Cheuk Daniel K L, Yeung Wing-Fai, Chung K F, Wong Virginia
Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
Cochrane Database Syst Rev. 2012 Sep 12;2012(9):CD005472. doi: 10.1002/14651858.CD005472.pub3.
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.
To determine the efficacy and safety of acupuncture for insomnia.
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.
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.
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.
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.
尽管传统的非药物和药物治疗失眠方法对许多人有效，但诸如针灸等替代疗法仍被广泛应用。然而，目前的证据是否足够严谨以支持针灸治疗失眠尚不清楚。
确定针灸治疗失眠的疗效和安全性。
我们于2011年10月检索了Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、EMBASE、PsycINFO、国际学位论文摘要数据库、护理学与健康照护领域数据库（CINAHL）、针灸与推拿医学数据库（AMED）、中国传统医学文献分析与检索系统（TCMLARS）、世界卫生组织（WHO）试验注册平台（ICTRP）以及Cochrane协作网的相关专业注册库。我们筛选了所有符合条件报告的参考文献列表，并联系了试验作者和该领域的专家。
评估任何形式针灸治疗失眠的随机对照试验。这些试验将针灸联合/不联合其他治疗与安慰剂、假治疗、不治疗或相同的其他治疗进行比较。我们排除了比较不同针灸方法或针灸与其他治疗的试验。
两位综述作者独立提取数据并评估偏倚风险。对于二分类和连续性结局，我们分别使用比值比（OR）和均数差值。我们在适当的情况下对数据进行Meta分析合并。
纳入了33项试验。这些试验招募了2293名年龄在15至98岁之间的失眠患者，其中一些患者伴有导致失眠的疾病（中风、终末期肾病、围绝经期、妊娠、精神疾病）。试验评估了毫针、电针、指压或磁珠压耳穴。与不治疗（两项研究，280名参与者）或假治疗/安慰剂（两项研究，112名参与者）相比，指压使更多人睡眠质量得到改善（与不治疗相比：OR 13.08，95%置信区间（CI）1.79至95.59；与假治疗/安慰剂相比：OR 6.62，95%CI 1.78至24.55）。然而，在敏感性分析中假设失访者结局更差时，针灸的有益效果尚无定论。与单独的其他治疗相比，针灸作为其他治疗的辅助手段可能会略微增加睡眠质量改善者的比例（13项研究，883名参与者，OR 3.08，95%CI 1.93至4.90）。亚组分析显示，仅毫针有效果，电针无效果。所有试验均存在高偏倚风险，且在失眠定义、参与者特征、穴位和治疗方案方面存在异质性。效应量一般较小，置信区间较宽。可能存在发表偏倚。不良反应报告很少，且程度较轻。
由于方法学质量差、高度异质性和发表偏倚，目前的证据不够严谨，无法支持或反驳针灸治疗失眠。需要开展更大规模的高质量临床试验。
