Abstract
Objective:
This study aimed to investigate the effects of a nursing regimen combining ward noise control with auricular acupressure on sleep quality and psychosomatic symptoms in patients with cervical spondylosis and insomnia.
Methods:
This retrospective analysis included 87 patients with cervical spondylosis and insomnia treated at The First Affiliated Hospital of Xinjiang Medical University between October 2023 and October 2025. Based on medical records, patients were assigned to two groups: a control group (n = 42, auricular acupressure only) and a study group (n = 45, auricular acupressure combined with systematic ward noise control). We compared continuous variables using the independent-samples t-test or paired-samples t-test, and categorical variables using the chi-square test. The two groups were compared regarding clinical efficacy, sleep quality (Pittsburgh Sleep Quality Index, PSQI), psychological symptoms (Symptom Checklist-90, SCL-90), and quality of life (Generic Quality of Life Inventory-74, GQOLI-74).
Results:
After the implementation of the nursing regimens, the total effective rate in the study group was 91.11%, which was significantly higher than the 71.43% observed in the control group (P < 0.05). Postregimen scores for all PSQI and SCL-90 subscales decreased significantly compared with baseline in both groups, with the study group demonstrating lower scores than the control group (P < 0.05). Conversely, scores for all GQOLI-74 subscales increased significantly from baseline in both groups, with the study group showing higher scores than the control group (P < 0.05).
Conclusion:
Adding systematic ward noise control to auricular acupressure yields superior therapeutic outcomes in patients with cervical spondylosis and insomnia. This combined approach can effectively improve sleep quality, alleviate psychosomatic symptoms such as anxiety and depression, and enhance the patient’s quality of life.
Keywords: noise, auriculotherapy, cervical spondylosis, sleep initiation and maintenance disorder, psychophysiologic disorder
KEY MESSAGES
-
(1)
The combined nursing intervention of ward noise control and auricular acupressure achieves a significantly higher total effective rate (91.11%) than auricular acupressure alone (71.43%) in treating cervical spondylosis with insomnia.
-
(2)
This combined approach demonstrates superior improvement in sleep quality (reduces all PSQI subscale and total scores), alleviates psychosomatic symptoms (lower SCL-90 scores for anxiety, depression, and somatization), and enhances quality of life (elevates GQOLI-74 scores in physical, psychological, social, and material dimensions).
-
(3)
As a nonpharmacological strategy, the synergy of environmental optimization (ward noise control) and Traditional Chinese Medicine external therapy (auricular acupressure) comprehensively addresses multifactorial sleep disorders, providing a safe and effective clinical nursing option.
INTRODUCTION
Cervical spondylosis is a clinical syndrome characterized by degenerative pathological changes in the cervical spine. Vertebral artery insufficiency and nerve root compression caused by this condition can easily lead to neurological dysfunction, subsequently triggering sleep disorders.[1] A study found that among 186 patients with cervical spondylosis, 105 experienced sleep disorders, representing an incidence rate of 56.5%.[2] Chronic insomnia not only potentially increases the risk of conditions such as hypertension and diabetes but also contributes to adverse psychological health outcomes like anxiety and depression, thereby negatively affecting quality of life and social functioning.[3,4] Current clinical management for cervical spondylosis with insomnia primarily relies on sedative-hypnotic medications. However, long-term use causes dependence, tolerance and cognitive impairment, limiting their clinical application.[5]
In Traditional Chinese Medicine (TCM), this condition falls under “insomnia” and “neck impediment.” The auricle is considered a holographic reflex zone of the body’s viscera and meridians. Stimulating specific auricular points is believed to dredge meridians, regulate qi and blood, and produce sedative and mind-calming effects.[6] Hospitalized patients’ sleep is influenced by complex environmental factors, among which ward noise is a significant and modifiable environmental factor that disrupts sleep and exacerbates psychosomatic stress. Studies have confirmed that hospital environmental noise commonly exceeds recommended levels, leading to sleep fragmentation, elevated stress hormone levels, and delayed recovery.[7] Therefore, systematic noise control is a crucial component in optimizing the inpatient rehabilitation environment and enhancing the efficacy of nonpharmacological treatments. Previous studies have examined ward noise control and auricular acupressure separately. The potential synergistic effect of combining environmental noise management with auricular acupressure—addressing external environmental stressors and internal neurophysiological dysregulation—has not been systematically investigated in patients with cervical spondylosis and comorbid insomnia. This study addresses this gap by evaluating whether adding systematic ward noise control to auricular acupressure improves sleep quality, psychosomatic symptoms, and quality of life compared with auricular acupressure alone. Accordingly, this study aimed to investigate whether the additional implementation of systematic ward noise control management, on top of routine auricular acupressure treatment, could further improve sleep and psychosomatic symptoms in patients with cervical spondylosis and insomnia through the synergy of environmental regimen and somatic therapy.
