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World Journal of
世界杂志

Psychiatry
精神病学

Submit a Manuscript: https://www.f6publishing.com World J Psychiatry 2022 April 19; 12(4): 636-650
提交手稿https://www.f6publishingcom世界精神病杂志 2022 年 4 月 19 日;12(4):636-650

DOI
数字对象标识符
: 10.5498/wjp.v12.i4.636 ISSN
国际标准刊号
2220-3206 (online
在线
)

Effects of mindfulness-based intervention programs on sleep among people with common mental disorders: A systematic review and
基于正念的干预计划对常见精神障碍患者睡眠的影响: 系统性研究和

meta-analysis
Meta 分析

Sunny Ho-Wan Chan, Danielle Lui, Hazel Chan, Kelly Sum, Ava Cheung, Hayley Yip, Chong Ho Yu
SunnyHo-Wan Chan,DanielleLui,Hazel Chan,Kelly Sum, Ava Cheung,Hayley Yip, ChongHo Yu

Specialty type: Psychiatry
专业类型: 精神病学

Provenance and peer review:
来源和同行评审:

Invited article; Externally peer reviewed.
特邀文章外部同行评审。

Peer-review model: Single blind
同行评议模式:单盲

Peer-review report’s scientific quality classification
同行评议报告的科学质量分类

Grade A (Excellent): 0
A 优秀):0

Grade B (Very good): 0
B 级很好): 0

Grade C (Good): C
C 良好):C

Grade D (Fair): 0
D 级合格):0

Grade E (Poor): 0
E 较差): 0

P-Reviewer: Kim Y, United States
P-审稿人: Kim Y, 美国

Received: February 24, 2021
收稿日期: 2021-02-24

Peer-review started: February 24, 2021
同行评审开始时间:2021 年 2 月 24 日

First decision: April 21, 2021
第一次决定:2021 年 4 月 2 日1 日

Revised: April 24, 2021
修订日期:2021 年 4 月 24

Accepted: March 14, 2022
录用日期: 2022-03-14

Article in press: March 14, 2022
新闻文章: March 14,2022

Published online: April 19, 2022
在线发布时间:2022 年 4 月 19 日

RESULTS
结果

We identified 397 articles, of which 10 randomised controlled trials, involving a total of 541 participants, were included in the meta-analysis. Studies of internet mindfulness meditation intervention (IMMI), mindfulness meditation (MM), mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction
我们确定了 397篇文章,其中10 项随机对照试验涉及541参与者,被纳入荟萃分析。互联网正念冥想干预研究(IMMI),正念冥想(MM),基于正念认知疗法MBCT),基于正念减压

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Chan SHW et al. Meta-analysis of MBI programs on sleep
ChanSHW人。 MBI计划睡眠荟萃分析

(MBSR) and mindfulness-based touch therapy (MBTT) met the inclusion criteria. The greatest effect sizes are reported in favour of MBTT, with SMDs of -1.138 (95%CI: -1.937 to -0.340; P = 0.005), followed by -1.003 (95%CI: -1.645 to -0.360; P = 0.002) for MBCT. SMDs of -0.618 (95%CI: - 0.980 to -0.257; P = 0.001) and -0.551 (95%CI: -0.842 to -0.260; P < 0.0001) were reported for IMMI and MBSR in the pooling trials, respectively. Significant effects on sleep problem improvement are shown in all reviewed MBI programs, except MM, for which the effect size was shown to be non- significant
(MBSR) 和基于正念的触摸疗法 (MBTT) 符合纳入标准。据报道,SMD 为 -1.138 的 MBTT 效应量最大(95% CI -1.937 至 -0.340;P = 0.005),然后是 -1.003(95% CI:-1.645 至 -0.360;P = 0.002),对于 -0.618 的 MBCTSMD (95% CI- 0.980 至 -0.257;P = 0.001)和 -0.551 (95% CI: -0.842 至 -0.260;在合并试验中分别报告了 IMMI 和 MBSR 的 P < 0.0001)。所有经过审查的 MBI 计划都显示了对睡眠问题改善的显着影响,但 MM 除外,其效应量被证明不显著
.

