Acupuncture for Insomnia

A Cochrane review [Abstract] 1 included 33 studies with a total of 2293 subjects. A total of 29 trials were performed in Asia, 19 in China, and only 4 trials outside Asian countries. Participant age ranged from 15 to 98 years, and the duration of insomnia varied from 6 months to 19 years. Some had medical conditions contributing to insomnia (stroke, end-stage renal disease, perimenopause, pregnancy, psychiatric diseases). The trials evaluated needle acupuncture, electroacupuncture, acupressure or magnetic acupressure.

• Compared with no treatment or sham/placebo, acupressure resulted in more people with improvement in sleep quality (compared to no treatment: OR 13.08, 95% CI 1.79 to 95.59, 2 studies, n=280; compared to sham/placebo: OR 6.62, 95% CI 1.78 to 24.55, 2 studies, n=112). However, when assuming that dropouts had a worse outcome in sensitivity analysis the beneficial effect of acupuncture was inconclusive.
• Compared with other treatment alone, acupuncture as an adjunct to other treatment might marginally increase the proportion of people with improved sleep quality (OR 3.08, 95% CI 1.93 to 4.90; 13 studies, n=883). On subgroup analysis, only needle acupuncture but not electroacupuncture showed benefits.

Adverse effects were rarely reported and they were minor.

Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment), inconsistency (heterogeneity in patients, interventions and outcomes), indirectness (the results may not be directly applicable to Western population), publication bias and imprecise results (few patients with wide confidence intervals).

References

• Cheuk DK, Yeung WF, Chung K et al. Acupuncture for insomnia. Cochrane Database Syst Rev 2012;9:CD005472. [PubMed]