MATERIALS AND METHODS
Baseline Data
We retrospectively enrolled 87 patients with cervical spondylosis and insomnia treated in the General Department of Traditional Chinese Medicine at The First Affiliated Hospital of Xinjiang Medical University from October 2023 to October 2025. All patients were admitted to the same general TCM ward during the study period; differences in nursing regimens reflected the phased implementation of the ward’s noise control program. Patients admitted during the earlier received only auricular acupressure, whereas those admitted later received auricular acupressure combined with systematic ward noise control after the program was instituted. According to the departmental nursing protocols during each phase, all patients received nursing care until discharge, and only those with a length of hospital stay ≥4 weeks were included in the analysis. Outcome assessments were extracted from the medical records at two time points: baseline (within 24 h of admission) and at discharge (after a minimum of 4 weeks of hospitalization). Based on the actual nursing regimen documented, we divided patients into a control group (n = 42, auricular acupressure only) and a study group (n = 45, auricular acupressure combined with noise control). This study was approved by the Ethics Committee of The First Affiliated Hospital of Xinjiang Medical University (Approval No. K202510-56). The informed consent form has been obtained. The study followed the Declaration of Helsinki (as revised in 2025).[8]
Sample Selection Process
From the medical record system of The First Affiliated Hospital of Xinjiang Medical University, we identified 124 patients with cervical spondylosis and insomnia treated between October 2023 and October 2025. After applying the exclusion criteria, 37 patients were excluded for the following reasons: 12 had comorbid severe cardiovascular or cerebrovascular diseases, eight had used sedative-hypnotic medications within 1 month prior to admission, six had incomplete medical records or missing scale assessment data, five had hearing impairment or auricular skin lesions, four had a history of psychiatric disorders, two of them were excluded due to their refusal to participate. The final analysis included 87 patients, 42 in the control group and 45 in the study group.
Inclusion Criteria
(1) Diagnosis of cervical spondylosis confirmed according to the guideline for cervical spondylotic myelopathy by McCormick et al.[9] and diagnosis of insomnia confirmed by the “European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023”;[10] (2) presence of typical cervical spondylosis symptoms (e.g., neck/shoulder pain, limb numbness) accompanied by insomnia manifestations (e.g., difficulty falling asleep, frequent dreams, easy awakening); (3) insomnia duration ≥1 month; and (4) clear consciousness and ability to cooperate with scale assessments.
Exclusion Criteria
(1) Comorbid major organic diseases such as malignant tumors, severe cardiovascular or cerebrovascular diseases, or hepatic/renal insufficiency; (2) psychiatric or psychological disorders (e.g., alcohol dependence and schizophrenia); (3) hearing impairment, auricular deformity, or skin damage/infection at the auricular acupressure sites; (4) use of sedative-hypnotic medications within 1 month before enrolment or participation in other similar therapeutic studies; (5) pregnancy or lactation; or (6) incomplete medical records or missing data for any outcome scales (PSQI, SCL-90, or GQOLI-74) at baseline or the 4-week follow-up.
Methods
Control Group (Auricular Acupressure)
Patients in the control group received auricular acupressure according to the following standardized protocol:
(1) Acupoint Selection: Auricular points were selected using the national standard “Nomenclature and Location of Auricular Points” (GB/T 13734-2008).[11] The selected points included Shenmen (TF4), subcortex (AT4), sympathetic (AH6a), occiput (AT3), temple (AT2), and neck (AH10, corresponding to the cervical vertebrae). The combination principle was: Shenmen, subcortex, and sympathetic were used collectively to exert sedative, calming, and autonomic nerve-regulating effects; occiput, temple, and neck were selected as corresponding regional points, aiming to dredge the cervical meridians, alleviate pain, and promote blood circulation.
(2) Operational Procedure: The procedure was performed by nurses who had undergone specialized training. Prior to application, the auricular area of the selected acupoints was disinfected using a 75% alcohol swab and allowed to air dry. Subsequently, Vaccaria segetalis (Wangbuliuxing) seed plasters (size: 0.6 cm × 0.6 cm) were accurately applied to the tender, sensitive spots on the selected acupoints. Patients were instructed to press the plasters using thumb and index finger, adjusting pressure to produce a tolerable sensation of soreness, numbness, distension, or pain. Each press lasted 5 min, three times daily (morning, noon, and evening), avoiding excessive force that could cause skin damage. The treatment was administered in 2-week courses (total 4 weeks).
