BMC Complementary and Alternative Medicine | |
Efficacy and safety of Suanzaoren decoction for primary insomnia: a systematic review of randomized controlled trials | |
Guo-qing Zheng3  Wen-jie Tang1  Yan Lin3  Ji-huang Li3  Hui-qin Li3  Ai-ju Liu3  Deng-lei Fu3  Lin Lu3  Wen-Wen Wang3  Yong Gu2  Cheng-long Xie3  | |
[1] Department of Psychology, School of Environmental Science and Public Health, Wenzhou Medical College, Wenzhou, 325000, China;School of Chinese Medicine, University of Hong Kong, Hong Kong, SAR, China;The Center of Neurology and Rehabilitation, The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, 325027, China | |
关键词: Systematic review; Suanzaoren decoction; Insomnia; | |
Others : 1231157 DOI : 10.1186/1472-6882-13-18 |
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received in 2012-10-22, accepted in 2013-01-03, 发布年份 2013 | |
【 摘 要 】
Background
Insomnia is a widespread human health problem, but there currently are the limitations of conventional therapies available. Suanzaoren decoction (SZRD) is a well known classic Chinese herbal prescription for insomnia and has been treating people’s insomnia for more than thousand years. The objective of this study was to evaluate the efficacy and safety of SZRD for insomnia.
Methods
A systematic literature search was performed for 6 databases up to July of 2012 to identify randomized control trials (RCTs) involving SZRD for insomniac patients. The methodological quality of RCTs was assessed independently using the Cochrane Handbook for Systematic Reviews of Interventions.
Results
Twelve RCTs with total of 1376 adult participants were identified. The methodological quality of all included trials are no more than 3/8 score. Majority of the RCTs concluded that SZRD was more significantly effective than benzodiazepines for treating insomnia. Despite these positive outcomes, there were many methodological shortcomings in the studies reviewed, including insufficient information about randomization generation and absence of allocation concealment, lack of blinding and no placebo control, absence of intention-to-treat analysis and lack of follow-ups, selective publishing and reporting, and small number of sample sizes. A number of clinical heterogeneity such as diagnosis, intervention, control, and outcome measures were also reviewed. Only 3 trials reported adverse events, whereas the other 9 trials did not provide the safety information.
Conclusions
Despite the apparent reported positive findings, there is insufficient evidence to support efficacy of SZRD for insomnia due to the poor methodological quality and the small number of trials of the included studies. SZRD seems generally safe, but is insufficient evidence to make conclusions on the safety because fewer studies reported the adverse events. Further large sample-size and well-designed RCTs are needed.
【 授权许可】
2013 Xie et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
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20151109052407644.pdf | 309KB | download | |
Figure 1. | 60KB | Image | download |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]Edinger JD, Bonnet MH, Bootzin RR, Doghramji K, Dorsey CM, Espie CA, Jamieson AO, McCall WV, Morin CM, Stepanski EJ: American Academy of Sleep Medicine Work Group. Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep 2004, 27:1567-1596.
- [2]Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C: Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med 2006, 7:123-130.
- [3]Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC: Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry 2006, 60:1364-1371.
- [4]Kuppermann M, Lubeck DP, Mazonson PD, Patrick DL, Stewart AL, Buesching DP, Fifer SK: Sleep problems and their correlates in a working population. J Gen Intern Med 1995, 10:25-32.
- [5]Daley M, Morin CM, LeBlanc M, Grégoire JP, Savard J, Baillargeon L: Insomnia and its relationship to health-care utilization, work absenteeism, productivity and accidents. Sleep Med 2009, 10:427-438.
- [6]Sivertsen B, Overland S, Neckelmann D, Glozier N, Krokstad S, Pallesen S, Nordhus IH, Bjorvatn B, Mykletun A: The long-term effect of insomnia on work disability: the HUNT-2 historical cohort study. Am J Epidemiol 2006, 163:1018-1024.
- [7]Pearson NJ, Johnson LL, Nahin RL: Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data. Arch Intern Med 2006, 166:1775-1782.
- [8]Chen FP, Jong MS, Chen YC, Kung YY, Chen TJ, Chen FJ, Hwang SJ: Prescriptions of Chinese Herbal Medicines for Insomnia in Taiwan during. Evid Based Complement Alternat Med 2002, 2011:236-341.
- [9]Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, Britton TC, Crowe C, Dijk DJ, Espie CA, Gringras P, Hajak G, Idzikowski C, Krystal AD, Nash JR, Selsick H, Sharpley AL, Wade AG: British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol 2010, 24:1577-1601.
- [10]Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL: Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep 2006, 29:1398-1414.
- [11]Bluestein D, Healey AC, Rutledge CM: Acceptability of behavioral treatments for insomnia. J Am Board Fam Med 2011, 24:272-280.
- [12]National Institutes of Health: National Institutes of Health State of the Science Conference Statement on manifestations and management of chronic insomnia in adults. Sleep 2005, 28:1049-1057.
- [13]Ferguson SA, Rajaratnam SM, Dawson D: Melatonin agonists and insomnia. Expert Rev Neurother 2010, 10:305-318.
