(24.9%)>CT(15.4%)。对主观评价工具总评分、睡眠潜伏期、睡眠效率、睡眠觉醒时间、总睡眠时长、睡眠质量进行发表偏倚分析,发现6个结局指标均存在一定的不对称性,提示存在一定的发表偏倚风险。结论 鉴于AE对多个睡眠指标有较好的改善作用,推荐失眠患者进行每周3次30 min左右的中等强度AE,如慢跑、快走等,此外,也可以选择每周4~5次中等强度的RT或AE+RT,在进行上述运动时需要额外注意时间段选择,尽量避免睡前3 h内进行运动。
医学研究方法预防医学体育
失眠睡眠运动系统评价网状 Meta 分析随机对照试验
朱芮含,龙伟,曹春梅,刘国纯,郑满,郭佳.不同运动方式对失眠患者睡眠影响效果的网状 Meta 分析[EB/OL].(2024-07-17)[2025-10-10].https://chinaxiv.org/abs/202407.00168.点此复制
BackgroundInsomnia not only decreases the quality of life and working efficiencybut also relates to other deceases. Suitable exercises may be useful to improve sleep quality. Howevercomparative studies on the effects of different types of exercise on sleep outcomes are currently lacked. ObjectiveTo compare the effects of different exercise types on sleep in insomnia patients and to provide insights for developing exercise prescriptions to improve sleep in this population. MethodsRandomized controlled trialsRCTs investigating the effects of different types of exercises on the sleep of people with insomnia were retrieved from the PubMedWeb of ScienceEBSCOScopusChina National Knowledge InfrastructureCNKIand Wanfang Data Knowledge Service Platform from database inception to December 2023. The quality of the literatures was assessed using the Jadad scale. A network meta-analysis was performed using the random-effects model of the frequency framework in Stata 17.0 softwareand publication bias was observed using a funnel plot. ResultsA total of 36 articles representing 2706 participants were included in this study. Exercise interventions were categorized into five typesincluding the aerobic exerciseAE resistance trainingRTmind-body exerciseMEprolonged time of exercisePTEand AE combined with RTAE+RT. The results of the network meta-analysis showed that there was a significant difference in the total score of the subjective evaluation tools between AE group and blank control groupSMD=2.2095%CI=0.35-4.05P<0.05. The maximum surface under the cumulative ranking curveSUCRA of the total score of the subjective evaluation tools was detected in AE group82.2% followed by ME71.1%AE+RT54.2%RT38.9%controlled trialCT29.2% and PTE groups24.4%. There was a significant difference in sleep latencySL between PTE group versus AE+RT groupSMD=-14.6695%CI=- 28.60--0.72between AE+RT group versus RT groupSMD=21.3295% CI 6.24-36.4and between AE+RT group versus AE groupSMD=11.1995%CI=1.56-20.81all P<0.05. The maximum SUCRA of SL was detected in AE+RT group96.7%followed by CT77.1%ME49.5%AE42.6%PTE27.9%and RT groups6.1%. There was a significant difference in sleep efficacySEbetween AE group versus CT groupSMD=4.5995%CI=1.59-7.58 P<0.05. The maximum SUCRA of SE was detected in the AE group83.1%followed by AE+RT59.9%RT50.7% ME46.9%PTE35.5%and CT groups23.9%. There was a significant difference in wake time after sleep onsetWASO between PTE group versus RT groupSMD=23.3995%CI=14.67-32.02between PTE group versus AE groupSMD=14.86 95%CI=4.64-36.40between PTE group versus CT groupSMD=12.1195%CI=7.62-16.59between RT group versus ME groupSMD=-27.6195%CI=-40.49--14.73between RT group versus CT groupSMD=-11.2895%CI=-20.86- -1.70between ME group versus AE groupSMD=19.0895%CI=5.18-32.98and between ME group versus CT group SMD=16.3395%CI=7.26-25.40all P<0.05. The maximum SUCRA of WASO was detected in the RT group94.7% followed by CT80.2%AE41.8%ME31.5% and PTE groups1.7%. There was a significant difference in the total sleep timeTSTbetween RT group versus AE groupSMD=-20.8495%CI=-38.46--3.23between AE group versus CT groupSMD=12.0295%CI=2.96-21.08all P<0.05. The maximum SUCRA of TST was detected in the AE group87.2%followed by AE+CT71.6%PTE53.8%ME40.6%CT35.9%and RT groups10.8%. There was no significant difference in the sleep qualitySQamong groupsP>0.05. The maximum SUCRA of SQ was detected in the AE group84.2%followed by AE+CT75.5%ME24.9%and CT groups15.4%. Publication bias analysis of the total score of subjective evaluation toolsSLSEWASOTSTand SQ revealed some asymmetry in all six outcome indicatorsindicating a certain risk of publication bias. ConclusionGiven the favorable effects of AE on multiple sleep parameterswe recommend insomnia patients engage in moderate-intensity AEsuch as jogging or brisk walkingthree times a week for approximately 30 minutes. Additionallyoptions include moderate-intensity RT or AE+RT four to five times a week. When engaging in the above exercisesattention should be paid to the choice of time periodand exercise within 3 hours before bedtime should be avoided as much as possible.
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