Efficacy and safety of acupuncture on sleep quality for post-stroke insomnia: a systematic review and meta-analysis

This study represents a comprehensive analysis of the efficacy of acupuncture in the treatment of post-stroke insomnia, a common complication that affects 38-40% of patients after a cerebrovascular accident. Post-stroke insomnia not only impairs quality of life but can also interfere with neurological recovery and increase the risk of future cardiovascular events. The research analyzed 41 randomized controlled trials involving 3,233 participants from 2004 to 2022, all conducted in China, providing robust evidence on this complementary intervention. The methodology rigorously followed PRISMA guidelines and used multiple databases to ensure a comprehensive search.

The results demonstrated that acupuncture, whether as monotherapy or adjuvant therapy, was superior to control groups in improving sleep quality. The Pittsburgh Sleep Quality Index (PSQI) showed significant improvements, with standardized mean differences of -1.03 for acupuncture versus control and -1.26 for acupuncture combined with conventional treatment versus control alone. Objective polysomnography data confirmed the subjective benefits, showing increased sleep efficiency (SMD = 0.65) and total sleep time (SMD = 0.54), as well as reduced sleep latency. A particularly important aspect was the demonstration of long-term efficacy, with benefits maintained for up to 3 months after treatment, suggesting that acupuncture may produce lasting changes in sleep patterns.

The most commonly used acupuncture points included GV-20 (Baihui), HT-7 (Shenmen), SP-6 (Sanyinjiao), GV-24 (Shenting), EX-HN1 (Sishencong), PC-6 (Neiguan), Anshen point, and GV-29, reflecting traditional Chinese medicine approaches focused on calming the spirit and regulating qi. In terms of safety, only 6 of the 41 studies reported adverse events, which were predominantly mild and included minimal bleeding at the needle site, sweating, dizziness, and nausea. No serious adverse events were related to acupuncture, suggesting a favorable safety profile compared with conventional hypnotic medications. Subgroup analysis revealed that acupuncture was effective regardless of stroke type, with particular benefits observed in patients after cerebral infarction.

Comparison with different drug classes (benzodiazepines, non-benzodiazepines, antidepressants) consistently showed the superiority of acupuncture. Study limitations include considerable methodological heterogeneity among the included studies, with quality of evidence rated as low to very low by the GRADE system. Many studies failed to adequately describe methods of randomization, allocation concealment, and blinding. Variability in acupuncture protocols, including point selection, treatment frequency, and duration, also contributed to heterogeneity.

In addition, the fact that all studies were conducted in China may limit the generalizability of the results to other populations. Clinical implications are significant, especially given the limitations of conventional pharmacological treatments for post-stroke insomnia. Benzodiazepines and hypnotics may worsen neuropsychological deficits and interfere with motor recovery, while also increasing the risk of falls and dependence in older populations. Acupuncture offers a non-pharmacological alternative that may be particularly valuable in this vulnerable population.

The results suggest that treatment protocols of 4 weeks or more with daily sessions may optimize benefits.