Intervention Review

Acupuncture for insomnia

  1. Daniel KL Cheuk1,*,
  2. Wing-Fai Yeung2,
  3. KF Chung2,
  4. Virginia Wong1

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 12 SEP 2012

Assessed as up-to-date: 13 OCT 2011

DOI: 10.1002/14651858.CD005472.pub3


How to Cite

Cheuk DKL, Yeung WF, Chung KF, Wong V. Acupuncture for insomnia. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD005472. DOI: 10.1002/14651858.CD005472.pub3.

Author Information

  1. 1

    The University of Hong Kong, Queen Mary Hospital, Department of Pediatrics and Adolescent Medicine, Hong Kong, China

  2. 2

    The University of Hong Kong, Department of Psychiatry, Hong Kong, China

*Daniel KL Cheuk, Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China. cheukkld@hkucc.hku.hk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 12 SEP 2012

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé scientifique
  5. Résumé simplifié
  6. 초록
  7. 쉬운 말 요약

Background

Although conventional non-pharmacological and pharmacological treatments for insomnia are effective in many people, alternative therapies such as acupuncture are widely practised. However, it remains unclear whether current evidence is rigorous enough to support acupuncture for the treatment of insomnia.

Objectives

To determine the efficacy and safety of acupuncture for insomnia.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts International, CINAHL, AMED, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), the World Health Organization (WHO) Trials Portal (ICTRP) and relevant specialised registers of the Cochrane Collaboration in October 2011. We screened reference lists of all eligible reports and contacted trial authors and experts in the field.

Selection criteria

Randomised controlled trials evaluating any form of acupuncture for insomnia. They compared acupuncture with/without additional treatment against placebo or sham or no treatment or same additional treatment. We excluded trials that compared different acupuncture methods or acupuncture against other treatments.

Data collection and analysis

Two review authors independently extracted data and assessed risk of bias. We used odds ratio (OR) and mean difference for binary and continuous outcomes respectively. We combined data in meta-analyses where appropriate.

Main results

Thirty-three trials were included. They recruited 2293 participants with insomnia, aged 15 to 98 years, some with medical conditions contributing to insomnia (stroke, end-stage renal disease, perimenopause, pregnancy, psychiatric diseases). They evaluated needle acupuncture, electroacupuncture, acupressure or magnetic acupressure.

Compared with no treatment (two studies, 280 participants) or sham/placebo (two studies, 112 participants), acupressure resulted in more people with improvement in sleep quality (compared to no treatment: OR 13.08, 95% confidence interval (CI) 1.79 to 95.59; compared to sham/placebo: OR 6.62, 95% CI 1.78 to 24.55). 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 (13 studies, 883 participants, OR 3.08, 95% CI 1.93 to 4.90). On subgroup analysis, only needle acupuncture but not electroacupuncture showed benefits. All trials had high risk of bias and were heterogeneous in the definition of insomnia, participant characteristics, acupoints and treatment regimen. The effect sizes were generally small with wide confidence intervals. Publication bias was likely present. Adverse effects were rarely reported and they were minor.

Authors' conclusions

Due to poor methodological quality, high levels of heterogeneity and publication bias, the current evidence is not sufficiently rigorous to support or refute acupuncture for treating insomnia. Larger high-quality clinical trials are required.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé scientifique
  5. Résumé simplifié
  6. 초록
  7. 쉬운 말 요약

Acupuncture for insomnia

Although conventional non-pharmacological and pharmacological treatments for insomnia are effective in many people, alternative therapies such as acupuncture are widely practised. This review was conducted to examine the efficacy and safety of acupuncture in treating insomnia. Thirty-three randomised controlled trials were eligible for inclusion in the review, involving 2293 participants. We considered all studies to have a high risk of bias. They were diverse in the types of participants, acupuncture treatments and sleep outcome measures used, which limited our ability to draw reliable conclusions. Currently there is a lack of high-quality clinical evidence to inform us about the efficacy and safety of acupuncture.

 

Résumé scientifique

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé scientifique
  5. Résumé simplifié
  6. 초록
  7. 쉬운 말 요약

L'acupuncture pour l'insomnie

Contexte

Bien que les traitements conventionnels non pharmacologiques et pharmacologiques de l'insomnie soient efficaces pour beaucoup de gens, des thérapies alternatives comme l'acupuncture sont très pratiquées. Il n'est cependant pas certain que les données actuelles soient suffisamment rigoureuses pour étayer l'acupuncture dans le traitement de l'insomnie.

Objectifs

Déterminer l'efficacité et l'innocuité de l'acupuncture pour l'insomnie.

