失眠老年人正念干预健康效益的系统综述

doi:10.3969/j.issn.1006-9771.2024.01.007

摘要/Abstract

摘要：

目的系统综述正念干预对失眠老年人的健康效益。

方法采用主题词检索法，在Web of Science、PubMed、Embase、EBSCO、中国知网、维普和万方数据库中，检索正念干预影响失眠老年人睡眠质量的相关文献，发表时间为建库至2023年8月。采用物理治疗证据数据库(PEDro)量表对纳入研究进行方法学质量评价。运用《国际疾病分类第11次修订本》、《国际功能、残疾和健康分类》和《国际健康干预分类》对失眠、睡眠功能以及正念干预进行编码，基于PRISMA指南开展系统综述。

结果共纳入9项研究，来自4个国家，涉及800例被试。研究设计均为随机对照试验。PEDro量表平均得分为7.1分。老年人的睡眠与健康相关问题涉及失眠和失眠并发轻度认知障碍。采用的正念干预方法主要有正念失眠疗法、正念减压疗法、正念认知疗法和正念冥想。干预场所涉及研究机构或健康中心、养老机构、社区卫生服务中心。干预周期6~8周。正念干预的健康效益包括改善睡眠质量以及改善心理和行为健康。

结论正念干预可以改善失眠老年人睡眠质量，减轻老年人抑郁、焦虑、压力感知等负性情绪，提高生活质量。

关键词: 老年人, 失眠, 睡眠质量, 正念干预, 系统综述

Abstract:

Objective To conduct a systematic review of the health benefits of mindfulness interventions for older adults with insomnia disorders.

Methods Thematic keyword search was conducted in databases including Web of Science, PubMed, Embase, EBSCO, CNKI, VIP and Wanfang data, for literature on the impact of mindfulness intervention on sleep quality in older adults with insomnia disorders, published up to August, 2023. The methodological quality of the researches was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Insomnia disorders, sleep function and mindfulness interventions were coded using International Classification of Diseases 11th Revision, International Classification of Functioning, Disability and Health, and International Classification of Health Interventions Beta-3； and a systematic review was conducted following the PRISMA.

Results Nine researches from four countries were included, involving 800 participants, and all the researches were randomized controlled trials. The average score of PEDro scale was 7.1. The health-related conditions were insomnia disorders and insomnia disorders complicated with mild cognitive impairment. Mindfulness interventions used included mindfulness-based therapy for insomnia, mindfulness-based stress reduction, mindfulness-based cognitive therapy and mindfulness meditation. Interventions were implemented in institutions or health centers, care facilities, and community health service centers, varying from six to eight weeks. Health benefits of mindfulness intervention included improvements in sleep quality and psychological and behavioral health.

Conclusion Mindfulness interventions effectively improve sleep quality in older adults with insomnia disorders, alleviate negative emotional states such as depression, anxiety and perceived stress, and improve the quality of life.

Key words: older adults, insomnia, sleep quality, mindfulness intervention, systematic review

中图分类号:

R749.7

葛可可, 范永红, 王航宇, 都丽露, 李长江, 邹敏. 失眠老年人正念干预健康效益的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 54-60.

GE Keke, FAN Yonghong, WANG Hangyu, DU Lilu, LI Changjiang, ZOU Min. Health benefit of mindfulness intervention for older adults with insomnia disorders: a systematic review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 54-60.

图/表 4

表1

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表2

表3

纳入文献基本特征"