Study Group (Auricular Acupressure Combined with Ward Noise Control)
The study group received the identical auricular acupressure protocol as the control group. Additionally, they were exposed to a comprehensive ward noise reduction management program throughout the 4 weeks. The specific measures included the following:
(1)Optimized Communication Mode: The department used mobile phones with WeChat as the primary communication tool for staff, who were instructed to prioritize WeChat messaging for work-related discussions to minimize loud conversations in patient rooms. Call response signs were posted at ward entrances to reinforce a protocol requiring staff to respond to patient calls within 3 min, aiming to reduce call bell frequency.
(2) Noise Monitoring and Control: Decibel meters (Hangzhou Aihua Instruments Co., Ltd., Hangzhou, China; model AWA5636; measuring range: 30–130 dB, accuracy: ±1 dB) were installed at the nursing station and in ward corridors for real-time monitoring. The program aimed to maintain ambient ward noise levels below 40 dB during daytime hours and below 35 dB at night. Auditory alerts, including call bells, telephones, and ward televisions, were reduced to (target ≤50 dB). Strict adherence to the “Four Quiets” principle was enforced: walk quietly, speak quietly, operate quietly, and close doors quietly.
(3) Spatial and Equipment Optimization: Given the absence of dedicated mobile nursing carts and the infeasibility of establishing a secondary nursing station, we optimized the placement of existing equipment (e.g., treatment carts and chairs) in designated corridor areas to reduce unnecessary traffic and noise. To minimize friction noise, lubricating oil was regularly applied to the wheel axles of all mobile equipment (e.g., treatment carts, visitor chairs), and silent pads were attached to door and window hinges. Nurses were also assigned to conduct hourly proactive rounding, allowing them to address patient needs promptly and thereby reduce the overall frequency of call bell usage.
(4) Staff Training and Conduct: Specialized noise reduction training sessions were conducted for all healthcare personnel, cleaning staff, and auxiliary workers, emphasizing the negative effect of noise on patient recovery. Staff were required to avoid congregating for conversations during duty hours. Personal mobile phones were to be set to silent or vibration mode, and the use of speakerphone functions within ward areas was strictly prohibited.
Data Collection
We extracted all outcome data retrospectively from the electronic medical record system of The First Affiliated Hospital of Xinjiang Medical University. The department’s standard nursing protocol stipulated that PSQI, SCL-90, and GQOLI-74 assessments be administered to all patients with cervical spondylosis and insomnia upon admission and again after 4 weeks of nursing care. Trained nursing staff conducted these assessments as part of routine clinical care and documented the results in the patients’ medical records. For this study, we extracted the documented scale scores at baseline and at the 4-week.
Outcome Measures
Clinical Efficacy
Clinical efficacy was evaluated based on criteria adapted from the Clinical Sleep Disorders reference[12] and categorized into four grades as follows:
(1) Ineffective: No improvement or worsening of insomnia symptoms; persistent, frequent dreams and easy awakening during the night; extreme fatigue during the day.
(2) Effective: Some alleviation of insomnia symptoms; nighttime sleep duration increased by less than 3 h compared with pre-regimen; acceptable daytime energy levels.
(3) Markedly Effective: Significant improvement in sleep quality; nighttime sleep duration ≥6 h with increased sleep depth; energetic during the day.
(4) Clinically Cured: Insomnia symptoms essentially disappeared (time to fall asleep ≤30 min, normal sleep maintenance); no daytime discomfort such as dizziness or fatigue; cervical spondylosis-related symptoms relief was not included as a criterion for efficacy grading in this study; the efficacy evaluation focused solely on insomnia.
The total effective rate was calculated as follows: (Number of effective cases + Number of markedly effective cases + Number of clinically cured cases) / Total number of cases × 100%.
Sleep Quality
Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), originally developed and validated by Buysse et al.,[13] and its Chinese version, translated and validated by Liu et al.,[14] which demonstrated satisfactory reliability and validity in Chinese clinical populations. The PSQI has 19 self-rated items and five bed partner/roommate-rated items, generating seven component scores. The 19 self-rated items are used for scoring. In the Chinese validation study, the PSQI demonstrated a Cronbach’s α coefficient of 0.84 and a test–retest reliability of 0.81. This scale comprises seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each component is scored from 0 to 3, yielding a global PSQI score ranging from 0 to 21, with higher scores indicating worse sleep quality. Assessments were done before the regimen and after 4 weeks of care.
