The Acupoints Of Qiao Meridian Acupuncture For Chronic Insomnia:A Systematic Review

Objective: This systematic review was to evaluate effectiveness and safety of Qiao meridian acupuncture treating chronic insomnia,to provide evidence for the clinical application of Qiao meridian acupuncture treating chronic insomnia,and to point out the direction and thread for future clinical studies.Methods:This systematic review searched CNKI database,CBM database,VIP database,Pubmed database,Cochrane Library database,Web of Science database with instituting strict inclusion criteria and exclusion criteria and combing with manual searches and supplementary retrieval through Baidu Scholar.The primary outcome about effective rate and the secondary outcome about kinds of sleep parameters and insomnia scales would be used to evaluate therapeutic effect of Qiao meridian acupuncture treating chronic insomnia.GRADE-pro GDT as the risk of bias tool by Cochrane Collaboration was used to evaluate the quality of final included studies.Review manager 5.3 was used for data analysis from included studies.Data analysis includes qualitative analysis and quantitative analysis.Results: Through strict screening,13 randomized controlled trials involving 1109 cases were ultimately meet the standards,all of them are Chinese literature.The quality of the evidence is generally low,mainly in the following aspects: the random sequence generation method is not clear;the allocation of the program is not hidden;no use of blind test more;not referred to the estimation of the sample size;most researches did not conduct intention analysis;a very small number of clinical studies reported in the treatment of patients after the follow-up situation.After the inclusion of the extracted data,the meta-analysis or descriptive analysis was performed.(1)clinical efficiency: in the impact of acupuncture on the clinical efficiency of the disease,due to the existence of a certain difference(Peto OR = 3.67,95% CI[2.50,5.38]).(2)Pittsburgh Sleep Quality Index(PSQI)total score: acupuncture Qiao meridian is better than sleeping drugs,the quality of the test,(MD =-2.65,95% CI [-3.58,-1.72]),the sensitivity analysis results consistent with the overall trend;It can prove the needle is better than sham acupuncture(Peto OR =5.37,95%CI[2.24,12.83]);(3)sleep-related factors: acupuncture Qiao meridian has more advantage than sleeping drugs in patients with chronic insomnia who improved sleep disorders(SMD=-0.66,95% CI [-0.93,-0.40]),daytime dysfunction(SMD=-0.88,95%CI[-1.15,-0.61]).And the sensitivity analysis was consistent with the meta-analysis.However,the current evidence can not prove that acupuncture Qiao meridian has more advantages than sleeping drugs in sleep efficiency(SMD=-0.21,95%CI[-0.46,-0.05]),fall asleep time(SMD=-0.27,95%CI[-1.08,0.54]),sleep quality(SMD =-0.80,95%CI [-1.07,-0.53]),sleep time(SMD=-0.21,95%CI[-0.46,-0.05]);the current evidence can not prove that the acupuncture Qiao meridian group was more effective than the sleep drugs group;(4)Hamilton Depression Scale : acupuncture Qiao meridian group was more effective than the sham acupuncture group(MD =-6.68,95% CI [-9.29,-4.07]);(5)sleep parameters: acupuncture Qiao meridian has more advantage than sham acupuncture in patients with chronic insomnia who improved mean sleep latency(MSL: SMD =-2.06,95% CI [-2.69,-1.43] / REM : SMD = 2.81,95% CI[2.09,3.53]);but it was not possible to show that acupuncture Qiao meridian had a better effect in improving SOL,NWAK and WASO.(6)Safety assessment: It is not possible to prove that acupuncture is superior to sleeping western drugs(RR = 0.60,95% CI [0.15,2.44]).Conclusion: The current research evidence shows that the quality of clinical trials of acupuncture Qiao meridian in the treatment of chronic insomnia is low.There are many methodological defects,especially in many experiments that some did not achieve random grouping and blind set.In terms of clinical efficiency,acupuncture Qiao meridian is better than the sleep drugs,but the current evidence can not confirm whether the acupuncture Qiao meridian is better than sham acupuncture;and PSQI total score,acupuncture Qiao meridian is better than the sleep drugs;in the impact of PSQI sleep factors,acupuncture Qiao meridian can improve sleep time,sleep disorders,daytime dysfunction,but it cannot confirm that acupuncture Qiao meridian can improve the sleep efficiency,sleep quality,total sleep time;the acupuncture Qiao meridian is better than sham acupuncture in improving the Hamilton Depression Scale;in improving sleep parameters,acupuncture Qiao meridian is better than the sleep drugs in the improvement of the average sleep latency Length of time,rapid eye movement,but it can not prove that acupuncture Qiao meridian is better than the sleep drugs in improving the sleep latency,the number of awakening,sleep awake time.Those have some effect on the conclusion and reliability of the systematic review might be affected in the future.More high quality randomized controlled trials should be used to further confirm the conclusion.