title: Auricular acupuncture with seed or pellet attachments for primary insomnia: a systematic review and meta-analysis.
abstract: BACKGROUND
  Primary insomnia is a common health issue in the modern world. We conducted a systematic review of the auricular therapy, aiming to evaluate whether there are advantages of auricular acupuncture with seed or pellet attachments for the treatment of primary insomnia.
  
  
  METHODS
  A search of relevant literatures was performed on major medical databases, including Medline, Embase, CENTRAL, CBM, CNKI, VIP, Wanfang Data and so on. Risk of bias evaluation, meta-analysis, sensitivity analysis and evidence rating of all extracted information were conducted also.
  
  
  RESULTS
  A total of 1381 records were identified, with 15 studies deemed eligible for the present review. Meta-analyses were conducted in two comparisons separately: participants received auricular acupuncture were more likely to make an improvement in clinical effective rate (RR = 1.40, 95% CI 1.07 to 1.83), sleep duration (MD = 56.46, 95% CI 45.61 to 67.31), sleep efficiency(MD = 12.86, 95% CI 9.67 to 16.06), global score on PSQI (MD = -3.41, 95% CI -3.93 to -2.89), number of awakenings( MD = -3.27, 95% CI -6.30 to -0.25) and sleep onset latency(MD = -10.35, 95% CI -14.37 to -6.33) when compared to sham auricular acupuncture or placebo; while in auricular acupuncture VS medications comparison, a better effective rate (RR = 1.24, 95% CI 1.15 to 1.34), better sleep efficiency(MD = 21.44, 95% CI 16.30 to 26.58), lower PSQI score (MD = -3.62, 95% CI -4.59 to -2.65) and less adverse effect (RR = 0.11, 95% CI 0.04 to 0.26) can be seen also in auricular acupuncture group. Although these results suggested benefits of auricular acupuncture, the overall quality of evidence rated by the GRADE system was low.
  
  
  CONCLUSIONS
  Statistical analyses of the outcomes revealed a positive effect of auricular acupuncture for primary insomnia. Nonetheless, considering the poor methodological quality, insufficient sample size and possible publication bias, current evidence is not yet adequate to provide a strong support for the use of auricular acupuncture in the treatment of primary insomnia. More strictly designed clinical studies will be needed to obtain a more explicit conclusion.
authors.affiliation: Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, No.37, Shierqiao Road, Jin Niu District, Chengdu, Sichuan, 610075, China. lanyingtcm@163.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lan
authors.affiliation: Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, No.37, Shierqiao Road, Jin Niu District, Chengdu, Sichuan, 610075, China. wuxi403@126.com.
authors.forename: Xi
authors.initials: X
authors.lastname: Wu
authors.affiliation: Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, No.37, Shierqiao Road, Jin Niu District, Chengdu, Sichuan, 610075, China. tanhj0607@gmail.com.
authors.forename: Hui-Juan
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, No.37, Shierqiao Road, Jin Niu District, Chengdu, Sichuan, 610075, China. wunanwy@126.com.
authors.forename: Nan
authors.initials: N
authors.lastname: Wu
authors.affiliation: VIP Ward of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No.314, An Shanxi Road, Nankai District, Tianjin, 300073, China. 508959904@qq.com.
authors.forename: Jing-Jing
authors.initials: JJ
authors.lastname: Xing
authors.affiliation: Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, No.37, Shierqiao Road, Jin Niu District, Chengdu, Sichuan, 610075, China. emvie91@gmail.com.
authors.forename: Fu-Sheng
authors.initials: FS
authors.lastname: Wu
authors.affiliation: Sichuan 2nd Hospital of Traditional Chinese Medicine, No.20, Sidao Street, Qing Yang District, Chengdu, Sichuan, 610031, China. 15156991@qq.com.
authors.forename: Lei-Xiao
authors.initials: LX
authors.lastname: Zhang
authors.affiliation: Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, No.37, Shierqiao Road, Jin Niu District, Chengdu, Sichuan, 610075, China. acuresearch@126.com.
authors.forename: Fan-Rong
authors.initials: FR
authors.lastname: Liang
mesh_terms: D020831:Acupuncture, Ear / Q000379:methods*; D004343:Drug Implants; D006801:Humans; D012639:Seeds; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*
chemical_list: D004343:Drug Implants