Clinical study on acupoint massage in improving cognitive function and sleep quality of elderly patients with hypertension

Lei Xiao-fang (雷曉芳), Chen Xiao-ling (陳曉玲), Lin Jun-xiang (林君祥), Bao Ai-fang (包愛(ài)芳), Tao Xu-cai (陶旭彩)

Nursing Department of Taishun County Hospital of Chinese Medicine, Zhejiang 325500, China

Clinical study on acupoint massage in improving cognitive function and sleep quality of elderly patients with hypertension

Lei Xiao-fang (雷曉芳), Chen Xiao-ling (陳曉玲), Lin Jun-xiang (林君祥), Bao Ai-fang (包愛(ài)芳), Tao Xu-cai (陶旭彩)

Nursing Department of Taishun County Hospital of Chinese Medicine, Zhejiang 325500, China

Objective:To investigate the effects of acupoint massage on cognitive function and sleep quality in elderly patients with hypertension.

Tuina; Massage; Acupoint Pressure Therapy; Acupoint Therapy; Hypertension; Memory Disorder; Neurobehavioral Manifestations; Sleep Disorders

Cognitive impairment is a basic manifestation of dementia. Studies have shown that arteriosclerosis caused by hypertension can lead to a significant impact on cognitive function of the elderly, thus becoming one of the important contributing factors to brain aging[1-3]. Sleep disorders are common symptoms in the elderly, and are manifested mainly by difficult falling asleep or maintaining sleep. With low immunity and poor physical health, the elderly are prone to sleep disturbances and cognitive impairment. Studies have suggested that patients with hypertension suffer from more severe sleep problems than others, and sleep disorders can lead to high blood pressure, therefore, hypertension and sleep disorders can affect each other, causing depression in the mood and further decline of cognitive function[4-6]. Acupoint massage can be an important role in improving patients’ mental health status and relieving the pressure[7]. In this study, we performed acupoint massage in elderly patients with hypertension and observed their improvement in cognitive function and sleep situation.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria of primary hypertension referred to the New Hypertension Treatment Guidelines of World Health Organization (WHO) and the International Union of Hypertension[8]: without medication use, on the base of the average blood pressure of 2 times or more than 2 times (not on the same day) measurements, the systolic blood pressure is more than 140 mmHg and/or the diastolic blood pressure is more than 90 mmHg.

1.2 Inclusion criteria

Conforming to the diagnosis criteria of primary hypertension; age over 60 years old; no secondary hypertension, no other severe internal diseases of heart, liver, kidney or mental diseases; willing to participate in this study and signed informed consent forms.

1.3 Exclusion criteria

Having secondary hypertension; having heart, liver or kidney dysfunctions; having mental diseases.

1.4 Statistical method

The SPSS 19.0 version statistical software was used for statistical analysis of the input data. Thet-test was used for the measurement data [expressed by mean ± standard deviationAPvalue of less than 0.05 indicates a statistical significance.

1.5 General data

Sixty-eight elderly patients with primary hypertension were enrolled from April 2013 to August 2013, and all of them were inpatients in the elderly ward in our hospital. The patients were randomly divided into a treatment group and a control group by Microsoft Excel spreadsheet, with 34 cases in each one. There were 19 males and 15 females in the treatment group, aged from 60 to 81 years old; while in the control group, there were 17 males and 17 females, aged from 61 to 80 years old. Two groups’ general data were in Table 1 including gender, age and duration. There were no statistical differences between the two groups according to statistical analysis (P＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Between-group comparison of general data

2 Treatment Methods

2.1 Treatment group

2.1.1 Acupoint massage

Patients in the treatment group conducted a self-massage according to the guidance of doctors or nurses. The massage manipulations were demonstrated by a nurse[9-10].

Massage face: Gently massage from the middle of the face to the backwards by hands (Figure 1).

Figure 1. Massage face

An-pressing and Rou-kneading Anmian [Extra, located at the midpoint between Yiming (EX-HN 14) and Fengchi (GB 20)]: Perform An-pressing and Roukneading manipulations by finger pulps of forefingers (Figure 2).

Figure 2. An-pressing and Rou-kneading Anmian (Extra)

An-pressing Taiyang (EX-HN 5) and circular Gua-scraping the two orbits: Conduct An-pressing and Rou-kneading manipulations at both Taiyang (EX-HN 5) by thumbs, and circular Gua-scraping the two orbits by both forefingers (Figure 3).

