😴益生菌🕵️‍♀️能改善睡眠嗎？😴睡眠の質がよくなる？😴sleep well?😴잠이 더 잘 자는가?🕵️‍♀️

在最近發表在《微生物學前沿》雜誌上的一篇評論文章中，研究人員總結了目前關於益生菌補充劑對失眠症患者睡眠品質和情緒的影響的科學知識。

根據隨機對照試驗 (RCT) 的證據，他們得出結論，益生菌幹預可以顯著改善睡眠品質（具有中等確定性的證據）並減輕憂鬱症狀（儘管確定性非常低並且可能存在憂鬱症結果的出版偏見的風險），而不會增加不良事件的風險。然而，這些結果高度異質，證據的整體強度因結果而異。

🥹失眠負擔沉重🥹

🙁腸腦高速公路很重要：益生菌可能透過腸道腦通訊網路（而不僅僅是神經傳導物質）來緩解發炎和平衡壓力荷爾蒙（如皮質醇），從而改善睡眠。

🙁失眠是一種普遍的睡眠障礙，其特徵是入睡困難、難以保持睡眠，或睡眠品質不佳，並且經常持續至少三個月。失眠症可以單獨發生（原發性失眠），也可以因為其他情況而發生（繼發性失眠症），但兩者通常很難區分。

這種疾病與大腦活動增強和生理失衡有關，例如過度活躍的壓力反應和神經傳導物質功能失調，這些都會阻礙正常睡眠。

🙁失眠症在成年人一生中的某個階段會影響 30% 至 50% 的成年人，並可能導致嚴重的健康風險，包括增加自殺風險、心血管疾病、糖尿病、疲勞和注意力不集中。

儘管可以採用認知行為療法和睡眠藥物等治療方法，但它們具有成本高或潛在依賴性等缺點，凸顯了對更方便、更安全的替代方法的需求。

🙁新興研究表明，腸道菌叢可能會影響睡眠質量，益生菌可以透過恢復腸道平衡和調節與睡眠相關的神經傳導物質來提供幫助。

關於評論

不僅僅是 GABA 和血清素：研究表明，特定菌株（如短雙歧桿菌 CCFM1025）可能透過影響調節身體壓力反應系統的其他化合物（如血清大豆黃酮）發揮作用。

這項統合分析旨在評估益生菌對改善失眠症患者睡眠和情緒的有效性。研究人員對八個資料庫進行了系統性搜索，以確定評估益生菌幹預治療失眠的 RCT，其中包括審查和薈萃分析中的六項研究。

😇納入的 RCT 發表於 2018 年至 2024 年之間，涉及 424 名中國、日本、韓國和澳洲的失眠患者。約29.5%的參與者為男性，平均年齡為39.3歲。其中，223 人服用益生菌，201 人屬於對照組。所使用的益生菌菌株包括清酒乳桿菌B2-16、布拉氏酵母菌、青春雙歧桿菌SBT2786、嗜酸乳桿菌DDS-1、多菌株配方和雙歧桿菌活性菌膠囊。 Cochrane 偏倚風險工具顯示，四項研究的偏倚風險較低，而兩項研究的偏倚風險較高，主要是由於隨機化和分配程序不明確。

對睡眠和情緒的影響

😇🤩所有六項研究都報告了匹茲堡睡眠品質指數 (PSQI) 的變化。益生菌補充劑可顯著降低 PSQI 評分，顯示睡眠品質有臨床意義的改善。此證據的確定性被評為中等。然而，觀察到了相當大的異質性，顯示研究之間存在差異。

亞組分析發現，睡眠品質的正面影響主要體現在中國和澳洲的參與者身上，而日本和韓國的研究並未發現顯著改善。

😇🤩🤩三項研究共涉及 226 名患者，探討了他們的總睡眠時間。益生菌組的總睡眠時間沒有顯著改善，且此結果的證據確定性被評為非常低。這意味著，雖然人們感覺睡眠品質有所改善，但沒有可靠的證據表明益生菌增加了實際的睡眠時間。

😇🤩地點影響睡眠結果：雖然益生菌整體上有助於提高睡眠質量，但分析發現，與日本或韓國相比，在中國和澳洲進行的研究發現，睡眠品質的改善更為明顯。

😇🤩睡眠效率定義為在床上睡眠時間的百分比，在兩項涉及 166 名患者的研究中被作為一項結果，沒有觀察到顯著變化。睡眠效率的證據品質被評為中等。我們發現入睡時間略有減少，但幅度接近顯著。但此結果的臨床意義有限，證據的確定性為中等至低。

