[Effects of electroacupuncture on sleep quality, cognitive function and cerebral hemodynamics in elderly maintenance hemodialysis patients].

Abstract / Summary

To observe the effects of electroacupuncture (EA) on sleep quality, cognitive function, sleep process and structure, as well as cerebral hemodynamics in elderly patients with maintenance hemodialysis (MHD). Sixty elderly MHD patients were randomized into an EA group (30 cases) and a sham acupuncture group (30 cases). EA was applied at Sishencong (EX-HN1) in the EA group, with continuous wave, in frequency of 2 Hz and in current of 1 mA. Sham acupuncture was applied at distal non-meridian and non-acupoint points in the sham acupuncture group, same EA parameters were given, and the electrical stimulation was stopped after 30 seconds. Both groups were intervened for 30 min per session, once daily, 5 days per week, for a total of 4 weeks. Before and after treatment, the scores of Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), Montreal cognitive assessment-basic (MoCA-B), mini-mental state examination (MMSE) were observed, and the incidence of sleep disorders was calculated based on PSQI score; the indexes of sleep process (sleep onset latency [SOL], total sleep time [TST], sleep efficiency [SE]) and sleep structure (percentages of stage 1 sleep [N1], stage 2 sleep [N2], stage 3 sleep [N3] and rapid eye movement sleep [REM] in TST) were observed by polysomnography system; and the cerebral hemodynamic indexes (mean blood flow velocity [Vm] of middle artery, regional cerebral blood flow [rCBF] and regional cerebral blood volume [rCBV]) were detected by transcranial Doppler ultrasound in the two groups. After treatment, the PSQI score, incidence of sleep disorders and ISI score in the EA group were decreased (P<0.05), while the scores of MoCA-B and MMSE were increased compared with those before treatment (P<0.05); in the EA group, the PSQI score, incidence of sleep disorders and ISI score were lower, while the scores of MoCA-B and MMSE were higher than those in the sham acupuncture group (P<0.001). Compared before treatment, SOL was shortened, TST was prolonged, the percentage of N1 in TST was decreased, the percentages of N2, N3 and REM in TST were increased, and SE was improved in the EA group after treatment (P<0.05); after treatment, all indexes of sleep process and structure in the EA group were superior to those in the sham acupuncture group (P<0.001, P<0.01). After treatment, the Vm of middle artery, rCBF and rCBV in the EA group were increased compared with those before treatment (P<0.05); the Vm of middle artery, rCBF and rCBV in the EA group were higher than those in the sham acupuncture group (P<0.001). EA can regulate sleep process and structure, and improve sleep quality and cognitive function in elderly MHD patients, which may be related to the improvement of cerebral hemodynamics. 目的：观察电针对老年维持性血液透析（MHD）患者睡眠质量、睡眠进程和结构、认知功能、脑血流动力学的影响。 方法：将60例老年MHD患者随机分为电针组（30例）和假针刺组（30例）。电针组于四神聪穴行电针干预，采用连续波，频率2 Hz，电流1 mA；假针刺组于远端非经非穴行假针刺，电针参数同电针组，予电刺激30 s后停止。两组均每次干预30 min，每天1次，每周5 d，共干预4周。分别于治疗前后观察两组患者匹兹堡睡眠质量指数（PSQI）、失眠严重程度指数（ISI）、蒙特利尔认知评估基础量表（MoCA-B）、简易智能状态检查量表（MMSE）评分，并根据PSQI评分计算睡眠障碍发生率；采用多导睡眠监测系统观察患者睡眠进程[睡眠潜伏期（SOL）、睡眠总时间（TST）、睡眠效率（SE）]和睡眠结构[1期睡眠（N1）、2期睡眠（N2）、3期睡眠（N3）和快速眼动睡眠期（REM）占TST的百分比]指标；采用经颅多普勒超声仪检测患者脑血流动力学指标[中动脉平均血流速度（Vm）、局部脑血流量（rCBF）、局部脑血容量（rCBV）]。 结果：治疗后，电针组患者PSQI评分、睡眠障碍发生率及ISI评分较治疗前降低（P<0.05），MoCA-B评分及MMSE评分较治疗前升高（P<0.05）；电针组患者PSQI评分、睡眠障碍发生率及ISI评分低于假针刺组（P<0.001），MoCA-B评分及MMSE评分高于假针刺组（P<0.001）。治疗后，电针组患者SOL较治疗前缩短（P<0.05），TST较治疗前延长（P<0.05），SE较治疗前提高（P<0.05），N1占比较治疗前减少（P<0.05），N2、N3及REM占比较治疗前增加（P<0.05）；电针组患者上述睡眠进程及结构指标均优于假针刺组（P<0.001，P<0.01）。治疗后，电针组患者中动脉Vm、rCBF及rCBV较治疗前升高（P<0.05），且电针组高于假针刺组（P<0.001）。 结论：电针能调节老年MHD患者的睡眠进程及结构，提高患者睡眠质量与认知功能，可能与改善脑血流动力学有关。.

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