Elsevier

Complementary Therapies in Medicine

Volume 42, February 2019, Pages 407-416
Complementary Therapies in Medicine

Acupuncture for treatment of insomnia: An overview of systematic reviews

https://doi.org/10.1016/j.ctim.2018.12.020Get rights and content

Highlights

  • The overview of System Reviews/Meta-analysis is a comprehensive research method for evaluating factors related to the treatment, etiology, diagnosis and prognosis of the same health problem.

  • PubMed, EMBASE, Web of science, Cochrane library, Chinese Biomedical Databases (CBM), VIP and China National Knowledge Infrastructure (CNKI) were retrieved and relevant data were extracted.

  • The methodological quality evaluation and outcome index quality evaluation of the systematic evaluation were carried out, and the effectiveness and safety of acupuncture in treating insomnia were analyzed systematically.

  • Our overview showed that acupuncture may be beneficial to insomnia patients. Based on the current evidence and the safety of acupuncture, there was a case for the use of acupuncture as an adjunctive therapy in insomnia.

Abstract

Purpose

To evaluate the reliability of the methodological quality and outcome measures of systematic review (SR) /meta-analysis (MA) of acupuncture for insomnia.

Methods

We conducted a comprehensive literature search for SRs with MAs in seven international and Chinese databases. Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the quality of evidence.

Results

Thirty-four reviews were included. The AMSTAR-2 score showed that most of the included studies were of low methodological quality and included only two high-quality literatures. The lowest score were the item 10 (all the studies didn't report on the sources of funding for the studies included in the review), item 7(32 studies didn't provide a list of excluded studies and justify the exclusions) and item 3 (27 studies didn't explain their selection of the study designs for inclusion in the review).

Conclusion

Most of the reviews included suggested that the acupuncture group was more effective than the control group in the treatment of insomnia, but the methodological quality of most of the studies and the quality of evidence were low.

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.

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