This is not the most recent version of the article. View current version (12 SEP 2012)
Acupuncture for insomnia
Editorial Group: Cochrane Depression, Anxiety and Neurosis Group
Published Online: 15 APR 2009
Assessed as up-to-date: 23 MAR 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Cheuk DKL, Yeung J, Chung KF, Wong V. Acupuncture for insomnia. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD005472. DOI: 10.1002/14651858.CD005472.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 15 APR 2009
This is not the most recent version of the article.View current version (12 Sep 2012)
Although conventional non-pharmacological and pharmacological treatments for insomnia are effective in many people, alternative therapies such as acupuncture are still widely practiced. However, it remains unclear whether the existing evidence is rigorous enough to support its use.
To determine the efficacy and safety of acupuncture in people with insomnia.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts International, CINAHL, AMED (the Allied and Complementary Medicine Database), TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System), National Center for Complementary and Alternative Medicine, the National Institute of Health Clinical Trials Database, the Chinese Acupuncture Trials Register, the Trials Register of the Cochrane Complementary Medicine Field, from inception to 2006, and the sleep bibliography, which is available at www.websciences.org/bibliosleep. We searched reference lists of retrieved articles, and contacted trial authors and experts in the field for information on ongoing/completed trials.
Randomised controlled trials evaluating any form of acupuncture involving participants of any age with any type of insomnia were included. Included trials compared acupuncture with placebo or sham or no treatment, or acupuncture plus other treatments compared with the same other treatments. Trials that compared only acupuncture methods or compared acupuncture alone against other treatments alone were excluded, since they did not yield the net effect of acupuncture.
Data collection and analysis
Two review authors independently extracted data and assessed quality according to a set of criteria for risk of selection bias, performance bias, attrition bias and detection bias. Relative risk (RR) and standardised mean difference (SMD) with 95% confidence intervals were used for binary and continuous outcomes respectively. Data were combined in meta-analyses (on an intention-to-treat basis), where more than one trial without significant clinical heterogeneity presented the same outcome.
Seven trials met the inclusion criteria. The studies included 590 participants with insomnia, of whom 56 dropped out. Participant age ranged from 15 to 98 years, and the duration of insomnia varied from 6 months to 19 years. Co-existing medical conditions contributing to insomnia included stroke, end-stage renal disease and pregnancy. Apart from conventional needle acupuncture, different variants of acupuncture such as acupressure, auricular magnetic and seed therapy, and transcutaneous electrical acupoint stimulation (TEAS) were evaluated. Meta-analysis was limited because of considerable heterogeneity between comparison groups and between outcome measures.
Based on the findings from individual trials, the review suggested that acupuncture and acupressure may help to improve sleep quality scores when compared to placebo (SMD = -1.08, 95% CI = -1.86 to -0.31, p=0.006) or no treatment (SMD -0.55, 95% CI = -0.89 to -0.21, p=0.002). TEAS also resulted in better sleep quality score in one trial (SMD = -0.74, 95% CI = -1.22 to -0.26, p=0.003). However, the efficacy of acupuncture or its variants was inconsistent between studies for many sleep parameters, such as sleep onset latency, total sleep duration and wake after sleep onset. The combined result from three studies reporting subjective insomnia improvement showed that acupuncture or its variants was not more significantly effective than control (RR = 1.66, 95% CI = 0.68 to -4.03) and significant statistical heterogeneity was observed. Only one study reported an adverse event, with one out of 16 patients (6.3%) withdrawing from acupuncture because of pain.
The small number of randomised controlled trials, together with the poor methodological quality and significant clinical heterogeneity, means that the current evidence is not sufficiently extensive or rigorous to support the use of any form of acupuncture for the treatment of insomnia. Larger high quality clinical trials employing appropriate randomisation concealment and blinding with longer follow-up are needed to further investigate the efficacy and safety of acupuncture for the treatment of insomnia.
Plain language summary
Acupuncture for insomnia
Although conventional non-pharmacological and pharmacological treatments for insomnia are effective in many people, alternative therapies such as acupuncture are still widely practiced. Acupuncture is mainly evaluated in observational and uncontrolled studies, and randomised controlled trials are scarce and of poor methodological quality. This review was conducted to examine the effectiveness of acupuncture in treating insomnia. Seven studies were eligible for inclusion in the review, involving 590 participants. The studies were of low methodological quality and were diverse in the types of participant, acupuncture treatments and sleep outcome measures used, which limited the ability to pool the findings and draw conclusions. Currently there is a lack of high quality clinical evidence supporting the treatment of people with insomnia using acupuncture. More rigorous studies are needed to assess the efficacy and safety of various forms of acupuncture for treating people with insomnia.
我們收集了CENTRAL(Cochrane Central Register of Controlled Trials控制試驗統合中心紀錄)、MEDLINE、EMBASE、 PsycINFO、國際博士論文、CINAHL、 AMED(the Allied and Complementary Medicine Database聯合醫學資料庫)、 TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System中國傳統醫學分析與檢索系統)、國際衛生臨床試驗中心資料庫(the National Institute of Health Clinical Trials Database) 、中國針灸治療試驗紀錄(the Chinese Acupuncture Trials Register)、由創立到2006年的醫學統合領域試驗紀錄(the Trials Register of the Cochrane Complementary Medicine Field)以及www.websciences.org/bibliosleep所列出的睡眠參考書目。我們找出所檢索文章的參考文獻，與進行試驗的作者及專家聯繫，收集此領域進行中或完成的試驗資料。
兩位作者分別萃取資料及評估資料的品質，依據的標準為選擇偏誤、表現偏誤、耗損偏誤和偵測偏誤等。另外，我們有分別以Relative risk (RR), standardised mean difference (SMD) with 95% confidence intervals 來計算連續性及雙方面的結果。所有的結果都合併入統計分析研究(以治療意向的基礎)，在此多於一個以上的研究都呈現相同的結論,且不具有意義的臨床異質性.
7個研究符合納入的規則.此研究包含590個失眠診斷的參與者,其中56個退出。參與者年紀範圍在15到98歲，失眠的時期在6到19年。共病的內科問題影響失眠的因素包括中風,末期腎臟疾病和懷孕。除了傳統針灸,另外也評估其他針灸的變異型包括針壓法,關節磁力及種子療法(auricular magnetic and seed therapy),經皮針灸點電刺激法(TEAS).統計分析研究受限於各組別間的異質性及不同的評估方法。根據個別研究的結果,回顧研究建議針灸和針壓法相較於安慰劑(SMD = −1.08, 95% CI = −1.86 to −0.31, p = 0.006);相對於不治療結果為(SMD −0.55, 95% CI = −0.89 to −0.21, p = 0.002)，可以改善睡眠品質分數。TEAS在1個臨床試驗也有較佳睡眠品質分數的結果(SMD = −0.74, 95% CI = −1.22 to −0.26, p = 0.003)。然而，針灸和其變異型的治療在各研究的各種變數中並未取得一致性，例如睡眠潛伏期,睡眠總時數,入睡後清醒時間。來自於3項試驗綜合的結論呈現針灸和其變異型的治療對於主觀睡眠改善相較對照組並未取得明顯的效果(RR = 1.66, 95% CI = 0.68 to −4.03);另外在這些結果也觀察到統計上的異質性。只有一項研究報告副作用，16位病患中有一位因為疼痛退出針灸治療。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。