Psychosomatic Symptoms
Psychosomatic symptoms were evaluated using the Symptom Checklist-90 (SCL-90), developed by Derogatis et al.[15]; the Chinese version was introduced and translated by Wang,[16] and its reliability and validity in Chinese populations have been well established.[17] The SCL-90 contains 90 items, each rated on a 5-point Likert scale (1 = not at all, 5 = extremely), grouped into nine primary symptom dimensions plus an additional category. In the Chinese validation study, the Cronbach’s α coefficients for the nine factors ranged from 0.78 to 0.90, and the split-half reliability was 0.85. The score for each dimension is the mean of the scores of its constituent items, with higher scores indicating more severe symptoms. Assessments were performed before the regimen and after 4 weeks of management.
Quality of Life
Quality of life was measured using the Generic Quality of Life Inventory-74 (GQOLI-74), developed and validated by Li and Hao[18] for Chinese populations, with documented reliability and validity in community and clinical samples. The GQOLI-74 comprises 74 items distributed across four dimensions: physical functioning (20), psychological functioning (20), social functioning (20), and material life (14). In the original validation study, the scale demonstrated a Cronbach’s α coefficient of 0.89, test–retest reliability of 0.86, and split-half reliability of 0.88. Each item is rated on a 5-point scale. Raw scores for each dimension were converted to standardized scores ranging from 0 to 100. For the social functioning, physical functioning and psychological functioning dimensions (raw score range: 20–100), the conversion formula was: [Raw score − 20] × 100 ÷ 80); for the material life (raw score range: 16–80), the conversion formula was: [Raw score − 16] × 100 ÷ 64). Higher scores indicating better quality of life. Assessments were done before the regimen and after 4 weeks of management.
Statistical Analysis
We performed statistical analyses using SPSS software (version 26.0; IBM Corp., Armonk, NY, USA). The Shapiro–Wilk test verified normality of all continuous variables. Normally distributed continuous data are presented as mean ± standard deviation (x̄±s). Within-group comparisons (pre- vs. post-regimen) used paired-samples t-tests; between-group comparisons used independent-samples t-tests. Categorical data are expressed as number (percentage) (n [%] and were compared using the chi-square (χ2) test. A two-tailed P-value < 0.05 was considered statistically significant.
RESULTS
Baseline Characteristics of Patients
A total of 87 patients were included in the study, including 42 cases in the control group and 45 cases in the study group. No significant differences in baseline data, such as sex, age, body mass index or the course of cervical spondylosis and insomnia, were observed between the two groups (P > 0.05), indicating comparability [Table 1].
Table 1.
Comparison of Baseline Characteristics between the Two Groups
| Project | Control Group (n =42) | Study Group (n =45) | χ2/t | P Value |
|---|---|---|---|---|
| Sex (n [%]) | 0.006 | 0.941 | ||
| Man | 23 (54.76) | 25 (55.56) | ||
| Woman | 19 (45.24) | 20 (44.44) | ||
| Age (years) | 56.32 ± 8.56 | 55.85 ± 9.12 | 0.247 | 0.805 |
| BMI (kg/m2) | 23.51 ± 2.83 | 23.72 ± 3.15 | 0.326 | 0.745 |
| Educational level (n [%]) | 0.315 | 0.854 | ||
| Primary or below | 10 (23.81) | 12 (26.67) | ||
| Secondary | 21 (50.00) | 20 (44.44) | ||
| Tertiary or above | 11 (26.19) | 13 (28.89) | ||
| Marital status (n [%]) | 0.171 | 0.679 | ||
| Married | 36 (85.71) | 40 (88.89) | ||
| Unmarried/divorced/widowed | 6 (14.29) | 5 (11.11) | ||
| Length of hospital stay (days), mean ± SD | 30.5 ± 2.5 | 31.2 ± 2.8 | 1.227 | 0.223 |
| Duration of cervical spondylosis (years), mean ± SD | 5.29 ± 2.10 | 5.59 ± 2.33 | 0.629 | 0.531 |
| Duration of insomnia (months), mean ± SD | 3.16 ± 1.21 | 3.36 ± 1.34 | 0.729 | 0.468 |
Note: BMI: body mass index; SD: standard deviation.
