Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis

Abstract Objective To investigate the effect of non-pharmacological interventions to improve sleep quality during pregnancy. Data sources A search was made in the NCBI/PubMed, ClinicalTrials.gov, Embase, BVS, and Web of Science databases. There were no limitations regarding language, sample size, and type of non-pharmacological intervention. We have included prospective clinical trials between July 2014 and July 2019. Selection of studies This study was registered in the Prospective International Registration of Systematic Reviews (PROSPERO) database was performed. Publication bias was also assessed with funnel plots. the primary outcome was the total score in the Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used for assessing methodological quality. From the 28 retrieved studies, we have selected 8 for qualitative analysis and 6 for meta-analysis. Data collection Two independent reviewers performed the study selection. In the case of disagreement, a third senior reviewer was consulted. The study was initially assessed based on the title, followed by abstract. Lastly, the full text was assessed to be included. Data Synthesis A significant improvement on the sleep quality (PSQI score) was observed when all interventions were grouped (MD = -3.03, 95%CI -4.15 to -1.92, n= 623, i2= 84%, p< 0.001). Analysis by subgroup (music listening: MD = -1.96, 95% CI -3.27 to -0.65, n= 207, i2= 67%, p= 0.003 and other interventions: MD = -3.66, 95% CI -4.93 to -2.40, n= 416, i2 = 80%, p< 0.001) showed an improvement, with high heterogeneity. Risk of bias has shown performance and detection bias for almost studies, and GRADE evidence was very low for all analyzed variables. Conclusion Non-pharmacological interventions—listening to music, physical exercise, relaxation exercises, lettuce seed, sleep hygiene, and acupressure—are effective for improving sleep quality during pregnancy.

摘要 目的：探讨非药物干预措施对改善妊娠期睡眠质量的效果。
数据来源：检索了NCBI/PubMed、ClinicalTrials.gov、Embase、BVS及Web of Science数据库，未对语言、样本量及非药物干预类型设置限制，纳入2014年7月至2019年7月间发表的前瞻性临床试验。
研究筛选：本研究已在系统评价前瞻性国际注册数据库（Prospective International Registration of Systematic Reviews，PROSPERO）完成注册，同时采用漏斗图评估发表偏倚。主要结局指标为干预前后匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index，PSQI）总分。采用偏倚风险评估工具及推荐分级、评估、制定与评价（Grading of Recommendations Assessment, Development, and Evaluation，GRADE）标准对研究方法学质量进行评价。从检索获得的28项研究中，最终筛选出8项进行定性分析，6项用于荟萃分析。
数据收集：由2名独立评审员完成研究筛选，若出现意见分歧，则咨询第三名资深评审员。首先通过标题进行初筛，随后通过摘要进一步筛选，最后评估全文以确定是否纳入研究。
数据综合：合并所有干预措施后，观察到睡眠质量（PSQI评分）得到显著改善（均数差MD=-3.03，95%置信区间CI：-4.15~-1.92，样本量n=623，I²=84%，P<0.001）。亚组分析结果显示，音乐聆听干预（MD=-1.96，95%CI：-3.27~-0.65，n=207，I²=67%，P=0.003）与其他非药物干预（MD=-3.66，95%CI：-4.93~-2.40，n=416，I²=80%，P<0.001）均能改善睡眠质量，但研究间异质性较高。偏倚风险评估结果显示，多数研究存在实施偏倚与检测偏倚；且所有分析变量的GRADE证据等级均为极低。
结论：包括音乐聆听、体育锻炼、放松训练、莴苣籽干预、睡眠卫生指导及穴位按压在内的非药物干预措施，均可有效改善妊娠期睡眠质量。