😇🤩兩項涉及 140 名患者的研究將憂鬱症症狀作為結果。在接受益生菌補充劑的干預組中，憂鬱評分在臨床和統計學上均顯著降低，這表明它可能對心理健康有益。然而，該證據的確定性被評為非常低，並且不能排除出版偏見，因此應謹慎解釋這些結果。

雖然兩項研究都報告了不良事件，但對照組和益生菌組之間的整體不良事件沒有顯著差異，這表明益生菌具有很高的耐受性。益生菌組的不良事件發生率在數值上較高，但差異並不具統計意義。大多數不良事件都是輕微的並且可自行痊癒。

😀結論

😀😎效率和持續時間沒有變化：儘管益生菌可以幫助人們感覺到睡眠品質有所改善，但在測量這些的研究中，益生菌實際上並沒有增加在床上睡眠的時間百分比（睡眠效率）或總睡眠時間。

😀😎😎值得注意的是，雖然益生菌似乎可以改善主觀睡眠質量，但總睡眠時間、睡眠效率和睡眠潛伏期等客觀睡眠指標並沒有顯示出明顯或可靠的改善。這意味著整體益處可能更多地在於感知到的睡眠質量，而不是睡眠時間或效率的可測量變化。

😀😎😎😎這項薈萃分析首次系統性地評估益生菌對失眠的影響。研究結果表明，益生菌補充劑可以顯著改善睡眠品質（該結果具有中等確定性）並減輕失眠患者的憂鬱症狀，但憂鬱症的證據非常不確定，並且可能受到偏見的影響。對總睡眠時間、睡眠效率或睡眠潛伏期沒有明顯影響，這些結果的確定性低至非常低。

😀😎從生物學角度來看，益生菌可能有助於透過腸腦軸調節睡眠和情緒，影響神經傳導物質（如 GABA 和血清素）、睡眠相關激素（如褪黑激素）並減少發炎。這些機制可以解釋它們對睡眠和心理健康的益處。

😀重要的是，益生菌被發現是安全且耐受性良好的，據報道僅有輕微的暫時副作用。

儘管結果令人鼓舞，但該評論仍存在一些局限性。納入的研究數量很少，大多數益生菌菌株、劑量和治療時間都有差異。一些研究缺乏盲法或適當的隨機化，而且很少有研究涉及老年人，這限制了它們對這一人群的適用性。

😀😎總之，益生菌似乎是支持失眠患者睡眠和情緒的安全自然的選擇。然而，讀者應該注意，雖然一些好處得到了中等確定性證據（主觀睡眠品質）的支持，但其他影響（憂鬱症狀、客觀睡眠測量）則不太確定。需要更大規模、更高品質的研究來證實這些結果並確定最佳的益生菌類型和治療策略。

In a recent review article published in the journal Frontiers in Microbiology, researchers summarized the current scientific knowledge on the effects of probiotic supplementation on sleep quality and mood in individuals with insomnia.

Based on evidence from randomized controlled trials (RCTs), they concluded that probiotic interventions may significantly improve sleep quality (with moderate certainty of evidence) and reduce symptoms of depression (although with very low certainty and a possible risk of publication bias for depression outcomes), without increasing the risk of adverse events. However, these results were highly heterogeneous, and the overall strength of evidence varied between outcomes.

A high burden of insomnia

The gut-brain highway matters: Probiotics likely improve sleep partly by calming inflammation and balancing stress hormones (like cortisol) through the gut-brain communication network, not just neurotransmitters.

Insomnia is a widespread sleep disorder characterized by difficulty falling or staying asleep, or experiencing non-restorative sleep, that occurs frequently over at least three months. It can occur on its own (primary insomnia) or due to other conditions (secondary insomnia), though the two are often difficult to distinguish.

The disorder is linked to heightened brain activity and physiological imbalances, such as overactive stress responses and disruptions in neurotransmitter function, that hinder normal sleep.

Affecting 30–50% of adults at some point in their lifetimes, insomnia is associated with serious health risks, including increased suicide risk, cardiovascular disease, diabetes, fatigue, and poor concentration.

Although treatments like cognitive-behavioral therapy and sleep medications are available, they have drawbacks like high cost or potential dependency, highlighting the need for accessible and safer alternatives.

Emerging research suggests that gut microbiota may influence sleep quality, and probiotics could help by restoring gut balance and regulating sleep-related neurotransmitters.

About the review

Not just GABA and serotonin: Research suggests specific strains like Bifidobacterium breve CCFM1025 might work by influencing other compounds (like serum daidzein) that regulate the body's stress-response system.

This meta-analysis was designed to evaluate the effectiveness of probiotics in improving sleep and mood among individuals with insomnia. Researchers conducted a systematic search of eight databases to identify RCTs that assessed probiotic interventions for insomnia treatment, including six studies in the review and meta-analysis.