Comparison and Analysis of Sleep Quality between the Two Groups
Before the nursing measures, no significant differences were observed between the two groups in any PSQI component scores or the global score (P > 0.05). After 4 weeks of nursing care, both groups showed significant improvements in all PSQI components, with the study group demonstrating significantly lower scores than the control group in all dimensions (P < 0.05). The PSQI global score decreased from 16.06 ± 2.51 to 11.35 ± 2.31 in the control group and from 15.87 ± 2.62 to 6.10 ± 1.66 in the study group, with the post-care score being significantly lower in the study group than in the control group (P < 0.001, Table 2).
Table 2.
Comparison and Analysis of Sleep Quality between the Two Groups (Score)
| Group | Time | Control Group (n =42) | Study Group (n = 45) | t | P |
|---|---|---|---|---|---|
| Daytime dysfunction | Precare | 2.51 ± 0.36 | 2.60 ± 0.35 | 1.182 | 0.241 |
| After care | 1.74 ± 0.40a | 0.94 ± 0.25a | 11.267 | <0.001 | |
| Use hypnotic drugs | Precare | 2.02 ± 0.35 | 1.90 ± 0.31 | 1.695 | 0.094 |
| After care | 1.36 ± 0.30a | 0.61 ± 0.23a | 13.138 | <0.001 | |
| Sleep disorder | Precare | 2.42 ± 0.30 | 2.37 ± 0.35 | 0.713 | 0.478 |
| After care | 1.59 ± 0.27a | 0.78 ± 0.22a | 15.385 | <0.001 | |
| Sleep duration | Precare | 2.31 ± 0.64 | 2.23 ± 0.60 | 0.602 | 0.549 |
| After care | 1.62 ± 0.45a | 0.91 ± 0.24a | 9.268 | <0.001 | |
| Sleep latency | Precare | 2.36 ± 0.25 | 2.32 ± 0.29 | 0.687 | 0.494 |
| After care | 1.82 ± 0.41a | 0.98 ± 0.25a | 11.625 | <0.001 | |
| Subjective sleep quality | Precare | 2.09 ± 0.24 | 2.13 ± 0.42 | 0.540 | 0.590 |
| After care | 1.60 ± 0.28a | 0.91 ± 0.25a | 12.141 | <0.001 | |
| Sleep efficiency | Precare | 2.35 ± 0.37 | 2.31 ± 0.30 | 0.556 | 0.580 |
| After care | 1.62 ± 0.20a | 0.97 ± 0.22a | 14.386 | <0.001 | |
| PSQI global score | Precare | 16.06 ± 2.51 | 15.87 ± 2.62 | 0.345 | 0.731 |
| After care | 11.35 ± 2.31a | 6.10 ± 1.66a | 12.234 | <0.001 |
Note: Compared with the same group before care aP < 0.05; PSQI: Pittsburgh Sleep Quality Index.
Analysis of Psychosomatic Symptoms in Two Groups
Before the nursing measures, SCL-90 factor scores were comparable between the two groups (P > 0.05). After 4 weeks of care, all SCL-90 factor scores decreased significantly from baseline in both groups (P < 0.05), and the postcare scores in the study group were significantly lower than those in the control group across all symptom dimensions (P < 0.05). The largest between-group differences were observed in anxiety, depression and additional factor dimensions [Table 3].
Table 3.
Analysis of Psychosomatic Symptoms in Two Groups
| Group | Time | Control Group (n =42) | Study Group (n = 45) | t | P |
|---|---|---|---|---|---|
| Somatization | Precare | 1.85 ± 0.54 | 1.75 ± 0.51 | 0.888 | 0.377 |
| After care | 1.33 ± 0.33a | 1.12 ± 0.36a | 2.830 | 0.006 | |
| Anxiety | Precare | 2.95 ± 0.81 | 2.80 ± 0.88 | 0.826 | 0.411 |
| After care | 1.97 ± 0.61a | 1.24 ± 0.51a | 6.071 | <0.001 | |
| Depression | Precare | 2.91 ± 0.86 | 2.80 ± 0.84 | 0.603 | 0.548 |
| After care | 1.86 ± 0.53a | 1.12 ± 0.36a | 7.663 | <0.001 | |
| Hostility | Precare | 1.62 ± 0.52 | 1.57 ± 0.60 | 0.414 | 0.680 |
| After care | 1.33 ± 0.37a | 1.16 ± 0.31a | 2.329 | 0.022 | |
| Terror | Precare | 1.33 ± 0.42 | 1.35 ± 0.37 | 0.236 | 0.814 |
| After care | 1.20 ± 0.30a | 1.01 ± 0.28a | 3.056 | 0.003 | |
| Interpersonal sensitivity | Precare | 2.58 ± 0.63 | 2.61 ± 0.57 | 0.233 | 0.816 |
| After care | 1.72 ± 0.54a | 1.43 ± 0.31a | 3.098 | 0.003 | |
| Psychotic | Precare | 1.72 ± 0.56 | 1.67 ± 0.45 | 0.461 | 0.646 |
| After care | 1.23 ± 0.38a | 1.05 ± 0.24a | 2.660 | 0.009 | |
| Obsessive–compulsive symptoms | Precare | 1.49 ± 0.36 | 1.42 ± 0.41 | 0.844 | 0.401 |
| After care | 1.23 ± 0.30a | 1.10 ± 0.27a | 2.127 | 0.036 | |
| Stubbornly biased | Precare | 2.17 ± 0.57 | 2.03 ± 0.73 | 0.992 | 0.324 |
| After care | 1.55 ± 0.49a | 1.28 ± 0.48a | 2.596 | 0.011 | |
| Additional factor | Precare | 2.71 ± 0.73 | 2.65 ± 0.86 | 0.350 | 0.728 |
| After care | 1.62 ± 0.42a | 1.04 ± 0.35a | 7.015 | <0.001 |
Note: Compared with the same group before care aP < 0.05, SCL-90: Symptom Checklist-90.
