Effectiveness and Safety of Acupuncture and Related Therapies for Poststroke Insomnia: A Network Meta-Analysis
-
Xinwang Chen
,
Run Zhang
,
Yajing Guo
,
Jing Wen
,
Yuzhu Wu
,
Wenming Chu
,
Yiming Wu
Abstract
Background: Poststroke insomnia (PSI) is a frequent complication for stroke patients. Acupuncture and related therapies demonstrate efficacy in PSI management. Despite their many types, the optimal strategy remains unclear. This network meta-analysis (NMA) compared the effectiveness of various acupuncture and related therapies.
Methods: Seven databases were searched up to 1st February 2024. The primary outcome was a reduction in the Pittsburgh Sleep Quality Index (PSQI) score. The secondary outcomes were the response rate and adverse events. The treatment ranking probabilities were calculated using the surface under the cumulative ranking curve (SUCRA).
Results: In total, 59 randomized controlled trials (RCTs) involving 4415 participants were included. Electroacupuncture (EA) provided the best result for PSQI reduction (SUCRA = 0.79), followed by warm acupuncture combined with auricular acupoint stimulation (WA+AAS) (0.68) and manual acupuncture combined with auricular acupoint stimulation (MA+AAS) (0.63). For the response rate, manual acupuncture combined with acupoint catgut embedding (MA+ACE) ranked highest (0.86), followed by EA (0.850) and manual acupuncture combined with moxibustion (MA+MOX) (0.83). A total of 96 adverse events were reported: 7 related to acupuncture interventions and 89 to conventional medicine (CM).
Conclusion: Acupuncture and related therapies are effective and safe for PSI treatment. Among them, EA and MA+ACE are the most promising interventions for improving sleep quality poststroke.
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3. Pajediene E, Pajeda A, Urnieziute G, et al (2020). Subjective and objective features of sleep disorders in patients with acute ischemic or hemorrhagic stroke: It is not only sleep apnoea which is im-portant. Med Hypotheses, 136:109512.
4. Baylan S, Griffiths S, Grant N, et al (2020). Incidence and prevalence of post-stroke insomnia: A systematic review and meta-analysis. Sleep Med Rev, 49:101222.
5. Matas A, Amaral L, Patto AV (2022). Is post-ischemic stroke insomnia related to a negative functional and cognitive out-come?. Sleep Med, 94:1-7.
6. Duss SB, Bernasconi C, Steck A, et al (2023). Multiple sleep-wake disturbances after stroke predict an increased risk of car-dio-cerebrovascular events or death: A prospective cohort study. Eur J Neurol, 30 (6):1696-1705.
7. Fan M, Sun D, Zhou T, et al (2020). Sleep patterns, genetic susceptibility, and inci-dent cardiovascular disease: a prospec-tive study of 385 292 UK biobank partic-ipants. Eur Heart J, 41 (11):1182-1189.
8. Bartoli F, Clerici M, Crocamo C, et al (2018). Insomnia as an additional clini-cal correlate of suicidal ideation after stroke. Gen Hosp Psychiatry, 51:126-127.
9. Gorgoni M, D'Atri A, Lauri G, et al (2013). Is sleep essential for neural plasticity in humans, and how does it affect motor and cognitive recovery? Neural Plast, 2013:103949.
10. Su Q, Zou D, Gai N, et al (2022). Tradi-tional Chinese Medicine for Post-stroke Sleep Disorders: The Evidence Mapping of Clinical Studies. Front Psychiatry, 13:865630.
11. Goldschen-Ohm MP (2022). Benzodiaze-pine Modulation of GABAA Receptors: A Mechanistic Perspective. Biomolecules, 12 (12):1784.
12. Topcuoglu MA, Saka E, Silverman SB, et al (2017). Recrudescence of Deficits After Stroke: Clinical and Imaging Phenotype, Triggers, and Risk Factors. JAMA Neurol, 74 (9):1048-1055.
13. Yue JL, Chang XW, Zheng JW, et al (2023). Efficacy and tolerability of pharmaco-logical treatments for insomnia in adults: A systematic review and network meta-analysis. Sleep Med Rev, 68:101746.
14. Ye Z, Lai H, Ning J, et al (2024). Traditional Chinese medicine for insomnia: Rec-ommendation mapping of the global clinical guidelines. J Ethnopharmacol, 322:117601.
15. Birch S, Lee MS, Alraek T, et al (2018). Overview of treatment guidelines and clinical practical guidelines that rec-ommend the use of acupuncture: A bib-liometric analysis. J Altern Complement Med, 24 (8):752–769.
16. Qiu X, Han NS, Yao JX, et al (2021). Acu-puncture Reduced the Risk for Insomnia in Stroke Patients: A Propensity-Score Matched Cohort Study. Front Aging Neu-rosci, 13:698988.
17. Yang J (2021). Acupuncture treatment for post-stroke insomnia: A systematic re-view and meta-analysis of randomized controlled trials. Complement Ther Clin Pract, 44:101396.
18. Hutton B, Salanti G, Caldwell DM, et al (2015). The PRISMA extension statement for reporting of systematic reviews in-corporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med, 162 (11):777-784.
