A short-term mindfulness and auricular acupressure program for preoperative sleep fragmentation in patients with...

To evaluate the association of a short-term mindfulness-based stress reduction program combined with auricular acupressure with preoperative sleep fragmentation, anxiety, pain, and physiological stress responses in patients with spinal metastases using a retrospective quasi-experimental before-and-after design.

This retrospective quasi-experimental before-and-after cohort study included patients with spinal metastases who underwent surgical treatment at Weifang People's Hospital between January 2023 and January 2025. Patients admitted before implementation of the program were assigned to the control cohort, whereas patients admitted after program implementation were assigned to the intervention cohort. 92 patients were assigned to either the intervention group (n = 46), who received mindfulness-based stress reduction and auricular acupressure, or the control group (n = 46), who received standard care only. The intervention group received a one-week preoperative program combining short-term MBSR and auricular acupressure, delivered in two phases: outpatient instruction and home-based self-practice. A WeChat-based mini-program was used to deliver standardized mindfulness audio guidance and provide routine reminders during the intervention period. Auricular acupressure points were selected in accordance with national standards. The control group received standard perioperative care and educational materials, without any psychological or auricular interventions. Both groups were managed under the same pharmacological protocol. Outcome measures included subjective sleep quality (Athens Insomnia Scale, AIS), anxiety (Self-Rating Anxiety Scale, SAS), pain (Visual Analogue Scale, VAS), salivary cortisol levels, and objective sleep parameters-wake after sleep onset (WASO) and the number of nighttime awakenings-measured via a wearable device. Data were collected at baseline and prespecified time points before surgery.

The intervention group showed more favorable changes across several domains compared to the control group. Anxiety levels were significantly lower (SAS: 52.28 ± 2.75 vs. 56.20 ± 3.06, P < 0.001), as were pain scores (VAS: 4.20 ± 0.86 vs. 6.09 ± 1.35 preoperatively; 4.02 ± 0.88 vs. 5.52 ± 1.07 on admission; both P < 0.001) and salivary cortisol concentrations (580.24 ± 10.67 ng/dL vs. 609.43 ± 22.56 ng/dL, P < 0.001). Objective sleep indicators also favored the intervention, with reduced average WASO (30.00 ± 1.87 min vs. 39.87 ± 1.77 min, P < 0.001) and fewer nighttime awakenings (2.54 ± 0.21 vs. 3.55 ± 0.22, P < 0.001). These findings suggest that short-term MBSR combined with auricular acupressure may help improve sleep continuity indicators, reduce anxiety and pain, and modulate physiological stress responses in this patient population.

The intervention was associated with improvements in anxiety, pain, salivary cortisol, and objective sleep continuity indicators, including reduced WASO and fewer nighttime awakenings. Although AIS scores were lower in the intervention group at an intermediate preoperative time point, the association between the intervention and AIS score change was attenuated after adjustment for covariates. Therefore, subjective insomnia outcomes should be interpreted cautiously.