An-pressing Shenmen (HT 7): Conduct Dian-digital pressing and An-pressing manipulations at Shenmen (HT 7) by fingertips of forefingers, each time lasted for 1-2 s (Figure 4).

An-pressing Fengchi (GB 20): Conduct Dian-digital pressing and An-pressing manipulations at bilateral Fengchi (GB 20) by bilateral thumbs, and each time lasted for 1-2 s (Figure 5).

Figure 3. An-pressing Taiyang (EX-HN 5) and circular Gua-scraping the two orbits

Figure 4. An-pressing Shenmen (HT 7)

An-pressing and Rou-kneading Neiguan (PC 6): Perform Dian-digital pressing and An-pressing manipulations at Neiguan (PC 6), each time lasting for 1-2 s (Figure 6).

An-pressing and Rou-kneading Sanyingjiao (SP 6): Conduct An-pressing and Rou-kneading manipulations at Sanyinjiao (SP 6) by fingertips of thumbs, each time lasting for 1-2 s (Figure 7).

Figure 5. An-pressing Fengchi (GB 20)

Figure 6. An-pressing and Rou-kneading Neiguan (PC 6)

Figure 7. An-pressing and Rou-kneading Sanyinjiao (SP 6)

First, nurses demonstrated massage method and taught patients, at the same time, corrected and guided the patients’ acupoints locating and massage method. After the study began, a specific person was sent to give patients good guidance. The patients were asked to conduct the above massage manipulations, and repeat each one at least 40 to 50 times. Acupoint locating needed to be precise, massage manipulations needed to be mild, strength intensity needed to be appropriate and even, and the manipulation action needed to maintain good coordination and coherence, in order to get sensation of soreness, distention, numbness and pain at the acupoints. During treatment, nurses should observe and ask whether the patient has adverse reactions. There were 4 times massage every day, respectively at 8:00, 12:00, 18:00 and the time before going to bed, and the treatments lasted for 1 month.

2.1.2 Guidance of mental health and education of sleep knowledge

Nurses gave all of the patients the guidance of mental health and education of sleep knowledge once per week.

Guidance of mental health: Simply explained the general knowledge of hypertension, such as treatment,examination, prognosis, and cautions, so that the older people had an objective understanding of their own disease; made them believe in science, and believe that the development of medicine will help control the disease and prolong human life; let them have no excessive demands on sleep, nor misunderstanding of insomnia, as well as no exaggeration of the adverse consequences of insomnia.

Education of sleep knowledge: Mainly asked them to avoid wrong sleep habits, such as prolonged time of lying in bed, going to bed early in the evening, and getting up late in the morning. Asked patients to make full use of the time in bed to improve sleep quality.

2.2 Control group

Patients in the control group only received the same guidance of mental health and education of sleep knowledge as those in the treatment group once per week.

Both groups were treated for 3 months.

3 Therapeutic Effects

3.1 Observation projects

The following items were assessed respectively before and after treatment.

3.1.1 Pittsburgh sleep quality index (PSQI)[11]

Patients were assessed referring to PSQI score system before and after treatment, including sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication and daytime dysfunction. Each factor score ranges from 0 to 3 points, and the cumulative score is PSQI total score. The higher score indicates poorer sleep quality.

3.1.2 Mini-mental state examination (MMSE) scale[12]

There were 30 questions in total in the scale aiming at testing patients’ time orientation, memory orientation, attention, calculation, latency memory, language and visuospatial, etc. Total score of the scale ranged from 0 to 30 points, with higher scores indicating higher cognitive level. All patients’ scales were evaluated by trained researchers and completed by 1 researcher to 1 patient, in order to make sure that patients expressed their own feelings, and ensure true and reliable assessment data.

3.2 Therapeutic outcomes

3.2.1 Between-group comparison of PSQI scores before and after treatment

Before treatment, there was no statistical difference in PSQI score (P＞0.05); after treatment, there was a significant difference in PSQI score (P＜0.05), indicating that patients in the treatment group obtained better effect in sleep improvement than those in the control group (Table 2).