CONCLUSION
结论

All MBI programs (MBTT, MBCT, IMMI andMBSR), except MM, are effective options to improve sleep problems among people with depression or anxiety disorder.
MM,所有 MBI 计划(MBTT、MBCT、IMMI 和MBSR)都是改善抑郁症或焦虑症患者睡眠问题的有效选择

KeyWords: Mindfulness-based intervention programs; Common mental disorders; Sleep; Systematic review; Meta-analysis
关键词: 基于正念的干预 programs;常见的精神障碍;睡;系统评价;Meta 分析

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
©作者 2022 年。BaishidengPublishing Group Inc. 出版 保留所有权利

Citation: Chan SHW, Lui D, Chan H, Sum K, Cheung A, Yip H, Yu CH. Effects of mindfulness-based intervention
引用:ChanSHW, Lui D, Chan H,Sum K, Cheung A, YipH,Yu CH.正念干预的效果

programs on sleep among people with common mental disorders: A systematic review and meta-analysis. World J Psychiatry 2022; 12(4): 636-650
常见精神障碍患者睡眠计划系统评价荟萃分析世界精神病杂志 2022;12(4):636-650

URL: https://www.wjgnet.com/2220-3206/full/v12/i4/636.htm
网址:https://www.wjgnet.com/2220-3206/full/v12/i4/636.htm

DOI: https://dx.doi.org/10.5498/wjp.v12.i4.636
DOI: https://dx.doi.org/10.5498/wjp.v12.i4.636

INTRODUCTION
介绍

Depression and anxiety disorder, also known as common mental disorders, are conditions that critically affect people’s emotions, energy and ability to function. Approximately 1 in 5 adults were identified as meeting criteria for a common mental disorder over the past 12 mo, with the lifetime prevalence reported as 20.8% and 28.8% for depression and anxiety disorder, respectively[1,2]. Both depression and anxiety disorder are among the top 10 causes of disease burden worldwide[3], prompting the necessity to find ways for better treatment and planning of care
抑郁症和焦虑症,也称为常见的精神障碍,是严重影响人们的情绪、精力和功能能力的疾病。在过去 12 个月中,大约每 5 名成年人中就有 1 名被确定为符合常见精神障碍的标准,据报道抑郁症和焦虑症的终生患病率分别为 20.8% 和 28.8%[12]。抑郁症和焦虑症都是全球疾病负担的 10 大原因之一[3],因此有必要寻找更好的治疗和护理规划方法
.

Insomnia frequently co-occurs with both depression[4] and anxiety disorder[5]. Sleep problems, which include difficulty in falling asleep, early awakening, poor sleep quality, daytime sleepiness and poor adherence to the sleep-wake cycle pattern, are particularly prevalent among people with depression and anxiety disorder[6]. The relationships between insomnia and common mental disorders appear to be bidirectional[7]. Symptoms of anxiety and depression, such as worry and rumination, can contribute to insomnia. Alternatively, insomnia can also increase the likelihood of developing depression or anxiety disorder, possibly due to the psychological distress as well as hormonal and neurochemical disturbances caused by poor sleep[8,9]. Thus, interventions aiming at reducing symptoms of insomnia should provide benefit for the disorder per se[10].
失眠经常抑郁症 [4] 焦虑症 [5] 同时发生。睡眠问题,包括入睡困难、醒、睡眠质量白天嗜睡睡眠-觉醒周期模式性差患有抑郁症和焦虑症[6]。失眠常见精神障碍之间的关系似乎是双向的[7]。焦虑抑郁的症状,忧愁反刍,都会导致失眠。或者,失眠也会增加抑郁症焦虑的可能性这可能是由于心理干扰以及荷尔蒙神经化学作用睡眠不佳引起的干扰[89]。 因此,旨在诱发失眠症状干预措施应该疾病本身提供益处[10]。

Individuals may consider psychotherapy instead of pharmaceutical treatment, due to possible side effects and potential dependence on medication[11-13]. Cognitive behavioural therapy (CBT) has been substantially confirmed to be an effective psychosocial treatment in managing depression and anxiety [14,15]. In a meta-analysis of 1205 CBT trials for anxiety disorders, results indicated that CBT for anxiety has a moderate effect on sleep[16]. In terms of the treatment of both depression and insomnia, another study found that the addition of CBT for insomnia (known as CBT-I) to antidepressant medication treatment can lead to better treatment outcomes [17]. However, some reviews showed that the effect sizes of CBT for depression have steadily decreased since its inception four decades ago [18,19]. Therefore, merely employing CBT might not be sufficient for managing mood disorders and their corresponding sleep problems.
由于可能的副作用和对药物的潜在依赖性,个体可能会考虑心理治疗而不是药物治疗[11-13]。认知行为疗法 (CBT) 已被基本证实是管理抑郁焦虑的有效社会心理治疗方法[1415]。 一项 1205 针对焦虑CBT试验荟萃分析中,结果表明CBT治疗焦虑睡眠中等影响[16]。 抑郁症失眠症的治疗方面另一项研究发现抗抑郁药物治疗加入治疗失眠的 CBT(称为CBT-I)可以带来更好的治疗结果[17]。 然而,一些综述表明CBT抑郁症疗效4年前开始以来一直在稳步下降[1819]。因此,仅使用CBT可能不足管理情绪障碍及其相应的睡眠问题。