19. Shea BJ, Reeves BC, Wells G, et al (2017). AMSTAR 2: a critical appraisal tool for systematic reviews that include random-ised or non-randomised studies of healthcare interventions, or both. BMJ, 358:j4008.
20. Sateia MJ (2014). International classifica-tion of sleep disorders-third edition: highlights and modifications. Chest, 146 (5):1387-1394.
21. Chen YF (2002). Chinese classification of mental disorders (CCMD-3): towards in-tegration in international classification. Psychopathology, 35 (2-3):171-175.
22. MacPherson H, Altman DG, Ham-merschlag R, et al (2010). Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. J Altern Complement Med, 16 (10):ST1-14.
23. Sterne JAC, Savović J, Page MJ, et al (2019). RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 366:l4898.
24. Higgins JP, Thompson SG, Deeks JJ, et al (2003). Measuring inconsistency in meta-analyses. BMJ, 327 (7414):557-560.
25. Jansen JP, Crawford B, Bergman G, et al (2008). Bayesian meta-analysis of multi-ple treatment comparisons: an introduc-tion to mixed treatment comparisons. Value Health, 11 (5):956-964.
26. Baek E, Ferron JM (2021). Bayesian Analy-sis for Multiple-baseline Studies Where the Variance Differs across Cases in OpenBUGS. Dev Neurorehabil, 24 (2):130-143.
27. Chaimani A, Higgins JP, Mavridis D, et al (2013). Graphical tools for network me-ta-analysis in STATA. PLoS One, 8 (10):e76654.
28. Liu T, Li W, Zhang W, et al (2023). Effect of warm needling at Sanyinjiao com-bined with auricular acupressure on in-somnia in elderly patients after stroke. Chinese Journal of Gerontology, 43 (4):858-861.
29. Zhang YY, Shi ZX, Lu YY (2023). Clinical observation of acupuncture combined with auricular acupressure for post-stroke insomnia and its effect on cere-bral blood flow velocity. Shanghai Journal of Acupuncture, 42 (4):336-341.
30. Zhang HJ, Yue LJ, Ma Q, et al (2022). Clini-cal observation of chronotherapy-based auricular acupressure for insomnia after ischemic stroke. Chinese Journal of Tradi-tional Chinese Medicine, 37 (2):1198-1200.
31. Liu JH, Huang HY, Lü SH, et al (2022). Therapeutic effect of Xingnao Kaiqiao combined with Wumen Shibian acu-puncture on insomnia after ischemic stroke and its influence on cerebrovas-cular reactivity. Shaanxi Journal of Tradi-tional Chinese Medicine, 43 (1):121-123.
32. Liu XH, Zhou X, Wang Y, et al (2022). Clin-ical observation on acupuncture at Zhaohai and Shenmai combined with auricular acupressure for post-stroke in-somnia. Sichuan Traditional Chinese Medi-cine, 40 (10):194-197.
33. Cao Y, Yan YJ, Xu JY, et al (2022). Acu-puncture for insomnia after ischemic stroke: an assessor-participant blinded, randomized controlled trial. Acupunct Med, 40 (5):443-452.
34. Li CY, Jin LT, Ma YQ, et al (2022). Clinical study on Xin-Nao Gongzhi acupuncture for sleep rhythm disorders after ischem-ic stroke. Information on Traditional Chinese Medicine, 39 (1):60–64.
35. Yu XJ (2021). Clinical efficacy of acupunc-ture at Siguan combined with auricular acupressure for post-stroke insomnia. Chinese General Practice, 24 (S1):175-176.
36. Xing Y, Kong LL, Li Y, et al (2021). Effect of acupuncture at Wuzangshu combined with moxibustion at Yongquan on serum 5-HT and dopamine levels in stroke pa-tients with insomnia. Shaanxi Journal of Traditional Chinese Medicine, 42 (12):1773-1775,1782.
37. Liu Y, Chen CY (2021). Clinical observation of electroacupuncture at Shenmen and Neiguan for post-stroke insomnia. Infor-mation on Traditional Chinese Medicine, 38 (10):68-71.
38. Chen Y, Wang XD, Zhang WD, et al (2021). Clinical observation on 28 cases with stroke-related insomnia treated by mox-ibustion. Journal of Gansu University of Chinese Medicine, 38 (2):56-61.
39. Zhan DM, Li WL, Ma FX, et al (2021). Clin-ical efficacy of resolving blood stasis, opening the orifices and tranquillizing the mind with acupuncture in treating poststroke insomnia with blood stasis and internal obstruction. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 19 (20):3590-3593.
40. Song SL, Zhou XJ, Zheng LQ (2021). Effect of auricular acupressure combined with acupuncture on sleep quality and neuro-transmitters in patients with post-stroke sleep disorders. Modern Journal of Integrat-ed Traditional Chinese and Western Medicine, 30 (3):290–293.
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| Issue | Vol 55 No 1 (2026) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v55i1.20975 | |
| Keywords | ||
| Acupuncture Poststroke insomnia Network meta-analysis | ||
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How to Cite
1.
Chen X, Zhang R, Guo Y, Wen J, Wu Y, Chu W, Wu Y. Effectiveness and Safety of Acupuncture and Related Therapies for Poststroke Insomnia: A Network Meta-Analysis. Iran J Public Health. 2026;55(1):87-100.
