The effectiveness of Suanzaoren (Ziziphi Spinosae Semen) in improving sleep: a systematic review of randomized studies on cancer and non-cancer patients
Sleep disorders are common and bothersome in both cancer and non-cancer populations.
Suanzaoren (Ziziphi Spinosae Semen) is commonly used to improve sleep, but its effectiveness and safety remain unclear.
Suanzaoren, also known as the seed of sour jujube or Ziziphus jujuba var. spinosa, is a plant belonging to the Rhamnaceae family and is mainly native to China. This seed is known for its calming and sedative properties and is often used in traditional Chinese medicine to treat sleep problems and anxiety.
In traditional Chinese medicine, it is believed that Suanzaoren can help relax the mind, promote sleep, and reduce irritability. It is frequently used in combination with other herbs and ingredients to formulate natural sleep remedies and alleviate nervousness.
A systematic search was conducted on PubMed, Cochrane Library, and EMBASE from the beginning to October 5, 2021, to identify randomized studies on Suanzaoren.
The included studies were randomized trials comparing Suanzaoren with placebo, drugs, cognitive-behavioral therapy (CBT), or usual care to improve sleep outcomes in cancer and non-cancer patients with insomnia or sleep disorders.
A risk of bias analysis was performed following Cochrane guidelines, and studies with similar comparators were grouped using fixed-effects and random-effects models based on heterogeneity.
The participants with insomnia were from nine studies, with a sample size of 785 participants, or sleep disorders from 9 studies with a sample size of 120 participants.
Compared to placebo, Suanzaoren led to significant improvements in subjective sleep quality in participants with insomnia and in patients with combined sleep disorders (mean standard difference -0.58, 95% CI -1.04, -0.11; P < .01); compared to benzodiazepines or CBT, Suanzaoren was associated with a significant reduction in insomnia severity (mean difference -2.68 points, 95% CI -5.50, -0.22; P = .03) at 4 weeks in the general population and in cancer patients.
The long-term effects of Suanzaoren varied among the studies. Suanzaoren did not increase the incidence of major adverse events. Placebo-controlled studies had a low risk of bias.
In conclusion, Suanzaoren is associated with short-term improvements in patient-reported sleep quality in individuals with insomnia or sleep disorders. Due to the small sample sizes and variable study quality, the clinical benefits and harms of Suanzaoren, particularly in the long term, should be further evaluated in a sufficiently powered randomized trial.
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Source: Yang M, Wang H, Zhang YL, Zhang F, Li X, Kim SD, Chen Y, Chen J, Chimonas S, Korenstein D, Mao JJ. The Herbal Medicine Suanzaoren (Ziziphi Spinosae Semen) for Sleep Quality Improvements: A Systematic Review and Meta-analysis. Integr Cancer Ther. 2023 Jan-Dec;22:15347354231162080. doi: 10.1177/15347354231162080. PMID: 37014010; PMCID: PMC10084578.
