Acupuncture For Insominia:A Systemic Review,a Meta-analysis,and A Study On Acupoints Selection

Objective:By searching the existing literature,compiling past research results related to acupuncture treatment of insomnia,understanding the current research progress of acupuncture treatment of insomnia,evaluating its effectiveness and safety,and collecting relevant data,the clinical acupoint selection rules for acupuncture treatment of i nsomnia will be explored and analyzed.Methods:We searched six domestic and foreign journal databases and traced citations.Based on inclusion and exclusion criteria,we screened randomized controlled clinical studies on acupuncture treatment of insomnia and searched for related clinical studies on acupuncture treatment of insomnia in the Chinese Clinical Trial Registry and the Cochrane Controlled Trials Register,tracing potential literature.The primary outcomes selected included the improvement of the Pittsburgh Sleep Quality Index(PSQI)and the clinical effectiveness rate of patient treatment.Secondary outcomes included the improvement of other sleep quality scales(ISI,AIS),the improvement of anxiety and depression-related scales(HAMD,SDS,SAS),changes in other insomnia-related outcome indicators included in the study,and the occurrence of adverse events.All acupuncture prescriptions in the studies were extracted,and the frequency of use and meridian classification of all acupoints were record ed.We used meta-analysis to analyze and summarize the efficacy and safety,and use cluster analysis and data mining algorithms to summarize the acupoint selection rules.Statistical software packages include IBM SPSS Statistics 26.0,Rev Man 5.4,and IBM SPSS Modeler 18.0.The bias assessment process will adopt the Cochrane risk of bias assessment tool,and the quality of evidence evaluation will be based on the GRADE principle.Results:The final search was conducted in January 2023,and a total of 3,507relevant research reports were retrieved.After screening,41 studies published between 2012 and 2021,involving 2,834 participants,were finally included.Main outcomes:Acupuncture therapy for insomnia has definite clinical efficacy and is superior to non-acupuncture therapy,with stable results(OR2.82,95%CI 2.23-3.58;I~2=0%;40 studies,2728 participants).Acupuncture can improve sleep quality in patients with insomnia,reduce ISI scores(MD-1.75,95%CI-2.41--1.09;I~2=14%;237 participants)and AIS scores(MD-4.70,95%CI-5.18--4.22;I~2=0%;145 participants),with stable results and good heterogeneity.It may also reduce patients’PSQI scores(MD-2.40,95%CI-3.00--1.80;I~2=98%;38 studies,2603 participants),but with high within-group heterogeneity.Subgroup analysis according to acupuncture technique suggests that electroacupuncture has lower heterogeneity and can improve scores(MD-2.73,95%CI-2.85--2.61;I~2=12%;393 participants),but manual acupuncture(MD-3.67,95%CI-3.74--3.59;I~2=98%;2258participants)still has high within-group heterogeneity.Secondary outcomes:Compared with non-acupuncture interventions,acupuncture was better at improving HAMD score(MD-3.02,95%CI-4.12—-1.93;I~2=0%;131 participants),SAS score(MD-8.15,95%CI-11.59—-4.71;I~2=96%;456 participants),and SDS score(MD-8.15,95%CI-11.59—-4.71;I~2=96%;456 participants).The HAMD subgroup had low heterogeneity and stable results,while SAS and SDS had good heterogeneity,but the source of heterogeneity was unclear and may be related to publication bias.Additionally,compared with non-acupuncture interventions,acupuncture had higher safety(OR 0.34,95%CI 0.17—0.66;I~2=38%;691participants).Acupoint selection patterns:Among the 41 studies conducted,a total of58 acupuncture prescriptions were extracted,involving 69 traditional acupoints with a total frequency of use of 389 times.The acupoints with the highest frequency of use were the Shenmen,the Baihui,Sanyinjiao,Yintang,and Neiguan.The meridians with the highest frequency of use were the Bladder Meridian,the Du Meridian,the Heart Meridian,the Kidney Meridian,and the Stomach Meridian.Through cluster analysis and association rule analysis,the possible core prescription for acupuncture treatment of insomnia was found to be Shenme,Baihui,Sanyinjiao,Yintang,Anmian.Conclusions:1.Acupuncture has a better therapeutic effect on insomnia,and can better improve the sleep quality of insomnia patients.2.Acupuncture treatment for insomnia patients has fewer adverse events and higher safety.3.Acupuncture has potential benefits in improving anxiety and depression in patients with insomnia.4.The core prescriptions for acupuncture tr eatment of insomnia include Shenmen,Baihui,Sanyinjiao,Yintang,and Anmian.