Interaction between depression and insomnia under acupuncture treatment: a secondary analysis of a randomized controlled trial

WANG Shanze; GAO Jinfeng; WU Bingxin; WU Qian; WEN Xiuyun; NING Baile; LIANG Xuesong; FU Wenbin

doi:10.13703/j.0255-2930.20230822-k0001

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Interaction between depression and insomnia under acupuncture treatment: a secondary analysis of a randomized controlled trial

Clinical Research | 更新时间：2024-06-14

- Interaction between depression and insomnia under acupuncture treatment: a secondary analysis of a randomized controlled trial
- Chinese Acupuncture & Moxibustion Vol. 44, Issue 6, Pages: 618-624(2024)
- 作者机构：
  
  1.广州中医药大学第二临床医学院，广东　广州　510120
  2.广州中医药大学针灸康复临床医学院
  3.广东药科大学健康学院
- 作者简介：
- 基金信息：
- DOI：10.13703/j.0255-2930.20230822-k0001
  CLC：
- Received：22 August 2023，
  
  Online First：29 December 2023，
  
  Published：12 June 2024
- 稿件说明：
移动端阅览
WANG Shanze, GAO Jinfeng, WU Bingxin, et al. Interaction between depression and insomnia under acupuncture treatment: a secondary analysis of a randomized controlled trial[J]. Chinese Acupuncture & Moxibustion, 2024, 44(6): 618-624.
DOI：

WANG Shanze, GAO Jinfeng, WU Bingxin, et al. Interaction between depression and insomnia under acupuncture treatment: a secondary analysis of a randomized controlled trial[J]. Chinese Acupuncture & Moxibustion, 2024, 44(6): 618-624. DOI： 10.13703/j.0255-2930.20230822-k0001.

摘要

目的：

探索优化针刺方案改善抑郁失眠共病患者情绪与失眠症状的交互作用。

方法：

对一项针刺治疗抑郁失眠共病的多中心随机对照试验进行二次分析。试验将140例抑郁失眠共病患者随机分为优化针刺组（70例，脱落8例）和常规针刺组（70例，脱落8例）。常规针刺组针刺印堂、百会及双侧合谷、太冲；优化针刺组在常规针刺组基础上加刺双侧列缺、照海，并于双侧心俞、胆俞及双侧肾俞、安眠两组穴位交替施皮内针疗法。两组均每周治疗2次，连续治疗6周。分别于治疗前后观察两组患者24项汉密尔顿抑郁量表（HAMD-24）及匹兹堡睡眠质量指数（PSQI）评分。采用中介效应分析分别评价PSQI与HAMD-24情绪相关因子的中介效应；根据HAMD-24评分采用潜剖面分析对患者进行亚组分类，并进一步对各亚组进行组间疗效比较。

结果：

PSQI在优化针刺方案改善抑郁情绪的间接效应为3.052（95%

[1.407

4.697

]

），占总效应的77.5%；抑郁情绪在优化针刺方案改善PSQI的间接效应为0.479（95%

[0.024

0.935

]

），占总效应的14.8%。潜剖面分析根据抑郁情绪和失眠症状将患者分为3类，仅在抑郁情绪和失眠症状相对较轻的亚组中可见优化针刺方案疗效优于常规针刺方案（PSQI：95%

[-10.98

-5.44

]

，

0.001；HAMD-24：95%

[-12.31

-3.73

]

= 0.001）。

结论：

优化针刺方案主要通过改善失眠症状进一步改善抑郁情绪，相比常规针刺方案其在轻症患者中更能体现疗效优势。

Abstract

Objective

To explore the interaction between emotional and insomnia symptom improvement in comorbid depression and insomnia patients treated with optimized acupuncture.

Methods

A secondary analysis was conducted on a multicenter randomized controlled trial of acupuncture treatment for comorbid depression and insomnia. One hundred and forty patients with comorbid depression and insomnia were randomly assigned to an optimized acupuncture group (70 cases

8 cases dropped out) and a conventional acupuncture group (70 cases

8 cases dropped out). The patients in the conventional acupuncture group were treated with acupuncture at Yintang (GV 24

)

Baihui (GV 20)

bilateral Hegu (LI 4) and Taichong (LR 3); the patients in the optimized acupuncture group were treated with additional acupuncture at bilateral Lieque (LU 7)

Zhaohai (KI 6)

and intradermal needling was applied alternately at bilateral Xinshu (BL 15) and Danshu (BL 19)

Shenshu (BL 23) and Anmian (Extra). Both groups received treatments twice a week for six weeks. The Hamilton depression scale-24 (H

AMD-24) and Pittsburgh sleep quality index (PSQI) scores were observed before and after treatment for both groups. Mediation analysis was used to assess the mesomeric effect of PSQI and HAMD-24 emotional factors

and latent profile analysis categorized patients into subgroups based on HAMD-24 scores

followed by between-group efficacy comparisons.

Results

The indirect effect of the optimized acupuncture on improving depression emotions through PSQI was 3.052 (95%

[1.407

4.697

]

)

accounting for 77.5% of the total effect. Conversely

the indirect effect of improving PSQI through the optimized protocol on depression emotions was 0.479 (95%

[0.024

0.935

]

)

representing 14.8% of the total effect. Latent profile analysis identified 3 categories based on emotional and insomnia symptoms

and statistically significant differences in efficacy favoring the optimized acupuncture protocol over the conventional acupuncture protocol were observed only in the subgroup with relatively mild depression and insomnia symptoms (PSQI: 95%

[-10.98

-5.44

]

0.001; HAMD-24: 95%

[-12.31

-3.73

]

=0.001).

Conclusion

The optimized acupuncture protocol primarily improves insomnia symptoms and further improves depression emotions. Its efficacy advantages are more evident in patients with mild symptoms compared with the conventional acupuncture protocol.

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