纳入文献	国家	样本特征	干预策略	比较	结局
Perini等^[11](2023)	新加坡	失眠年龄58~80岁对照组(n = 62) 干预组(n = 65)	干预场所：研究机构或健康中心干预方法：对照组采用SHEEP，干预组采用MBTI 干预频率：每次120 min，每周1次干预时间：8周	与对照组比较	睡眠质量 ISI分数下降 PSQI得分下降睡眠潜伏期缩短入睡后觉醒次数减少，觉醒时间缩短心理健康：未提及
Shaif等^[12](2022)	新加坡	睡眠困难年龄58~80岁对照组(n = 58) 干预组(n = 55)	干预场所：健康中心干预方法：对照组采用SHEEP，干预组采用MBTI 干预频率：每次120 min，每周1次干预时间：8周	与对照组比较	睡眠质量睡眠潜伏期缩短入睡后觉醒时间缩短主客观睡眠潜伏期差异减少心理健康：未提及
Wong等^[13](2022)	新加坡	睡眠障碍年龄58~80岁对照组(n = 46) 干预组(n = 48)	干预场所：研究机构或健康中心干预方法：对照组采用SHEEP，干预组采用MBTI 干预频率：每次120 min，每周1次干预时间：8周	与对照组比较	睡眠质量 ISI得分下降 PSQI得分下降 PSAS得分降低 N₂睡眠阶段增长，睡眠时间增加心理健康：未提及
Li等^[14](2020)	中国	失眠年龄≥ 65岁对照组(n = 33) 干预组(n = 35)	干预场所：养老机构干预方法：空白对照，干预组采用正念冥想干预频率：每次90 min，每周2~3次干预时间：8周	与对照组比较	睡眠质量 PSQI得分下降服用安眠药频率减少心理健康：未提及
Zhang等^[15](2015)	中国	慢性失眠年龄≥ 75岁对照组(n = 30) 干预组(n = 30)	干预场所：医院干预方法：空白对照，干预组采用MBSR 干预频率：每次120 min，每周1次干预时间：8周	与对照组比较	睡眠质量 PSQI得分下降，日间功能障碍改善心理健康 GDS得分显著降低，抑郁症状减轻
Cai等^[16](2022)	中国	轻度认知障碍并发失眠症年龄≥ 60岁对照组(n = 37) 干预组(n = 38)	干预场所：养老机构干预方法：对照组采用健康教育课程,干预组采用正念冥想干预频率：每次90 min，每周1次干预时间：8周	与对照组比较	睡眠质量 PSQI分数下降 ISI、AIS得分均下降心理健康 SAS、PSS得分均降低
Gallegos等^[17](2018)	美国	睡眠障碍年龄≥ 65岁对照组(n = 51) 干预组(n = 67)	干预场所：社区干预方法：对照组无干预，干预组采用MBSR 干预频率：每次120 min，每周1次干预时间：8周	与对照组比较	睡眠质量 PSQI得分下降心理健康：未提及
Black等^[18](2015)	美国	睡眠障碍年龄≥ 55岁对照组(n = 25) 干预组(n = 24)	干预场所：社区卫生服务中心干预方法：对照组采用睡眠卫生教育，干预组采用正念冥想干预频率：每次120 min，每周1次干预时间：6周	与对照组比较	睡眠质量 PSQI得分显著降低 AIS得分降低心理健康 BDI-Ⅱ得分显著降低
Camino等^[19](2022)	西班牙	失眠年龄> 60岁对照组(n = 48) 干预组(n = 48)	干预场所：社区卫生服务中心干预方法：对照组采用电影论坛活动，干预组采用MBCT 干预频率：每次90 min，每周1次干预时间：8周	与对照组比较	睡眠质量 ISI得分降低 PSQI得分下降，日间睡眠改善心理健康：未提及

表3

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人群(Population)		干预(Intervention)	比较(Comparison)	结局(Outcome)
健康及健康相关状况	ICD-11和ICF编码	干预(Intervention)	比较(Comparison)	结局(Outcome)
失眠失眠并发轻度认知障碍年龄≥ 55岁匹兹堡睡眠质量指数≥ 5	ICD-11编码 07睡眠-觉醒障碍 ICF编码 b134睡眠功能 b1340 睡眠量 b1341 睡眠开始时间 b1342 睡眠维持时间 b1343 睡眠质量 b1344 涉及睡眠周期功能	干预属性及ICHI编码：睡眠功能训练(ATK.PH.ZZ) 干预方法：MBTI、MBSR、MBCT、正念冥想干预方案：干预频率、持续时间干预场所：研究机构、健康中心、养老机构、社区卫生服务中心	干预前后比较干预方式比较干预组与对照组比较	1.睡眠质量：主观测量：失眠严重程度、觉醒次数、服用安眠药频率、睡前觉醒程度、日间功能障碍客观测量：睡眠潜伏期、入睡后清醒时间、睡眠时长 2.心理与行为健康：抑郁、焦虑、压力感知

纳入文献	资格标准	随机分配	分配隐藏	基线相似	被试施盲	治疗师施盲	被试流失率< 15%	ITT意向治疗分析	组间统计比较	报告点测量和变异量值	总分
Perini等^[11](2023)	√	√	√	√			√	√	√	√	7
Shaif等^[12](2022)	√	√	√	√			√	√	√	√	7
Wong等^[13](2022)	√	√	√	√				√	√	√	6
Li等^[14](2020)	√	√		√			√	√	√	√	6
Zhang等^[15](2015)	√	√	√	√			√	√	√	√	7
Cai等^[16](2022)	√	√	√	√	√	√	√	√	√	√	9
Gallegos等^[17](2018)	√	√	√	√			√	√	√	√	7
Black等^[18](2015)	√	√	√	√	√	√	√	√	√	√	9
Camino等^[19](2022)	√	√		√			√	√	√	√	6