| Objective: A reticulated meta-analysis was used to evaluate the effect of different TCM care techniques on insomnia,explore the best TCM care techniques under various outcome indicators,and provide an evidence-based basis for clinical TCM care for insomnia.Methods: Computer searches of randomized controlled trials on different TCM care techniques for insomnia in China Knowledge Network,Wanfang Data Knowledge Service Platform,Vip Info Chinese Journal Service Platform,China Biomedical Literature Database,Pubmed,Embase,Cochrane Library,and Web of Science were conducted from the time of database creation to December 7,2021.Literature screening and data extraction were performed according to the established inclusion and exclusion criteria.The included literature quality was evaluated using the Cochrane Collaboration Network’s RCT Risk of Bias Assessment Tool.Total clinical effectiveness,total Pittsburgh Sleep Quality Index score,sleep quality,time to sleep,sleep duration,sleep efficiency,sleep disturbance,hypnotic medication,and daytime dysfunction were used as outcome indicators.The mean difference was used as the effect analysis statistic for continuous variables,the rate ratio was used as the effect analysis statistic for dichotomous variables,and 95% confidence intervals were calculated for each effect measure.Bayesian mesh meta-analysis was applied to the Revman 5.3,Stata 14.2,R4.0.4,and gemtc packages to calculate the area under the cumulative ranking curve and predict and rank each treatment regimen’s effects.Results: A total of 46 RCTs,42 in Chinese and 4 in English,involving 3062 insomnia patients with eight single interventions were included in this study.The results of the reticulated meta-analysis showed that(1)in terms of total clinical effectiveness,the top three TCM care techniques ranked by SUCRA values were gua sha(SUCRA=92.1),auricular acupressure(SUCRA=88.1),and tui na(SUCRA=61.9).(2)In terms of total PSQI score,the top three TCM care techniques with SUCRA values were moxibustion(SUCRA=78.9)and auricular acupressure(SUCRA=74.5),and tui na(SUCRA=66.9).(3)In terms of sleep quality,the top three TCM care techniques in terms of SUCRA value were gua sha(SUCRA=91.1),cupping(SUCRA=74.7),and moxibustion(SUCRA=67.1).(4)In terms of time to sleep,the top three TCM care techniques in terms of SUCRA values were gua sha(SUCRA=92.5),cupping(SUCRA=66.7),and moxibustion(SUCRA=53.2).(5)In terms of sleep duration,the top three TCM care techniques in terms of SUCRA values were moxibustion(SUCRA=90.4),acupressure(SUCRA=85.1),and tui na(SUCRA=62).(6)In terms of sleep efficiency,the top three TCM care techniques in terms of SUCRA values were tui na(SUCRA=77.8),gua sha(SUCRA=67.1),and moxibustion(SUCRA=63.4).(7)In terms of sleep disorders,the top three TCM care techniques in terms of SUCRA values were gua sha(SUCRA=85.7),cupping(SUCRA=66.2),and moxibustion(SUCRA=60.2).(8)In terms of hypnotic drugs,the top three TCM care techniques with SUCRA values were moxibustion(SUCRA=94.5)and auricular acupressure(SUCRA=61.2),and acupoint compressing(SUCRA=39.1).(9)In terms of daytime dysfunction,the top three TCM care techniques in terms of SUCRA values were auricular acupressure(SUCRA=73.5)and tui na(SUCRA=72.9),and acupoint compressing(SUCRA=57).The TCM care techniques reported in the included studies had only minor adverse effects that resolved independently,indicating a better safety profile for TCM care techniques.Conclusion: The results of this study suggest that TCM care techniques are effective in the care of insomnia,with moxibustion playing an essential role in reducing the total Pittsburgh Sleep Quality Index score,increasing sleep duration,and reducing the use of hypnotic drugs;gua sha is more effective in increasing the total clinical efficiency,improving sleep quality,shortening the time to sleep,and relieving sleep disorders;tui na has relatively significant advantages in improving sleep efficiency,and auricular acupressure is most likely to be effective in enhancing daytime dysfunction. |
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