Traditional needle acupuncture treatment for insomnia: a systematic review of randomized controlled trials.
OBJECTIVE
Previous reviews regarding traditional needle acupuncture (TNA) treatment for insomnia were limited to English scientific literature. A comprehensive review including Chinese and English literature has therefore been conducted to examine the efficacy of TNA for insomnia.


METHODS
We performed systematic review of randomized controlled trials (RCTs) of TNA as intervention for insomnia against placebo, Western medication, and non-treated controls. The methodological quality of the studies was assessed by the modified Jadad score and the acupuncture procedure was appraised by the STRICTA criteria.


RESULTS
Twenty RCTs were identified for detailed analysis. Majority of the RCTs concluded that TNA was significantly more effective than benzodiazepines for treating insomnia, with mean effective rates for acupuncture and benzodiazepines being 91% and 75%, respectively. In two more appropriately conducted trials, TNA appeared to be more efficacious in improving sleep than sleep hygiene counseling and sham acupuncture. Standardized and individualized acupuncture had similar effective rates. Despite these positive outcomes, there were methodological shortcomings in the studies reviewed, including imprecise diagnostic procedure, problems with randomization, blinding issues, and insufficient safety data. Hence, the superior efficacy of TNA over other treatments could not be ascertained.


CONCLUSIONS
Since the majority of evidence regarding TNA for insomnia is based on studies with poor-quality research designs, the data, while somewhat promising, do not allow a clear conclusion on the benefits of TNA for insomnia. Moreover, the results support the need for large scale placebo-controlled double-blinded trials.
Yeung
Wing-Fai
WF
Department of Psychiatry, University of Hong Kong, Pokfulam Road, Hong Kong SAR, China.
Chung
Ka-Fai
KF
Leung
Yau-Kwong
YK
Zhang
Shi-Ping
SP
Law
Andrew C K
AC
D015670:Acupuncture Therapy / Q000295:instrumentation*; D006801:Humans; D009339:Needles; D016032:Randomized Controlled Trials as Topic; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*