Stratégie de recherche documentaire

Nous avons effectué en octobre 2011 une recherche dans le registre central Cochrane des essais contrôlés (CENTRAL), MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts International, CINAHL, AMED, le Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), le portail des essais de l'Organisation mondiale de la Santé (OMS) (ICTRP) et les registres spécialisés pertinents de la Cochrane Collaboration. Nous avons passé au crible les références bibliographiques de tous les rapports éligibles et contacté des auteurs d'essais et des experts du sujet.

Critères de sélection

Des essais contrôlés randomisés ayant évalué une quelconque forme d'acupuncture pour l'insomnie. Ils avaient comparé l'acupuncture avec/sans traitement supplémentaire à un placebo, à un traitement fictif ou à l'absence de traitement ou au même traitement supplémentaire. Nous avons exclu les essais ayant comparé entre elles différentes méthodes d'acupuncture ou ayant comparé l'acupuncture à d'autres traitements.

Recueil et analyse des données

Deux auteurs de la revue ont extrait les données et évalué le risque de biais de façon indépendante. Nous avons utilisé le rapport de cotes (RC) et la différence moyenne pour, respectivement, les variables binaires et continues. Lorsque cela était approprié, nous avons regroupé les données dans des méta-analyses.

Résultats principaux

Trente-trois essais ont été inclus. Ils avaient enrôlé 2 293 participants insomniaques âgés de 15 à 98 ans, dont certains avaient des problèmes médicaux contribuant à l'insomnie (accident vasculaire cérébral, insuffisance rénale terminale, périménopause, grossesse, maladies psychiatriques). Ils avaient évalué l'acupuncture à aiguilles, l'électro-acupuncture, l'acupression ou l'acupression magnétique.

En comparaison avec l'absence de traitement (deux études, 280 participants) ou le traitement fictif / placebo (deux études, 112 participants), l'acupression avait amélioré la qualité du sommeil de plus de gens (par rapport à l'absence de traitement : RC 13,08, intervalle de confiance (IC) à 95 % 1,79 à 95,59 ; par rapport au traitement fictif / placebo : RC 6,62, IC à 95 % 1,78 à 24,55). Toutefois, si l'on prend en compte que les abandons avaient un impact plus mauvais sur l'analyse de sensibilité, l'effet bénéfique de l'acupuncture n'était pas concluant. En comparaison avec un autre traitement seul, l'acupuncture en adjonction d'un autre traitement pourrait accroitre légèrement la proportion de personnes bénéficiant d'une qualité de sommeil améliorée (13 études, 883 participants, RC 3,08, IC à 95 % 1,93 à 4,90). Dans l'analyse de sous-groupes, seule l'acupuncture à aiguilles mais pas l'électro-acupuncture ont montré des bénéfices. Tous les essais présentaient un risque élevé de biais et étaient hétérogènes dans la définition de l'insomnie, les caractéristiques des participants, les points d'acupuncture et le régime de traitement. Les effets étaient généralement de petite ampleur avec de larges intervalles de confiance. Il y avait probablement un biais de publication. Des effets indésirables avaient rarement été signalés et ils étaient mineurs.

Conclusions des auteurs

La faible qualité méthodologique, les niveaux élevés d'hétérogénéité et le biais de publication font que les données actuelles ne sont pas suffisamment rigoureuses pour étayer ou récuser l'acupuncture pour le traitement de l'insomnie. De plus vastes essais cliniques de qualité sont nécessaires.

 

Résumé simplifié

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé scientifique
  5. Résumé simplifié
  6. 초록
  7. 쉬운 말 요약

L'acupuncture pour l'insomnie

Bien que les traitements conventionnels non pharmacologiques et pharmacologiques de l'insomnie soient efficaces pour beaucoup de gens, des thérapies alternatives comme l'acupuncture sont très pratiquées. Cette revue a été menée pour examiner l'efficacité et l'innocuité de l'acupuncture dans le traitement de l'insomnie. Trente-trois essais contrôlés randomisés étaient éligibles à l'inclusion dans la revue, portant au total sur 2 293 participants. Nous avons considéré que toutes les études présentaient un risque élevé de biais. La variété des types de participants, des traitements d'acupuncture et des mesures de qualité de sommeil utilisés, a limité notre capacité à tirer des conclusions fiables. On manque actuellement de données cliniques de qualité pour nous informer sur l'efficacité et l'innocuité de l'acupuncture.

