Zhang Qin-Hong, Liu Yong-Jian, Yang Guanhu, Zhu Mei-Yi, Yang Jia-Hui, Li Lun, Yan Xiu-Mei, Liu Qi-Lin, Yue Jin-Huan, Li Xiao-Ling, Li Yi-Ming, Xu Tian-Cheng, Jiang Fan
Shenzhen Frontiers in Chinese Medicine Research Co., Ltd., Shenzhen, China.
Heilongjiang University of Chinese Medicine, Harbin, China.
Front Neurol. 2025 Jul 29;16:1607903. doi: 10.3389/fneur.2025.1607903. eCollection 2025.
Primary insomnia (PI) is a prevalent sleep disorder that significantly impacts quality of life. While pharmacological treatments are common, concerns about side effects and dependency have led to increased interest in non-pharmacological alternatives. This study systematically evaluates the efficacy and safety of various non-pharmacological therapies for adult PI through a network meta-analysis, providing evidence-based guidance for clinicians.
We analyzed 53 randomized controlled trials (RCTs) involving 4,181 adults with PI. The included studies assessed 11 non-pharmacological interventions, such as acupuncture, acupressure, cupping therapy, and cognitive behavioral therapy (CBT), alongside control groups (e.g., placebo, waitlist, and pharmacological comparators). Primary outcomes included the Pittsburgh Sleep Quality Index (PSQI), total sleep time (TST), sleep efficiency (SE), and sleep latency (SL). Data synthesis was performed using STATA 17 software with a random-effects model, and evidence quality was appraised using the GRADE framework.
Pooled analyses revealed that all seven non-pharmacological therapies significantly improved PI outcomes compared to controls. Acupuncture reduced PSQI scores by -2.71 points (95% confidence interval (CI): -4.94 to -0.49) versus waitlist, while acupuncture showed a - 1.81 point reduction (95% CI: -2.93 to -0.68). For SE, acupressure and CBT increased SE by 1.48% (95% CI: 0.56-2.39) and 1.34% (95% CI: 0.70-1.98), respectively, compared to SH. Notably, CBT and acupressure shortened SL by approximately 10 min (e.g., CBT: -10.15 min, 95% CI: -11.79 to -8.52 vs. benzodiazepines), while acupressure extended TST by 2.07 h (95% CI: 0.46-3.68). SUCRA rankings identified CBT as the most effective for reducing SL (85.8% probability) and improving SE (89.2%), whereas acupuncture excelled in increasing TST (84.8%). Adverse events were infrequent and mild, primarily limited to transient localized reactions in acupuncture studies.
This study demonstrates that non-pharmacological therapies are effective and safe in managing PI, with CBT, acupuncture, and acupressure emerging as optimal choices for specific sleep parameters. These findings advocate non-pharmacological interventions into clinical practice and offer clinicians valuable insights for selecting appropriate treatment modalities for PI management. However, study limitations like heterogeneity and small sample sizes highlight the need for larger, well-designed RCTs. Future studies should use standardized measures for more specific insomnia assessment.
原发性失眠（PI）是一种常见的睡眠障碍，对生活质量有显著影响。虽然药物治疗很普遍，但对副作用和依赖性的担忧导致人们对非药物替代疗法的兴趣增加。本研究通过网络荟萃分析系统评价了各种非药物疗法治疗成人PI的疗效和安全性，为临床医生提供循证指导。
我们分析了53项随机对照试验（RCT），涉及4181名患有PI的成年人。纳入的研究评估了11种非药物干预措施，如针灸、指压、拔罐疗法和认知行为疗法（CBT），以及对照组（如安慰剂、等待名单和药物对照）。主要结局包括匹兹堡睡眠质量指数（PSQI）、总睡眠时间（TST）、睡眠效率（SE）和睡眠潜伏期（SL）。使用STATA 17软件采用随机效应模型进行数据合成，并使用GRADE框架评估证据质量。
汇总分析显示，与对照组相比，所有七种非药物疗法均显著改善了PI结局。与等待名单相比，针灸使PSQI评分降低了-2.71分（95%置信区间（CI）：-4.94至-0.49），而与假手术相比，针灸使PSQI评分降低了-1.81分（95%CI：-2.93至-0.68）。对于SE，与假手术相比，指压和CBT分别使SE提高了1.48%（95%CI：0.56-2.39）和1.34%（95%CI：0.70-1.98）。值得注意的是，CBT和指压使SL缩短了约10分钟（例如，CBT：-10.15分钟，95%CI：-11.79至-8.52，与苯二氮䓬类药物相比），而指压使TST延长了2.07小时（95%CI：0.46-3.68）。SUCRA排名确定CBT在降低SL（概率为85.8%）和改善SE（概率为89.2%）方面最有效，而针灸在增加TST（概率为84.8%）方面表现出色。不良事件很少且轻微，主要限于针灸研究中的短暂局部反应。
本研究表明，非药物疗法在管理PI方面是有效且安全的，CBT、针灸和指压是特定睡眠参数的最佳选择。这些发现提倡将非药物干预措施纳入临床实践，并为临床医生选择合适的PI管理治疗方式提供有价值的见解。然而，异质性和样本量小等研究局限性凸显了进行更大规模、设计良好的RCT的必要性。未来的研究应使用标准化措施进行更具体的失眠评估。
