The Correlation Between Auricular Acupressure Related Sleep Quality Improvement And Blood Pressure In Hemodialysis Patients

ObjectivesBased on the data of a multi-center randomized controlled study,we retrospectively analyzed the correlation between the change of sleep quality score and blood pressure to determine whether auricular acupressure can improve the sleep quality in hemodialysis patients and play a positive role in blood pressure management.MethodsThis is a retrospective analysis based on the data analysis of previous studies on multicenter,double-blind,randomized controlled trials(RCT).The patients were classified into two groups:a reduction of PSQI global score≥3 or a reduction of PSQI global score<3 on the basis of the change of Pittsburgh Sleep Quality Index(PSQI)before and after auricular acupressure.The difference of blood pressure at 8th week,blood pressure change(0th-8th week)and the use of antihypertensive drugs between the two groups wore compared to explore whether hemodialysis patients with insomnia and hypertension can improve their sleep quality and have a positive effect on blood pressure management.Uni variate analysis was used to analyze the influencing factors of blood pressure decline in hemodialysis patients with sleep disorder and hypertension.Result1.General information:A total of 130 effective cases were included in this RCT,including 78 cases that met the criteria of this study.78 cases completed auricular acupressure for 8 weeks,with 33 male cases(42.3%)and 45 female cases(57.7%).The youngest age is 19 years old meanwhile the oldest is 75 years old.Dialysis days were 157 days at least and about 120 months at most.The first protopathy is primary glomerulonephritis(n=F26,33.3%),followed by 25 cases(32.1%)of hypertensive renal damage,17 cases(21.8%)of diabetic nephropathy,6 cases(7.7%)of polycystic kidney disease,3 cases(3.8%)of lupus nephritis and 1 case(1.3%)of obstructive nephropathy.The dialysis method was hemodialysis(HD)in 51 cases(65.4%)and hemodialysis(HD)and intermittent hemodiafiltration(HDF)in 27 cases(34.6%).59 patients(75.6%)had dialysis three times a week and 19 patients(24.4%)had dialysis five times every two weeks.2.Among 78 patients with maintenance hemodialysis complicated by hypertension and insomnia,only 19(24.4%)MHD patients met the blood pressure standard with 59(75.6%)MHD patients did not.78 patients with hypertension took antihypertensive drugs,of which 65 took CCB,45 took β receptor blocker,38 took ARB,18 took a receptor blocker,4 took ACEI,and only one used central antihypertensive drugs.21 cases(26.9%)received single medication.27 cases(34.6%)received double medication.24 cases(30.8%)received triple medication and 6 cases(7.7%)received quadruple medication.3.According to the changes of Pittsburgh Sleep Quality Index(PSQI)before and after auricular acupressure,the patients were classified into two groups:a reduction of PSQI global score≥3(n=43)and a reduction of PSQI global score<3(n=35).The two groups were well balanced in all conditions including sex,age,primary disease,dialysis condition,laboratory examination,use of sleeping drugs,antihypertensive drugs and baseline blood pressure between the two groups(P>0.05).There was no significant difference in the change of systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)between the two groups before and after treatment(P>0.05).Spearman’s Rho concluded that there was no correlation between PSQI score decline and the change of SBP,DBP and MAP(P>0.05).4.The group of a reduction of PSQI global score≥3 did subgroup analysis by the upper and tlower quartiles.The upper quartile is 4 and the lower quartile is 6.The group of a reduction of PSQI global score≥3 were divided into two groups:a reduction of PSQI global score<4(n=10)and a reduction of PSQI global score>6(n=8).The two groups were well balanced in all baseline situation.Before and after treatment,the changes of SBP were-4.3±20.44 mmHg,13.42±10.9 mmHg and the changes of DBP were-3.04±10.16 mmHg,5.59±5.45 mmHg.Before and after treatment,the changes of MAP were-3.46±13.05 mmHg,8.2±7.03 mmHg.Those difference were statistically significant(P<0.05).5.Univariate analysis showed that PSQI score change was the influencing factor of SBP and DBP decrease(P<0.05).ConclusionThe improvement of sleep quality in most patients was not enough to play a positive role in blood pressure management.In patients with a significant decline in PSQI score(a reduction of PSQI global score>6),the benefit of blood pressure management was observed.