Notes de traduction

Traduit par: French Cochrane Centre 30th October, 2012
Traduction financée par: Ministère du Travail, de l'Emploi et de la Santé Français

 

초록

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé scientifique
  5. Résumé simplifié
  6. 초록
  7. 쉬운 말 요약

불면증에 대한 침치료

배경

불면증은 현대의학의 비약물적, 약물적 치료가 많은 사람들에게 효과적으로 사용되고 있지만, 침치료와 같은 보완대체의학적 치료법은 또한 많이 임상에서 활용되고 있다. 그러나 불면증의 침치료 효과를 지지해줄 만한 충분한 근거가 있는지에 대해서는 아직 의문의 여지가 남아 있다.

목적

불면증에 대한 침치료 효능 및 안전성에 대한 연구

검색 전략

CENTRAL, MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts International, CINAHL, AMED, 중의문헌 분석 시스템 (TCMLARS), WHO, ICTRP그리고 코크란 연합의 관련 레지스터를 2011년 11월까지 검색하였다. 또한 연구 주제안에서 관련 보고서를 검토하였으며 포함 연구 저자 및 전문가에게 연락하였다.

선정 기준

불면증 치료 대한 다양한 종류의 침 치료 효과를 평가하는 무작위 대조연구를 포함시켰다. 부가적인 치료가 포함되는 것과 없는 침치료군을 위약군, 무치료군 또는 동일한 추가적인 치료를 받은 대조군과 비교한 것을 포함시켰다. 침치료 방법 및 침 종류에 대해 비교한 연구는 제외하였다.

자료 수집 및 분석

두명의 저자가 독립적으로 자료를 추출하고 질 평가를 수행하였다. 자료 분석은 이분형 자료 결과치에 대해서는 오즈비(OR) 그리고 연속형 자료 결과에 대해서는 평균차(MD)를 사용하였다. 가능한 경우 메타분석을 통해 자료를 합성하였다.

주요 결과


33개 연구들이 포함되었다. 불면증을 가지고 있는 15세에서 98세 사이의 2,293명이 모집되었으며 몇몇은 다소 불면증에 영향을 미치는 증상(뇌졸중, 말기 신장 질환, 폐경기, 임신, 정신 질환)을 가지고 있었다. 수기침, 전침, 지압 또는 자기지압에 대해 평가하였다.

무치료군(2개 연구, 280명 참가), 거짓/위약군(2개 연구, 112명) 그리고 지압과 비교하여 수면의 질적 향상에 대해 비교평가하였다(무치료 비교: OR 13.08, 95% CI 1.79~95.59; 거짓/위약군: OR 6.62, 95% CI 1.78~24.55까지). 그러나 민감도 분석을 통해 많은 결측치들로 인해서 결과도출에 영향을 받은 것으로 추정되기 때문에 침의 유의한 효과에 대해서는 결론을 내리기 어렵다. 다른 단독 치료군과 비교했을 때, 다른 치료와 병행한 침치료군은 미비하게 수면의 질적 향상을 보인 사람들의 비율이 증가 하였다 (13개 연구, 883명, OR 3.08, 95% CI 1.93~4.90). 하위그룹 분석에서 전침을 제외한 수기침에서 오직 효과가 있음을 보였다. 모든 연구는 비뚤림 위험이 높았으며, 불면증, 참가자의 특성, 침자리 그리고 치료 방법에 있어서 이질성이 있었다. 효과 크기는 일반적으로 작고 신뢰구간은 넓었다. 출판 편향의 가능성도 존재한다. 부작용은 거의 보고되지 않았거나 미비했다.

연구진 결론

질적 수준은 낮고, 높은 이질성 그리고 출판비뚤림 때문에 현재의 근거수준에서 불면증의 침치료 효과에 대해 충분하게 지지할 수 없다. 많은 질적 수준이 우수한 연구들이 필요하다.

 

쉬운 말 요약

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé scientifique
  5. Résumé simplifié
  6. 초록
  7. 쉬운 말 요약

불면증에 대한 침치료

불면증에 대한 현대의학적 비약물적, 약물적 치료가 많은 사람들에게 효과적으로 사용되고 있지만, 침치료와 같은 보완대체의학적 치료법은 또한 많이 임상에서 활용되고 있다. 이 리뷰는 불면증 치료에 대한 침치료의 효능 및 안전성을 평가하였다. 33개(2293대상)의 무작위 임상연구가 포함되었다. 모든 연구가 방법론적 질은 낮았다. 다양한 참가자, 침치료 방법, 사용된 수면평가결과치로 인해 신뢰할 만한 결론을 도출하기는 어렵다. 현재 침치료의 효능 및 안전성에 대해 질적으로 우수한 임상적 근거는 부족하다.

역주

이 리뷰는 최지애님 (한국한의학연구원) 이 번역하였습니다. 번역 내용과 관련한 문의점은 choijiae0723@gmail.com으로 연락주세요.