Due to the limitations of traditional treatments, many people who experience insomnia are willing to consider using complementary and alternative medicine (CAM) as an alternative therapeutic option,
由于传统疗法的局限性,许多患者愿意考虑使用补充替代医学 (CAM) 作为替代治疗选择,

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Chan SHW et al. Meta-analysis of MBI programs on sleep
ChanSHW人。 MBI计划睡眠荟萃分析

including natural herbal products, acupuncture, or mind-body interventions, for example. A national health survey revealed that approximately 1.6 million adults in the United States have used CAM therapies to treat sleep problems[20]. Among different CAM therapies, the mind-body domains are by far the most commonly used[20]. Mindfulness-based interventions (MBIs), as a kind of CAM mind-body treatment with a focus on cultivating a sense of awareness, was originally developed to help people dealing with stress, anxiety, depression, or pain[21]. Mindfulness (Pali: sati) originated from Buddhism. As such, mindfulness can be defined as deliberately cultivating non-judgmental moment-to-moment awareness and experiences, through observing one’s own mind in a detached manner [22]. Various formal and informal mindfulness activities, such as body scan and sitting meditation, are included within the MBIs. Through these practices, the technique of ‘focusing on present moment’ can be acquired based on approach, compassion and decentring[23]. The inquiry process, which assists participants in identifying their thoughts, emotions and behaviours, is also included in these programs to help participants respond with more flexibility and awareness[24].
例如,包括天然草药产品、针灸或身心干预一项全国健康调查显示美国成年人中约有1.6使用 CAM疗法治疗睡眠问题[20]。在不同的CAM疗法中,身心疗法迄今为止最常用的[20]。 基于正念的干预 MBI作为一种专注于培养意识的 CAM身心治疗最初是为了帮助人们应对压力焦虑抑郁疼痛[21]。 正念Palisati起源佛教因此正念可以定义为刻意培养非评判性的每时每刻的意识体验,通过超然的方式观察一个人的own[22]。MBI 包括各种正式非正式心理活动,例如身体扫描着冥想。通过这些实践,可以获得基于方法、悲悯中心化的“专注于预先发送的时刻”的技术[23]。 探究过程,帮助参与者识别他们的想法、情绪行为,包含在这些计划中以帮助参与者以更灵活的方式回答意识[24]。

Conventional MBI has standardised protocols, and typically incorporates three formal mindfulness practices, namely body scan, mindful movement and sitting meditation[23]. A traditional program called mindfulness-based stress reduction (MBSR), kicking off the development of the mindfulness- based program in the health care domain, was first introduced by Kabat-Zinn[22]. It is an 8-wk program using mindfulness meditation (MM) and mindfulness practice in everyday life to relieve stress. Since then, another well-researched program — mindfulness-based cognitive therapy (MBCT) — was developed with comparable structures [25]. It is also an 8-wk program, which includes mindfulness practice and psychoeducation about depression, promoting awareness, acceptance and adaptive reaction towards negative automatic thoughts[25]. Apart from preventing relapse in depression, MBCT is also used to treat patients with psychiatric conditions, like anxiety disorders and post-traumatic stress disorder (PTSD)[26,27].
传统的 MBI 具有标准化的协议,通常包括三种正式正念练习,身体扫描、正念运动着冥想[23]。首先引入了一个名为基于正念的减压 (MBSR) 的额外计划该计划开始了医疗保健领域基于正念的计划的发展作者:Kabat-Zinn[22]。这是一个为期 8 的计划日常生活中使用正念冥想 (MM) 正念练习来缓解压力。从那时起另一个经过充分研究的项目——基于正念的认知疗法 (MBCT) ——被开发出来,具有类似的结构es[25]。 它也是一个8 周的计划,包括正念练习关于depression心理教育促进对消极自动想法的认识、接受适应性反应[25]。除了预防抑郁症复发外MBCT 用于治疗患有精神疾病的患者焦虑创伤应激障碍PTSD)[2627]。