Table 2. Between-group comparison of PSQI scores before and after treatment

Table 2. Between-group comparison of PSQI scores before and after treatment

Group n Before treatment After treatment Treatment 34 9.09±1.24 7.35±1.47 Control 34 9.06±1.10 8.85±1.10 t value 0.162 6.806 P value 0.872 0.000

3.2.2 Between-group comparison of MMSE scores before and after treatment

Before treatment, there was no statistical difference in MMSE score (P＞0.05); after treatment, there was a significant difference in MMSE score (P＜0.05), indicating that patients in the treatment group obtained better effect in cognitive function than those in the control group (Table 3).

Table 3. Between-group comparison of MMSE scores before and after treatment

Table 3. Between-group comparison of MMSE scores before and after treatment

Group n Before treatment After treatment Treatment 34 24.39±2.23 26.78±2.02 Control 34 24.27±2.20 24.67±2.52 t value 1.46 －8.76 P value 0.163 0.000

4 Discussion

Acupoint massage is based on meridians and acupoints, and it prevents and cures diseases by stimulating acupoints[13]. It has a similar function mechanism to acupuncture. However, acupoints massage is simple and easier to manipulate with high safety and high patient acceptance, and can effectively avoid the damage and pain caused by acupuncture. In traditional Chinese medicine theory, sleep is closely related to meridian and acupoints as well as qi and blood circulation. In clinic, acupoints massage can unblock meridians and collaterals, smooth qi and blood circulation, and regulate functions of Zang-fu organs through meridian conduction. In this study, we use massage manipulations to stimulate the related acupoints at patient’s head, face and body to promote qi and blood circulation of head and face and effectively increase patient’s peripheral nerve excitability. Massage at Taiyang (EX-HN 5), Neiguan (PC 6), Anmian (Extra) and Sanyinjiao (SP 6) has effects such as tonifying the spleen and nourishing the heart, regulating Zang-fu organs, and balancing yin and yang, which can help effectively regulate patient’s heart, spleen and brain functions, as a result to improve the sleep status of older patient with primary hypertension. Good sleep quality can make the brain have sufficient energyreserves, improve patients’ memory, enhance logical reasoning ability and their resilience. Therefore, improving the elderly’s sleep quality can effectively enhance their cognitive function[14-15].

In this study, PSQI scores were around 9 in both groups before treatment. After 3-month interventions, the score of the control group did not change significantly, while score of the treatment group decreased obviously (P＜0.05), indicating that patients in the treatment group had a more significant sleep improvement after massage. There was no betweengroup statistical difference in MMSE score before treatment. After 3-month interventions, score of the control group had no significant change, while score of the treatment group increased significantly (P＜0.05), showing that the patients in the treatment group had a significant improvement of cognition function after massage.

Therefore, acupoint massage can effectively improve sleep quality and enhance cognition function of the elderly patients with primary hypertension, thus it is worthy of promoting in nursing work.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Acknowledgments

This work was supported by the Project of Taishun County Science and Technology Bureau, Zhejiang Province (浙江省泰順縣科學(xué)技術(shù)局課題, No. 2014082).

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 3 December 2014/Accepted: 6 January 2015

[1] Paglieri C, Bisbocci D, Caserta M, Rabbia F, Bertello C, Canadè A. Hypertension and cognitive function. Clin Exp Hypertens, 2008, 30(8): 701-710.

[2] Birns J, Kalra L. Cognitive function and hypertension. Journal of human hypertension, 2009, 23(2): 86-96.

[3] Amenta F, Mignini F, Rabbia F, Tomassoni D, Veglio F. Protective effect of anti-hypertensive treatment on cognitive function in essential hypertension: analysis of published clinical data. J Neurol Sci, 2002, 203-204: 147-151.

[4] Zhu WF, Sun JX. Study on the correlation between hypertension disease and sleep disorders. Shiyong Yixue Zazhi, 2014, 30(1): 139-142.

[5] Fogari R, Mugellini A, Zoppi A, Marasi G, Pasotti C, Poletti L, Rinaldi A, Preti P. Effects of Valsartan compared with Enalapril on blood pressure and cognitive function in elderly patients with essential hypertension. Eur J Clin Pharmacol, 2004, 59(12): 863-868.

[6] Manolio TA, Olson J, Longstreth JW. Hypertension and cognitive function: pathophysiologic effects of hypertension on the brain. Curr Hypertens Rep, 2003, 5(3): 255-261.

