Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 55 1 2026 02 07 87 100 EN Xinwang Chen Henan University of Chinese Medicine, Zhengzhou, Henan Province, China Run Zhang The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China Yajing Guo Henan University of Chinese Medicine, Zhengzhou, Henan Province, China Jing Wen Henan University of Chinese Medicine, Zhengzhou, Henan Province, China Yuzhu Wu Henan University of Chinese Medicine, Zhengzhou, Henan Province, China Wenming Chu Henan University of Chinese Medicine, Zhengzhou, Henan Province, China Yiming Wu The Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China 2025 03 09 2025 10 24 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. https://ijph.tums.ac.ir/index.php/ijph/article/view/38447 https://ijph.tums.ac.ir/index.php/ijph/article/download/38447/8749