Since the commencement of MBSR, various forms of mindfulness programs have evolved with different adaptations or modifications, such as the Mindfulness-Based Therapy for Insomnia (MBTI) [28], internet mindfulness meditation intervention (IMMI)[29], Mindfulness Awareness Program (MAP) [30], or mindfulness-based touch therapy (MBTT)[31]. Specifically, MBTI was developed for patients with insomnia. It integrates mindful meditation and behavioural therapy. By promoting awareness and adaptive response towards sleep disturbances, MBTI helps people with chronic insomnia with sleep restrictions and stimulus control[28]. IMMI was developed to offer mindfulness training anytime and anywhere by use of an Internet mode of delivery. IMMI includes six 1-h weekly sessions with 20 min of home-practice meditation between sessions [29]. MAP aims to teach participants principles of mindfulness, develop meditation practice and apply them in daily lives. MAP is mainly conducted in community settings, with a combination of lecture, hands-on practice, group feedback and discussion [30]. MBTT is an 8-wk program that combines components of MBSR and touch therapy. It was inspired by Ogden et al[32]’s model of hierarchical information processing, in which touch stimulus triggers sensorimotor reaction, which is then experienced as emotions and interpreted cognitively. Touch is believed to have healing effects on both the mind and body[31].
MBSR 开始以来,各种形式的正念课程已经发展起来,有不同的适应或修改例如基于正念失眠疗法 (MBTI)[28]、互联网正念冥想干预 IMMI)[29]、正念意识计划 MAP)[30] 或基于正念的触摸疗法 (MBTT)[31]。具体来说,MBTI是为失眠患者开发的。它整合了正念冥想和行为疗法。通过提高睡眠障碍的认识适应性反应MBTI帮助慢性失眠患者限制睡眠刺激控制[28]。IMMI 的开发旨在通过使用互联网交付方式随时随地提供正念训练IMMI包括每周 6 次1 小时的课程两次之间有 20分钟家庭练习冥想[29]。MAP旨在教授参与者正念的原则发展冥想练习并将其应用于日常生活MAP主要社区环境中进行,结合讲座、动手实践、小组反馈讨论[30]。 MBTT 是一个 8 的项目结合了MBSR触摸疗法组成部分,它的灵感来自 Ogden[32] 的模型分层信息处理,其中触摸刺激我们触发感觉运动反应,然后作为情绪体验认知解释触摸被认为身心都有治愈作用[31]。

At present, various studies have been published for the different MBIs. However, the review type studies usually focus on the conventional programs, like MBSR or MBCT [33,34]. While there are different forms of emerging MBIs in recent years, it is essential to have a comprehensive evaluation on their clinical effectiveness. Moreover, the traditional MBI programs have usually targeted general physical and psychiatric conditions; later on, they were used in the management of various kinds of physical or psychosomatic conditions, and even insomnia problems[35]. Recent meta-analyses indicated that MBIs show promising effects on the reduction of sleep problems[36-39]. However, these meta- analyses focused on the general population only or on people with physical comorbidities, such as cancer and fibromyalgia. Therefore, systematic review and meta-analysis on the effectiveness of the various MBI programs for sleep problems in individuals with depression or anxiety disorders is implied.
目前已经发表了针对不同MBI 的各种研究然而,综述类型的研究通常集中在常规项目MBSRMBCT[3334]。虽然近年来出现了不同形式的新兴 MBI但对其临床有效性进行全面评价至关重要。此外,传统的MBI计划通常具有针对一般身体精神状况;后来他们用于管理各种身体心身疾病甚至失眠问题[35]。 最近的荟萃分析表明MBIs减少睡眠问题方面显示出有希望的效果[36-39]。 然而,这些荟萃分析关注普通人群患有癌症纤维肌痛躯体合并症的人群因此,各种MBI计划抑郁焦虑个体睡眠问题的有效性进行系统评价荟萃分析暗示了 disorders

The objective of this meta-analysis was to determine and compare the clinical importance of different MBI programs on sleep problems among individuals with common mental disorders. Based on our research, this meta-analysis is uniquely able to fill a crucial gap in the field
本荟萃分析的目的是确定和比较不同 MBI 计划对常见精神障碍个体睡眠问题的临床重要性。根据我们的研究,这项荟萃分析独特地能够填补该领域的关键空白
.

MATERIALS AND METHODS
材料和方法

Literature search
文献检索

Literature searches were performed according to the 2009 PRISMA Statement for systematic reviews, by two independent researchers (Lui D and Chan H). The search keywords ofmindfulnessand mood or anxiety or depress*” and “sleep or insomnia” were used to ensure comprehensive coverage. Keyword searches were conducted in Embase, Medline (accessed through EBSCOhost), PubMed and PsycINFO (accessed through ProQuest) databases. Papers published between January 2010 and June 2020 were included. Publications were only restricted to English language and peer-reviewed.
根据 2009 年 PRISMA声明两名独立研究人员 LuiDChanH) 的系统评价进行文献检索使用正念情绪焦虑或抑郁*”和“睡眠或失眠”检索来确保全面覆盖。Embase、Medline通过EBSCOhost 访问)、PubMedPsycINFO通过ProQuest 访问)数据库中进行关键字搜索。包括 2010 年 1 月至 2020年 6 月期间发表论文。出版物仅限于英语,并经过同行评审。

