A systematic review of acupuncture for sleep quality in people with insomnia.
OBJECTIVE
Acupuncture is widely used in Asia and increasingly in Western countries. We performed a systematic review and meta-analysis to examine the effects of acupuncture for insomnia.


METHODS
We identified randomized controlled trials from English and Chinese databases. Data were extracted using a predefined form and analysed using RevMan 5.2. We included studies that compared acupuncture to sham/placebo, standard pharmacotherapy or cognitive behavioral therapy. Risk of bias was assessed using the Cochrane risk of bias tool. The primary outcome was sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI).


RESULTS
A total of 30 studies involving 2363 participants were included. Acupuncture point combinations included the use of at least one of the recommended points for insomnia, HT7, GV20, SP6. Pharmacotherapy control was used in 27 studies and sham/placebo in three studies. Cognitive behavioral therapy was not used in any of the studies. Pharmacotherapies in all studies were benzodiazepine receptor agonists, except for one that used an antidepressant. Acupuncture was superior to sham/placebo in terms of PSQI (MD -0.79, 95% CI -1.38, -0.19, I(2)=49%). Acupuncture was also more effective than pharmacotherapy (MD -2.76, 95% CI -3.67, -1.85, I(2)=94%). Most studies were at risk of bias. Some mild adverse events were reported but they were not causally related to the acupuncture treatments.


CONCLUSIONS
Acupuncture compared to sham/placebo and pharmacotherapy showed statistically significant results. However, the evidence is limited by bias in the included studies and heterogeneity. Well-designed studies are needed to confirm the results identified in this review.
School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.
Johannah Linda
JL
Shergis
School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia; Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Science, Guangzhou, China; The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Xiaojia
X
Ni
School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia.
Melinda L
ML
Jackson
School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.
Anthony Lin
AL
Zhang
Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Science, Guangzhou, China; The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Xinfeng
X
Guo
Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Science, Guangzhou, China; The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Yan
Y
Li
Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Science, Guangzhou, China; The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China. Electronic address: luchuanjian888@vip.sina.com.
Chuanjian
C
Lu
School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia; Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Science, Guangzhou, China; The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China. Electronic address: charlie.xue@rmit.edu.au.
Charlie Changli
CC
Xue
D015670:Acupuncture Therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
Acupuncture; Insomnia; Meta-analysis; Randomized controlled trial; Systematic review