- [14]Yeung WF, Chung KF, Man-Ki Poon M, Yan-Yee Ho F, Zhang SP, Zhang ZJ, Tat-Chi Ziea E, Wong VT: Chinese herbal medicine for insomnia: A systematic review of randomized controlled trials. Sleep Med Rev 2012, 16:497-507.
- [15]Liu JP, McIntosh H, Lin H: Chinese medicinal herbs for chronic hepatitis B. Cochrane Database Syst Rev 2001, 7:CD001940.
- [16]Yeh CH, Arnold CK, Chen YH, Lai JN: Suanzaoren Decoction as an original treatment for sleep difficulty in climacteric women: a prospective clinical observation. Evid Based Complement Alternat Med 2011, 9:673-813.
- [17]Yi PL, Tsai CH, Chen YC, Chang FC: Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration. J Biomed Sci 2007, 14:285-297.
- [18]Yi PL, Lin CP, Tsai CH, Lin JG, Chang FC: The involvement of serotonin receptors in suanzaorentang-induced sleep alteration. J Biomed Sci 2007, 14:829-840.
- [19]Yang B, Zhang A, Sun H, Dong W, Yan G, Li T, Wang X: Metabolomic study of insomnia and intervention effects of Suanzaoren decoction using ultra-performance liquid-chromatography/electrospray-ionization synapt high-definition mass spectrometry. J Pharm Biomed Anal 2012, 58:113-124.
- [20]Li Y, Liang X, Xiao H, Bi K: Determination of spinosin in rat plasma by reversed-phase high-performance chromatography after oral administration of Suanzaoren decoction. J Chromatogr B Analyt Technol Biomed Life Sci 2003, 787:421-425.
- [21]Chen CY, Chen YF, Tsai HY: What is the effective component in suanzaoren decoction for curing insomnia? Discovery by virtual screening and molecular dynamic simulation. J Biomol Struct Dyn 2008, 26:57-64.
- [22]Kanba S, Yamada K, Mizushima H, Asai M: Use of herbal medicine for treatingpsychiatric disorders in Japan. Psychiatry Clin Neurosci 1998, 52(Suppl):S331-333.
- [23]Kanba S, Richelson E: Herbal Medicines for Neuropsychiatric Diseases: Current Developments and Research. London: Routledge; 1999.
- [24]Zhou MQ, Shi YQ: Jiajian Suanzaoren decoction to treat insomnia: A systematic review. Zhejiang Journal of Integrated Traditional Chinese and Western Medicine 2011, 21:684-687.
- [25]Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009, 6:e1000097.
- [26]Chinese Society of Psychiatry. CCMD-3: Chinese Classification of Metal Disorders. Jinan Shandong Press of Science and Technology; 2001.
- [27]Guideline for Clinical Trials of New Patent Chinese Medicines. 1st edition. Beijing: Ministry of Health of the People’s Republic of China; 1993:186-187.
- [28]Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989, 28:193-213.
- [29]Spiegel R: Sleep and sleeplessness in advanced age: Advances in Sleep Research. Lancaster UK: MTP Press; 1981:1-272.
- [30]Xiao WD, Liu P, Ma H, Zhang HY, Shu L, Cao XT: The reliability and validity of Sleep Dysfunction Rating Scale in patients with insomnia. Chin Ment Heal J 2007, 21:40-42.
- [31]Wu LM, Hao FL: Clinical observation of 70 cases of chronic severe insomnia treated with modified Suanzaoren Decoction. In Compilation of papers in Symposium of basic research and clinical applications of formula-syndrome. Bejing: Chinese Society of Chinese Medicine; 2005:149-151.
- [32]Yu HT, Fu HP, Liu JD, Meng G: Control study of modified Suanzaoren Deccoction in treating insomnia. Chin J Pract Chin Mod Med 2005, 18:1779-1780.
- [33]Liu SN: Treating 50 cases of insomnia with Suanzaoren decoction. Clin J Chin Med 2012, 4:94-95.
- [34]Luo YF: Clinical observations of 30 cases of insomnia treated with Suanzaoren Decoction. Inner Mongol J Tradit Chin Med 2009, 28:7-8.
- [35]Tan B: Clinical effects of Suan-zao-ren-tang combined with oxazepam in the treatment of undergraduate insomnia. Chin J Clin Pharmacol 2006, 2:175.
- [36]Yu BK: Baihe Suanzaoren decoction in Treating 63 cases of simple insomnia. Zhejiang J integra Tradit Chin West Med 2006, 16:580.
- [37]She YQ: Clinical observation of female insomnia treated with Suanzaoren Decoction. J Guangxi Tradit Chin Med Univ 2009, 12:14-16.
- [38]Yuan MS, Zhuang ZZ, Zhou X: Clinical observation of 69 cases of primary insomnia treated with modified Suanzaoren Decoction. Guiding J Tradit Chin Med Pharm 2009, 15:13-15.
- [39]Feng HP: Modified Suanzaoren Tang in treating 78 cases of insomnia. J Pract Tradit Chin Internal Med 2011, 25:56-57.