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Chan SHW et al. Meta-analysis of MBI programs on sleep
ChanSHW人。 MBI计划睡眠荟萃分析

Study eligibility
研究资格

Titles and abstracts were screened, and full texts were selected for further review according to the following criteria. The inclusion criteria were as follows: (1) Experimental study with MBI; (2) Subjects selected for depression or anxiety disorder; (3) Sleep-related data taken at baseline and post- intervention; and (4) Randomised controlled trials (RCTs). The exclusion criteria were as follows: (1) Mixed intervention; or (2) Subjects with comorbidities other than depression or anxiety disorders. The selection criteria were confirmed according to the results of searching. The PRISMA flow diagram is shown in Figure 1
筛选标题和摘要,并根据以下标准选择全文进行进一步审查。纳入标准如下: (1) MBI 实验研究;(2) 选择抑郁症或焦虑症的受试者;(3) 在基线和干预后采集的睡眠相关数据;(4) 随机对照试验 (RCT)。排除标准如下: (1) 混合干预;或 (2) 患有抑郁症或焦虑症以外的合并症的受试者。根据检索结果确认纳入标准。PRISMA 流程图如图 1 所示
.

Data extraction
数据提取

An extraction form was used for each article to collect the following data: year of publication; subject setting; inclusion and exclusion criteria for participants; sample size for the experimental and control groups; participants’ age and sex; intervention given; and outcome measures related to sleep quality. Relevant statistics and effect sizes were also extracted, if available
每篇文章都使用提取表格来收集以下数据:出版年份;主题设置;参与者的纳入和排除标准;实验组和对照组的样本量;参与者的年龄和性别;给予干预;以及与睡眠质量相关的结果测量。如果可用,还提取了相关的统计数据和效应大小
.

Assessment on quality
质量评估

Two reviewers (Lui D andYip H), working independently, assessed the level of evidence (LoE) and appraisal stage for each of the articles using a standard quality assessment, namely the LoE [40] and revised cochrane risk-of-bias tool for randomised trials (RoB)[41] respectively. The LoE categorizes different experimental studies into different levels on a scale of I to V, with a smaller number indicating a higher LoE. The RoB was used to assess the risk of bias in the RCTs. A series of signalling questions were available in each of the five domains of assessment, and judgements were facilitated by an algorithm that maps responses to the signalling questions to a proposed judgement. Overall risk of bias of the individual study would be reported as “low risk of bias”, “some concerns” or “high risk of bias” . Disagreements between the two independent reviewers were resolved by a third reviewer through a consensus-based discussion
两名综述作者(Lui D 和 Yip H)独立工作,分别使用标准质量评估,即 LoE [40] 和修订的随机试验偏倚风险工具 (RoB)[41] [41],评估每篇文章的证据水平 (LoE) 和评价阶段。LoE 将不同的实验研究分为不同的级别,范围为 V 级,数字越小表示 LoE 越高。RoB 用于评估 RCT 的偏倚风险。在五个评估领域中,每个领域都有一系列信号问题,并且通过一种算法来促进判断,该算法将对信号问题的回答映射到建议的判断。单个研究的总体偏倚风险将报告为“低偏倚风险”、“一些担忧”或“高偏倚风险”。两位独立评价员之间的分歧由第三位评价员通过基于共识的讨论解决
.

Statistical analysis
统计分析

Statistical analysis of the pooled results was carried out using the Comprehensive Meta-Analysis software version 3.0 (https://www.meta-analysis.com). In nine of the ten studies, standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using post-intervention differences between the mean of mindfulness-based programs and the mean of controls, divided by the pooled standard deviation. No real differences in variability among studies were assumed according to the Cochrane Handbook for Systematic Reviews of Interventions[42]. A global estimation of r = 0.6 was, therefore, used as the correlation coefficient between post-treatment scores. In the remaining study, Cohen’s d was calculated using the two groups, via the one-way F-test using a practical meta-analysis effect size calculator[43]. When there was more than one group compared to the MBI group in the RCT, the non-intervention group was used as the control. The Q-statistic was used as the heterogeneity test, in which a statistically significant level of P < 0.05 indicated the variations in effect sizes were due to heterogeneity rather than sampling error. A random-effects model would be used when there was notable heterogeneity. Random-/fixed-effects models were used as the intervention effects are unlikely to be identical[44] given that there are significant variations in characteristics of each sample population. Publication bias was assessed by funnel plot, trim-and-fill and failsafe N. Unless otherwise specified, all statistical tests were two-sided with a significance level of 0.05.
使用ComprehensiveMeta-Analysis软件 3.0 https://www.meta-analysis.com版对合并结果进行统计分析 10 项研究中的 9 项研究中,使用基于正念的计划的平均值控件除合并的标准差。 根据 Cochrane干预系统评价手册 [42]假设研究之间的变异性没有真正的差异。因此,r=0.6全局估计用作治疗后评分之间的相关系数其余研究中,使用实用的荟萃分析效应计算器通过单向F 检验使用计算 Cohen 的d[43]。 RCTMBI相比止一组,非干预组被用作对照。采用Q 统计作为异质性检验,其中P<0.05统计学显著水平表明效应变异ns由于异质性而不是抽样误差。存在明显的异质性时将使用随机效应模型。 使用随机/固定效应模型干预效果不太可能相同[44]因为每个样本特征存在显著差异除非另有说明,否则所有统计检验均为显著性水平 0.05。

