Lian Jiaying, Jiang Yanhong, Kong Lingli, Zhou Mingqi
Department of Neurology, Quzhou Hospital of Traditional Chinese Medicine, Quzhou, People's Republic of China.
Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China.
Nat Sci Sleep. 2025 Jun 9;17:1217-1229. doi: 10.2147/NSS.S507392. eCollection 2025.
Post-stroke sleep disorders (PSSD) are among the most prevalent complications of stroke, significantly impeding neurological recovery and increasing the risk of recurrence. While Western medicine primarily relies on pharmacological treatments, these often come with side effects and inconsistent outcomes. Recent evidence supports the effectiveness of various acupuncture therapies for PSSD, but the optimal treatment strategy remains unclear.
To compare the efficacy of different acupuncture therapies for PSSD using a network meta-analysis.
We conducted systematic searches in multiple databases, including CNKI (since 1994), VIP (since 1989), CBM (since 1978), WanFang (since 1998), the Chinese Clinical Trial Registry (since 2005), PubMed (since 1966), EMBASE (since 1974), The Cochrane Library (since 1993), Web of Science (since 1900), and ClinicalTrials (since 2000). Randomized controlled trials (RCTs) on acupuncture therapies for PSSD were included up to May 31, 2024. Studies were screened based on predefined inclusion and exclusion criteria, and their quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Data were analyzed using RevMan 5.3 and Stata 14.
A total of 53 RCTs involving 3973 patients were included. The network meta-analysis evaluated 12 interventions. Auricular acupressure combined with Western medicine ranked highest for improving PSQI scores (surface under the cumulative ranking curve [SUCRA]: 96.2%), followed by acupuncture (68.5%) and moxibustion combined with Western medicine (63.6%). For increasing serum 5-HT levels, moxibustion combined with Western medicine ranked highest (SUCRA: 89.3%), followed by acupuncture combined with Western medicine (79.1%). Acupuncture combined with Western medicine was most effective in reducing serum NE levels (SUCRA: 97%).
Acupuncture therapies are effective for PSSD and it is more effective when used in combination with western medicine. These effects may be mediated by modulating neurotransmitter levels. However, further large-scale, multi-center RCTs are needed to confirm these findings. This study followed PRISMA guidelines and was registered with PROSPERO (CRD42023470398).
中风后睡眠障碍（PSSD）是中风最常见的并发症之一，严重妨碍神经功能恢复并增加复发风险。西医主要依靠药物治疗，但这些治疗往往伴有副作用且效果不一。最近的证据支持各种针灸疗法对PSSD的有效性，但最佳治疗策略仍不明确。
采用网状Meta分析比较不同针灸疗法治疗PSSD的疗效。
我们在多个数据库中进行了系统检索，包括中国知网（自1994年起）、维普资讯（自1989年起）、中国生物医学文献数据库（自1978年起）、万方数据（自1998年起）、中国临床试验注册中心（自2005年起）、PubMed（自1966年起）、EMBASE（自1974年起）、考克兰图书馆（自1993年起）、科学引文索引（自1900年起）和临床试验数据库（自2000年起）。纳入截至2024年5月31日关于针灸疗法治疗PSSD的随机对照试验（RCT）。根据预先定义的纳入和排除标准筛选研究，并使用《考克兰系统评价干预措施手册》评估其质量。使用RevMan 5.3和Stata 14进行数据分析。
共纳入53项RCT，涉及3973例患者。网状Meta分析评估了12种干预措施。耳穴按压联合西医在改善PSQI评分方面排名最高（累积排序曲线下面积[SUCRA]：96.2%），其次是针灸（68.5%）和艾灸联合西医（63.6%）。在提高血清5 - HT水平方面，艾灸联合西医排名最高（SUCRA：89.3%），其次是针灸联合西医（79.1%）。针灸联合西医在降低血清NE水平方面最有效（SUCRA：97%）。
针灸疗法对PSSD有效，与西医联合使用时效果更佳。这些效果可能是通过调节神经递质水平介导的。然而，需要进一步的大规模、多中心RCT来证实这些发现。本研究遵循PRISMA指南，并在PROSPERO（CRD42023470398）注册。
