Available online 31 January 2015
Open Access
Original article
Effect
of acupressure with valerian oil 2.5% on the quality and quantity of
sleep in patients with acute coronary syndrome in a cardiac intensive
care unit
- doi:10.1016/j.jtcme.2014.11.005
- Get rights and content
Abstract
The
purpose of this three-group double-blind clinical trial study was to
investigate the effect of acupressure (指壓 zhǐ yā) with valerian (纈草 xié
cǎo) oil 2.5% on the quality and quantity of sleep in patients with
acute coronary syndrome (ACS) in a coronary intensive care unit (CCU).
This study was conducted on 90 patients with ACS in Mazandaran Heart
Center (Sari, Iran) during 2013. The patients were randomly assigned to
one of three groups. Patients in the acupressure with valerian oil 2.5%
group (i.e., valerian acupressure group) received bilateral acupoint (穴位
xué wèi) massage with two drops of valerian oil for 2 minutes for three
nights; including every point this treatment lasted in total 18
minutes. Patients in the acupressure group received massage at the same
points with the same technique but without valerian oil. Patients in the
control group received massage at points that were 1–1.5 cm from the
main points using the same technique and for the same length of time.
The quality and quantity of the patients' sleep was measured by the St.
Mary's Hospital Sleep Questionnaire (SMHSQ). After the intervention,
there was a significant difference between sleep quality and sleep
quantity in the patients in the valerian acupressure group and the
acupressure group, compared to the control group (p < 0.05).
Patients that received acupressure with valerian oil experienced
improved sleep quality; however, this difference was not statistically
significant in comparison to the acupressure only group. Acupressure at
the ear spirit gate (神門 shén mén), hand Shenmen, glabella (印堂 yìn táng),
Wind Pool (風池 fēng chí), and Gushing Spring (湧泉 yǒng quán) acupoints
can have therapeutic effects and may improve the quality and quantity of
sleep in patients with ACS. Using these techniques in combination with
herbal medicines such valerian oil can have a greater impact on
improving sleep and reducing waking during the night.
Graphical abstract
CCU = coronary intensive care unit.
Keywords
- acupressure;
- acute coronary syndrome;
- cardiac intensive care unit;
- sleep quality;
- sleep quantity;
- valerian oil
1. Introduction
Cardiovascular
diseases are among the most common diseases in human societies and the
number of these patients has increased in recent decades.
1
In 2008, coronary artery disease caused one of every six deaths in
America. On average, one American experiences cardiac events every 25
minutes, and one person dies every 1 minute.
2
The emergence of cardiovascular diseases, especially coronary diseases,
is widely increasing in China, India, Pakistan, the East Mediterranean
region, and the Middle East; it is an important health and social
problem.
3, 4, 5 and 6
Every year, approximately 3.6 million people are hospitalized in
hospitals under the Ministry of Health and Medical Education and
Treatment of Iran. A remarkable number of these patients have heart
disease, especially patients with acute coronary syndrome (ACS), which
includes acute myocardial infarction and unstable angina.
7 Most sleep problems encountered by patients are because of their hospitalization.
8
Many patients who are hospitalized in a coronary intensive care unit
(CCU) experience reduced quality and quantity of sleep with regard to
mental and environmental factors.
9, 10, 11, 12 and 13
Even if environmental factors are controlled, patients with acute
myocardial infarction have an altered sleep structure (i.e., sleep
pattern) that can result from physiologic inflammatory changes or from
the nature of the myocardial infarction itself.
14
Approximately 56% of the patients are sleep-deprived at the end of the 1
st
day of hospitalization. Based on other studies, ACS patients have low
sleep quality during the first 3 days of their hospitalization.
15 and 16
Comfortable sleep is difficult for patients hospitalized in intensive
care units because of constant monitoring, lighting on the unit, noise
due to the staff caring for other patients, mechanical ventilation,
frequent awakening by the nurses, the use of sedating and inotrope
drugs, disease severity, and the staff awakening patients early in the
morning in these units even though the patients need more sleep.
9 Hospitalization can remarkably disturb the sleeping model.
17
Sleep
is a primary need of human beings. It is necessary for maintaining
energy, appearance, and physical well-being. Sleep has an important role
in cardiovascular function. Its deprivation intensifies anxiety,
irritability, and anger, and increases the heart rhythm and myocardial
oxygen demand in a frequent and dangerous cycle.
18 and 19 Insomnia can be treated by drugs, herbal medicine, psychotherapy, and physiological treatments.
20 The most common way to treat or cope with sleeping problems is by using drugs. Based on research studies,
11
there is no significant difference in sleep quality and quality of the
patients who use these drugs and patients who do not use them. The
effectiveness of drugless therapies is slower than the effectiveness of
sleep aids; however, drugless therapies are more permanent and do not
have the side effects of drugs such as memory deficits, drug resistance,
drug dependency, and drug addiction.
Insomnia can be treated by medication, herbal therapy, and psychological or physical therapy.
20
Acupressure (指壓 zhǐ yā) can enhance comfort and sleep through massaging
and stimulating certain points in the head, hands, and back.
21 Individuals can use this treatment method by themselves or with the help of other family members.
22
A
traditional way of treating insomnia is by using valerian herb (纈草 xié
cǎo) self grown in nature plant. It is one of many plants used to treat
insomnia.
23 The effect of valerian is similar to that of the benzodiazepines (e.g., its effect is comparable with that of 10 mg oxazepam
24);
however, the adverse effects of valerian are fewer. When the human body
absorbs valerian, gamma-aminobutyric acid (GABA) receptor activity
increases.
25 The result of a review article concluded that valerian could improve sleep quality with minimal or no adverse effect.
26
Based
on available data, an article concerning the effectiveness of
acupressure with valerian oil on the quality and quantity of sleep in
patients with ACS has not been previously published. Because of the high
prevalence of insomnia in intensive care units and because of the
effect that acupressure has as a noninvasive and complementary method in
treating sleep disorders, the present study aimed to examine the effect
of acupressure with valerian oil on sleep quality and quantity in
patients hospitalized in a CCU, and thus improve sleep quality, health,
and life quality and satisfaction in patients with ACS.
Evidence-Based Complementary and Alternative Medicine
Infertility: ART, Medicinal Plants, and Acupuncture
Systematic reviews that only discuss
the limitations and weaknesses of previously conducted research will not be accepted