RESULTS
结果

Study selection
研究选择

A total of 808 entries were identified through database searches, and 397 of them were screened after duplicates removed. After reading the abstract and title of the remaining 397, we removed 25 reviews, case reports, and protocols. Full versions were retrieved for 372 papers, after which they were reviewed by two independent researchers (Chan H and Sum K) and disagreements were resolved by a third reviewer (Lui D) on a consensus-based discussion. In total, 362 full articles were excluded for not meeting all the inclusion criteria. Finally, 10 eligible studies were selected for systematic review and meta-analysis (details shown in Figure 1).
通过数据库检索共识别808条目其中 397个条目在去掉重复项后进行筛选。在阅读了其余397 篇的摘要标题后,我们删除了25综述、病例报告和方案。检索了 372 篇论文的完整版本,之后两名独立研究人员 (ChanHSumK) 审查第三审查员 (LuiD) 解决了分歧总共 362完整的文章不符合所有纳入标准而被排除在外。最后,选择了 10符合条件的研究进行系统评价荟萃分析详情如图 1 所示)。

Study characteristics
研究特征

Ten studies met the inclusion criteria, overall reporting five different kinds of mindfulness-based programs, including IMMI, MM, MBCT, MBSR and MBTT. Table 1 shows the study characteristics of the 10 trials. The studies were conducted in the United States, Germany, Norway, Australia and Austria, within years that fell between 2010 and 2019. A total of 541 participants were included in the intervention groups and comparison groups. When there were multiple intervention groups, we chose the mindfulness-based programs as the major intervention groups[45-47].
10项研究符合纳入标准,总体报告5种不同类型的静观项目包括IMMI、MM、MBCT、MBSRMBTT。 表 1显示了 10 试验的研究特征特性这些研究在美国德国挪威澳大利亚奥地利进行时间20102019 年不等。干预组和对照组纳入541参与者存在多个干预组时,我们选择基于正念的项目作为主要干预[45-47]。

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ChanSHW人。 MBI计划睡眠荟萃分析

Ref. Country Sample
参考国家样本

Age
年龄

range (mean)
范围(平均值)

Women, n (%)
女性,n(%)

Randomisation
随机化

Intervention
介入

group

(comparison group)
(比较组)

Intervention duration
干预持续时间

Group size for effect
效果的组大小

size
大小

calculation,
计算

n

Outcome
结果

measure for sleep
睡眠测量

Wahbeh
瓦贝

United
联合

Older adult with
老年人

55-80

21 (81)
21(81)

R

IMMI

6 wk
6

I = 26 C = 24

20.00

Sleep disturbance
睡眠障碍
,

[29], 2018
29],2018

States
国家

depression symptoms
抑郁症状

(64.8)

(waitlist control)
(候补名单控制)

ISI

Boettcher
博特彻

Germany
德国

Community
社区

18+

34 (75.6)
34(75.6)

R

IMMI

8 wk
8

I = 45 C = 46

7.69

ISI

et al[50
等人50
],

dwellers with
居民

(37)

(discussion
讨论

2014

anxiety disorders
焦虑障碍

forum control group
论坛控制组
)

Wahbeh et

United
联合

Combat veterans
退伍军人

25-65 (I
25-65(一)

2 (7)
2(7)

R

MM (sitting
MM(坐着

6 wk
6

I = 27 C = 25

0

PSQI

al[47], 2016
AL47],2016

States
国家

with post-traumatic stress disorder
伴有创伤应激障碍

= 53.3; C =

53.0)

quietly
悄悄地
)

Britton et

United
联合

Antidepressant
抗抑郁药

24-61

21 (80.8)
21(80.8)

