Effectiveness of different acupuncture therapies for primary insomnia

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According to the results of a study published in sleep medicine.

Insomnia is one of the most common health problems, affecting up to 50% of the general population. Primary insomnia presents as a subjective difficulty in initiating or maintaining sleep, lasting at least one month. Some evidence suggests that acupuncture may improve symptoms of insomnia.

Researchers in the current study at Lanzhou University in China sought to review the body of evidence on acupuncture in insomnia by searching publication databases for relevant randomized controlled trials up to March 2021.


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A total of 57 studies including 4678 participants were included in this analysis. The study population ranged in age from 20.99 to 75.67 years and the average proportion of women among the cohorts was 36.32%.

Active interventions were fire needle (FN), balance acupuncture, electroacupuncture, auricular acupressure (AP), manual acupuncture (MA), catgut integration of acupuncture points (ACE), acupuncture point application, plum blossom needle (PBM), head penetration needling (HPN), and intradermal needle techniques. Control treatments were sham acupuncture and usual treatment.

In the network meta-analysis, no comparison produced high-certainty evidence.

Comparisons that produced moderate-certainty evidence found that, compared with usual care, ACE, ACE + MA, MA, AP + MA, PNH and PBM + MA improved overall efficacy from 2.31 to 2.83 points and reduced Pittsburgh Sleep Quality Index (PSQI) scores. from 4.13 to 7.22 points. Compared to the sham treatment, MA improved the efficacy by 1.73 points and ACE, ACE+MA, ACE+AP, FN and PNH reduced the PSQI from 3.58 to 6.16 points. In active treatments, ACE+MA improved efficacy by 1.12 points compared to MA alone.

All other comparisons were of low or very low quality.

Overall, compared to usual care, the most effective treatment was found to be ACE followed by FN, PNH, ACE+MA, PBN+MA, ACE+AP, and MA. All other active interventions were associated with low certainty of evidence.

Adverse events were reported by 22 trials, including 3382 participants, of whom 1179 received usual care or sham treatment. People reported hematoma (n=44 vs 11), pain (n=36 vs 4), headache (n=17 vs 27), bleeding (n=24 vs 3), dizziness (n = 8 vs 6) and blood stasis (n = 10 vs 1) among active intervention and control cohorts, respectively. No adverse events were reported following AP or ACE interventions.

Limitations of the study included the lack of high quality evidence as well as the lack of direct comparisons between active treatment strategies.

“With moderate to low-certainty evidence, several acupuncture therapies have shown impressive improvement in insomnia, particularly ACE, AP+MA, and EA+APA,” the researchers said. However, the quality of the evidence was low. More high quality studies are needed to confirm the effectiveness of using acupuncture to treat insomnia.

Reference

Lu Y, Zhu H, Wang Q, et al. Comparative efficacy of several acupuncture therapies for primary insomnia: a systematic review and network meta-analysis of a randomized trial. Medical Sleep. 2022;93:39-48. doi:10.1016/j.sleep.2022.03.012

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