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2019年4月6日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表德国癌症研究中心、全国肿瘤疾病中心、海德堡大学医学院的研究报告，比较了体力与身心锻炼对乳腺癌治疗相关睡眠问题的影响。 该研究首先对截至2018年8月发表于Pub Med、Web of Science、Cochrane数据库的乳腺癌患者任何类型锻炼干预随机对照研究进行系统检索，研究结局为患者主观自评或客观评定睡眠指标。随后，荟萃分析不同锻炼干预对乳腺癌治疗期间或之后患者主观自评和客观评定睡眠指标的影响。最后，通过随机效应模型，计算标准化平均差。 结果，荟萃分析包括22项研究共计2107例患者。其中，17项研究采用匹兹堡睡眠质量指数，6项研究采用客观睡眠评定。体力锻炼干预包括步行、有氧锻炼、抗阻锻炼或两者联合。身心锻炼干预包括瑜伽、太极和气功。大多数干预受到监督。 体力、身心锻炼干预的睡眠总体评分均有改善（标准化平均差：-0.32、-0.27，95%置信区间：-0.54～-0.10、-0.44～-0.09）。亚组分析表明，乳腺癌治疗期间与之后的干预相比，睡眠总体评分相似。 根据睡眠质量指数，锻炼前后相比，睡眠质量、睡眠障碍的评分改善（标准化平均差：-0.28、-0.26，95%置信区间：-0.44～-0.11、-0.45～-0.06）。根据客观睡眠评定，未见显著影响。 因此，该研究结果表明，身体和身心锻炼可以改善乳腺癌患者的主观睡眠问题。不过，锻炼对客观睡眠指标无显著影响。有必要开展进一步研究，根据患者个体和治疗特征，明确哪种类型的干预可能最有效。 相关阅读 Breast Cancer Res Treat. 2019 Apr 6. Effects of physical and mind-body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis. Charlotte Kreutz, Martina E. Schmidt, Karen Steindorf. German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany; Faculty of Medicine Heidelberg, Heidelberg, Germany. PURPOSE: We conducted a meta-analysis evaluating the effects of different exercise interventions on self-reported and objective sleep measurements during or after breast cancer treatment. METHODS: Three databases were systematically searched for randomized controlled trials with any type of exercise intervention in women with breast cancer. Outcomes were self-reported or objective sleep measurements. Standardized mean differences (SMDs) were calculated using random-effects models. RESULTS: The meta-analysis included 22 trials with 2107 participants. Of these, 17 studies used the Pittsburgh Sleep Quality Index (PSQI), six studies included objective sleep assessments (ActiGraph). Physical exercise interventions included walking, aerobic exercise, resistance exercise or a combination of both. Mind-body exercise interventions included yoga, Tai Chi and Qigong. Most interventions were supervised. Both, physical (SMD -0.32; 95% CI -0.54 to -0.10) and mind-body exercise interventions (SMD -0.27; 95% CI -0.44 to -0.09), resulted in improvements of total sleep scores. Subgroup analyses revealed no clear differences between interventions conducted during versus after breast cancer treatment. Considering the PSQI subscales, exercise resulted in improvements of sleep quality (SMD -0.28; 95% CI -0.44 to -0.11) and sleep disturbances (SMD -0.26; 95% CI -0.45 to -0.06). Regarding the objective measurements, no significant effects were found. CONCLUSIONS: Physical as well as mind-body exercise can improve subjective sleep problems in breast cancer patients. In contrast, there was no effect of exercise on objective sleep measures. Future studies should clarify which type of intervention might be most effective depending on individual patients' and treatments' characteristics. KEYWORDS: Breast neoplasm Sleep Exercise interventions Yoga Insomnia Actigraphy DOI: 10.1007/s10549-019-05217-9
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