R

MBCT

8 wk
8

I = 14 C = 10

7.69

TIB, TST, SE, SOL
TIB、TST、SE、SOL
,

al[49], 2012
AL49],2012

States
国家

medication users with sleep
睡眠服药者

complaints
投诉

(47.0)

(control)
(控制)

WASO,TWT, Stage 1, SWS, Quality
WASO,TWT,阶段 1,SWS质量

llestad

Norway
挪威

Community
社区

18-65

26 (66.7)
26(66.7)

R

MBSR

8 wk
8

I = 39 C = 37

14

BIS

et al[51],
etal51],

dwellers with
居民

(42.5)

(waitlist
(候补名单

2011

anxiety disorders
焦虑障碍

control)
控制)

Britton et

United
联合

Community
社区

33-64

9 (69.2)
9(69.2)

R

MBCT

8 wk
8

I = 13 C = 8

19.23

TIB, TST, SE, SOL
TIB、TST、SE、SOL
,

al[48], 2010
AL48],2010

States
国家

dwellers with
居民

partially remitted depression
部分缓解的抑郁

(45.4)

(control)
(控制)

WASO, NWAK, Arousals, Stage 1, SWS, Quality
WASO、NWAK、唤醒、阶段 1、SWS质量

Hoge et al
Hoge

United
联合

Referral/community
推荐/社区

18+ (I =
18+(I=

23 (47.9)
23(47.9)

R

MBSR (stress
MBSR应力

8 wk
8

I = 48 C = 45

4.30

Sleep quality, PSQI
睡眠质量PSQI

[52], 2013
52],2013

States
国家

dwellers with
居民

generalized anxiety disorder
广泛性焦虑障碍

41; C = 37)
41 页;C= 37)

management education)
管理教育)

Horenstein
霍伦斯坦

United
联合

Adults with social
具有社交

18+

Not

R

MBSR

12 wk
12

I = 36 C = 36

15.28

Sleep quality, PSQI
睡眠质量PSQI

et al[45], 2019
et al45], 2019

States
国家

anxiety disorder
焦虑障碍

(32.7)

specified
指定

(control)
(控制)

Pinniger et

Australia
澳大利亚

Adults with self-
自我

18-68

10 (90.9)
10(90.9元)

R

MM (waitlist
MM候补名单

8 wk
8

I = 11 C = 23
我 =11C= 23

30.60

Sleeping
睡眠

al[46], 2013
AL46],2013

reported feelings of stress, anxiety
报告的压力感、焦虑感
,

and/or depression
和/或抑郁症

(39.5)

control)
控制)

difficulty/insomnia, ISI
困难/失眠,ISI

Stötter et al
Stötter

Austria
奥地利

Patients of the
患者的

18+ (I =
18+(I=

11

R

MBTT

8 wk
8

I = 14 C = 14

0

Sleep-onset
入睡

[31], 2013
31],2013

psychiatric hospital of Hall in Tirol
蒂罗尔霍尔精神病医院

42.8; C = 41.4)
42.8 页;C= 41.4)

(68.75)

(control)
(控制)

disorder, Sleep
disorder, 睡眠

maintenance
保养

disorders, Terminal sleep disorders,
疾病, 终末期睡眠障碍,

HDRS
HDRS (高动态范围)

Across studies, participants had a range of mean age between 32.7 and 64.8 years. Seven out of ten (70%) of the studies had a majority of female participants. Four out of ten studies (40%) focused on community dwellers with anxiety and/or major depressive disorder. One study included participants of veterans with PTSD. Six out of ten studies reported significant improvement in sleep quality as measured by insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), Bergen insomnia scale (referred to as BIS), Hamilton depression rating scale (HDRS) and sleep diaries, provided that the P value of the experiment was lower than 0.05. All of the studies were RCTs. The duration of the intervention ranged from 6 wk to 12 wk and delivered over 6 to 12 sessions. Details of intervention techniques and selected outcome measures of each study are provided in Table 2
在研究中,参与者的平均年龄在 32.7 至 64.8 岁之间十分之七 (70%) 的研究中大多数是女性参与者十分之四的研究 (40%) 侧重于患有焦虑症和/或重度抑郁症的社区居民。一项研究包括患有 PTSD 的退伍军人的参与者。如果实验的 P 值低于 0.05,则 10 项研究中有 6 项报告了通过失眠严重程度指数 (ISI)、匹兹堡睡眠质量指数 (PSQI)、卑尔根失眠量表 (简称 BIS)、汉密尔顿抑郁量表 (HDRS) 和睡眠日记测量的睡眠质量显着改善。所有研究均为 RCT。干预持续时间从 6 周到 12 周不等,分 6 到 12 次进行。表 2 提供了每项研究的干预技术和选定结果测量的详细信息
.