Comparison of Quality of Life between the Two Groups
Baseline GQOLI-74 scores did not differ significantly between groups (P > 0.05). After 4 weeks, all four dimension scores increased significantly in both groups compared with precare values (P < 0.05). The study group achieved significantly higher postcare scores than the control group in social functioning, material life, physiological functioning and psychological functioning (P < 0.05, Table 4).
Table 4.
Comparison of Quality of Life between the Two Groups (Score)
| Group | Time | Control Group (n = 42) | Study Group (n = 45) | t | P |
|---|---|---|---|---|---|
| Social functioning | Precare | 54.70 ± 5.59 | 53.74 ± 7.85 | 0.653 | 0.516 |
| After care | 69.68 ± 6.75a | 76.59 ± 7.82a | 4.398 | <0.001 | |
| Material life | Precare | 54.57 ± 7.90 | 56.81 ± 6.58 | 1.441 | 0.153 |
| After care | 69.90 ± 8.82a | 79.41 ± 7.96a | 5.286 | <0.001 | |
| Physiological functioning | Precare | 49.79 ± 5.18 | 51.48 ± 7.39 | 1.227 | 0.223 |
| After care | 64.78 ± 8.26a | 71.93 ± 7.36a | 4.269 | <0.001 | |
| Psychological functioning | Precare | 51.58 ± 5.35 | 53.30 ± 7.69 | 1.203 | 0.232 |
| After care | 67.95 ± 8.35a | 73.10 ± 7.23a | 3.081 | 0.003 |
Note: Compared with the same group before care aP < 0.05, GQOLI-74: Generic Quality of Life Inventory-74.
Comparison of Clinical Effects between the Two Groups
Four weeks after nursing measures, the clinical effective rate was 91.11% in the study group, significantly higher than 71.43% in the control group, and the difference was statistically significant (P < 0.05, Table 5).
Table 5.
Comparison of Clinical Effects between the Two Groups
| Group | Number of Cases | Be Invalid | Effective | Show Effect | Clinical Recovery | With Good Efficiency |
|---|---|---|---|---|---|---|
| Control group | 42 | 12(28.57) | 8(19.05) | 9(21.43) | 13(30.95) | 30(71.43) |
| Study group | 45 | 4(8.89) | 7(15.56) | 16(35.56) | 18(40.00) | 41(91.11) |
| χ2 | 5.607 | |||||
| P | 0.018 |
Noise Level Monitoring Results
During the 4-week nursing measures period, we recorded daily ambient noise levels in the ward areas where patients in both groups stayed. The mean daytime noise level in the study group ward was 55.2 ± 4.1 dB, significantly lower than the 64.8 ± 5.6 dB recorded in the control group ward (t = 9.166, P < 0.001). Similarly, the mean nighttime noise level was lower in the study group ward (42.5 ± 3.6 dB) than in the control group ward (53.6 ± 4.9 dB, t = 12.097, P < 0.001). The proportion of daytime hours with noise levels exceeding 40 dB was 98.5% in the control group ward compared with 76.3% in the study group ward. The proportion of nighttime hours with noise levels exceeding 35 dB was 96.2% in the control group ward compared with 68.4% in the study group ward. These data confirm that the systematic ward noise control program effectively reduced ambient noise exposure in the study group [Table 6].
Table 6.
