亮光疗法治疗卒中后睡眠障碍：系统评价与荟萃分析

文献信息

中文摘要

目的： 睡眠障碍在卒中后常见，并可能对神经功能恢复产生不良影响。尽管卒中后睡眠障碍包括失眠症状、昼夜节律睡眠-觉醒障碍和睡眠呼吸障碍，但研究主要集中于阻塞性睡眠呼吸暂停。本综述评估了亮光疗法（BLT）——一种可能影响昼夜节律调节的非药物干预——对卒中后睡眠结局的影响。
方法： 检索了十个电子数据库，涵盖英文和中文文献，检索时间从建库至2026年4月9日。纳入涉及成人卒中患者、评估了经过验证的主观或客观睡眠结局的随机对照试验。当研究在临床和方法学上具有足够可比性时，采用随机效应模型合并数据。使用Cochrane偏倚风险2工具评估偏倚风险。主要结局为入睡后觉醒时间（WASO）和主观睡眠质量。该方案已在PROSPERO注册（CRD420251111617）。
结果： 共纳入5项随机对照试验，涉及343名参与者。3项试验涉及181名参与者纳入WASO分析；合并估计无统计学意义（MD = -39.17分钟，95% CI -115.34至36.99；P = 0.31），异质性较大（I2 = 96%）。4项试验涉及300名参与者纳入主观睡眠质量分析；合并估计支持BLT（SMD = -0.85，95% CI -1.38至-0.32；P = 0.002），尽管异质性较大（I2 = 78%）。排除Song Chang-yu后，合并效应仍具有统计学意义但有所减弱，异质性降至0%（SMD = -0.55，95% CI -0.83至-0.28）。
结论： BLT可能改善卒中后主观睡眠质量；然而，由于证据基础较小且异质性较大，关于客观睡眠连续性的证据仍不确定。需要更大规模、方法学严谨的试验，使用标准化的光照参数、标准化的结局测量和直接的昼夜节律评估，以阐明BLT的临床效果并确定最佳治疗方案。
系统评价注册： https://www.crd.york.ac.uk/PROSPERO/view/CRD420251111617，标识符CRD420251111617。

英文摘要

OBJECTIVE: Sleep disturbances are common after stroke and may adversely affect neurological recovery. Although post-stroke sleep disturbances encompass insomnia symptoms, circadian rhythm sleep-wake disturbances, and sleep-disordered breathing, research has focused predominantly on obstructive sleep apnea. This review evaluated the effects of bright light therapy (BLT), a non-pharmacological intervention that may influence circadian regulation, on sleep outcomes after stroke.
METHODS: Ten electronic databases covering English-and Chinese-language literature were searched from inception to April 9, 2026. Randomized controlled trials involving adults with stroke that evaluated validated subjective or objective sleep outcomes were eligible. Data were pooled using random-effects models when studies were sufficiently comparable clinically and methodologically. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The primary outcomes were wake after sleep onset (WASO) and subjective sleep quality. The protocol was registered in PROSPERO (CRD420251111617).
RESULTS: Five randomized controlled trials involving 343 participants were included. Three trials involving 181 participants contributed to the WASO analysis; the pooled estimate was not statistically significant (MD = -39.17 min, 95% CI -115.34 to 36.99; P = 0.31), and heterogeneity was substantial (I2 = 96%). Four trials involving 300 participants contributed to the subjective sleep quality analysis; the pooled estimate favored BLT (SMD = -0.85, 95% CI -1.38 to -0.32; P = 0.002), although heterogeneity was substantial (I2 = 78%). After exclusion of Song Chang-yu, the pooled effect remained statistically significant but was attenuated, and heterogeneity decreased to 0% (SMD = -0.55, 95% CI -0.83 to -0.28).
CONCLUSION: BLT may improve subjective sleep quality after stroke; however, evidence for objective sleep continuity remains uncertain because of the small evidence base and substantial heterogeneity. Larger, methodologically rigorous trials using standardized light parameters, standardized outcome measures, and direct circadian assessments are needed to clarify the clinical effects of BLT and identify optimal treatment protocols.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251111617, identifier CRD420251111617.