- [40]Zou LH, Li H, Deng ZH, Cheng XD, Huang XT: Clinical observation on effect of treatment of insomnia by integrative Chinese and western medicine. Health Must-read Mag 2011, 20:65.
- [41]Cong K, Jiao FE, Xie W: Clinical observation of insomnia treated with Suanzaoren Decoction. J Pract Tradit Chin Med 2011, 27:669.
- [42]Wu LM, Zhang XX, Cheng XF: Modified Suanzaoren decoction combined with alprazolam in treating 260 cases of chronic severe insomnia. Lishizhen Med Mater Med Res 2008, 19:202-203.
- [43]Chen HC, Hsieh MT: Clinical trial of Suanzaorentang in the treatment of insomnia. Clin Ther 1985, 7:334-337.
- [44]Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, Carpenter J, Rücker G, Harbord RM, Schmid CH, Tetzlaff J, Deeks JJ, Peters J, Macaskill P, Schwarzer G, Duval S, Altman DG, Moher D, Higgins JP: Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011, 343:d4002.
- [45]Higgins JPT, Green S: Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1, Updated March 2011. Oxford: The Cochrane Collaboration; 2012. Available from: URL: http://www.cochrane-handbook.org webcite.
- [46]Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996, 17:1-12.
- [47]Schulz KF, Chalmers I, Hayes RJ, Altman DG: Empirical evidence of bias: Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995, 273:408-412.
- [48]Sarris J: Chinese herbal medicine for sleep disorders: Poor methodology restricts any clear conclusion. Sleep Med Rev 2012, 16:493-495.
- [49]Ernst E, Lee MS: A trial design that generates only “positive” results. J Postgrad Med 2008, 54:214-216.
- [50]Chen M, Zheng H, Yin LP, Xie CG: Is oral administration of Chinese herbal medicine effective and safe as an adjunctive therapy for managing diabetic foot ulcers? A systematic review and meta-analysis. J Altern Complement Med 2010, 16:889-898.
- [51]Rathbone J, Zhang L, Zhang M, Xia J, Liu X, Yang Y: Chinese herbal medicine for schizophrenia. Cochrane Database Syst Rev 2005, 11:CD003444.
- [52]Hollis S, Campbell F: What is mean by intention to treat analysis? Survey of published randomised controlled trials. Br Med J 1999, 319:670-674.
- [53]Dickersin K: The existence of publication bias and risk factors for its occurrence. JAMA 1990, 263:1385-1389.
- [54]Egger M, Smith GD: Bias in location and selection of studies. BMA 1998, 316:61-66.
- [55]Ernst E, Pittler MH: Alternative therapy bias. Nature 1997, 385:480.
- [56]Pittler MH, Abbot NC, Harkness EF, Ernst E: Location bias in controlled clinical trials of complementary / alternative therapies. J Clin Epidemiol 2000, 53:485-489.
- [57]Vickers A, Goyal N, Harland R, Rees R: Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials 1998, 19:159-166.
- [58]De Angelis C, Drazen JM, Frizelle FA, Haug C, Hoey J, Horton R, Kotzin S, Laine C, Marusic A, Overbeke AJ, Schroeder TV, Sox HC, Van Der Weyden MB: International Committee of Medical Journal Editors. Clinical trial registration: a statement from the International Committee of Medical Journal Editors. N Engl J Med 2004, 117:U1054.
- [59]Halbreich U: The diagnosis of premenstrual syndromes and premenstrual dysphoric disorder-clinical procedures and research perspectives. Gynecol Endocrinol 2004, 19:320.
- [60]Yeung WF, Chung KF, Leung YK, Zhang SP, Law AC: Traditional needle acupuncture treatment for insomnia: a systematic review of randomized controlled trials. Sleep Med 2009, 10:694-704.
- [61]Morin CM: Measuring outcomes in randomized clinical trials of insomnia treatments. Sleep Med Rev 2003, 7:263-279.
- [62]Kjaergard LL, Villumsen J, Gluud C: Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001, 135:982-989.
- [63]Schulz KF, Grimes DA: Sample size calculations in randomised trials: mandatory and mystical. Lancet 2005, 365:1348-1353.
- [64]Wang Y, Xie CL, Fu DL, Lu L, Lin Y, Dong QQ, Wang XT, Zheng GQ: Clinical efficacy and safety of Chinese herbal medicine for Wilson’s disease: a systematic review of 9 randomized controlled trials. Complement Ther Med 2012, 20:143-54.
- [65]Kotsirilos V: Complementary and alternative medicine. Part 2--evidence and implications for GPs. Aust Fam Physician 2005, 34:689-691.
- [66]Sarris J, Byrne GJ: A systematic review of insomnia and complementary medicine. Sleep Med Rev 2011, 15:99-106.
- [67]Gagnier JJ, Boon H, Rochon P, Moher D, Barnes J, Bombardier C: Reporting randomized, controlled trials of herbal interventions: an elaborated CONSORT statement. Ann Intern Med 2006, 144:364-367.
- [68]Schulz KF, Altman DG, Moher D: CONSORT Group: CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. BMJ 2010, 340:c332.
- [69]Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG: CONSORT Group: CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomized trial. BMJ 2010, 340:c869.