[7] Jiang Y, Zhou XX, Cai L. Experience of abdomen meridians and foot acupoints massage preventing patients with chronic heart failure from constipation. Guoji Hulixue Zazhi, 2012, 31(12): 2393-2394.

[8] Huang ZH. New hypertension treatment guidelines of World Health Organization (WHO) and the International Union of Hypertension. Zhongguo Xinyao Linchuang Yaoli, 1999, 18(3): 190.

[9] Ju TT, Xu J, Lu JF. Application experience of acupoint massage’s antiemetic effect. Guoji Hulixue Zazhi, 2012, 31(9): 1749-1750.

[10] Zeng H, Wang P, Kang JX. Effect of acupressure training on sleep quality and cognitive function of elderly. Zhonghua Huli Zazhi, 2012, 47(9): 773-776.

[11] Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh sleep quality index in primary insomnia. J Psychosom Res, 2002, 53(3): 737-740.

[12] Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB, Weintraub D. Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology, 2009, 73(21): 1738-1745.

[13] Wang P. Study of self-massage training’s effect on sleep quality and cognitive function in elderly. Changsha: Master Thesis of Central South University, 2011: 1-63.

[14] Ma XM, Huang YF, Huang XP. Effect of chinese medicine foot massage plus acupressure therapy on hospitalized patients with sleep disorders. Huli Xuebao, 2012, 19(14): 66-68.

[15] Benito-León J, Vega-Quiroga S, Villarejo-Galende A, Bermejo-Pareja F. Hypercholesterolemia in elders is associated with slower cognitive decline: a prospective, population-based study (NEDICES). J Neurol Sci, 2015, 350(1): 69-74.

Translator:Deng Ying (鄧櫻)

穴位按摩改善老年高血壓患者認(rèn)知功能和睡眠質(zhì)量的臨床研究

目的：觀察穴位按摩對(duì)老年高血壓患者認(rèn)知功能和睡眠質(zhì)量的影響。方法：共納入60歲以上老年高血壓患者68例, 采用簡(jiǎn)單隨機(jī)法分為對(duì)照組和治療組, 每組34例。對(duì)照組進(jìn)行常規(guī)的心理健康指導(dǎo)及睡眠知識(shí)教育, 治療組在對(duì)照組采取的干預(yù)措施基礎(chǔ)上進(jìn)行穴位按摩, 共治療3個(gè)月, 記錄并比較治療前后匹茲堡睡眠質(zhì)量指數(shù)(Pittsburgh sleep quality index, PSQI)和簡(jiǎn)易精神狀態(tài)檢查量表(mini-mental state examination, MMSE)的評(píng)分。結(jié)果：兩組患者治療前PSQI評(píng)分比較, 差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。治療3個(gè)月后兩組PSQI評(píng)分比較, 差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。治療前MMSE分值比較, 差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05), 治療后MMSE分值比較, 差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論：對(duì)原發(fā)性老年高血壓患者進(jìn)行穴位按摩有助于改善其睡眠質(zhì)量, 增強(qiáng)其認(rèn)知功能,在臨床護(hù)理工作中具有一定的推廣運(yùn)用價(jià)值。

推拿; 按摩; 點(diǎn)穴療法; 穴位療法; 高血壓; 記憶障礙; 神經(jīng)病學(xué)表現(xiàn); 睡眠障礙

R244.1 【

】A

Author: Lei Xiao-fang, bachelor, nurse-in-charge

E-mail: nesr0102@163.com

Methods:A total of 68 elderly patients with hypertension were enrolled, and their ages were all over 60 years old. They were divided into a control group and a treatment group by simple random method, with 34 cases in each group. Patients in the control group were treated by routine psychological health guidance and sleep knowledge education, while patients in the treatment group were treated by acupoint massage on the base of the interventions given to the control group. Both of their treatment courses were 3 months. Pittsburgh sleep quality index (PSQI) scores and mini-mental state examination (MMSE) scores before and after treatment were recorded and compared.

Results:Two groups’ PSQI scores before treatment had no significant difference (P＞0.05). After 3 months of treatment, their PSQI scores were statistically different (P＜0.05). There was also no between-group statistical difference in MMSE score before treatment (P＞0.05), but there was a significant difference after treatment (P＜0.05).

Conclusion:Acupoint massage for elderly patients with primary hypertension can improve their sleep quality and enhance their cognitive function, thus it is worthy of being applied in clinical nursing work.