Comparison of Ward Noise Levels between the Two Groups during the 4-Week Period
| Noise Parameter | Control Group Ward | Study Group Ward | t/χ2 | P Value |
|---|---|---|---|---|
| Daytime noise level (dB), mean ± SD | 64.8 ± 5.6 | 55.2 ± 4.1 | 9.166 | <0.001 |
| Nighttime noise level (dB), mean ± SD | 53.6 ± 4.9 | 42.5 ± 3.6 | 12.097 | <0.001 |
| Daytime hours >40 dB (%) | 98.5 | 76.3 | 129.64 | <0.001 |
| Nighttime hours >35 dB (%) | 96.2 | 68.4 | 98.53 | <0.001 |
Note: SD: standard deviation.
DISCUSSION
The present study evaluated the effects of combining ward noise control with auricular acupressure on sleep quality and psychosomatic symptoms in patients with cervical spondylosis and insomnia. The main findings were as follows: (1) the study group achieved a significantly higher total effective rate (91.11%) compared with the control group (71.43%); (2) improvements in all PSQI component and the global score were significantly greater in the study group; (3) reductions in SCL-90 factor scores, particularly for anxiety and depression, were more pronounced in the study group; and (4) the study group demonstrated significantly greater improvements in all four dimensions of the GQOLI-74. These findings suggest that adding systematic ward noise control to auricular acupressure yields superior therapeutic outcomes across multiple domains.
The total effective rate was 91.11% in the study group, which was higher than the 71.43% in the control group. This suggests that adding auricular acupressure to a foundation of ward noise control can enhance clinical efficacy for patients with cervical spondylosis and insomnia, representing an effective therapeutic strategy. Environmental noise management alone is a fundamental and effective measure for improving inpatient sleep and alleviating psychological distress—as evidenced by Martí et al.,[19] who demonstrated that music therapy, as an environmental intervention, significantly reduces anxiety and sadness and improves mood and quality of life in hospitalized patients—it is fundamentally insufficient to comprehensively address the neurovascular dysfunction secondary to local cervical lesions and the resulting anxiety and depressive states.[20] Singular environmental management is insufficient to comprehensively address these complex pathophysiological links. This study combined TCM auricular acupressure, a targeted somato-neural regulatory therapy, with environmental management. By stimulating acupoints such as Shenmen, subcortex, and sympathetic, auricular acupressure modulates autonomic nervous function and cortical excitability. Its sedative, mind-calming, and meridian-dredging effects have been validated in previous study.[21] Therefore, the combined nursing regimen likely operates through dual pathways, more comprehensively covering the primary inducing and perpetuating factors of the disease, thereby achieving a significant enhancement in clinical efficacy.
The combined nursing regimen yielded superior improvements in all PSQI component scores and the global score compared with noise control alone. Patients in the control group already demonstrated significant progress in sleep quality, confirming the efficacy of environmental noise control as a core component of nonpharmacological sleep hygiene education.[22] Noise disrupts sleep continuity by activating auditory pathways and the reticular activating system, adversely affecting sleep maintenance. Furthermore, chronic noise exposure also activate the hypothalamic–pituitary–adrenal axis, increasing cortisol levels and sympathetic nervous system arousal, which collectively contribute to sleep fragmentation and prolonged sleep latency.[23] The systematic noise control measures implemented in this study, by reducing sudden and continuous noise exposure, may have attenuated this neuroendocrine stress response, thereby creating a more stable physiological environment conducive to sleep. Within this stabilized external environment, auricular acupressure may further optimize sleep initiation and maintenance processes by modulating autonomic nervous balance and alleviating concomitant anxiety. Branches of the vagus nerve, trigeminal nerve, and the cervical plexus richly innervate the auricle. Stimulation of auricular acupoints, particularly Shenmen and subcortex, has been demonstrated to activate the parasympathetic nervous system via the auricular branch of the vagus nerve, reducing sympathetic tone and promoting a state of relaxation conducive to sleep onset.[24] While noise control provided the physical foundation for sleep recovery, the combined therapy more profoundly improved the psychophysiological regulatory aspects of sleep.