The included RCTs were published between 2018 and 2024, involving 424 patients with insomnia across China, Japan, South Korea, and Australia. Approximately 29.5% of the participants were male, with an average age of 39.3 years. Of these, 223 received probiotics, while 201 were in control groups. The probiotic strains used included Lactobacillus sakei B2-16, Saccharomyces boulardii, Bifidobacterium adolescentis SBT2786, Lactobacillus acidophilus DDS-1, multi-strain formulations, and Bifidobacterium active bacteria capsules. The Cochrane Risk of Bias tool revealed that four studies had a low risk of bias, while two showed high risk, mainly due to unclear randomization and allocation procedures.

Impacts on sleep and mood

All six studies reported changes in the Pittsburgh Sleep Quality Index (PSQI). Probiotic supplementation resulted in a significant reduction in PSQI scores, indicating a clinically meaningful improvement in sleep quality. The certainty of this evidence was rated as moderate. However, substantial heterogeneity was observed, suggesting variability across studies.

Subgroup analyses found that positive effects on sleep quality were observed primarily in participants from China and Australia, while no significant improvements were noted in studies from Japan or South Korea.

Total time spent sleeping was explored in three studies involving 226 patients. No significant improvement was found in the probiotic group for total sleep time, and the certainty of evidence for this outcome was rated very low. This means that while people felt their sleep quality improved, there was no reliable evidence that probiotics increased the actual hours of sleep.

Location influenced sleep results: While probiotics helped sleep quality overall, the analysis found the improvement was much clearer in studies done in China and Australia compared to Japan or South Korea.

Sleep efficiency, defined as the percentage of time that is spent asleep while in bed, was included as an outcome in two studies involving 166 patients, with no significant changes observed. The certainty of evidence for sleep efficiency was rated as moderate.

Sleep latency, defined as the time it takes for individuals to transition from being fully awake to falling asleep, was included as an outcome in three studies involving 226 patients. A modest but borderline significant reduction in the time to fall asleep was observed. However, this result was of limited clinical significance, and the certainty of the evidence was moderate to low.

Two studies involving 140 patients included depressive symptoms as an outcome. A clinically and statistically significant reduction in depression scores was observed in the intervention group that received probiotic supplementation, suggesting potential mental health benefits. However, the certainty of this evidence was rated as very low, and publication bias could not be ruled out, so these results should be interpreted with caution.

While adverse events were reported in two studies, no significant differences in total adverse events were observed between the control and probiotic groups, indicating that probiotics show a high level of tolerability. The rate of adverse events was numerically higher in the probiotic group, but the difference was not statistically significant. Most adverse events were mild and self-limiting.

Conclusions

Efficiency and duration didn't budge: Despite helping people feel their sleep quality improved, the probiotics didn't actually increase the percentage of time spent asleep while in bed (sleep efficiency) or the total hours slept in the studies measuring these.

It is important to note that while probiotics appeared to improve subjective sleep quality, objective sleep measures such as total sleep time, sleep efficiency, and sleep latency did not show clear or reliable improvements. This means the overall benefit may be more about perceived sleep quality than measurable changes in sleep duration or efficiency.

This meta-analysis is the first to systematically evaluate the effect of probiotics on insomnia. The findings show that probiotic supplements can significantly improve sleep quality (with moderate certainty for this outcome) and reduce symptoms of depression in people with insomnia, but the evidence for depression is very uncertain and potentially subject to bias. There was no clear impact on total sleep time, sleep efficiency, or sleep latency, with low to very low certainty for these outcomes.

Biologically, probiotics may help regulate sleep and mood through the gut-brain axis, influencing neurotransmitters (like GABA and serotonin), sleep-related hormones (like melatonin), and reducing inflammation. These mechanisms could explain their benefits on both sleep and mental health.

Importantly, probiotics were found to be safe and well-tolerated, with only mild, temporary side effects reported.

Despite promising results, the review has several limitations. The number of included studies was small, and most had variations in probiotic strains, doses, and treatment lengths. Some studies lacked blinding or proper randomization, and few included older adults, which limited their applicability to this population.

In conclusion, probiotics appear to be a safe and natural option for supporting sleep and mood in individuals with insomnia. However, readers should note that while some benefits are supported by moderate-certainty evidence (subjective sleep quality), other effects (depression symptoms, objective sleep measures) are much less certain. Larger, high-quality studies are needed to confirm these results and identify the best probiotic types and treatment strategies.

https://www.news-medical.net/news/20250720/Can-probiotics-help-you-sleep-better.aspx