Acupuncture for treatment of insomnia: An overview of systematic reviews
Introduction
Insomnia is the most common sleep disorder in the clinic. In adults, the diagnostic criteria for insomnia are as high as 10%–15%, and it is a chronic disease.1 Insomnia seriously damages the physical and mental health of patients, affects their quality of life, even induces traffic accidents and endangers personal and public safety. It is a serious burden to individuals and society. Proven approaches of treating insomnia include traditional Chinese medicine therapy, western medicine therapy and so on. The main drugs include estrazolam, alprazolam, diazepam, etc. Although pharmacological treatments are effective in the treatment of insomnia, their usage is limited due to concerns about abuse, addiction, dependence, inhibition of respiration and adverse reactions.1,2 So, beyond the above strategies, people try to relieve insomnia by complementary or alternative treatments,3 such as acupuncture is one of the most effective complementary treatments for treatment of insomnia.
Acupuncture is a Traditional Chinese Medicine (TCM) therapy that involves penetrating the skin with thin, solid, metallic needles that are operated by hand or electrical stimulation.4 As a safe and effective natural therapy, acupuncture has been added to the latest guidelines for the diagnosis and treatment of insomnia in China formulated by the China Sleep Research Association.5
Some SRs/MAs about acupuncture for insomnia have been published, those studies had compared the efficacy of acupuncture treatment with drug therapy. However, the quality of them has not been evaluated, which is an essential step before treatment recommendations was presented and applied confidently.6,7 The current overview intended to fill these gaps in the literature, investigate the general characteristics, evaluate the methodological quality and the reliability of the conclusions of the SR of acupuncture for insomnia through AMSTAR-2 statement and GRADE system in order to provide evidence reference for evidence-based decision-making.
Section snippets
Material and methods
The overview of systematic reviews was performed according to the Cochrane handbook (http://www.cochrane.org/resources/handbook), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement as well as some high quality methodological articles.8, 9, 10
Study identification
In total, 395 reviews were identified for screening. After de-duplication, 208 studies were retrieved from the database search and screened via title and abstract. Following title and abstract screening, 73 full-text review articles were selected for further evaluation. Examining these full-text articles resulted in the exclusion of 37 articles (Appendix B), 34 reviews met all inclusion criteria and are included in our overview of systematic reviews. The flow diagram depicting the selection
Discussion
The overview of SRs/MAs is a comprehensive research method for evaluating factors related to the treatment, etiology, diagnosis and prognosis of the same health problem.14,36 the purpose of us was to provide a comprehensive overview of the evidence obtained from the SRs/MAs to determine the effectiveness of acupuncture in the treatment of insomnia.
This was the first overview that evaluated the SRs/MAs of acupuncture treatment of insomnia. Our overview included 34 SRs/MAs of acupuncture for
Conclusion
Although acupuncture is more effective than traditional medicine, sham acupuncture and sleep hygiene counseling used to treat insomnia, the results of this study show that the methodological quality of the included studies is generally low. Therefore, the interpretation of seemingly "promising" results should be very cautious. At present, the evidence level of SR/MA of methodology quality and outcome index of acupuncture for insomnia needs to be improved. Researchers should observe the relevant
Conflict of interest
The authors declare that they have no conflict of interests.
Funding
No funding was received for this research.
Acknowledgements
The authors would like to thank Zhu yilong and the School of Public Health of Lanzhou University and the Evidence-based Medicine Center of Lanzhou University, for their help with this study.
References (53)
- et al.
The use of conventional and complementary therapies for insomnia among Hong Kong Chinese: a telephone survey
Complement Ther Med
(2014) - et al.
[PRISMA declaration: a proposal to improve the publication of systematic reviews and meta-analyses]
Med Clin (Barc)
(2010) - et al.
Network meta-analyses could be improved by searching more sources and by involving a librarian
J Clin Epidemiol
(2014) - et al.
A systematic review of acupuncture for sleep quality in people with insomnia
Complement Ther Med
(2016) - et al.
Acupuncture and moxibustion for primary insomnia: a systematic review and meta-analysis of randomized controlled trials
Eur J Integr Med
(2017) - et al.
Traditional needle acupuncture treatment for insomnia: A systematic review of randomized controlled trials
Sleep Med
(2009) - et al.
Efficacy of topical Rose (Rosa damascena Mill.) oil for migraine headache: A randomized double-blinded placebo-controlled cross-over trial
Complement Ther Med
(2017) - et al.
Interpretation of Chinese guideline for insomnia disorder diagnosis and its treatment in 2017
World Clin Drugs
(2018) - et al.
Trends in the use of complementary and alternative medicine in the United States: 2002-2007
J Health Care Poor Underserved
(2011) - et al.
Understanding the use of acupuncture for insomnia among cancer survivors: a qualitative study
J Altern Complement Med (New York, NY).
(2018)
Clinical curative effect research status and analysis of acupuncture treatment for primary insomnia
Chin Acupunct Moxibust
Insomnia: can acupuncture help?
Pain Manag
Efficacy of 42 pharmacologic cotreatment strategies added to antipsychotic monotherapy in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence
JAMA Psychiatry
Red blood cell transfusion to treat or prevent complications in sickle cell disease: an overview of cochrane reviews
Cochrane Database Syst Rev
AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both
BMJ
An introduction of AMSTAR-2: a quality assessment instrument of systematic reviews including randomized or non-randomized controlled trials or both
Chin J Drug Eval
Grading quality of evidence and strength of recommendations
BMJ
Treatment of migraine with acupuncture: an overview of systematic reviews
J Tradit Chin Med
Acupuncture for insomnia
Cochrane Database Syst Rev
Acupuncture for primary insomnia: a systematic review
Meta-analysis on RCTs of menopause sleep disorders treated by acupuncture therapy
Chin J Inform TCM
The study of acupuncture combine with intradermal needle on perimenopausal insomnia of women
Curative effect of acupuncture therapy for insomnia of Yin deficiency type: a meta analysis
Mod J Integr Tradit Chin West Med
Acupuncture to reduce sleep disturbances in perimenopausal and postmenopausal women a systematic review and meta-analysis
Obstet Gynecol
Acupuncture for insomnia after stroke: a systematic review and meta-analysis
BMC Complement Altern Med
Acupuncture for insomnia in the elderly: a meta-analysis
China J Health Psychol
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