阻塞型睡眠呼吸中止症病人使用耳穴貼壓改善呼吸中止及淺呼吸指數之成效探討The effect of using auricular acupressure to reduce the Apnea-hypopnea Index inpatients with obstructive sleep apnea

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2018-06-14 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

廖芙欣* 賴維淑 * 方素瓔

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

睡眠醫學 Sleep Medicine

科別

  • 臨床指引/實證照護成效 Clinical Guidelines/Evidence Based Outcomes

中文關鍵詞

耳穴貼壓 阻塞型睡眠呼吸中止症 呼吸中止-淺呼吸指數 多頻睡眠檢查

英文關鍵詞

Auricular plaster therapy Obstructive sleep apnea syndrome Apnea- Hypopnea Index AHI Polysomnography PSG

機構名稱

國立成功大學

申請單位

醫學院護理學系

中文摘要

形成臨床提問:
阻塞型睡眠呼吸中止症影響病人生活品質,夜間睡覺時呼吸中止或呼吸通氣量低下,引發鼾聲、覺醒、血氧降低及二氧化碳上升等情形,中斷睡眠而造成白天疲勞、嗜睡、注意力不集中與記憶力減退等症狀。同時由於睡眠過程反覆「缺氧-再供氧」的循環及交感神經興奮的刺激,久之易產生心血管病變,導致病人在睡眠中誘發心肌梗塞以及中風的風險。因此,如何改善阻塞型睡眠呼吸中止症極為重要。 回顧使用耳穴貼壓改善阻塞型睡眠呼吸中止症病人呼吸中止及淺呼吸指數之成效,作為應用於阻塞型睡眠呼吸中止症病人改善睡眠呼吸中止症相關研究與臨床應用之參考。
文獻搜尋的方法與分析:
本文以系統性文獻回顧法,搜尋發表於國內外相關利用耳穴貼壓法介入措施改善阻塞型睡眠呼吸中止症病人,呼吸中止及淺呼吸指數(Apnea-Hypopnea Index, AHI)的文章,搜尋資料庫包括The Cochrane Library、EBSCO、PubMed、華藝線上圖書館、中國知網等資料庫,使用關鍵字阻塞型睡眠呼吸中止症、耳穴貼壓、呼吸中止及淺呼吸指數,共獲得14篇相關文獻,最後選擇符合主題且證據等級為Level 2的3篇隨機控制實驗研究。
文獻的品質評讀:
列入評讀之3篇文獻依照GRADE評分系統證據品質為中等級。以個案特性來看,研究對象皆為確診為阻塞型睡眠呼吸中止症之成年病人(>18歲)。介入措施取穴位有神門、交感、皮質下、心、肺、脾、腎、垂前、咽喉,耳穴貼壓操作方法:將王不留行藥籽或磁珠分別置於0.4*0.4~0.7*0.7cm2的膠布上,貼在選定的穴位上,再用食、拇指捻壓至酸沉麻木或疼痛為得氣,每天按壓3-5次,每次以有前述感覺為度。每次貼一側耳朵(先左後右),兩耳交替貼敷。3篇研究執行時間有所差異,分別為10日貼敷為1個療程、每周貼敷1次共12周、以及每周貼敷2次以2周為1個療程。測量方法透過「多頻睡眠檢查」(polysomnography, PSG),監測「呼吸中止-淺呼吸指數」(AHI),採實驗前、後測方法評估阻塞型睡眠呼吸中止症之改善成效。3篇研究並分別在統計學上具有顯著意義(p < .01; p < .05; p < .05),三篇文獻之Cohen’s d介於0.47-1.45之間,屬接近中等至高的效果量。
結論與建議:
綜合三篇文獻之介入作法,依照GRADE建議強度分級,顯示介入措施利大於弊,屬於強建議。將阻塞型睡眠呼吸中止症病人的耳穴貼壓法標準化,提出臨床使用建議,以建立耳穴貼壓對阻塞型睡眠呼吸中止症的介入療效。

英文摘要

Ask an answerable question (PICO):
Obstructive Sleep apnea affects the patient quality of life. Sleep apnea and hypopnea may cause snoring, arousal, hypoxemia and high carbon dioxide and other circumstances. Interruption of sleep will cause lethargy, lack of concentration and memory loss in the daytime. Repeated cycle of sleep process "hypoxia - re-oxygen" and sympathetic excitement may lead to cardiovascular disease which increase the risk of myocardial infarction and stroke in sleeping easily. Therefore, it is extremely important to improve the sleep apnea.
The Method and Analysis of Literature Review:
To review the studies related to the effect of using auricular plaster therapy to reduce the Apnea-Hypopnea Index (AHI) and to provide clinical application for obstructive sleep apnea patients. A systematic review was conducted. Electronic databases including, Cochrane Library, EBSCO, PubMed , airiti library and CNKI were retrieved for relevant articles. Keywords included “auricular plaster therapy, obstructive sleep apnea syndrome, Apnea-Hypopnea Index (AHI), and polysomnography” with MeSH terms. A total of 14 articles that matched the search criteria were extracted. After screening the topics and deletions repetitions, three randomized controlled trials (RCT) which have level 2 of evidence were selected as the final studies.
Critical Appraisal:
According to the GRAD, the quality of these three literatures evidence were intermediate level. In terms of case characteristics, the subjects studied were all adult patients diagnosed with obstructive sleep apnea (> 18 years). The auricular plaster therapy was given at Ear Shengmen, Jiaogan, Pizhixia, Heart, Lung, Spleen, Kidney, Chuiqian and throat with Wang Bu Liu Xing (Vaccaria Seed) or magnetic beads, and the auricular points were pressed 3-5 times a day. Pressing one ear for each time (right side first). Execution time has different definition for each reference. First one define ten days as a treatment course, secondary define once a week for total twelve weeks. Third define twice a week for total two weeks only. Use Apnea-Hypopnea Index (AHI) to evaluate the improvement of obstructive sleep apnea after the experiment by polysomnography (PSG). Three studies were statistically significant (p< .01; p< .05; p< .05). The Cohen's d of the three literature is between 0.47 and 1.45, which is the medium-to-high effect size.
Conclusions and Recommendations:
According to the GRADE evidence to recommendation, the intervention of these three literature was strong recommendation. Because it clealy show that desirable effects of an intervention outweigh its undesirable effects. The clinical protocol of auricular plaster therapy on obstructive sleep apnea can be standardized to provide clinical application. To establish auricular plaster therapy interventional effect on obstructive sleep apnea syndrome.