The study group showed greater reductions in key SCL-90 factor scores, including anxiety, depression and somatization, than the control group. A strong bidirectional relationship exists between chronic insomnia and anxiety/depression.[25] Feelings of helplessness and discomfort associated with the ward environment may exacerbate patients’ psychological stress. Systematic noise control, by enhancing environmental comfort and predictability, likely mitigated this stress response to some extent, which may explain the improvement in psychosomatic symptoms observed in the control group. The proactive and visible noise management measures implemented in this study, such as installing decibel meters and establishing clear behavioral protocols, not only reduced noise levels but also enhanced patients’ sense of security and control over their environment, which, in itself, has a psychologically soothing effect. Systematic noise control broke the cycle of environmental exacerbation, creating space for emotional improvement. On this foundation, auricular acupressure further promoted psychosomatic relaxation through meridian regulation. The advantage of the combined regimen lies in blocking external stressors via environmental management while concurrently assisting in the regulation of internal emotional responses via TCM external therapy, achieving more comprehensive management of psychosomatic symptoms. Improvements in all GQOLI-74 dimension scores were greater in the study group than in the control group. Better sleep quality and fewer psychosomatic symptoms naturally improve patients’ daily life experiences and social functioning. Studies by Sullivan et al.[26] and Yuan et al.[27] have confirmed the close interrelationship between sleep, mood and overall quality of life. Improved sleep and reduced psychological distress facilitate greater engagement in social activities and enhance perceived satisfaction with material conditions, which are key components of the GQOLI-74 assessment. Thus, the combined management not only targets core symptoms but also substantially enhances patients’ subjective perceptions across multiple domains, including physical function, psychological state, social activities and satisfaction with material life.
This study has several limitations. First, it is a single-center study with a relatively limited sample size, the generalizability of the findings requires further validation through larger-scale, multicenter randomized controlled trials. Second, the retrospective design introduces inherent biases, including potential selection bias and the inability to control for unmeasured confounding variables such as patients’ baseline anxiety levels, home sleep environment, or individual noise sensitivity. Reliance on medical records for group assignment and outcome assessment may have introduced information bias. Third, the 4-week follow-up period precludes evaluation of the long-term sustainability of the observed improvements in sleep quality and psychosomatic symptoms. Fourth, the study did not conduct subgroup analyses based on different TCM syndrome types of cervical spondylosis with insomnia. Finally, objective measures of sleep (e.g., polysomnography or actigraphy) and noise exposure (e.g., continuous decibel monitoring data) were not available, and all outcome assessments relied on self-report questionnaires, which may be subject to recall and reporting biases. Future research should use prospective study designs, incorporate objective measurements, and extend follow-up to validate the long-term effects and mechanisms of action of this combined nursing regimen.
CONCLUSION
In patients with cervical spondylosis and insomnia receiving auricular acupressure, adding systematic ward noise control management is associated with superior therapeutic outcomes. The combined regimen improved sleep quality, reduced psychosomatic symptoms including anxiety and depression, and enhanced quality of life across physical, psychological and social domains. These findings support integrating environmental noise control with auricular acupressure as a nonpharmacological, comprehensive nursing strategy for this patient population.
Availability of Data and Materials
The data supporting the findings of this study are derived from the medical record system of The First Affiliated Hospital of Xinjiang Medical University. Data are available upon reasonable request from the corresponding author, subject to ethical approval and institutional data access policies. The materials used in the study (e.g., Vaccaria segetalis seed plasters, decibel meters) are commercially available and do not require special access.
Author Contributions
YuHong Yao: Collected clinical data; drafted the initial manuscript. Jie Lu: Collated clinical cases; revised the manuscript critically. HongMei Li: Analyzed clinical data; helped with manuscript editing. JieZhen Li: Verified clinical data; provided clinical data support. JinRong Chen (corresponding author): Supervised the clinical research; responsible for all paper correspondence. All authors read and approved the final version.
Ethics Approval and Consent to Participate
This study was approved by the Ethics Committee of The First Affiliated Hospital of Xinjiang Medical University (Approval No. K202510-56). The informed consent form has been obtained.
Conflicts of Interest
The authors declare that there are no conflicts of interest.
Acknowledgment
The authors thank all participants and staff engaged in physical examination and data collection. We are grateful to the nursing team from the General Department of Traditional Chinese Medicine, The First Affiliated Hospital of Xinjiang Medical University, for their help in arranging historical ward records and collecting complete clinical files of auricular acupressure patients.
Funding Statement
This research was supported and funded by the Xinjiang Uygur Autonomous Region Tianshan Talent Cultivation Program (Grant No. TSYC202401B178) and the Natural Youth Project of Xinjiang Autonomous Region (Grant No. 2025D01C420).
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data supporting the findings of this study are derived from the medical record system of The First Affiliated Hospital of Xinjiang Medical University. Data are available upon reasonable request from the corresponding author, subject to ethical approval and institutional data access policies. The materials used in the study (e.g., Vaccaria segetalis seed plasters, decibel meters) are commercially available and do not require special access.