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Intervention components
干预组成部分
Selecte
选择
d outcome
D 结果

measures for effect size Ref.
效应大小的测量 参考

program Intervention group Comparison group calculation
程序干预组比较组计算

IMMI

DI + MM + MPS

WL

ISI

Wahbeh[29], 2018
Wahbeh29],2018

ME + psychoeducation
ME + 心理教育

DF

ISI

Boettcher et al[50], 2014
Boettcher 等人502014

MM

BS

SB

PSQI

Wahbeh et al[47], 2016
Wahbeh 等人47],2016

BS

BS + SB

PSQI

Wahbeh et al[47], 2016
Wahbeh 等人47],2016

BS

SQ

PSQI

Wahbeh et al[47], 2016
Wahbeh 等人47],2016

BS + MB + MW + music meditation
BS + MB+ MW+ 音乐冥想

WL

ISI

Pinniger et al[46], 2013
Pinniger46],2013

MBCT

MA + HW (Guided audio CD
MA + HW 引导音频 CD
)

Control
控制

Sleep diary
睡眠日记

Britton et al[48], 2010
Britton 等人48],2010

MA (MB + MS + MW + lying + other simple movement) + HW (MM using audio CD + worksheet
MA MB + MS + MW + 躺着 + 其他简单动作)+ HW MM 使用音频 CD + 工作表
)

Control
控制

Sleep diary
睡眠日记

Britton et al[49], 2012
Britton 等人49],2012

MBSR

BS + SM + MB + AR + DI + ME + MMV + HW

WL

Bergen insomnia scale
卑尔根失眠量表

llestad et al[51], 2011
llestadetal51], 2011

BS+ BA+ gentle Hatha Yoga
BS+ BA+ 温柔哈达瑜伽

SME

PSQI

Hoge et al[52], 2013
Hoge52],2013

BS + SM + MS + MPS
理学学士 + 硕士 + 硕士 + 硕士

WL

PSQI

Horenstein et al[45], 2019
Horenstein 等人45],2019

MBTT

BA + touch + HW + counselling
BA + 触摸 + HW+ 咨询

BMT

HDRS

Stötter et al[31], 2013
Stötteretal31], 2013

Assessment of quality
质量评估

Results from quality assessments are presented in Tables 3 and 4. All studies were RCTs. All trials had adequate sequence generation, among which five (50%) indicated a concealed allocation[49-51]. As for blinding, two trials adopted double-blind design[48,49], one trial used single-blind design[31] and two used blind evaluators[47,52]. The drop-out rates of the trials ranged from 0% to 30.6%, as shown in Table 1. Of the 10 trials, 3 had low drop-out rates (≤ 5%)[31,47,52] and two had high drop-out rates (≥ 20%)[29,46]. The overall LoE was level II (n = 10), showing that the papers under current review were of high LoE. The overall RoBs were as follows: low (n = 2); some concerns (n = 6); and high (n = 2). The majority of papers showed some concerns of risk of bias, mainly due to bias in the measurement of outcome
质量评估结果见表 3 和 4所有研究均为 RCT。所有试验都有充分的序列生成,其中 5 项 (50%) 表明存在隐蔽分配 [49-51]。至于盲法,2 项试验采用双盲设计 [4849],1 项试验采用单盲设计 [31],2 项试验采用盲法评价器[4752]。试验的退出率从 0% 到 30.6% 不等,如 表 1 所示。在这 10 项试验中,3 项的退出率较低 (≤ 5%)[314752] 和 2 项的退出率较高 (≥ 20%)[2946]。总体 LoE 为 II 级 (n = 10),表明当前综述下的论文为高 LoE总体 RoB 如下低 (n = 2);一些担忧 (n = 6);和高 (n = 2)。大多数论文显示出一些偏倚风险的担忧,主要是由于结局测量中的偏倚
.

Analysis of overall effect
整体效果分析

This meta-analysis focused on examining the effect at the end point of different mindfulness-based programs, including IMMI, MM, MBCT, MBSR and MBTT, due to variations in follow-up periods and absence of reported follow-up effects in several studies. The overall effect analysed was based on the comparison between different mindfulness-based programs and comparison groups, including discussion forum, waitlist control, slow breathing, stress management education, sitting quietly and basic medicinal therapy. Self-rated outcome measurements were reported in the 10 RCTs assessed, including PSQI, ISI, sleep quality of sleep diary, and sleep maintenance of HDRS. The overall scores of sleep quality were reported in PSQI, ISI, BIS and sleep diaries. On the other hand,