The efficacy and safety of multiple acupuncture therapies in primary insomnia: A Bayesian network meta-analysis

Acupuncture (AT) therapy is an effective treatment for primary insomnia. However, no comprehensive study has compared and evaluated the efficacy and safety of multiple AT therapies and hypnotics.

We searched eight databases from inception to July 2024 for randomized controlled trials (RCTs) of AT treatment for primary insomnia, including PubMed, Web of Science, Embase, Cochrane Library, Wanfang database, China National Knowledge Infrastructure database, and VIP Chinese Science and Technique Journals database. After screening, the Pittsburgh Sleep Quality Index (PSQI) score and clinical effectiveness rate were extracted from the included RCTs as outcome measures. We performed network meta-analysis using the Stata and R software.

Sixty-four RCTs involving 4443 patients were included in this study. Multiple AT therapies had better efficacy in improving PSQI scores than hypnotics, with AT combined with moxibustion (MOX) and AT combined with auriculotherapy (AU) as the best interventions. Regarding clinical effectiveness, acupoint catgut embedding (ACE) had the greatest potential of being the best intervention, and no serious adverse events related to AT therapies were observed in any of the studies.

This review suggests that most AT therapies improve sleep indicators and have good clinical efficacy compared to hypnotics, especially AT combined with AU, AT combined with MOX, and ACE. The safety of AT therapies is reliable; however, the overall quality of the included trials was low, and higher-quality RCTs are required to provide sufficient evidence.

PROSPERO, CRD42017067402.